Effects of switching from olanzapine, quetiapine, and risperidone to aripiprazole on 10-year coronary heart disease risk and metabolic syndrome status: results from a randomized controlled trial.
Effects of switching from olanzapine, quetiapine, and risperidone to aripiprazole on 10-year coronary heart disease risk and metabolic syndrome status: results from a randomized controlled trial.
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从奥氮平、喹硫平和利培酮转换为阿立哌唑对 10 年冠心病风险和代谢综合征状态的影响：随机对照试验的结果。
DOI：
10.1016/j.schres.2013.01.013
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发表时间：
2013
影响因子：
4.5
通讯作者：
Hamer,RobertM
中科院分区：
文献类型：
--
作者：
Stroup,TScott;Byerly,MatthewJ;Nasrallah,HenryA;Ray,Neepa;Khan,AhsanY;Lamberti,JSteven;Glick,IraD;Steinbook,RichardM;McEvoy,JosephP;Hamer,RobertM
目的：本研究通过检测弗雷明汉风险评分（FRS）和代谢综合征状态预测心血管疾病（CVD）风险的变化，探讨从奥氮平、喹硫平或利培酮转向阿立哌唑的临床意义。FRS估计“硬”冠心病（CHD）结果（心肌梗死和冠状动脉死亡）的10年风险，而代谢综合征与心血管疾病、中风和糖尿病的风险增加有关。方法比较BMI≥27和非hdl - c≥130mg/dL随机分配到稳定治疗组（奥氮平、喹硫平或利培酮）或切换到阿立哌唑治疗组的FRS和代谢综合征状态的变化，随访24周。所有的研究参与者都参加了一个促进健康饮食和锻炼的行为项目。结果预先指定的分析包括89名转换者和98名留置者，他们有基线后测量需要评估变化。转换组10年冠心病风险的最小二乘平均估计值（从7.0%降至5.2%）比停留组（从7.4%降至6.4%）下降更多（p=0.0429）。最后一次观察时发生代谢综合征的比值比为1.748 （95% CI 0.919, 3.324, p=0.0885）。结论：从奥氮平、喹硫平或利培酮转向阿立哌唑，与单独的行为方案相比，预测10年冠心病风险的降低幅度更大。开启代谢综合征的优势没有统计学意义。转换的益处必须与其风险相平衡，在本研究中，风险包括更多的研究治疗中断，但没有显著增加症状或住院治疗。
PURPOSEThis study examined the clinical significance of switching from olanzapine, quetiapine, or risperidone to aripiprazole by examining changes in predicted risk of cardiovascular disease (CVD) according to the Framingham Risk Score (FRS) and metabolic syndrome status. FRS estimates 10-year risk of “hard” coronary heart disease (CHD) outcomes (myocardial infarction and coronary death) while metabolic syndrome is associated with increased risk of CVD, stroke, and diabetes mellitus.METHODChanges in FRS and metabolic syndrome status were compared between patients with BMI≥27 and non-HDL-C≥130mg/dL randomly assigned to stay on stable current treatment (olanzapine, quetiapine, or risperidone) or switch to treatment with aripiprazole with 24weeks of follow-up. All study participants were enrolled in a behavioral program that promoted healthy diet and exercise.RESULTSThe pre-specified analyses included 89 switchers and 98 stayers who had post-baseline measurements needed to assess changes. Least squares mean estimates of 10-year CHD risk decreased more for the switch (from 7.0% to 5.2%) than the stay group (from 7.4% to 6.4%) (p=0.0429). The odds ratio for having metabolic syndrome (stay vs. switch) at the last observation was 1.748 (95% CI 0.919, 3.324, p=0.0885).CONCLUSIONSwitching from olanzapine, quetiapine, or risperidone to aripiprazole was associated with larger reductions in predicted 10-year risk of CHD than the behavioral program alone. The advantage of switching on metabolic syndrome was not statistically significant. The benefits of switching must be balanced against its risks, which in this study included more discontinuations of the study treatment but no significant increase in symptoms or hospitalizations.