Christoph U Correll1, Delbert G Robinson1, Nina R Schooler2, Mary F Brunette3, Kim T Mueser4, Robert A Rosenheck5, Patricia Marcy6, Jean Addington7, Sue E Estroff8, James Robinson9, David L Penn10, Susan Azrin11, Amy Goldstein11, Joanne Severe11, Robert Heinssen11, John M Kane1. 1. Division of Psychiatry Research, North Shore-LIJ Health System, The Zucker Hillside Hospital, Glen Oaks, New York2The Feinstein Institute for Medical Research, Manhasset, New York3Hofstra North Shore-LIJ School of Medicine, Hempstead, New York4Albert Eins. 2. Division of Psychiatry Research, North Shore-LIJ Health System, The Zucker Hillside Hospital, Glen Oaks, New York5State University of New York Downstate Medical Center, New York. 3. Geisel School of Medicine at Dartmouth, Dartmouth, New Hampshire7Bureau of Behavioral Health, Department of Health and Human Services, Dartmouth, New Hampshire. 4. Department of Occupational Therapy, Center for Psychiatric Rehabilitation, Boston University, Boston, Massachusetts9Department of Psychiatry, Center for Psychiatric Rehabilitation, Boston University, Boston, Massachusetts10Department of Psychology, Center. 5. Department of Psychiatry and Epidemiology, Yale University, Princeton, New Jersey12Department of Public Health, Yale University, Princeton, New Jersey. 6. Division of Psychiatry Research, North Shore-LIJ Health System, The Zucker Hillside Hospital, Glen Oaks, New York2The Feinstein Institute for Medical Research, Manhasset, New York. 7. Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada. 8. Department of Social Medicine, University of North Carolina, Chapel Hill. 9. Nathan Kline Institute, Orangeburg, New York. 10. Department of Psychology, University of North Carolina, Chapel Hill. 11. National Institute of Mental Health, Bethesda, Maryland.
Abstract
IMPORTANCE: The fact that individuals with schizophrenia have high cardiovascular morbidity and mortality is well established. However, risk status and moderators or mediators in the earliest stages of illness are less clear. OBJECTIVE: To assess cardiometabolic risk in first-episode schizophrenia spectrum disorders (FES) and its relationship to illness duration, antipsychotic treatment duration and type, sex, and race/ethnicity. DESIGN, SETTING, AND PARTICIPANTS: Baseline results of the Recovery After an Initial Schizophrenia Episode (RAISE) study, collected between July 22, 2010, and July 5, 2012, from 34 community mental health facilities without major research, teaching, or clinical FES programs. Patients were aged 15 to 40 years, had research-confirmed diagnoses of FES, and had less than 6 months of lifetime antipsychotic treatment. EXPOSURE: Prebaseline antipsychotic treatment was based on the community clinician's and/or patient's decision. MAIN OUTCOMES AND MEASURES: Body composition and fasting lipid, glucose, and insulin parameters. RESULTS: In 394 of 404 patients with cardiometabolic data (mean [SD] age, 23.6 [5.0] years; mean [SD] lifetime antipsychotic treatment, 47.3 [46.1] days), 48.3% were obese or overweight, 50.8% smoked, 56.5% had dyslipidemia, 39.9% had prehypertension, 10.0% had hypertension, and 13.2% had metabolic syndrome. Prediabetes (glucose based, 4.0%; hemoglobin A1c based, 15.4%) and diabetes (glucose based, 3.0%; hemoglobin A1c based, 2.9%) were less frequent. Total psychiatric illness duration correlated significantly with higher body mass index, fat mass, fat percentage, and waist circumference (all P<.01) but not elevated metabolic parameters (except triglycerides to HDL-C ratio [P=.04]). Conversely, antipsychotic treatment duration correlated significantly with higher non-HDL-C, triglycerides, and triglycerides to HDL-C ratio and lower HDL-C and systolic blood pressure (all P≤.01). In multivariable analyses, olanzapine was significantly associated with higher triglycerides, insulin, and insulin resistance, whereas quetiapine fumarate was associated with significantly higher triglycerides to HDL-C ratio (all P≤.02). CONCLUSIONS AND RELEVANCE: In patients with FES, cardiometabolic risk factors and abnormalities are present early in the illness and likely related to the underlying illness, unhealthy lifestyle, and antipsychotic medications, which interact with each other. Prevention of and early interventions for psychiatric illness and treatment with lower-risk agents, routine antipsychotic adverse effect monitoring, and smoking cessation interventions are needed from the earliest illness phases.
IMPORTANCE: The fact that individuals with schizophrenia have high cardiovascular morbidity and mortality is well established. However, risk status and moderators or mediators in the earliest stages of illness are less clear. OBJECTIVE: To assess cardiometabolic risk in first-episode schizophrenia spectrum disorders (FES) and its relationship to illness duration, antipsychotic treatment duration and type, sex, and race/ethnicity. DESIGN, SETTING, AND PARTICIPANTS: Baseline results of the Recovery After an Initial Schizophrenia Episode (RAISE) study, collected between July 22, 2010, and July 5, 2012, from 34 community mental health facilities without major research, teaching, or clinical FES programs. Patients were aged 15 to 40 years, had research-confirmed diagnoses of FES, and had less than 6 months of lifetime antipsychotic treatment. EXPOSURE: Prebaseline antipsychotic treatment was based on the community clinician's and/or patient's decision. MAIN OUTCOMES AND MEASURES: Body composition and fasting lipid, glucose, and insulin parameters. RESULTS: In 394 of 404 patients with cardiometabolic data (mean [SD] age, 23.6 [5.0] years; mean [SD] lifetime antipsychotic treatment, 47.3 [46.1] days), 48.3% were obese or overweight, 50.8% smoked, 56.5% had dyslipidemia, 39.9% had prehypertension, 10.0% had hypertension, and 13.2% had metabolic syndrome. Prediabetes (glucose based, 4.0%; hemoglobin A1c based, 15.4%) and diabetes (glucose based, 3.0%; hemoglobin A1c based, 2.9%) were less frequent. Total psychiatric illness duration correlated significantly with higher body mass index, fat mass, fat percentage, and waist circumference (all P<.01) but not elevated metabolic parameters (except triglycerides to HDL-C ratio [P=.04]). Conversely, antipsychotic treatment duration correlated significantly with higher non-HDL-C, triglycerides, and triglycerides to HDL-C ratio and lower HDL-C and systolic blood pressure (all P≤.01). In multivariable analyses, olanzapine was significantly associated with higher triglycerides, insulin, and insulin resistance, whereas quetiapine fumarate was associated with significantly higher triglycerides to HDL-C ratio (all P≤.02). CONCLUSIONS AND RELEVANCE: In patients with FES, cardiometabolic risk factors and abnormalities are present early in the illness and likely related to the underlying illness, unhealthy lifestyle, and antipsychotic medications, which interact with each other. Prevention of and early interventions for psychiatric illness and treatment with lower-risk agents, routine antipsychotic adverse effect monitoring, and smoking cessation interventions are needed from the earliest illness phases.
Authors: Daniel J Coletti; Mary Brunette; Majnu John; John M Kane; Anil K Malhotra; Delbert G Robinson Journal: Schizophr Bull Date: 2015-08-27 Impact factor: 9.306
Authors: Kristen M Ward; Larisa Yeoman; Cora McHugh; A Zarina Kraal; Stephanie A Flowers; Amy E Rothberg; Alla Karnovsky; Arun K Das; Vicki L Ellingrod; Kathleen A Stringer Journal: Pharmacotherapy Date: 2018-06 Impact factor: 4.705
Authors: María José Morlán-Coarasa; María Teresa Arias-Loste; Víctor Ortiz-García de la Foz; Obdulia Martínez-García; Carmen Alonso-Martín; Javier Crespo; Manuel Romero-Gómez; Emilio Fábrega; Benedicto Crespo-Facorro Journal: Psychopharmacology (Berl) Date: 2016-09-12 Impact factor: 4.530