Antipsychotic effects on estimated 10-year coronary heart disease risk in the CATIE schizophrenia study

Johns Hopkins Medical Institutions, Welch Center for Prevention, Epidemiology and Clinical Research, 2024 East Monument Street, Suite 2-500, Baltimore, MD 21287, United States.
Schizophrenia Research (Impact Factor: 4.43). 10/2008; 105(1-3):175-87. DOI: 10.1016/j.schres.2008.07.006
Source: PubMed

ABSTRACT Persons with schizophrenia die earlier than the general population, in large part due to cardiovascular disease. The study objective was to examine effects of different antipsychotic treatments on estimates of 10-year coronary heart disease (CHD) risk calculated by the Framingham Heart Study formula.
Change in 10-year risk for CHD was compared between treatment groups in 1125 patients followed for 18 months or until treatment discontinuation in the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) Schizophrenia Trial.
The covariate-adjusted mean change in 10-year CHD risk differed significantly between treatments. Olanzapine was associated with a 0.5% (SE 0.3) increase and quetiapine, a 0.3% (SE 0.3) increase; whereas risk decreased in patients treated with perphenazine, -0.5% (SE 0.3), risperidone, -0.6% (SE 0.3), and ziprasidone -0.6% (SE 0.4). The difference in 10-year CHD risk between olanzapine and risperidone was statistically significant (p=0.004). Differences in estimated 10-year CHD risk between drugs were most marked in the tertile of subjects with a baseline CHD risk of at least 10%. Among individual CHD risk factors used in the Framingham formula, only total and HDL cholesterol levels differed between treatments.
These results indicate that the impact on 10-year CHD risk differs significantly between antipsychotic agents, with olanzapine producing the largest elevation in CHD risk of the agents studied in CATIE.

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Available from: Jeffrey A Lieberman, Aug 16, 2015
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    • "The prevalence of metabolic syndrome in people with SMI is reported to be 37–61.6% globally (Brunero et al. 2009; John et al. 2009; McEnvoy et al. 2005; van Winkel et al. 2008), and rates of cardiovascular disease and diabetes are more than double that of the general population (Daumit et al. 2008; De Hert et al. 2009; Goff et al. 2005; Morgan et al. 2011). The literature reviewed for the present study (Barnett et al. 2007; Edward et al. 2010; Lambert 2009; 2011; Lambert & Chapman 2004; Rege 2008; Usher et al. 2006) strongly endorses the implementation of a targeted cardiometabolic monitoring (CMM) system, based on metabolic syndrome criteria, as the first step towards addressing the poor cardiometabolic health outcomes for consumers of mental health services. "
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