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Metabolic syndrome in outpatients receiving antipsychotic therapy in routine clinical practice: A cross-sectional assessment of a primary health care database

Published online by Cambridge University Press:  16 April 2020

Antoni Sicras-Mainar*
Affiliation:
Planning Directorate, Badalona Serveis Assistencials SA, Gaietá Soler, 8-entresuelo, 08911Badalona (Barcelona), Spain
Milagrosa Blanca-Tamayo
Affiliation:
Department of Psychiatry, Badalona Serveis Assistencials, Badalona (Barcelona), Spain
Javier Rejas-Gutiérrez
Affiliation:
Department of Health Outcomes Research, Medical Unit, Pfizer España, Alcobendas (Madrid), Spain
Ruth Navarro-Artieda
Affiliation:
Medical Documentation Service. Germans Trías i Pujol Hospital, Badalona (Barcelona), Spain
*
*Corresponding author. Tel.: +34 93 507 2684. E-mail address: [email protected] (A. Sicras-Mainar).
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Abstract

Objective

To determine the prevalence of metabolic syndrome (MS) in outpatients treated with antipsychotics included in a primary-health-care database.

Methods

A cross-sectional study was carried out assessing an administrative outpatients claim-database from 5 primary-health-centers. Subjects on antipsychotics for more than 3 months were included. The control group was formed by the outpatients included in the database without exposition to any antipsychotic drugs. MS was defined according to the modified NCEP-ATP III criteria, and required confirmation of at least 3 of the 5 following components: body mass index >28.8 kg/m2, triglycerides >150 mg/ml, HDL-cholesterol <40 mg/ml (men)/<50 mg/ml (women), blood pressure >130/85 mmHg, and fasting serum glucose >110 mg/dl.

Results

We identified 742 patients [51.5% women, aged 55.1 (20.7) years] treated with first- or second-generation antipsychotics during 27.6 (20.3) months. Controls were 85.286 outpatients [50.5% women, aged 45.5 (17.7) years]. MS prevalence was significantly higher in subjects on antipsychotics: 27.0% (95% CI, 23.8–30.1%) vs. 14.4% (14.1–14.6%); age- and sex-adjusted OR = 1.38 (1.16–1.65, P < 0.001). All MS components, except high blood pressure, were significantly more prevalent in the antipsychotic group, particularly body mass index >28.8 kg/m2: 33.0% (29.6–36.4%) vs. 17.8% (17.6–18.1%), adjusted OR = 1.63 (1.39–1.92, P < 0.001), and low HDL-cholesterol levels: 48.4% (44.8–52.0%) vs. 29.3% (29.0–29.6%); adjusted OR = 1.65 (1.42–1.93, P < 0.001). Compared with the reference population, subjects with schizophrenia or bipolar disorder (BD), but not dementia, showed a higher prevalence of MS.

Conclusions

Compared with the general outpatient population, the prevalence of MS was significantly higher in patients with schizophrenia or BD treated with antipsychotics.

Type
Original articles
Copyright
Copyright © Elsevier Masson SAS 2008

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Footnotes

*

The material in this paper was presented as a poster at the 16th European Congress of Psychiatry, Nice, March 2006.

References

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;58:797806.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(2):596601.CrossRefGoogle Scholar
Basu, R., Brar, J.S., Chengappa, K.N.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;6:314318.CrossRefGoogle ScholarPubMed
Bautista, M.C., Engler, M.M.The Mediterranean diet: is it cardioprotective? Prog Cardiovasc Nurs 2005;20:7076.CrossRefGoogle ScholarPubMed
Bobes, J., Arango, C., Aranda, P., Carmena, R., García-García, M.Rejas J, on behalf of CLAMORS collaborative study group. Cardiovascular and metabolic risk in outpatients with schizophrenia treated with antipsychotics: Results of the CLAMORS Study. Schizophr Res 2007;90:162173.CrossRefGoogle Scholar
Calbo, J.M., Terrancle de Juan, I., Fernández, P., Rodríguez, M.J., Martínez, V., Santisteban, Y.et al.Prevalencia del síndrome metabólico en la provincia de Albacete. Rev Clin Esp 2007;207(2):6468.CrossRefGoogle Scholar
Casey, D.Metabolic issues and cardiovascular disease in patients with psychiatric disorders. Am J Med 2005;118:164–120.Google ScholarPubMed
Chrousos, G.P.The role of stress and the hypothalamic-pituitary-adrenal axis in the pathogenesis of the metabolic syndrome: neuro-endocrine and target tissue-related causes. Int J Obes Relat Metab Disord 2000;24(Suppl 2):S50S55.CrossRefGoogle ScholarPubMed
Citrome, L.Metabolic syndrome and cardiovascular disease. Psychopharmacology 2005;19(Suppl. 6):8493.CrossRefGoogle 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;35:436437.CrossRefGoogle Scholar
Cohn, T., Prud'homme, D., Streiner, D., Kameh, H., Remington, G.Characterizing coronary hearth disease risk in chronic schizophrenia: High prevalence of the metabolic syndrome. Can J Psychiatry 2004;49:753760.CrossRefGoogle Scholar
Correll, C.U., Frederickson, A.M., Kane, J.M., Manu, P.Metabolic syndrome and the risk of coronary heart disease in 367 patients treated with second-generation antipsychotics drugs. J Clin Psychiatry 2006;67:575583.CrossRefGoogle Scholar
De Hert, M.A., Van Winkel, R., Van Eyck, D., Hanssens, L., Wampers, M., Scheen, A.et al.Prevalence of metabolic syndrome in patients with schizophrenia treated with antipsychotic medication. Schizophr Res 2006;83:8793.CrossRefGoogle ScholarPubMed
Elman, I., Adler, C.M., Malhotra, A.K., Bir, C., Pickar, D., Breier, A.Effect of acute metabolic stress on pituitary-adrenal axis activation in patients with schizophrenia. Am J Psychiatry 1988;155:979981.CrossRefGoogle Scholar
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;192:1927.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;7:424430.CrossRefGoogle ScholarPubMed
Hagg, S., Lindblom, Y., Mjorndal, T., Adolfsson, R.High prevelence of the metabolic syndrome among a Swedish cohort of patients with schizophrenia. Int Clin Psychopharmacol 2006;21:9398.Google Scholar
Kaneda, Y., Fujii, A., Ohmori, T.The hypothalamic-pituitary-adrenal axis in chronic schizophrenic patients long-term treated with neuroleptics. Prog Neuropsychopharmacol Biol Psychiatry 2002;26:935938.CrossRefGoogle ScholarPubMed
Kilbourne, A.M., Cornelius, J.R., Han, X., Pincus, H.A., Shad, M., Salloum, I.Burden of general medical conditions among individuals with bipolar disorder. Bipolar Disord 2004;6:368373.CrossRefGoogle ScholarPubMed
Kokkinos, P., Panagiotakos, D.B., Polychronopoulos, E.Dietary influences on blood pressure: the effect of the Mediterranean diet on the prevalence of hypertension. J Clin Hypertens (Greenwich) 2005;7:165170.CrossRefGoogle ScholarPubMed
Lakka, H.M., Laaksonen, D.E., Lakka, T.A., Niskanen, L.K., Kumpusalo, E., Tuomilheto, J.et al.The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men. JAMA 2002;288:27092716.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;65:702706.CrossRefGoogle ScholarPubMed
Lamberts, H., Wood, M.Clasificación Internacional de la Atención Primaria CIAP-2. Clasificación de razones de consulta Barcelona: Masson/SG; 1990.Google Scholar
Lindenmayer, J.P., Czobor, P., Volavka, J., Citrome, L., Sheitman, B., McEvoy, J.P.et al.Changes in glucose and cholesterol levels in patients with schizophrenia treated with typical or atypical antipsychotic. Am J Psychiatry 2003;160:290296.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;11:14801487.CrossRefGoogle ScholarPubMed
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;125:481486.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;80:1932.CrossRefGoogle ScholarPubMed
McIntyre, R.S., McCann, S.M., Kennedy, S.H.Antipsychotic metabolic effects: weight gain, diabetes mellitus, and lipid abnormalities. Can J Psychiatry 2001;46:273281.CrossRefGoogle ScholarPubMed
Meltzer, H.Y., Davidson, M., Glassman, A.H., Vieweg, W.V.Assessing cardiovascular risks versus clinical benefits of atypical antipsychotic drug treatment. J Clin Psychiatry 2002;63:2529.Google ScholarPubMed
Meyer, J., Loh, C., Leckband, S.G., Boyd, J.A., Wirshing, W.C., Pierre, J.M.et al.Prevalence of the metabolic syndrome in veterans with schizophrenia. J Psychiatr Pract 2006;12:510.CrossRefGoogle ScholarPubMed
National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment on High Blood Cholesterol in Adults (Adult Treatment Panel III).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;106:31433421.CrossRefGoogle Scholar
Newcomer, J.W.Second-generation (atypical) antipsychotics and metabolic effects: a comprehensive literature review. CNS Drugs 2005;19(Suppl 1):193.CrossRefGoogle ScholarPubMed
Reaven, G.M.Role of insulin resistance in human disease. Diabetes 1988;37:15951607.CrossRefGoogle ScholarPubMed
Ridker, P.M., Buring, J.E., Cook, N.R., Rifai, N.C-reactive protein, the metabolic syndrome, and risk of incident cardiovascular events: an 8-year follow-up of 14,719 initially healthy American women. Circulation 2003;107:391397.CrossRefGoogle ScholarPubMed
Rodriguez-Artalejo, F., Baca, E., Esmatjes, E., Merino-Torres, J.F., Monereo, S., Moreno, B.et al.Assessment and control of metabolic and cardiovascular risk in patients with schizophrenia. Med Clin (Barc) 2006;127(14):542548.Google ScholarPubMed
Ryan, M.C., Thakore, J.H.Physical consequences of schizophrenia and its treatment: the metabolic syndrome. Life Sci 2002;71:239257.CrossRefGoogle ScholarPubMed
Sattar, N., Gaw, A., Scherbakova, O., Ford, I., O'Reilly, D.S., Haffner, S.M.et al.Metabolic syndrome with and without C-reactive protein as a predictor of coronary heart disease and diabetes in the West of Scotland Coronary Prevention Study. Circulation 2003;108:414419.CrossRefGoogle ScholarPubMed
Sicras, A., Rejas, J., Navarro, R., Serrat, J., Blanca, M.Metabolic syndrome in bipolar disorder: a cross-sectional assessment of a Health Management Organization database. Bipolar Disord, in press.Google Scholar
Thakore, J.H., Mann, J.N., Vlahos, I., Martin, A., Reznek, R.Increased visceral fat distribution in drug-naive and drug-free patients with schizophrenia. Int J Obes Relat Metab Disord 2002;26:137141.CrossRefGoogle ScholarPubMed
Tunstall-Pedoe, H., Kuulasmaa, K., Mahonen, M., Tolonen, H., Ruokokoski, E., Amouyel, P.Contribution of trends in survival and coronary-event rates to changes in coronary heart disease mortality: 10-year results from 37 WHO MONICA Project populations. Lancet 1999;353:15471557.CrossRefGoogle ScholarPubMed
Yumru, M., Savas, H.A., Kurt, E., Kaya, M.C., Selek, S., Savas, E.et al.Atypical antipsychotics related metabolic syndrome in bipolar patients. J Affect Disord 2007;98:247252.CrossRefGoogle ScholarPubMed
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