Cardiovascular and metabolic risk in outpatients with schizoaffective disorder treated with antipsychotics: Results from the CLAMORS study European Psychiatry Cambridge Core

Cardiovascular and metabolic risk in outpatients with schizoaffective disorder treated with antipsychotics: Results from the CLAMORS study - Volume 27 Issue 4

Abstract
References

AimTo assess the coronary heart disease (CHD) risk and prevalence of the metabolic syndrome (MS) in patients with schizoaffective disorder (SD) receiving antipsychotics.

MethodsPatients meeting DSM-IV criteria for SD and receiving antipsychotic treatment were recruited in a retrospective, cross-sectional, multicenter study (the CLAMORS study). MS was defined as at least three of the following components: waist circumference greater than 102cm (men)/greater than 88cm (women); serum triglycerides greater or equal to 150mg/dl; HDL cholesterol less than 40mg/dl (men)/less than 50mg/dl (women); blood pressure greater or equal to 130/85mmHg; fasting blood glucose greater or equal to 110mg/dl. The 10-year CHD risk was assessed by the Systematic coronary risk evaluation (SCORE) (cardiovascular mortality) and Framingham (any cardiovascular event) functions. Clinical severity was assessed using the PANSS and CGI-S scales.

ResultsA total of 268 valuable patients with SD (127 men, 48.1%), 41.9±12.3years (mean±S.D.), were analyzed. The 10-year overall cardiovascular mortality and CV-event risk were 0.8±1.6 (SCORE) and 6.5±6.8 (Framingham), respectively. A high/very high risk of any CV event (Framingham≥10%) was associated with severity CGI-S=3–4; OR: 4.32 (1.15–16.26), P = 0.03). MS was present in 26.5% (95%CI: 21.2–31.8) of subjects, without gender differences, but significantly associated with patient’s impression of severity: CGI=3–4; OR=1.90 (0.83–4.36), and CGI=5–7; OR=3.13 (1.06–9.24), P = 0<0.001, and age OR=1.91 (1.09–3.34), P<0.024).

ConclusionsCHD risk and MS prevalence were high among patients with SD, being MS prevalence associated with age and severity of disease.

Metabolic syndromeCardiovascular riskSchizoaffective disordersOutpatientsAntipsychotic treatmentMental statusGet access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)1 Alberti, K.G., Zimmet, P., Shaw, J.IDF Epidemiology task Force Consensus Group The metabolic syndrome – a new worldwide definition.Lancet.2005; 366: 1059–1062.CrossRefGoogle ScholarPubMed 2 Alegría, E., Cordero, A., Laclaustra, M., Grima, A., León, M., Casasnovas, J.A.et al.En representación de los investigadores del registro MESYAS. Prevalencia del síndrome metabólico en población laboral española: registro MESYAS.Rev Esp Cardiol.2005; 58: 797–806.CrossRefGoogle Scholar 3 Álvarez, E.E., Ribas, L., Serra, L.Prevalence of the metabolic syndrome in the population of Canary Islands, Spain.Med Clin (Barc).2003; 120: 172–174.Google Scholar 4 Álvarez-Cosmea, A., López, V., Suárez, S., Arias, T., Prieto, M.A., Díaz, L.Diferencias en la prevalencia del síndrome metabólico según las definiciones del ATP-III y la OMS.Med Clin (Barc).2005; 124: 368–370.CrossRefGoogle Scholar 5 American Diabetes Association, American Psychiatric Association, American Association of Clinical Endocrinologists, North American Association for the Study of Obesity Consensus development conference on antipsychotic drugs and obesity and diabetes. Diabetes Care. 2004; 27: 596–601.Google Scholar 6 American Psychiatric AssociationDiagnostic and statistical manual of mental disorders.4th text rev. edWashington, DC: Author; 2000.Google Scholar 7 Aranceta, J., Perez, C., Serra, L., Ribas, L., Quiles, J., Vioque, J.et al.Prevalence of obesity in Spain: results of the SEEDO 2000 study.Med Clin (Barc).2003; 120: 608–612.CrossRefGoogle ScholarPubMed 8 Aranceta, J., Pérez-Rodrigo, C., Foz-Saal, M., Mantilla, T., Serra, L.l., Moreno, B.et al.Tablas de evaluación del riesgo coronario adaptadas a la población española. Estudio DORICA.Med Clin (Barc).2004; 123: 686–691.CrossRefGoogle Scholar 9 Ascaso, J.F., Gabriel, R., Franch, J., Godoy, A., Fernández de Bobadilla, J., Ortega, R.et al.Grado de concordancia de los distintos criterios que definen el síndrome metabólico en el estudio DESIRE abstract.Av Diabetologia.2004; 20: 23.Google Scholar 10 Bai, Y.M., Chen, T.T., Yang, W.S., Chi, Y.C., Lin, C.C., Liou, Y.J.et al.Association of adiponectin and metabolic syndrome among patients taking atypical antipsychotics for schizophrenia: a cohort study.Schizophr Res.2009; 111: 1–8.CrossRefGoogle ScholarPubMed 11 Basu, R., Brar, J.S., Chengappa, R., John, V., Parepally, H., Gershon, S.et al.The prevalence of the metabolic syndrome in patients with schizoaffective disorder – bipolar subtype.Bipolar Disord.2004; 6: 314–318.CrossRefGoogle ScholarPubMed 12 Bobes, J., Rejas, J., Garcia-Garcia, M., Rico-Villademoros, F., García-Portilla, M.P., Fernández, I.et al.Weight gain in patients with schizophrenia treated with risperidone, olanzapine, quetiapine or haloperidol: results of the EIRE study.Schizophr Res.2003; 62: 77–88.CrossRefGoogle ScholarPubMed 13 Bobes, J., Arango, C., Aranda, P., Carmena, R., Garcia-Garcia, M., Rejas, J.Cardiovascular and metabolic risk in outpatients with schizophrenia treated with antipsychotics: results of the CLAMORS Study.Schizophr Res.2007; 90: 162–173.CrossRefGoogle ScholarPubMed 14 Brown, S., Inskip, H., Barraclough, B.Causes of the excess mortality of schizophrenia.Br J Psychiatry.2000; 177: 212–217.CrossRefGoogle ScholarPubMed 15 Cabrera de León, A., Rodriguez-Perez, M.C., del Castillo-Rodriguez, J.C., Brito-Diaz, B., Perez-Mendez, L.I., Muros de Fuentes, M.et al.Coronary risk in the population of the Canary Islands, Spain, using the Framingham function.Med Clin.2006; 126: 535–536.Google ScholarPubMed 16 Coca, M.M., Hernanz, P., Vega, M., Suárez, C.Prevalencia de síndrome metabólico en la población de un centro de atención primaria urbano.Aten Primaria.2005; 35: 436–437.CrossRefGoogle Scholar 17 Cohn, T., Remington, G., Zipursky, R.B., Azad, A., Connolly, P., Wolever, T.Insulin resistance and adiponectin levels in drug-free patients with schizophrenia: a preliminary report.Can J Psychiatry.2006; 51: 382–386.CrossRefGoogle ScholarPubMed 18 Conroy, R.M., Pyorala, K., Fitzgerald, A.P., Sans, S., Menotti, A., De Backer, G.et al.Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project.Eur Heart J.2003; 24: 987–1003.CrossRefGoogle ScholarPubMed 19 De Hert, M., Schreurs, V., Vancampfort, D., Van Winkel, R.Metabolic syndrome in people with schizophrenia: a review.World Psychiatry.2009; 8: 15–22.CrossRefGoogle ScholarPubMed 20 De Hert, M., Dekker, J.M., Wood, D., Kahl, K.G., Holt, R.I., Möller, H.J.Cardiovascular disease and diabetes in people with severe mental illness position statement from the European Psychiatric Association (EPA), supported by the European Association for the Study of Diabetes (EASD) and the European Society of Cardiology (ESC).Eur Psychiatry.2009; 24: 412–424.CrossRefGoogle Scholar 21 Dixon, L., Weiden, P., Delahanty, J., Goldberg, R., Postrado, K., Lucksted, A.et al.Prevalence and correlates of diabetes in national schizophrenia samples.Schizophr Bull.2000; 26: 903–912.CrossRefGoogle ScholarPubMed 22 Enger, C., Weatherby, L., Reynolds, R.F., Glasser, D.B., Walker, A.M.Serious cardiovascular events and mortality among patients with schizophrenia.J Nerv Ment Dis.2004; 192: 19–27.CrossRefGoogle ScholarPubMed 23 Fagiolini, A., Frank, E., Scott, J.A., Turkin, S., Kupfer, D.J.Metabolic syndrome in bipolar disorder: findings from the Bipolar Disorder Center for Pennsylvanians.Bipolar Disord.2005; 7: 424–430.CrossRefGoogle ScholarPubMed 24 Garcia-Portilla, M.P., Saiz, P.A., Benabarre, A., Sierra, P., Perez, J., Rodriguez, A.et al.The prevalence of metabolic syndrome in patients with bipolar disorder.J Affect Disord.2008; 106: 197–201.CrossRefGoogle ScholarPubMed 25 Goff, D.C., Sullivan, L.M., McEvoy, J.P., Meyer, J.M., Nasrallah, H.A., Daumit, G.L.et al.A comparison of ten-year cardiac risk estimates in schizophrenia patients from the CATIE study and matched controls.Schizophr Res.2005; 80: 45–53.CrossRefGoogle ScholarPubMed 26 Guy, W.Early Clinical Drug Evaluation (ECDEU). Assessment Manual. Rockville.Nat Inst Ment Health.1976218–222.Google Scholar 27 Hanssens, L., van Winkel, R., Wampers, M., Van Eyck, D., Scheen, A., Reginster, J.Y.et al.A cross-sectional evaluation of adiponectin plasma levels in patients with schizophrenia and schizoaffective disorder.Schizophr Res.2008; 106: 308–314.CrossRefGoogle ScholarPubMed 28 Holt, R.I.Diagnosis, epidemiology and pathogenesis of diabetes mellitus: an update for psychiatrists.Br J Psychiatry.suppl. 47: 2005S55–S63.Google Scholar 29 International Conference on Harmonization (ICH): E9 Statistical Principles for Clinical Trials. Rockville (USA). Food Drug Adm;1998.Google Scholar 30 Kane, J.M., Barrett, E.J., Casey, D.E., Correll, C.U., Gelenberg, A.J., Klein, S.et al.Metabolic effects of treatment with atypical antipsychotics.J Clin Psychiatry.2004; 65: 1447–1455.CrossRefGoogle ScholarPubMed 31 Kay, S.R., Fiszbein, A., Opler, L.A.The positive and negative syndrome scale (PANSS) for schizophrenia.Schizophr Bull.1987; 13: 261–276.CrossRefGoogle Scholar 32 Kilbourne, A.M., Brar, J.S., Drayer, R.A., Xu, X., Post, E.P.Cardiovascular disease and metabolic risk factors in male patients with schizophrenia, schizoaffective disorder, and bipolar disorder.Psychosomatics.2007; 48: 412–417.CrossRefGoogle ScholarPubMed 33 Lamberti, J.S., Crilly, J.F., Maharaj, K., Olson, D., Wiener, K., Dvorin, S.et al.Prevalence of diabetes mellitus among outpatients with severe mental disorders receiving atypical antipsychotic drugs.J Clin Psychiatry.2004; 65: 702–706.CrossRefGoogle ScholarPubMed 34 Lamberti, J.S., Olson, D., Crilly, J.F., Olivares, T., Williams, G.C., Tu, X.et al.Prevalence of the Metabolic Syndrome among patients receiving clozapine.Am J Psychiatry.2006; 163: 1273–1276.CrossRefGoogle ScholarPubMed 35 Levkovitz, Y., Ben-Shushan, G., Hershkovitz, A., Isaac, R., Gil-Ad, I., Shvartsman, D.et al.Antidepressants induce cellular insulin resistance by activation of IRS-1 kinases.Mol Cell Neurosci.2007; 36: 305–312.CrossRefGoogle ScholarPubMed 36 Lorenzo, C., Serrano-Ríos, M., Martínez-Larrad, M.T., Gabriel, R., Williams, K., Gómez-Gerique, J.A.et al.Central adiposity determines prevalence differences of the metabolic syndrome.Obes Res.2003; 11: 1480–1487.CrossRefGoogle ScholarPubMed 37 Mackin, P., Bishop, D., Watkinson, H., Gallagher, P., Ferrier, I.N.Metabolic disease and cardiovascular risk in people treated with antipsychotics in the community.Br J Psychiatry.2007; 191: 23–29.CrossRefGoogle Scholar 38 Martínez-Larrad, M.T., Fernández-Pérez, C., González-Sánchez, J.L., López, A., Fernández-Álvarez, J., Riviriego, J.et al.Prevalence of the metabolic syndrome (ATP-III criteria). Population-based study of rural and urban areas in the Spanish province of Segovia.Med Clin (Barc).2005; 125: 481–486.Google Scholar 39 McEvoy, J.P., Meyer, J.M., Goff, D.C., Nasrallah, H.A., Davis, S.M., Sullivan, L.et al.Prevalence of the metabolic syndrome in patients with schizophrenia: baseline results from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) schizophrenia trial and comparison with national estimates from NHANES III.Schizophr Res.2005; 80: 19–32.CrossRefGoogle ScholarPubMed 40 Meyer, J.M., Stahl, S.M.The metabolic syndrome and schizophrenia.Acta Psychiatr Scand.2009; 119: 4–14.CrossRefGoogle Scholar 41 Meyer, J.M., Nasrallah, H.A., McEvoy, J.P., Goff, D.C., Davis, S.M., Chakos, M.et al.The Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) Schizophrenia Trial: clinical comparison of subgroups with and without the metabolic syndrome.Schizophr Res.2005; 80: 9–18.CrossRefGoogle ScholarPubMed 42 National Institutes of Health Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III) Final Report. Circulation. 2002; 106: 3143–3421.CrossRefGoogle Scholar 43 Peralta, V., Cuesta, M.Validation of positive and negative symptom scale (PANSS) in a sample of Spanish schizophrenia patients.Actas Luso Esp Neurol Psiquiatr Cienc Afines.1994; 22: 171–177.Google Scholar 44 Pérez-Fernández, R., Mariño, A.F., Cadarso-Suárez, C., Botana, M.A., Tome, M.A., Solache, I.et al.Prevalence, awareness, treatment and control of hypertension in Galicia (Spain) and association with related diseases.J Hum Hypertens.2007; 21: 366–373.CrossRefGoogle ScholarPubMed 45 Ribeiro, P.J., Lopes, F.The prevalence of metabolic syndrome among psychiatric inpatients in Brazil.Rev Bras Psiquiatr.2007; 29: 330–336.Google Scholar 46 Ryan, M.C., Collins, P., Thakore, J.H.Impaired fasting glucose tolerance in first-episode, drug-naive patients with schizophrenia.Am J Psychiatry.2003; 160: 284–289.CrossRefGoogle ScholarPubMed 47 Saari, K.M., Lindeman, S.M., Viilo, K.M., Isohanni, M.K., Järvelin, M.R., Laurén, L.H.et al.A 4-fold risk of metabolic syndrome in patients with schizophrenia: the Northern Finland 1966 Birth Cohort study.J Clin Psychiatry.2005; 66: 559–563.CrossRefGoogle ScholarPubMed 48 SEA. Obesidad y riesgo cardiovascular. Documento consenso. Sociedad Española de Arterioesclerosis; 2003.Google Scholar 49 Sernyak, M.J., Leslie, D.L., Alarcon, R.D., Losonczy, M.F., Rosenheck, R.Association of diabetes mellitus with use of atypical neuroleptics in the treatment of schizophrenia.Am J Psychiatry.2002; 159: 561–566.CrossRefGoogle ScholarPubMed 50 Stroup, T.S., Lieberman, J.A., McEvoy, J.P., Swartz, M.S., Davis, S.M., Rosenheck, R.A.et al.Effectiveness of olanzapine, quetiapine, risperidone, and ziprasidone in patients with chronic schizophrenia following discontinuation of a previous atypical antipsychotic.Am J Psychiatry.2006; 163: 611–622.CrossRefGoogle ScholarPubMed 51 Sutherland, J.P., McKinley, B., Eckel, R.H.The metabolic syndrome and inflammation.Metab Syndr Relat Disord.2004; 2: 82–104.CrossRefGoogle ScholarPubMed 52 Suvisaari, J.M., Saarni, S.I., Perala, J., Suvisaari, J.V., Harkanen, T., Lonnqvist, J.et al.Metabolic Syndrome among persons with schizophrenia and other psychotic disorders in a general population survey.J Clin Psychiatry.2007; 68: 1045–1055.CrossRefGoogle Scholar 53 van Winkel, R., van Os, J., Celic, I., Van Eyck, D., Wampers, M., Scheen, A.et al.Psychiatric diagnosis as an independent risk factor for metabolic disturbances: results from a comprehensive, naturalistic screening program.J Clin Psychiatry.2008; 69: 1319–1327.CrossRefGoogle ScholarPubMed 54 Vara-González, L., Muñoz Cacho, P., Sanz de Castro, S.Arterial hipertensión prevalence, detection, treatment and control in Cantabria, Spain, 2002.Rev Esp Salud Publica.2007; 81: 211–219.CrossRefGoogle Scholar 55 Wilson, P.W., D’Agostino, R.B., Levy, D., Belanger, A.M., Silbershatz, H., Kannel, W.B.Prediction of coronary heart disease using risk factor categories.Circulation.1998; 97: 1837–1847.CrossRefGoogle ScholarPubMed 56 Wirshing, D.A.Schizophrenia and obesity: impact of antipsychotic medications.J Clin Psychiatry.2004; 65: 13–26.Google ScholarPubMed 57 WMA. Policy. World Medical Association Declaration of Helsinki. Ethical principles for medical research involving human subjects; 2004. http://www.wma.net/e/policy/b3.htm.Google Scholar No Comments have been published for this article.CancelConfirm