Antipsychotic effects on estimated 10-year coronary heart disease risk in the CATIE schizophrenia study

• Published in: Schizophrenia research 2008-10, Vol.105 (1), p.175-187
• Main Authors: Daumit, Gail L, Goff, Donald C, Meyer, Jonathan M, Davis, Vicki G, Nasrallah, Henry A, McEvoy, Joseph P, Rosenheck, Robert, Davis, Sonia M, Hsiao, John K, Stroup, T. Scott, Lieberman, Jeffrey A
• Format: Article
• Language: English
• Subjects: Adult; Antipsychotic; Antipsychotic Agents - adverse effects; Antipsychotic Agents - therapeutic use; Biological and medical sciences; Blood pressure; Cholesterol; Comorbidity; Coronary Disease - chemically induced; Coronary Disease - epidemiology; Coronary heart disease risk; Drug toxicity and drugs side effects treatment; Female; Follow-Up Studies; Humans; Hypertension - epidemiology; Longitudinal Studies; Male; Medical sciences; Obesity - chemically induced; Obesity - epidemiology; Outcome Assessment, Health Care; Patient Dropouts; Pharmacology. Drug treatments; Psychiatry; Risk Assessment; Risk Factors; Schizophrenia; Schizophrenia - drug therapy; Schizophrenia - epidemiology; Schizophrenic Psychology; Smoking - adverse effects; Smoking - epidemiology; Toxicity: cardiovascular system; Treatment Outcome; Weight Gain - drug effects
• ISSN: 0920-9964; 1573-2509
• DOI: 10.1016/j.schres.2008.07.006

Abstract Objective Persons with schizophrenia die earlier than the general population, in large part due to cardiovascular disease. The study objective was to examine effects of different antipsychotic treatments on estimates of 10-year coronary heart disease (CHD) risk calculated by the Framingham Heart Study formula. Method Change in 10-year risk for CHD was compared between treatment groups in 1125 patients followed for 18 months or until treatment discontinuation in the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) Schizophrenia Trial. Results The covariate-adjusted mean change in 10-year CHD risk differed significantly between treatments. Olanzapine was associated with a 0.5% (SE 0.3) increase and quetiapine, a 0.3% (SE 0.3) increase; whereas risk decreased in patients treated with perphenazine, − 0.5% (SE 0.3), risperidone, − 0.6% (SE 0.3), and ziprasidone − 0.6% (SE 0.4). The difference in 10-year CHD risk between olanzapine and risperidone was statistically significant ( p = 0.004). Differences in estimated 10-year CHD risk between drugs were most marked in the tertile of subjects with a baseline CHD risk of at least 10%. Among individual CHD risk factors used in the Framingham formula, only total and HDL cholesterol levels differed between treatments. Conclusions These results indicate that the impact on 10-year CHD risk differs significantly between antipsychotic agents, with olanzapine producing the largest elevation in CHD risk of the agents studied in CATIE.