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

Published online by Cambridge University Press:  15 April 2020

J. Bobes ,
C. Arango ,
P. Aranda ,
R. Carmena ,
M. Garcia-Garcia ,
J. Rejas  and
on behalf of the CLAMORS Study Collaborative Group1
J. Bobes*
Affiliation:
Medicine Department, Psychiatry Area, University of Oviedo, Centro de Investigación Biomédica en Red de Salud Mental CIBERSAM, C/Julián Clavería, 6, 33006Oviedo (Asturias), Spain
C. Arango
Affiliation:
Psychiatry Department, Hospital General Universitario Gregorio Marañón and Centro de Investigación Biomédica en Red de Salud Mental CIBERSAM, Madrid, Spain
P. Aranda
Affiliation:
Hypertension Unit, Carlos Haya Hospital, Málaga, Spain
R. Carmena
Affiliation:
Department of Endocrinology, Valencia University Clinic Hospital, Valencia, Spain
M. Garcia-Garcia
Affiliation:
Operations Department, Biometria Clinica CRO, Barcelona, Spain
J. Rejas
Affiliation:
Health Outcomes Research Department, Medical Unit, Pfizer España, Madrid, Spain
*
*Corresponding author. Tel.: +34 985 10 35 53; fax: +34 985 10 35 53. E-mail address: bobes@uniovi.es (J. Bobes).
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Abstract

Aim

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

Methods

Patients 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.

Results

A 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)].

Conclusions

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

Keywords

Metabolic syndromeCardiovascular riskSchizoaffective disordersOutpatientsAntipsychotic treatmentMental status
Type
Original articles
Information
European Psychiatry , Volume 27 , Issue 4 , May 2012 , pp. 267 - 274
Copyright
Copyright © Elsevier Masson SAS 2012

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References

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
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
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
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
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
American Psychiatric Association Diagnostic and statistical manual of mental disorders. 4th text rev. edWashington, DC: Author; 2000.Google Scholar
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
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
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
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
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
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
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
Brown, S., Inskip, H., Barraclough, B.Causes of the excess mortality of schizophrenia. Br J Psychiatry. 2000; 177: 212–217.CrossRefGoogle ScholarPubMed
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
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
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
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
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
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
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
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
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
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
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
Guy, W.Early Clinical Drug Evaluation (ECDEU). Assessment Manual. Rockville. Nat Inst Ment Health. 1976 218–222.Google Scholar
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
Holt, R.I.Diagnosis, epidemiology and pathogenesis of diabetes mellitus: an update for psychiatrists. Br J Psychiatry. suppl. 47: 2005 S55–S63.Google Scholar
International Conference on Harmonization (ICH): E9 Statistical Principles for Clinical Trials. Rockville (USA). Food Drug Adm;1998.Google Scholar
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
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
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
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
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
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
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
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
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
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
Meyer, J.M., Stahl, S.M.The metabolic syndrome and schizophrenia. Acta Psychiatr Scand. 2009; 119: 4–14.CrossRefGoogle Scholar
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
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
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
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
Ribeiro, P.J., Lopes, F.The prevalence of metabolic syndrome among psychiatric inpatients in Brazil. Rev Bras Psiquiatr. 2007; 29: 330–336.Google Scholar
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
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
SEA. Obesidad y riesgo cardiovascular. Documento consenso. Sociedad Española de Arterioesclerosis; 2003.Google Scholar
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
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
Sutherland, J.P., McKinley, B., Eckel, R.H.The metabolic syndrome and inflammation. Metab Syndr Relat Disord. 2004; 2: 82–104.CrossRefGoogle ScholarPubMed
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
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
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
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
Wirshing, D.A.Schizophrenia and obesity: impact of antipsychotic medications. J Clin Psychiatry. 2004; 65: 13–26.Google ScholarPubMed
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
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