Which comes first: atypical antipsychotic treatment or cardiometabolic risk?

• Published in: Acta Psychiatrica Scandinavica 2009-03, Vol.119 (3), p.171-179
• Main Authors: Stahl, S. M., Mignon, L., Meyer, J. M.
• Format: Article
• Language: English
• Subjects: Antipsychotic Agents - adverse effects; Antipsychotic Agents - therapeutic use; Appetite - drug effects; atypical antipsychotic; Biological and medical sciences; cardiovascular; Cardiovascular Diseases - blood; Cardiovascular Diseases - chemically induced; Cardiovascular Diseases - genetics; Cholesterol, HDL - blood; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - chemically induced; Diabetes Mellitus, Type 2 - genetics; Drug therapy; Drug toxicity and drugs side effects treatment; Genetic Predisposition to Disease - genetics; Humans; Hypertriglyceridemia - blood; Hypertriglyceridemia - chemically induced; Hypertriglyceridemia - genetics; insulin resistance; Medical sciences; metabolic; Metabolic Syndrome - blood; Metabolic Syndrome - chemically induced; Metabolic Syndrome - genetics; Metabolism; Miscellaneous (drug allergy, mutagens, teratogens...); Obesity - blood; Obesity - chemically induced; Obesity - genetics; Pharmacology. Drug treatments; Psychotropic drugs; Risk; Risk factors; Schizophrenia - blood; Schizophrenia - drug therapy; Schizophrenia - genetics; Toxicity: cardiovascular system; triglycerides; Triglycerides - blood; Weight Gain - drug effects
• ISSN: 0001-690X; 1600-0447; 0065-1591
• DOI: 10.1111/j.1600-0447.2008.01334.x

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.