Article

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

ABSTRACT

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]. "
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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). "
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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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