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: 3.92). 10/2008; 105(1-3):175-87. DOI: 10.1016/j.schres.2008.07.006
Source: PubMed


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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    • "gs are used . As seen before , clozapine and olanzapine are two compounds which are associated with the higher increase LDL and triglycerides in serum ( Goff et al . , 2005 ; Daumit et al . , 2008 ) . It is important that the clinicians respond rapidly in the early phase of treatment when weight gain is most likely to occur ( Goff et al . , 2005 ; Daumit et al . , 2008 ) . It has been recommended that clinicians should measure lipid levels every 2 – 3 months following the commencement of treatment and also once weight - gain has reached stable levels ( De Hert et al . , 2009a ) . Lipid concentration can be reduced rapidly following a psycho— educational and monitoring program focused on diet , physica"
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