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Certain Antipsychotic Medications May Increase Risk for Heart Disease BETHESDA, Md -- October 17, 2008 -- Certain atypical antipsychotic medications may raise the risk for heart disease in people with schizophrenia, according to an analysis of data from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study published in the October 2008 issue of Schizophrenia Research. Heart disease is prevalent among people with schizophrenia. Patients with schizophrenia also have higher rates of diabetes and high blood pressure, and lower levels of high-density lipoprotein or "good" cholesterol. Although factors such as smoking and lack of access to quality medical care may be 2 reasons for higher heart disease rates, atypical antipsychotics are known to be associated with cardiovascular side effects as well. Gail Daumit, MD, Johns Hopkins University, Baltimore, Maryland, and colleagues assessed the effects of antipsychotic medications used in CATIE on participants' 10-year coronary heart disease (CHD) risk. The 5 CATIE antipsychotics were the atypical antipsychotics olanzapine (Zyprexa), quetiapine (Seroquel) risperidone (Risperdal), and ziprasidone (Geodon), and the conventional antipsychotic perphenazine. At the beginning of the trial, participants had a higher estimated 10-year CHD risk compared to the general population, and had been treated with antipsychotics for an average of 14 years. The researchers collected data on vital signs, smoking status, and weight from the participants multiple times during the 18-month first phase of the trial, and found that the mean change in risk for CHD differed significantly among the medications. They found that the risk for CHD increased 0.5% for those taking olanzapine and 0.3% for those taking quetiapine. However, risk decreased 0.5% for patients taking perphenazine, 0.6% for those taking risperidone, and 0.6% for those taking ziprasidone, especially among participants whose risk for CHD was higher than 10% at the start of the study. According to the researchers, the results suggest that these 3 antipsychotics may counteract some metabolic side effects associated with prior use of antipsychotics. Participants taking risperidone or ziprasidone also showed somewhat lower total cholesterol levels. Conversely, those taking olanzapine tended to show increases in total cholesterol levels, echoing recent studies that found large increases in triglyceride levels associated with olanzapine. Dr. Daumit and colleagues concluded by suggesting that when clinicians are choosing antipsychotic treatment for their patients, they should consider the relative cardiovascular risks associated with each medication, especially for older patients and those with existing cardiovascular risk factors. SOURCE: National Institute of Mental Health E-mail this page to a friend or colleague! To print, use this version