Which comes first: atypical antipsychotic treatment or cardiometabolic risk?
OBJECTIVE
To provide an overview for practicing clinicians on the pharmacological basis of cardiometabolic risk induced by antipsychotic drugs in patients with serious mental illness, to propose hypotheses to explain these risks and to give tips for managing cardiometabolic risk during antipsychotic treatment.


METHODS
A MEDLINE search using terms for atypical antipsychotics (including individual drug names), metabolic, cardiovascular, weight gain and insulin resistance, cross-referenced with schizophrenia was performed on articles published between 1990 and May 2008.


RESULTS
Strong evidence exists for significant cardiometabolic risk differences among several antipsychotic agents. Histamine H1 and serotonin 5HT2C antagonism are associated with risk of weight gain, but receptor targets for dyslipidemia and insulin resistance have not yet been identified. Convincing data indicate that hypertriglyceridemia and insulin resistance may occur in the absence of weight gain with certain antipsychotics.


CONCLUSIONS
Although lifestyle and genetics may contribute independent risks of cardiometabolic dysfunction in schizophrenia and other serious mental illness, antipsychotic treatment also represents an important contributor to risk of cardiometabolic dysfunction, particularly for certain drugs and for vulnerable patients. Mental health professionals must learn to recognize the clinical signposts indicating antipsychotic-related cardiometabolic problems to forestall progression to type II diabetes, cardiovascular events and premature death.
Stahl
S M
SM
Department of Psychiatry, University of California, San Diego School of Medicine, San Diego, CA 92008, USA. smstahl@neiglobal.com
Mignon
L
L
Meyer
J M
JM
D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001066:Appetite / Q000187:drug effects; D002318:Cardiovascular Diseases / Q000097:blood / Q000139:chemically induced* / Q000235:genetics; D008076:Cholesterol, HDL / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000139:chemically induced / Q000235:genetics; D020022:Genetic Predisposition to Disease / Q000235:genetics; D006801:Humans; D015228:Hypertriglyceridemia / Q000097:blood / Q000139:chemically induced* / Q000235:genetics; D024821:Metabolic Syndrome / Q000097:blood / Q000139:chemically induced* / Q000235:genetics; D009765:Obesity / Q000097:blood / Q000139:chemically induced* / Q000235:genetics; D012306:Risk; D012559:Schizophrenia / Q000097:blood / Q000188:drug therapy* / Q000235:genetics; D014280:Triglycerides / Q000097:blood; D015430:Weight Gain / Q000187:drug effects
D014150:Antipsychotic Agents; D008076:Cholesterol, HDL; D014280:Triglycerides