I recently read the article, "Dysmetabolic Syndrome: Reducing Cardiovascular Risk" (Vol. 29, No. 10) with much interest and would like to compliment the authors for their clear and precise explanation of this very important health problem.

I would also like to mention one risk factor that was not included in the article. Although the prevalence of dysmetabolic syndrome is approximately 24% in the United States, 1 patients with schizophrenia and chronic mood disorder have roughly twice the risk. Although there may be many reasons that contribute to the association between severe mental illness and dysmetabolic syndrome, including heredity and lifestyle, new research indicates a possible link between the newer atypical antipsychotic drugs (particularly clozapine and olanzapine) and key aspects of dysmetabolic syndrome-mainly glucose metabolism and insulin resistance.

Psychiatric and primary care advanced practice nurses should be aware of the risks of these antipsychotics. Routine screenings should include baseline evaluations for components of dysmetabolic syndrome such as monitoring for diabetes and cardiovascular disease, weight, waist and hip measurements, and lipid level monitoring. These should become part of the standard of treatment for all schizophrenic and mood disorder patients, but in particular, those who use clozapine or olanzapine. 2 Patients should also be made aware that treatment may increase the risk of weight gain, diabetes, and dyslipidemia.

Janet Samiee, BSN, RN

Chapel Hill, NC

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