Cardiometabolic Risk in Patients With First-Episode Schizophrenia Spectrum Disorders

Abstract

IMPORTANCEThe 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 A 1c based, 15.4%) and diabetes (glucose based, 3.0%; hemoglobin A 1c 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 Յ .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 Յ .02). CONCLUSIONS AND RELEVANCEIn 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.

BAP guidelines on the management of weight gain, metabolic disturbances and cardiovascular risk associated with psychosis and antipsychotic drug treatment

“…In the EUFEST study, of individuals experiencing their first episode of schizophrenia, weight gain of 7% or greater of initial body weight was found in 65% of the follow-up population at 1 year (Kahn et al, 2008). In a study of individuals in the early stages of treatment for a first episode of psychosis, Correll et al (2014) found a pattern of increases in several metabolic risk indices after an average of 47 days of antipsychotic treatment.…”

Diabetes and Cardiovascular Care Among People with Severe Mental Illness: A Literature Review

“…90 In another recent study of young adults (15-40 years old) with first-episode schizophrenia spectrum disorders, 15.4 % (43/394) had hemoglobin A1c-defined prediabetes. 91 Women. In the Schizophrenia PORT field study (N = 719), Medicaid sample (N = 6066) and Medicare sample (N = 14,182), all found that women with schizophrenia had higher rates of diabetes than men (field study: 21.9 % vs 10.8 %, p < 0.001; Medicaid: 15 % vs. 4.3 %, p < 0.001; Medicare: 16.7 % vs. 8.8 %, p < 0.001).…”

Responses to Tobacco Smoking-Related Health Messages in Young People With Recent-Onset Schizophrenia

“…Smoking prevalence among persons with psychosis range from 44% to 77%, [5][6][7][8][9][10] with over 50% of 404 participants with first episode psychosis reporting current smoking in a recent treatment study. 11 People with severe mental illness (SMI) are also more likely to be heavy smokers (>1 ppd), 12 less likely to quit, 13 and die up to 25 years earlier than the general population, primarily due to smoking-related cardiac illness. 14 Almost one-third of current smokers in the United States have a mental illness 15 and smoking accounts for over half the illness-related deaths in persons with schizophrenia.…”