Cardiometabolic Risk in Patients With First-Episode Schizophrenia Spectrum Disorders: Baseline Results From the RAISE-ETP Study

Study Questions:

What is the cardiometabolic risk in first-episode schizophrenia spectrum disorders (FES) and its relationship to illness duration; antipsychotic treatment duration; and type, sex, and race/ethnicity?

Methods:

Baseline results of the RAISE (Recovery After an Initial Schizophrenia Episode) study were used, from data 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 ages 15-40 years, had research-confirmed diagnoses of FES, and had <6 months of lifetime antipsychotic treatment. Pre-baseline antipsychotic treatment was based on the community clinician’s and/or patient’s decision. The main outcome measures were body composition and fasting lipid, glucose, and insulin parameters.

Results:

In 394 of 404 patients with cardiometabolic data (mean [standard deviation] age, 23.6 [5.0] years; mean 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 < 0.01), but not elevated metabolic parameters (except triglycerides to high-density lipoprotein cholesterol [HDL-C] ratio [p = 0.04]). 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 ≤ 0.01). 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 ≤ 0.02).

Conclusions:

The authors concluded that in patients with schizophrenia spectrum disorders, cardiometabolic risk factors and abnormalities are present early in the illness.

Perspective:

This study reports that in patients with schizophrenia spectrum disorders, cardiometabolic risk factors and abnormalities are present early and likely related to the underlying illness, unhealthy lifestyle, and antipsychotic medications, which interact with each other. These results highlight the importance of assessing all patients for cardiometabolic risk prior to and throughout treatment, choosing low-risk antipsychotics, and managing cardiometabolic adverse effects that emerge during care of patients with FES. Additional research is indicated to assess the trajectory of cardiometabolic risk, underlying mechanisms, and mediating variables, including preferred treatment choices for FES and/or cardiometabolic risk factors.

Clinical Topics: Diabetes and Cardiometabolic Disease, Dyslipidemia, Prevention, Vascular Medicine, Hypertriglyceridemia, Lipid Metabolism, Nonstatins, Novel Agents, Diet, Hypertension

Keywords: Life Style, Dibenzothiazepines, Blood Pressure, Prehypertension, Risk Factors, Insulin Resistance, Glucose, Waist Circumference, Dyslipidemias, Hemoglobins, Smoke, Obesity, Cholesterol, HDL, Hypertension, Benzodiazepines, Antipsychotic Agents, Prediabetic State, Outcome Assessment (Health Care), Insulin, Metabolic Syndrome X, Schizophrenia, Body Composition, Body Mass Index, Triglycerides, Fasting, Diabetes Mellitus


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