Use of clinical markers to identify metabolic syndrome in antipsychotic-treated patients.
OBJECTIVE
Metabolic syndrome (MetS) is prevalent among antipsychotic-treated patients; however, in psychiatric clinics, scarce resources often limit the feasibility of monitoring all 5 criteria that are necessary for diagnosing MetS. As one goal of the MetS definition is to facilitate the clinical identification of insulin-resistant individuals, other biomarkers of insulin resistance have been explored. However, there are relatively few data from antipsychotic-treated patients, especially on the association between these markers and the clinical MetS diagnosis.


METHODS
We analyzed data from 196 psychiatric patients over age 40 years enrolled in an ongoing study of antipsychotic-related metabolic effects that began in August 2005. In addition to anthropometric measures and MetS criteria, levels of certain metabolism-related peptides (ghrelin, adiponectin, peptide YY, leptin, and insulin) were measured. The utility of these clinical and metabolic markers to identify individuals with MetS was evaluated by constructing receiver operating characteristic curves. Optimal cutoff values were calculated for markers with the greatest area under the curve on the basis of sensitivities and specificities for MetS diagnosis.


RESULTS
Ninety-nine subjects (50.5%) met MetS criteria. The receiver operating characteristic analysis found that waist circumference, triglyceride to high-density lipoprotein (TG:HDL) ratio, and body mass index had the greatest area under the curve. The waist circumference cutoff value of 40 inches, TG:HDL ratio of 2.6, and body mass index of 28 kg/m² yielded sensitivities and specificities of 73% and 80%, 74% and 78%, and 75% and 74%, respectively, for MetS diagnosis.


CONCLUSIONS
Waist circumference, TG:HDL cholesterol ratio, or body mass index could be used as screens for identifying possible MetS in antipsychotic-treated patients to prompt complete investigation into all MetS criteria.


BACKGROUND
clinicaltrials.gov Identifier: NCT00245206.
Department of Psychiatry, University of California, San Diego, Veterans Affairs San Diego Healthcare System, 3350 La Jolla Village Drive (MC-116A), San Diego, CA 92161, USA. hjin@ucsd.edu
Hua
H
Jin
Jonathan
J
Meyer
Sunder
S
Mudaliar
Robert
R
Henry
Srikrishna
S
Khandrika
Danielle K
DK
Glorioso
Helena
H
Kraemer
Dilip
D
Jeste
D052242:Adiponectin / Q000097:blood; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014150:Antipsychotic Agents / Q000009:adverse effects*; D015415:Biomarkers / Q000097:blood*; D015992:Body Mass Index; D005260:Female; D054439:Ghrelin / Q000097:blood; D006801:Humans; D007328:Insulin / Q000097:blood; D020738:Leptin / Q000097:blood; D008075:Lipoproteins, HDL / Q000097:blood; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood / Q000139:chemically induced*; D008875:Middle Aged; D019894:Peptide YY / Q000097:blood; D012372:ROC Curve; D014280:Triglycerides / Q000097:blood; D055105:Waist Circumference / Q000187:drug effects
D052242:Adiponectin; D014150:Antipsychotic Agents; D015415:Biomarkers; D054439:Ghrelin; C034396:HDL-triglyceride; D007328:Insulin; D020738:Leptin; D008075:Lipoproteins, HDL; D014280:Triglycerides; D019894:Peptide YY