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Development of an atherogenic metabolic risk factor profile associated with the use of atypical antipsychotics.

Publication Type:

Journal Article

Source:

J Clin Psychiatry, Volume 65, Issue 4, p.557-64 (2004)

Keywords:

Adult, Antipsychotic Agents, Benzodiazepines, Biomarkers, Carrier State, Cholesterol, HDL, Coronary Artery Disease, Cross-Sectional Studies, Factor Analysis, Statistical, Fasting, Health Surveys, Humans, Hypertriglyceridemia, Insulin, Male, Metabolic Syndrome X, Obesity, Prevalence, Psychotic Disorders, Risk Factors, Risperidone, Weight Gain

Abstract:

<p><b>BACKGROUND: </b>It is important to assess cardiovascular risk factors to properly verify the potential consequences of atypical antipsychotic-related weight gain. The objective of the present study was to evaluate whether 2 atypical antipsychotics differ regarding their impact on the cardiovascular disease risk profile compared with a reference group.</p><p><b>METHOD: </b>We conducted a cross-sectional, multicenter study to assess anthropometric indices of obesity and to obtain a comprehensive fasting metabolic risk profile. Either risperidone or olanzapine had to be prescribed as the first and only antipsychotic for a minimum of 6 months. Patients were compared with a reference group of nondiabetic men. Data were collected from August 1999 to August 2001.</p><p><b>RESULTS: </b>Eighty-seven patients treated with olanzapine (N = 42) or risperidone (N = 45) were evaluated. Olanzapine-treated patients had significantly higher plasma triglyceride concentrations (2.01 +/-1.05 vs. 1.34 +/-0.65 mmol/L, p < or =.05), lower high-density lipoprotein (HDL)-cholesterol levels (0.92 +/-0.17 vs. 1.04 +/- 0.21 mmol/L, p < or =.05), higher cholesterol/HDL-cholesterol ratios (5.62 +/-1.70 vs. 4.50 +/- 1.44, p < or =.05), higher apolipoprotein B levels (1.07 +/- 0.35 vs. 0.92 +/- 0.27 g/L, p < or =.05), smaller low-density lipoprotein peak particle diameters (252.6 +/-4.1 vs. 255.2 +/-4.3 A, p <.01), and higher fasting insulin concentrations (103.9 +/- 67.6 vs. 87.5 +/- 56.1 pmol/L, p < or =.05) than risperidone-treated patients. Moreover, 33% of olanzapine-treated patients were carriers of 3 atherogenic features of the metabolic syndrome as opposed to a prevalence of only 11% of risperidone-treated patients.</p><p><b>CONCLUSION: </b>These results suggest that olanzapine-treated patients are characterized by a more deteriorated metabolic risk factor profile compared with risperidone-treated patients. These observations raise concerns about the potential differential long-term deleterious effects of some antipsychotics, such as olanzapine, on cardiovascular health.</p>

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