Literature

Early lipid changes ≥5% during psychotropic therapy as a warning sign of future clinically relevant dyslipidemia

30-10-2017 • Delacrétaz A et al., J Clin Lipidol 2017


Early changes of blood lipid levels during psychotropic drug treatment as predictors of long-term lipid changes and of new onset dyslipidemia

 
Delacrétaz A, Vandenberghe F, Gholam-Rezaee M et al.,
Journal Clin Lipidol. 2017 Published online: October 16. DOI: http://dx.doi.org/10.1016/j.jacl.2017.10.002
 

Background

Persons with severe mental illness, such as schizophrenia, bipolar and major depressive disorders have lower life expectancy than subjects from the general population. A large part of this premature mortality has been attributed to CV diseases, as a consequence of the metabolic syndrome [1]. Psychiatric disease-related factors, unhealthy lifestyle, poverty and adverse effects of treatment may contribute to this excess CV risk [2,3].
Aspects of the metabolic syndrome may develop early during psychotropic treatment [4-6] and may ultimately progress to cardiometabolic disease [7]. Thus, it seems important to monitor metabolic parameters during treatment. A 5% weight gain during the first month of psychotropic treatment has recently been described to predict subsequent important weight gain [4]. Nothing is known about other thresholds to predict worsening of cardiometabolic parameters during psychotropic treatment.
Dyslipidemia (high LDL-c and/or low HDL-c and/or high TG) is very common in schizophrenia patients on psychotropic medication, with a prevalence of up to 55% [8]. Although previously considered to be related to therapy-induced weight gain, new data showed that these lipogenic effects may occur very early during treatment, even preceding weight gain [3, 6, 9-11].
This study examined how plasma lipid changes during the first month of psychotropic treatment could predict mid- and long-term plasma lipid changes and new onset dyslipidemia (NOD) in a cohort of 180 patients. Adherence to the psychotropic treatment was ascertained by therapeutic drug monitoring. Patients did not receive any lipid-lowering agents.
 

Main results

  • Predictors were selected based on a high sensitivity (70-100%) and specificity (53-72%). Early increase (≥5% at 1 month) for total cholesterol (TC), LDL-c, TG and non-HDL-c and early decreased (≥5%) of HDL-c were the best predictors for clinically relevant modifications of blood lipid levels after 3 and 12 months of treatment (≥30% TC, ≥40% LDL-c, ≥45% TG, ≥55% non-HDL-c increase and ≥20% HDL-c decrease).
  • The value of these thresholds as predictors for subsequent lipid changes were confirmed in linear mixed models (3 months), and replicated in an independent psychiatric sample (at 3 and 12 months).
  • Incidence of NOD was significantly higher in patients with TC, LDL-c, TG and non-HDL increased and HDL-c decreases ≥5%, as compared with patients without early lipid changes. Other risk factors including sex, early weight gain and medication were also associated with dyslipidemia risk.
  • When patients exceeded several early thresholds, as compared with exceeding 0 or 1 threshold, the risk of developing dyslipidemia at a later stage in any of the four lipid variables was increased 14.4-fold, irrespective of which lipid threshold was exceeded.
 

Conclusion

In this cohort of psychiatric patients, a worsening of lipid parameters was seen during psychotropic treatment. Changes of at least 5% of several lipid parameters after one month of treatment predicted subsequent clinically relevant lipid changes after 3 and 12 months and the occurrence of new onset dyslipidemia. These data underscore the importance of prospectively monitoring metabolic and lipid parameters in all patients starting psychotropic treatment, including antipsychotic drugs, mood stabilizers and some antidepressants, as these drugs may cause or exacerbate metabolic syndrome
 
Find this article online at J Clin Lipidol
 

References

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9 Correll CU, Robinson DG, Schooler NR, et al. Cardiometabolic risk in patients 499 with first-episode schizophrenia spectrum disorders: baseline results from the RAISE-ETP study. JAMA psychiatry. 2014;71:1350-1363.
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11 Lindenmayer JP, Czobor P, Volavka J, et al. Changes in glucose and cholesterol levels in patients with schizophrenia treated with typical or atypical antipsychotics. The American journal of psychiatry. 2003;160:290-296.


CVRMdepressiondyslipidemiaLipidsmental illnesspsychotropicschizophrenia

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