[en] BACKGROUND: Mortality rates in patients with schizophrenia are double compared to those in the general population, with cardiovascular disease causing 50% of the excess. Lowering low-density lipoprotein (LDL) cholesterol is recognized as a primary target for the prevention of cardiovascular mortality according to the National Cholesterol Education Program-Adult Treatment Panel III. Use of lipid-lowering drugs such as statins is recommended when lifestyle changes are not sufficient to reach the LDL goal. The efficacy and safety of rosuvastatin treatment were evaluated in schizophrenic patients. METHOD: 100 schizophrenic patients with severe dyslipidemia were identified. All were treated with antipsychotics. Fifty-two patients were treated with rosuvastatin and compared with 48 who did not receive statin treatment. All patients were screened for cardiovascular risk factors and examined at baseline. The effects of lipid-lowering medication on lipid profile, glucose homeostasis, and components of metabolic syndrome were evaluated at 3-month follow-up. The study began in 2003, and all data available until December 2005 are reported. RESULTS: After 3 months of statin therapy, a significant decrease in triglycerides, total cholesterol, LDL cholesterol, and non-high-density lipoprotein (non-HDL) cholesterol and in associated ratios (LDL/HDL, total cholesterol/HDL) was observed. The difference was highly significant compared to patients not receiving statin treatment. No significant changes occurred in HDL cholesterol, body mass index and waist circumference, or glucose homeostasis. The only component of metabolic syndrome affected by statin therapy was the serum triglyceride level. CONCLUSION: Rosuvastatin proved effective in the management of dyslipidemia in patients with schizophrenia treated with antipsychotics. More complex treatment may be required for associated metabolic disturbances.
Disciplines :
Psychiatry Pharmacy, pharmacology & toxicology
Author, co-author :
De Hert, Marc
Kalnicka, Dita
van Winkel, Ruud
Wampers, Martien
Hanssens, Linda
Van Eyck, Dominique
Scheen, André ; Université de Liège - ULiège > Département des sciences cliniques > Diabétologie, nutrition et maladie métaboliques - Médecine interne générale
Peuskens, Joseph
Language :
English
Title :
Treatment with rosuvastatin for severe dyslipidemia in patients with schizophrenia and schizoaffective disorder.
Publication date :
2006
Journal title :
Journal of Clinical Psychiatry
ISSN :
0160-6689
eISSN :
1555-2101
Publisher :
Physicians Postgraduate Press, Memphis, United States - Tennessee
Vaughan CJ, Gotto AM. Update on statins: 2003. Circulation 2004;110:886-892
Conroy RM, Pyorala K, Fitzgerald AP, et al. Estimation of 10-year risk of fatal cardiovascular disease in Europe: the SCORE project. Eur Heart J 2003;24:987-1003
Expert Panel on Detection and Evaluation of Treatment of High Blood Cholesterol in Adults. Executive summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001;285:2486-2497
Task Force Report. Prevention of coronary heart disease in clinical practice: recommendations of the Second Joint Task Force of European and Other Societies on Coronary Prevention. Eur Heart J 1998;19:1434-1503
Schuster H, Fox JC. Investigating cardiovascular risk reduction: the Rosuvastatin GALAXY Programme. Expert Opin Pharmacother 2004;5:1187-1200
De Backer G, Ambrosioni E, Borch-Johnsen K, et al. European guidelines on cardiovascular disease prevention in clinical practice: Third Joint Task Force of European and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of eight societies and by invited experts). Eur Heart J 2003;24:1601-1610
Grundy SM. The changing face of cardiovascular risk. J Am Coll Cardiol 2005;46:173-175
Jin H, Meyer JM, Jeste DV. Atypical antipsychotics and glucose dysregulation: a systematic review. Schizophr Res 2004;71:195-212
McEvoy JP, Meyer JM, Goff DC, et al. Prevalence of the metabolic syndrome in patients with schizophrenia: baseline results from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) schizophrenia trial and comparison with national estimates from NHANES III. Schizophr Res 2005;80:19-32
Meyer JM, Koro CE. The effects of antipsychotic therapy on serum lipids: a comprehensive review. Schizophr Res 2004;70:1-17
Meyer JM, Nasrallah HA, McEvoy JP, et al. The Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) Schizophrenia Trial: clinical comparison of subgroups with and without the metabolic syndrome. Schizophr Res 2005;80:9-18
De Hert M, van Winkel R, Van Eyck D, et al. Prevalence of the metabolic syndrome in patients with schizophrenia treated with antipsychotic medication. Schizophr Res 2006;83:87-93
Grundy SM, Cleeman JI, Daniels SR, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation 2005;112:2735-2752
Byrne CD, Wild SH. The global burden of the metabolic syndrome and its consequences for diabetes and cardiovascular disease. In: Byrne CD, Wild SH, eds. The Metabolic Syndrome. West Sussex, Md: John Wiley & Sons; 2005:1-42
Alberti KGMM. Introduction to the metabolic syndrome. Eur Heart J Suppl 2005;7:3-5
Alberti KGMM, Zimmet P, Shaw J, for the IDF Epidemiology Task Force Consensus Group. The metabolic syndrome: a new worldwide definition. Lancet 2005;366:1059-1062
International Diabetes Federation. The IDF Worldwide Definition of the Metabolic Syndrome. Brussels, Belgium: International Diabetes Federation; 2005. Available at: http://www.idf.org/home/index.cfm?unode=1120071E-AACE-41D2-9FA0- BAB6E25BA072. Accessability verified September 25, 2006
Scheen AJ. Management of the metabolic syndrome. Minerva Endocrinol 2004;29:31-45
Stalenhoef AF, Ballantyne CM, Sarti C, et al. A comparative study with rosuvastatin in subjects with metabolic syndrome: results of the COMETS study. Eur Heart J 2005;26:2664-2672
Blasetto JW, Stein EA, Brown WV, et al. Efficacy of rosuvastatin compared with other statins at selected starting doses in hypercholesterolemic patients and in special population groups. Am J Cardiol 2003;91:3-10
Jones PH, Davidson MH, Stein EA, et al. Comparison of the efficacy and safety of rosuvastatin versus atorvastatin, simvastatin, and pravastatin across doses (STELLAR* trial). Am J Cardiol 2003;92:152-160
Olsson AG, Istad H, Luurila O, et al. Effects of rosuvastatin and atorvastatin compared over 52 weeks of treatment in patients with hypercholesterolemia. Am Heart J 2002;144:1044-1051
Stender S, Schuster H, Barter P, et al. Comparison of rosuvastatin with atorvastatin, simvastatin and pravastatin in achieving cholesterol goals and improving plasma lipids in hypercholesterolaemic patients with or without metabolic syndrome in the MERCURY I trial. Diabetes Obes Metab 2005;7:430-438
Deedwania PC, Hunninghake DB, Bays HE, et al. STELLAR Study Group. Effects of rosuvastatin, atorvastatin, simvastatin, and pravastatin on atherogenic dyslipidemia in patients with characteristics of the metabolic syndrome. Am J Cardiol 2005;95:360-366
Resch U, Tatzber F, Budinsky A, et al. Reduction of oxidative stress and modulation of autoantibodies against modified low-density lipoprotein after rosuvastatin therapy. Br J Clin Pharmacol 2006;61:262-274
Nissen SE, Nicholls SJ, Sipahi I, et al. Effect of very high-intensity statin therapy on regression of coronary atherosclerosis: the ASTEROID trial. JAMA 2006;295:1556-1565
Brown S. Excess mortality of schizophrenia: a meta-analysis. Br J Psychiatry 1997;171:502-508
Joukamaa M, Heliovaara M, Knekt P, et al. Mental disorders and cause-specific mortality. Br J Psychiatry 2001;179:498-502
Osby U, Correia N, Brandt L, et al. Mortality and causes of death in schizophrenia in Stockholm county, Sweden. Schizophr Res 2000;45:21-28
Brown S, Birtwistle J, Roe L, et al. The unhealthy lifestyle of people with schizophrenia. Psychol Med 1999;29:697-701
Strassnig M, Brar JS, Ganguli R. Self-reported body weight perception and dieting practices in community-dwelling patients with schizophrenia. Schizophr Res 2005;75:425-432
Chue P. The assessment and management of antipsychotic-associated metabolic disturbances from a psychiatric perspective. Can J Psychiatry 2004;49:200-207
American Diabetes Association. Consensus development conference on antipsychotic drugs and obesity and diabetes. Diabetes Care 2004;27:596-601
Newcomer JW. Second-generation (atypical) antipsychotics and metabolic effects: a comprehensive literature review. CNS Drugs 2005;19(suppl 1):1-93
Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Follow-up report on the diagnosis of diabetes mellitus. Diabetes Care 2003;26:3160-3166
Freeman DJ, Norrie J, Sattar N, et al. Pravastatin and the development of diabetes mellitus: evidence for a prospective treatment effect in the West of Scotland Coronary Prevention Study. Circulation 2001;103:357-362
Yee A, Majumdar SR, Simpson SH, et al. Statin use in type 2 diabetes mellitus is associated with a delay in starting insulin. Diabet Med 2004;21:962-967
Paniagua JA, Lopez-Miranda J, Escribano A, et al. Cerivastatin improves insulin sensitivity and insulin secretion in early-state obese type 2 diabetes. Diabetes 2002;51:2596-2603
Paolisso G, Barbagallo M, Petrella G, et al. Effects of simvastatin and atorvastatin administration on insulin resistance and respiratory quotient in aged dyslipidemic non-insulin dependent diabetic patients. Atherosclerosis 2000;150:121-127
Lamendola C, Abbasi F, Chu JW, et al. Comparative effects of rosuvastatin and gemfibrozil on glucose, insulin, and lipid metabolism in insulin-resistant, nondiabetic patients with combined dyslipidemia. Am J Cardiol 2005;95:189-193
Shepherd J, Hunninghake DB, Stein EA, et al. Safety of rosuvastatin. Am J Cardiol 2004;94:882-888
Bottorff MB. Safety and statins: pharmacologic and clinical perspectives. Prev Med Managed Care 2004;4:30-37
Jeste DV, Gladsjo JA, Lindamer LA, et al. Medical comorbidity in schizophrenia. Schizophr Bull 1996;22:413-430
Buckley PF, Miller DD, Singer B. Clinicians' recognition of the metabolic adverse effects of antipsychotic medications. Schizophr Res 2005;79:281-288
Newcomer JW, Nasrallah HA, Loebel AD. The Atypical Antipsychotic Therapy and Metabolic Issues National Survey: practice patterns and knowledge of psychiatrists. J Clin Psychopharmacol 2004;24:1-6
De Nayer A, De Hert M, Scheen A, et al. Conference report: Belgian consensus on metabolic problems associated with second-generation antipsychotics. Int J Psych Clin Pract 2005;9:130-137
De Hert M, Van Eyck D, De Nayer A. Metabolic abnormalities associated with second generation antipsychotics: fact or fiction? development of guidelines for screening and monitoring. Int Clin Psychopharmacol 2006;21(suppl 2):S11-S15
Marder SR, Essock SM, Miller AL, et al. Physical health monitoring of patients with schizophrenia. Am J Psychiatry 2004;161:1334-1349
De Hert M, Hanssens L, van Winkel R, et al. A case series: evaluation of the metabolic safety of aripiprazole. Schizophr Bull [Epub ahead of print] Aug 29, 2006
