Cardiometabolic Risk in Patients With First-Episode Schizophrenia Spectrum Disorders Baseline Results From the RAISE-ETP Study
Cardiometabolic Risk in Patients With First-Episode Schizophrenia Spectrum Disorders Baseline Results From the RAISE-ETP Study
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DOI：
10.1001/jamapsychiatry.2014.1314
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发表时间：
2014-12-01
期刊：
影响因子：
25.8
通讯作者：
Kane, John M.
中科院分区：
文献类型：
--
作者：
Correll, Christoph U.;Robinson, Delbert G.;Kane, John M.
精神分裂症患者心血管疾病的发病率和死亡率较高，这一事实已得到公认。然而，在疾病的最早阶段的风险状态和调节剂或介质不太清楚。目的评估首发精神分裂症谱系障碍（FES）患者的心脏代谢风险及其与病程、抗精神病药物治疗持续时间和类型、性别、种族/ethnication.Design、设置和参与者初始精神分裂症发作后恢复（RAISE）研究的基线结果，收集于2010年7月22日至2012年7月5日。来自34个社区精神卫生机构，没有主要的研究，教学或临床FES计划。患者年龄为15至40岁，研究证实患有FES，终生抗精神病治疗时间少于6个月。暴露基线前抗精神病治疗基于社区临床医生和/或患者的决定。主要结果和指标身体成分和空腹血脂、血糖和胰岛素参数。结果404名患者中有394名有心脏代谢数据（平均[SD]年龄，23.6 [5.0]岁;平均[SD]抗精神病药物治疗寿命，47.3 [46.1]天），48.3%肥胖或超重，50.8%吸烟，56.5%有血脂异常，39.9%有高血压前期，10.0%有高血压，13.2%有代谢综合征。前驱糖尿病（基于葡萄糖，4.0%;基于血红蛋白A（1c），15.4%）和糖尿病（基于葡萄糖，3.0%;基于血红蛋白A1 c，2.9%）发生率较低。总的精神疾病病程与较高的体重指数、脂肪量、脂肪百分比和腰围显著相关（均P <0.01），但与代谢参数升高无关（甘油三酯与HDL-C比值除外[P = 0.04]）。相反，抗精神病药物治疗持续时间与非HDL-C、甘油三酯和甘油三酯与HDL-C比值升高以及HDL-C和收缩压降低显著相关（均P
IMPORTANCE The fact that individuals with schizophrenia have high cardiovascular morbidity and mortality is well established. However, risk status and moderators or mediators in the earliest stages of illness are less clear. OBJECTIVE To assess cardiometabolic risk in first-episode schizophrenia spectrum disorders (FES) and its relationship to illness duration, antipsychotic treatment duration and type, sex, and race/ethnicity.DESIGN, SETTING, AND PARTICIPANTS Baseline results of the Recovery After an Initial Schizophrenia Episode (RAISE) study, collected between July 22, 2010, and July 5, 2012, from 34 community mental health facilities without major research, teaching, or clinical FES programs. Patients were aged 15 to 40 years, had research-confirmed diagnoses of FES, and had less than 6 months of lifetime antipsychotic treatment.EXPOSURE Prebaseline antipsychotic treatment was based on the community clinician's and/or patient's decision.MAIN OUTCOMES AND MEASURES Body composition and fasting lipid, glucose, and insulin parameters.RESULTS In 394 of 404 patients with cardiometabolic data (mean [SD] age, 23.6 [5.0] years; mean [SD] lifetime antipsychotic treatment, 47.3 [46.1] days), 48.3% were obese or overweight, 50.8% smoked, 56.5% had dyslipidemia, 39.9% had prehypertension, 10.0% had hypertension, and 13.2% had metabolic syndrome. Prediabetes (glucose based, 4.0%; hemoglobin A(1c) based, 15.4%) and diabetes (glucose based, 3.0%; hemoglobin A1c based, 2.9%) were less frequent. Total psychiatric illness duration correlated significantly with higher body mass index, fat mass, fat percentage, and waist circumference (all P < .01) but not elevated metabolic parameters (except triglycerides to HDL-C ratio [P = .04]). Conversely, antipsychotic treatment duration correlated significantly with higher non-HDL-C, triglycerides, and triglycerides to HDL-C ratio and lower HDL-C and systolic blood pressure (all P