MON-436 Age and Smoking Status Affect Cardiometabolic Risk Trends Over Time in People with Serious Mental Illness on Psychotropic Medications - A Call for Personalized Screening

Abstract H. Chin: None. L. Wang: None. S.H. Lopa: None. T. Pauly: None. S.U. Miedlich: None. People with serious mental illness (SMI) have high cardiometabolic morbidity and mortality. Psychotropic medications, socioeconomic deprivation, adverse health behaviors, poor access to and quality of healthcare mediate unfavorable health outcomes in people with SMI. Per prospective screening by oral glucose tolerance test and hemoglobin A1c (HbA1c), we previously showed that the majority of adult patients with SMI on second-generation antipsychotic medications (SGA), seen at a large primary care clinic for people with SMI at the University of Rochester, have prediabetes or diabetes mellitus1. In this study, we explored cardiometabolic risk profiles in the above patients over time with respect to psychotropic medication use, age, and smoking status. Data were obtained per review of electronic health records, entered into REDCap, and analyzed using R. The following data were collected between 2014-2021: weight, systolic and diastolic blood pressure, pulse rate (average of last 3 observations/year), annual HbA1c and lipid profiles, as well as use of psychotropic medications. Smoking rates are high in our patient cohort (37.5%). More than 90% of patients were on at least one SGA at any given year, and 10-25% of patients were on more than one SGA, 46-65% of patients were also on antidepressant medications (ADM), 12-28% of patients were on mood stabilizers. Overall, weight trends correlated tightly with HbA1c trends (+0.5kg/year, +0.06%/year, p<0.0001). Smokers gained less weight (-0.8kg/year, p=0.02) and had lower HbA1c levels over time (-0.1%/year, p=0.02) with a trend of lower triglyceride as well as higher HDL levels. Conversely, younger patients (<50 years) gained more weight (+1kg/year, p=0.003) and had larger HbA1c increases (+0.23%/year, p<0.0001) than patients aged 50 years or older. Cardiometabolic trends did not differ between patients on various SGA and/or additional psychotropic medications except for cholesterol profiles. Both, total cholesterol and LDL levels were higher in patients on ADM compared to patients not on ADM (p=0.03). In conclusion, patients with SMI on SGA, and more specifically non-smokers and younger patients, are at risk for ongoing weight gain and concomitant HbA1c increases over time, stressing the importance of regular diabetes screening, particularly in non-smokers and younger patients with SMI. Notably, young adult patients with SMI are less likely to be screened for diabetes mellitus despite their metabolic risk2. Conversely, smokers will likely benefit more from a focus on smoking cessation counseling and therapy. Altogether, our data stress the need for personalized cardiometabolic health screening in people with SMI. Differences in lipid profiles in patients off/on ADM need further investigation. References: 1. Miedlich S et al., J Endocr Soc 2022. Nov-Dec;6(Suppl 1):A422-A423. 2. Mangurian C et al., J Gen Intern Med 2018. Jan;33(1):79-86. Monday, June 3, 2024