Metabolic Syndrome and the Risk of Coronary Heart Disease in 367 Patients Treated With Second-Generation Antipsychotic Drugs

The Zucker Hillside Hospital, North Shore-Long Island Jewish Health System, Glen Oaks, NY 11004, USA.
The Journal of Clinical Psychiatry (Impact Factor: 5.5). 04/2006; 67(4):575-83. DOI: 10.4088/JCP.v67n0408
Source: PubMed


To examine the relationship between presence of metabolic syndrome and the risk of coronary heart disease (CHD) events (angina pectoris, myocardial infarction, and sudden cardiac death) in patients treated with second-generation antipsychotic medications.
367 adults treated with second-generation antipsychotics randomly selected from consecutive psychiatric admissions to a single hospital between August 1, 2004, and March 1, 2005, underwent assessments evaluating the presence of metabolic syndrome. The 10-year risk of CHD events was calculated according to the Framingham scoring system for age, smoking, total cholesterol, high-density lipoprotein (HDL)-cholesterol, blood pressure, and history of diabetes and was compared in patients with and without the metabolic syndrome.
Metabolic syndrome, present in 137 patients (37.3%), was associated with a significantly greater age- and race-adjusted 10-year risk of CHD events, i.e., 11.5% vs. 5.3% for men (risk ratio = 2.18, 95% CI = 1.88 to 2.48, p < .0001) and 4.5% vs. 2.3% for women (risk ratio = 1.94, 95% CI = 1.65 to 2.23, p = .0005). The increased risk of CHD events in patients with metabolic syndrome remained significant after the exclusion of diabetic patients. In a logistic regression analysis of variables independent of the Framingham scoring system, triglyceride levels (p < .0001), waist circumference (p = .035), and white race (p = .047) were significantly associated with the 10-year risk of CHD events (R2 = 0.134; p < .0001).
These data confirm the high prevalence of metabolic syndrome in patients receiving second-generation anti-psychotics, indicate that metabolic syndrome doubles the 10-year risk of CHD events in this population, and emphasize the importance of the "hypertriglyceridemic waist" for the identification of psychiatric patients at high risk of CHD.

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    • "Finally, patients with these disorders have increased mortality resulting from, among others, increased risk of cardiovascular events (e.g. myocardial infarction, sudden cardiac death and stroke) [1]. These events are closely related to metabolic abnormalities (raised lipids and glucose blood levels, central (abdominal) obesity, diabetes, hypertension). "
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    ABSTRACT: The aim of this study is to investigate differences in triglycerides (TGA), cholesterol (TC), HDL, LDL and glucose (FPG) levels in patients with acute schizophrenia, unipolar depression, bipolar depression and bipolar mania. Results for 2305 Caucasian patients were included in the study (1377 women, 59.7%; mean age 45.6). Mean TGA level was: schizophrenia: 139.9±90.6mg/dL, unipolar depression: 125.4±70.8mg/dL, bipolar disorder: 141.1±81.9mg/dL, bipolar depression: 147.7±82.8mg/dLmg/dL, bipolar mania: 120.2±76.1mg/dL, inter-group differences were significant (p<0.001). Mean TC level was: schizophrenia: 188.5±40.4mg/dL, unipolar depression: 198.8±50.7mg/dL, bipolar disorder: 194.4±48.3mg/dL, bipolar depression: 198.9±48.8mg/dL, bipolar mania: 180.1±43.8mg/dL, inter-group differences were significant (p<0.001). Mean HDL level was: schizophrenia: 45.3±13.9mg/dL, unipolar depression: 48.1±14.8mg/dL, bipolar disorder: 45.4±15.3mg/dL, bipolar depression: 45.1±15.4mg/dL, bipolar mania: 46.4±15.1mg/dL, inter-group differences were significant (p<0.001). Mean LDL level was: schizophrenia: 115.4±34.7mg/dL, unipolar depression: 125.7±44.1mg/dL, bipolar disorder: 120.9±42.1mg/dL, bipolar depression: 124.5±43.1mg/dL, bipolar mania: 109.3±36.9mg/dL, inter-group differences were significant (p<0.001). Mean FPG level was: schizophrenia: 95.9±24.9mg/dL, unipolar depression: 94.8±22.9mg/dL, bipolar disorder: 97.2±24.4mg/dL, bipolar depression: 98.3±25.3mg/dL, bipolar mania: 93.9±21.1mg/dL, inter-group differences were not significant (p=0.08). Odds ratios for glucose and lipids abnormalities, correlations with age, sex distribution in diagnostic groups for normal ranges of glucose and lipids, differences in glucose and lipids levels between the age groups were also calculated. Our results confirm that there is a high prevalence of lipid and glucose abnormalities in patients with schizophrenia and mood disorders (both unipolar and bipolar). However, we have demonstrated that these diagnostic groups differ in terms of types and frequency of these metabolic dysfunctions. Women and patients aged 40+ are at particularly high risk. Copyright © 2015 Diabetes India. Published by Elsevier Ltd. All rights reserved.
    Diabetes and Metabolic Syndrome Clinical Research and Reviews 04/2015; 9(3). DOI:10.1016/j.dsx.2015.04.004
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    • "Abdominal obesity and/or insulin resistance have gained increasing attention as the core manifestations of the syndrome (Alberti et al., 2006). In people with schizophrenia, MetS is associated with a more than two-fold increased risk for CVD and, consequently, with premature mortality (Correll et al., 2006). "
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    ABSTRACT: The primary aim was to determine whether the presence of metabolic syndrome (MetS) limits aerobic fitness in patients with schizophrenia. A secondary aim was to investigate the associations between aerobic fitness and MetS parameters. Aerobic fitness (expressed as predicted maximal oxygen uptake) was assessed using the Astrand-Rhyming test. Those with MetS (n = 19) were similar in age, sex, antipsychotic medication use, symptoms, and smoking behavior than those without (n = 31). Estimated maximal oxygen uptake was 21.4% lower (p = 0.001) in patients with MetS than in patients without MetS (29.5 +/- 7.4 ml of O2/min/kg vs. 37.5 +/- 8.2 ml of O2/min/kg, respectively). The estimated maximal oxygen uptake of the entire sample was correlated with waist circumference, the level of high-density lipoproteins, and fasting glucose. The current study demonstrates that the additive burden of MetS might place people with schizophrenia at increased risk for functional limitations in daily life activities.
    Journal of Nervous & Mental Disease 01/2015; 203(1). DOI:10.1097/NMD.0000000000000229 · 1.69 Impact Factor
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    • "Clozapine and olanzapine have been associated with the highest risk, followed by risperidone, ziprasidone, and aripiprazole , which have the least risk [7]. The Framingham Point System Scores (FPSS) tool has been used in several studies to evaluate the risk of CAD in patients with schizophrenia, who they report are at higher risk of CAD [16] [19] [20]. The FPSS is a widely used rating scale system for predicting the risk of development of a coronary event [21] and covers a set of risk factors known to predict CAD, including age, sex, blood pressure, and lipid profile. "
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    ABSTRACT: The prevalence rate of metabolic syndrome (MS) and coronary artery disease (CAD) has been found to be high in patients with chronic schizophrenia. Current evidence shows that CAD is underdiagnosed in this group. Our study evaluated the prevalence of MS and the risk of CAD in patients with chronic schizophrenia in a chronic care mental hospital in southern Taiwan. We included all patients with the diagnosis of schizophrenia or schizoaffective disorder. We collected all laboratory, physical examination, psychiatric interview, and chart review data. We also evaluated the risk of CAD in these patients using the Framingham point system. There was no significant age difference in the MS prevalence rate in these patients. The young patients with schizophrenia in our study tended to have a higher prevalence of MS than the general population. In addition, female patients had a higher prevalence rate of MS than males. Based on the Framingham point system, we found the 10-year risk of CAD to be higher among the patients with schizophrenia than in the general population. Our study highlights the importance of the high risk of MS in both younger and older patients with schizophrenia, without a significant relationship to the use of antipsychotics. More complete cohort studies are needed to confirm these findings. Psychiatrists may want to establish more specific and detailed clinical guidelines for patients with chronic schizophrenia with comorbid physical diseases, especially MS and CAD.
    The Kaohsiung journal of medical sciences 11/2014; 30(11). DOI:10.1016/j.kjms.2014.09.002 · 0.80 Impact Factor
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