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Clinical Practice Guideline on the Pharmacological Management of Antipsychotic-Related Dyslipidemia

Carolan A, Hynes-Ryan C, Bourke R, Columb D, Cullen W, deFerranti S, Harrington SM, Kelleher I et al.

Schizophrenia bulletin, 2026

Abstract

Background: People taking antipsychotic medicines and those with severe mental illness experience elevated cardiovascular risk compared to the general population which is not adequately addressed by existing guidelines. Increases in lipid levels can occur soon after starting antipsychotics but often go untreated. Cumulative exposure to dyslipidemia from childhood, through young adulthood, facilitates atherogenesis. Regression of early lesions is possible; however, plaque progression can be irreversible, leading to sustained long-term cardiovascular risk. Although lipid-lowering therapies are effective at lowering cardiovascular risk, they are underutilized in this population. We have thus developed a clinical practice guideline for the pharmacological management of antipsychotic-related dyslipidemia.

Study design: Using GRADE-ADOLOPMENT methodology, an international, multidisciplinary panel including experts-by-experience, developed a guideline for the pharmacological management of antipsychotic-related dyslipidemia. Literature was reviewed to answer key health questions. Patient important outcomes were identified. An evidence-to-decision framework informed the strength of recommendations and external reviews evaluated the rigor of the methods.

Study results: Seven recommendations were developed on how and when to initiate lipid-lowering therapy based on specific criteria including established cardiovascular disease/high-risk conditions, cardiovascular risk assessment, or…

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