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Dyslipidemia Independent of Body Mass in Antipsychotic-Treated Patients Under Real-Life Conditions

Birkenaes, Astrid B. MD*; Birkeland, Kåre I. MD, PhD; Engh, John A. MD*; Færden, Ann MD*; Jonsdottir, Halldora MD*; Ringen, Petter Andreas MD*; Friis, Svein MD, PhD*; Opjordsmoen, Stein MD, PhD*; Andreassen, Ole A. MD, PhD*

Journal of Clinical Psychopharmacology: April 2008 - Volume 28 - Issue 2 - p 132-137
doi: 10.1097/JCP.0b013e318166c4f7
Original Contributions
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Objective: Antipsychotic (AP) treatment, in particular with some second-generation drugs, is associated with weight gain and other metabolic side effects. However, the relationship between drug-induced weight gain and dyslipidemia is not well understood. We investigated how cardiometabolic risk factors were related to body mass during treatment with different APs under real-life conditions.

Methods: This cross-sectional naturalistic study included 242 subjects with severe mental disorders who were on monotherapy with olanzapine (OLZ) or clozapine (CLZ) (n = 80), monotherapy with other APs (n = 80), or unmedicated (n = 82). Groups were adjusted for age and compared for prevalence of the metabolic syndrome and its components. Groups were further adjusted for body mass and compared for mean values of blood pressure, lipids, and fasting glucose.

Results: There was no significant intergroup difference in the prevalence of metabolic syndrome, obesity, hypertension, or hyperglycemia. Despite similar body mass index, OLZ/CLZ-treated subjects had significantly higher prevalence of dyslipidemia (high triglyceride and low HDL cholesterol levels) than unmedicated subjects. They also had higher mean values of triglycerides (P = 0.003) and lower mean values of HDL cholesterol (P < 0.001). Patients treated with other APs had intermediate values.

Conclusions: Intergroup differences in body mass index were minimal in this naturalistic setting, probably because of awareness of this treatment hazard among clinicians. However, independently of body mass, dyslipidemia was significantly associated with AP treatment, in particular with OLZ and CLZ. These findings indicate a primary effect of APs on lipid regulation, important in understanding their mechanism of action, and with clinical implications.

*Section for Psychosis Research, Division of Psychiatry, Ulleval University Hospital and Institute of Psychiatry; and †Department of Endocrinology, Aker University Hospital and Faculty Division, Aker University Hospital, University of Oslo, Oslo, Norway.

Received June 22, 2007; accepted after revision December 5, 2007.

The study is part of the Thematic Organized Psychosis Research study, and was financially supported by a grant from the Research Council of Norway (No. 147787/320), grants from Solveig and Johan P. Sommers' Foundation, and from Brukseier and spouse Maja Jonn-Nilsen's Foundation. All blood sample analyses were performed at the Department of Clinical Chemistry, Ulleval University Hospital, and the Hormone Laboratory, Aker University Hospital.

Address correspondence and reprint requests to Astrid B. Birkenaes, MD, Section for Psychosis Research, Division of Psychiatry, Ulleval University Hospital, 0407 Oslo, Norway. E-mail: a.b.birkenas@medisin.uio.no.

© 2008 Lippincott Williams & Wilkins, Inc.