Pharmacological interventions to manage cardiometabolic outcomes in adults with severe mental illness: umbrella review

Background People living with severe mental illness (SMI) experience a shorter life expectancy and poorer physical health than those without SMI. Cardiometabolic illness accounts for a significant proportion of this health inequality. Pharmacological management could reduce the noted inequalities. Aims This umbrella review aimed to synthesise evidence from systematic reviews for pharmacological interventions to manage cardiometabolic outcomes in adults with SMI. Method Databases (Embase, MEDLINE, Cochrane Database of Systematic Reviews) were searched from inception to 11 June 2024 for systematic reviews of pharmacological interventions for all cardiometabolic outcomes in adults. Titles, abstracts and full texts were independently screened by two reviewers. Corrected cover area was calculated, and quality was assessed using AMSTAR 2. Results were analysed and a narrative synthesis conducted. Results Thirty-three systematic reviews were included following screening of 1723 titles. Metformin, the most commonly studied intervention ( n = 18), was effective in preventing and treating weight gain, dyslipidaemia (total cholesterol and triglycerides) and dysglycaemia. Topiramate and glucagon-like peptide-1 agonists demonstrated efficacy in treating weight gain, but the effect across other parameters was less consistent. Licensed treatments, such as statins for dyslipidaemia, were reviewed in low numbers ( n = 2). Nicotine replacement, bupropion and varenicline were effective for smoking cessation, an outcome that can significantly lower cardiometabolic risk. The corrected cover area was 6.3%, indicating moderate overlap. Most reviews ( n = 16, 48%) were rated critically low quality using AMSTAR 2, and the remainder rated either low ( n = 7, 21%), moderate ( n = 2, 7%) or high quality ( n = 7, 24%). Conclusions Pharmacological interventions can improve cardiometabolic outcomes in adults with SMI when non-pharmacological interventions are either insufficient alone, impractical or unacceptable. However, licensed treatments have been reviewed in relatively low numbers. Improving cardiometabolic outcomes is a key area in psychiatry, and the results of this review will be important in shaping future guidance.