Which comes first: atypical antipsychotic treatment or cardiometabolic risk?

Abstract

Objective: To provide an overview for practicing clinicians on the pharmacological basis of cardiometabolic risk induced by antipsychotic drugs in patients with serious mental illness, to propose hypotheses to explain these risks and to give tips for managing cardiometabolic risk during antipsychotic treatment.Method: A MEDLINE search using terms for atypical antipsychotics (including individual drug names), metabolic, cardiovascular, weight gain and insulin resistance, cross‐referenced with schizophrenia was performed on articles published between 1990 and May 2008.Results: Strong evidence exists for significant cardiometabolic risk differences among several antipsychotic agents. Histamine H1 and serotonin 5HT2C antagonism are associated with risk of weight gain, but receptor targets for dyslipidemia and insulin resistance have not yet been identified. Convincing data indicate that hypertriglyceridemia and insulin resistance may occur in the absence of weight gain with certain antipsychotics.Conclusion: Although lifestyle and genetics may contribute independent risks of cardiometabolic dysfunction in schizophrenia and other serious mental illness, antipsychotic treatment also represents an important contributor to risk of cardiometabolic dysfunction, particularly for certain drugs and for vulnerable patients. Mental health professionals must learn to recognize the clinical signposts indicating antipsychotic‐related cardiometabolic problems to forestall progression to type II diabetes, cardiovascular events and premature death.

Antipsychotics Associated with the Development of Type 2 Diabetes in Antipsychotic-Naïve Schizophrenia Patients

“…The finding that the current use of the SGAs, olanzapine, and clozapine increases the risk of diabetes is consistent with earlier findings (Gianfrancesco et al, 2002;Ramaswamy et al, 2006;Smith et al, 2008;Stahl et al, 2009;Yood et al, 2009). However, to our knowledge, this is the first study showing that the metabolic effects of olanzapine early or during treatment can alter the trajectory to diabetes.…”

Acute effects of oral olanzapine treatment on the expression of fatty acid and cholesterol metabolism-related gene in rats

“…However, olanzapine have the highest risk for serious metabolic side-effects, such as obesity, dyslipidemia, and even diabetes (Allison et al 2009;Deng 2013). These metabolic side-effects increase risk for cardiovascular disease and premature death (Stahl et al 2009).…”

A simple screening tool for metabolic syndrome risk in the psychiatric patient treated with antipsychotic medication

“…Meyer's determination of metabolic syndrome was based on HDL, BP, and waist circumference, all of which can be determined without fasting test results. Stahl, et al [13] advocates for complete pre-morbid condition screening due to the fact that some SGAs can rapidly increase TRG levels resulting in an increase in insulin resistant without an increase…”