title: Cardiac-related findings at autopsy in people with severe mental illness treated with clozapine or risperidone.
abstract: Clozapine is a superior agent for treatment-refractory patients with schizophrenia, but is underutilized in the US, likely due to the risk of side effects. This study examined all available autopsy data on cardiac disease and risk factors in people with schizophrenia in a sample of deceased persons with severe mental illness who had received clozapine (N=62) or risperidone (N=42). The mean body mass index (BMI) at the time of death was 31.4+/-8.8 kg/m2 and 27.1+/-8.2 kg/m2 in the clozapine and risperidone groups respectively (t=1.98, df=60, p=0.052). Cardiac related measures examined included: abdominal wall thickness, heart weight, left ventricle thickness, right ventricle thickness, presence of notable cardiac involvement (atherosclerosis, fibrosis and hypertrophy) and number of cardiac arteries occluded. No significant differences in any of the cardiac findings were noted between patients in the clozapine and risperidone groups. Independent of treatment, cardiomyopathy deaths were associated with a higher abdominal wall thickness (p=0.042) and a tendency towards higher BMI (p=0.051) as compared to the other causes of death. The results of this study suggest that while clozapine is associated with weight gain and metabolic abnormalities, there does not appear to be an increased occurrence of cardiac abnormalities in deceased persons who were treated with clozapine as compared to risperidone.
authors.affiliation: Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD 21228, United States. dkelly@mprc.umaryland.edu
authors.forename: Deanna L
authors.initials: DL
authors.lastname: Kelly
authors.forename: Heidi J
authors.initials: HJ
authors.lastname: Wehring
authors.forename: Jared
authors.initials: J
authors.lastname: Linthicum
authors.forename: Stephanie
authors.initials: S
authors.lastname: Feldman
authors.forename: Robert P
authors.initials: RP
authors.lastname: McMahon
authors.forename: Raymond C
authors.initials: RC
authors.lastname: Love
authors.forename: Tara
authors.initials: T
authors.lastname: Wagner
authors.forename: Joo Cheol
authors.initials: JC
authors.lastname: Shim
authors.forename: David R
authors.initials: DR
authors.lastname: Fowler
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D015992:Body Mass Index; D016022:Case-Control Studies; D002423:Cause of Death; D003024:Clozapine / Q000009:adverse effects* / Q000627:therapeutic use; D003324:Coronary Artery Disease / Q000139:chemically induced* / Q000401:mortality / Q000473:pathology; D003331:Coronary Vessels / Q000473:pathology; D004719:Endomyocardial Fibrosis / Q000139:chemically induced* / Q000401:mortality / Q000473:pathology; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000139:chemically induced* / Q000401:mortality / Q000473:pathology; D017380:Hypertrophy, Right Ventricular / Q000139:chemically induced* / Q000401:mortality / Q000473:pathology; D008297:Male; D008396:Maryland; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology; D012307:Risk Factors; D018967:Risperidone / Q000009:adverse effects* / Q000627:therapeutic use; D012559:Schizophrenia / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D049629:Waist-Hip Ratio
chemical_list: D014150:Antipsychotic Agents; D003024:Clozapine; D018967:Risperidone