Clozapine, diabetes mellitus, hyperlipidemia, and cardiovascular risks and mortality: results of a 10-year naturalistic study

J Clin Psychiatry. 2005 Sep;66(9):1116-21. doi: 10.4088/jcp.v66n0905.

Abstract

Objective: The goal of this 10-year naturalistic study was to examine, in clozapine-treated patients, the change in cardiovascular risk factors following clozapine initiation and the mortality estimates from cardiovascular disease.

Method: Data were collected from medical records from January 1992 to December 2003 and included age, gender, race, diagnosis, family history of diabetes, and age at clozapine initiation for clozapine-treated patients with schizophrenia or schizoaffective disorder (DSM-IV criteria). Clozapine dosage and laboratory results were recorded at 12-month intervals.

Results: At the time of clozapine initiation, the mean +/-?SD age of the 96 patients studied was 36.5 +/- 7.9 years; 28% (N = 27) were women. The Kaplan-Meier estimate for 10-year mortality from cardiovascular disease was 9%. African American and Hispanic American patients exhibited elevated risk of cardiovascular disease-related mortality (odds ratio [OR] = 7.2, p = .09; OR = 11.3, p = .04, respectively) compared to white patients. Body mass index (BMI) significantly increased the odds ratio of mortality (OR = 1.2, p < .01). The Kaplan-Meier estimate for new-onset diabetes mellitus was approximately 43%, and Hispanic American (OR = 4.3, p = .027) and African American (OR = 11.5, p = .0001) patients showed elevated risks of developing diabetes mellitus compared to white patients. Additionally, BMI (OR = 1.11, p = .0006), total cholesterol level (OR = 1.006, p = .04), and serum triglyceride level (OR = 1.002, p = .04) modestly increased the odds ratio for the development of diabetes mellitus.

Conclusions: These results support the hypothesis that clozapine-treated patients appear to be at risk for death from cardiovascular disease secondary to clozapine-associated medical disorders such as obesity, diabetes, hypertension, and hyperlipidemia.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • African Americans / statistics & numerical data
  • Antipsychotic Agents / adverse effects*
  • Antipsychotic Agents / therapeutic use
  • Cardiovascular Diseases / chemically induced
  • Cardiovascular Diseases / epidemiology
  • Cardiovascular Diseases / mortality*
  • Cause of Death
  • Clozapine / adverse effects*
  • Clozapine / therapeutic use
  • Comorbidity
  • Diabetes Mellitus / chemically induced
  • Diabetes Mellitus / epidemiology*
  • Female
  • Hispanic Americans / statistics & numerical data
  • Humans
  • Hyperlipidemias / chemically induced
  • Hyperlipidemias / epidemiology*
  • Longitudinal Studies
  • Male
  • Metabolic Syndrome / chemically induced
  • Metabolic Syndrome / epidemiology
  • Psychotic Disorders / drug therapy*
  • Psychotic Disorders / epidemiology
  • Risk Factors
  • Risperidone / adverse effects
  • Risperidone / therapeutic use
  • Schizophrenia / drug therapy
  • Schizophrenia / epidemiology
  • Survival Analysis

Substances

  • Antipsychotic Agents
  • Clozapine
  • Risperidone