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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    • "Factors that also contribute to the development of MetS are long-term duration of illness, old age, female sex, lifestyle factors related to psychotic disorder [5] . Patients suffering from psychiatric disorders have significantly increased morbidity and mortality ranges – increased risk of cardiovascular events and premature death is estimated to 10 to 25 years earlier than in general population [6] . Data in literature indicate that treatment-induced metabolic abnormalities , such as raised lipids and glucose blood levels, eventually result in abdominal obesity, may contribute to the development of diabetes mellitus type 2 and arterial hypertension, and may account for up to 60% of premature deaths of persons with serious mental illness [7]. "
    [Show abstract] [Hide abstract] ABSTRACT: Introduction: The risk of metabolic abnormalities is greatly increased in schizophrenic patients started on atypical antipsychotic medication. Patients with psychiatric disorders have exceeded mortality ranges resulting from, among others, increased risk of cardiovascular events. Other factors contributing to the development of metabolic syndrome include prolonged duration of illness, increasing age, female gender and lifestyle factors. Objective: This cross-sectional study was taken up to assess the prevalence of the metabolic syndrome (MetS) in schizophrenic patients receiving olanzapine monotherapy for at least six months and to determine the most important risk factors associated with metabolic syndrome presence in these patients. Method: Total of 93 long term hospitalized schizophrenic patients (71 men, 22 women), had a screening of: case-history data, psychiatric scales, anthropometric measures, blood (fasting glucose, lipid status, CRP) and urine samples (microalbuminuria). Results: Prevalence of the metabolic syndrome (MetS) according to IDF criteria in our study was 34.4%. The multivariate analysis distinguished significant predictors of MetS presence (in order of appearance): data about diabetes mellitus in family history (p=0.002), Body Mass Index >25kg/m2 (p=0.002), hyperlipidemia in family history (p=0.008), and elevated CRP value (p=0.042). Conclusion: High rate of MetS in patients treated with olanzapine in this study exceeds MetS prevalence in general population. Among observed parameters, our study pointed few “high risk” predictors, associated with MetS presence. Regular monitoring of cardiometabolic risk factors is highly recommended. Positive heredity distress mentioned above may direct a psychiatrist to prescribe some other drug than olanzapine in the long term treatment of schizophrenia. Key words: Metabolic syndrome, schizophrenia, olanzapine
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    • "Current researches indicate that MetS prevalence may be higher in patients treated with antipsychotics comparing to general population (De Hert et al., 2006) and therefore patients with psychiatric disorders may have increased mortality resulting from increased risk of cardiovascular events (e.g. myocardial infarction, sudden cardiac death and stroke) (Correll et al., 2006). Treatment-induced metabolic disorders may account for dramatically increased mortality of schizophrenia patients (Auquier et al., 2006). "
    [Show abstract] [Hide abstract] ABSTRACT: This study was undertaken with the purpose to determine if there are changes in metabolic parameters during 6-month add-on treatment with sarcosine in patients with schizophrenia. This was a randomized double blind, placebo-controlled and parallel group study. Eligible participants were randomly assigned to receive 2 g of sarcosine (n=30) or placebo (n=29). Sarcosine was administered as supplementation to the ongoing antipsychotic treatment. Augmentation with sarcosine had no effect on any of the analyzed cardiometabolic parameters. Also, augmentation with sarcosine had no effect on any of the analyzed body composition parameters. This is the first randomized placebo-controlled study to examine the metabolic safety of sarcosine in patients with schizophrenia. Clinically, this observation is of high importance considering how prevalent are metabolic abnormalities in patients with schizophrenia.
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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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