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Antipsychotic medications: metabolic and cardiovascular risk
1Department of Psychiatry, Center for Clinical Studies, Washington University School of Medicine, St. Louis, Mo, USA. newcomerj@wustl.edu
Insights
Serious mental illness (SMI) patients face higher risks of obesity, diabetes, and cardiovascular disease. Certain antipsychotic medications worsen these cardiometabolic risks, necessitating careful monitoring.
Area of Science:
- Medical Science
- Psychiatry
- Public Health
Background:
- Individuals with serious mental illness (SMI) exhibit significantly higher rates of morbidity and mortality, particularly from cardiovascular disease.
- Obesity is a prevalent issue in the SMI population, acting as an independent risk factor for cardiometabolic diseases like diabetes mellitus, dyslipidemia, and hypertension.
- Metabolic syndrome, characterized by abdominal obesity, hyperglycemia, hypertension, and dyslipidemia, is highly prevalent in SMI patients, especially those with schizophrenia.
Purpose of the Study:
- To review the elevated prevalence of cardiometabolic risk factors in individuals with serious mental illness.
- To examine the role of obesity and metabolic syndrome in contributing to excess morbidity and mortality in this population.
- To discuss the impact of psychotropic medications, particularly antipsychotics, on weight gain and cardiometabolic health.
Main Methods:
- Literature review of clinical samples and evidence regarding cardiometabolic risk factors in serious mental illness.
- Analysis of the association between obesity, metabolic syndrome components, and increased risk of diabetes and cardiovascular disease.
- Examination of the influence of specific psychotropic agents on weight gain and metabolic parameters.
Main Results:
- Cardiovascular disease is the leading cause of death in individuals with SMI.
- Obesity is a significant independent risk factor, contributing to dyslipidemia, hypertension, and type 2 diabetes.
- Antipsychotic medications, especially clozapine and olanzapine, are linked to substantial weight gain and increased risk of diabetes and dyslipidemia.
Conclusions:
- Patients with serious mental illness have a high burden of cardiometabolic risk factors, including obesity and metabolic syndrome.
- Psychotropic medications can exacerbate these risks through weight gain and metabolic changes.
- Regular monitoring of cardiometabolic risk factors is crucial for managing patients with serious mental illness.
Abstract:
Individuals with serious mental illness experience excess morbidity and mortality, including an increased prevalence of diabetes mellitus and cardiovascular disease. Cardiovascular disease is the leading cause of death in persons with serious mental illness, and the elevated prevalence of obesity in this population is of particular concern. Obesity is an independent cardiometabolic risk factor that impacts morbidity and mortality and contributes to the development of other cardiometabolic risk factors, such as dyslipidemia and hypertension. In addition, obesity is a major risk factor for type 2 diabetes, with the relative risk of diabetes increasing with body mass index. Increased abdominal fat is strongly associated with insulin resistance, which can lead to impaired glucose regulation. Abdominal obesity, hyperglycemia, hypertension, and dyslipidemia are key components of the metabolic syndrome, a constellation of cardiometabolic risk factors linked by their common association with insulin resistance. Evidence from large clinical samples indicates a high prevalence of metabolic syndrome and all of its components in persons with serious mental illness, particularly in patients with schizophrenia. In addition, psychotropic agents, including some antipsychotic medications, are associated with substantial weight gain, as well as with adiposity-dependent and possibly adiposity-independent changes in insulin sensitivity and lipid metabolism, which increase the risk of diabetes and cardiovascular disease. Among the second-generation antipsychotics, clozapine and olanzapine are associated with the highest risk of substantial weight gain, similar to the weight gain potential associated with low-potency first-generation antipsychotics such as thioridazine or chlorpromazine, as well as with an increased risk of diabetes and dyslipidemia. Various strategies for monitoring cardiometabolic risk factors in patients with mental illness are discussed in this review.
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