Cardiovascular risk in a first-episode psychosis sample: a 'critical period' for prevention?
OBJECTIVE
Studies in first episode psychosis samples about status of cardiovascular risk factors have shown discordant results. We aimed to determine the 10-year risk of developing coronary heart disease in a sample of first episode psychosis patients referred to an early intervention clinic and compared the same with age, gender, and race matched controls from the U.S. National Health and Nutrition Examination Survey (NHANES).


METHODS
We conducted a cross-sectional analysis of baseline data of 56 subjects enrolled in first episode psychosis clinic from April 2006 to January 2010. This sample was compared with age, gender, and race matched 145 individuals drawn from NHANES 2005-2006 database. Sociodemographic and clinical variables were collected. Physical examination including laboratory evaluation was used to screen for common medical illnesses. The 10-year risk of developing coronary heart disease was calculated by using a tool developed by the National Cholesterol Education Program (NCEP-ATP III).


RESULTS
There were elevated rates of smoking (46%) and hypertension (11%) albeit statistically significant differences from the control could not be demonstrated for these measures or weight, body mass index, or total or HDL cholesterol, fasting plasma glucose, status of diabetes and impaired fasting plasma glucose, HbA1C level. The 10-year median (range) risk of developing coronary heart disease in patients and controls was 1 (0-5)% and 0 (0-9)% respectively. The difference was not statistically significant.


CONCLUSIONS
First episode psychosis patients do not present with significantly higher cardiovascular risk than age and race-matched controls despite clinically significant prevalence of individual risk factors. This sample presents an opportunity for early intervention for the primary prevention of cardiovascular morbidity and mortality.
Yale University School of Medicine, United States.
Vivek H
VH
Phutane
Cenk
C
Tek
Lydia
L
Chwastiak
Joseph C
JC
Ratliff
Banu
B
Ozyuksel
Scott W
SW
Woods
Vinod H
VH
Srihari
D000293:Adolescent; D000328:Adult; D002318:Cardiovascular Diseases / Q000145:classification / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology*; D002908:Chronic Disease; D003423:Critical Period, Psychological; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D011618:Psychotic Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology*; D012189:Retrospective Studies; D012307:Risk Factors; D012559:Schizophrenia / Q000453:epidemiology / Q000503:physiopathology; D055815:Young Adult
Schizophr Res. 2008 Jul;102(1-3):329-36
18396386
Schizophr Res. 2010 Jan;116(1):16-9
19896336
Psychiatr Serv. 2009 Nov;60(11):1426-8
19880454
Schizophr Res. 2008 Jan;98(1-3):287-94
18031996
Hypertension. 2003 Dec;42(6):1206-52
14656957
J Clin Psychiatry. 2009 Jul;70(7):997-1000
19497246
Diabetes Metab. 2008 Nov;34(5):490-6
18693056
Psychol Med. 2010 Feb;40(2):187-200
19656426
JAMA. 2001 May 16;285(19):2486-97
11368702
Schizophr Res. 2005 Jul 15;76(2-3):135-57
15949648
Schizophr Res. 2006 Mar;83(1):87-93
16481149
Lancet. 2004 Sep 11-17;364(9438):937-52
15364185
Diabetes Care. 2005 Jan;28 Suppl 1:S37-42
15618111
Schizophr Res. 2000 Sep 29;45(1-2):21-8
10978869
Br J Psychiatry. 2000 Sep;177:212-7
11040880
Circulation. 1998 May 12;97(18):1837-47
9603539
N Engl J Med. 2005 Sep 22;353(12):1209-23
16172203
J Am Coll Cardiol. 2004 Aug 4;44(3):720-32
15358046
Diabetes. 2003 Aug;52(8):2160-7
12882936
Schizophr Res. 2008 Feb;99(1-3):13-22
18053689
J Clin Psychopharmacol. 2008 Apr;28(2):125-31
18344721
J Nerv Ment Dis. 2004 Jan;192(1):19-27
14718772
Arch Gen Psychiatry. 2007 Feb;64(2):242-9
17283292
Cochrane Database Syst Rev. 2006 Oct 18;(4):CD004718
17054213
J Clin Psychiatry. 2007 Nov;68(11):1733-40
18052567
Schizophr Res. 2005 Dec 1;80(1):45-53
16198088
J Clin Psychiatry. 2009;70 Suppl 3:30-6
19570499
Acta Psychiatr Scand. 2009 Mar;119(3):171-9
19178394
J Clin Psychiatry. 2004 Oct;65(10):1335-42
15491236
J Clin Psychiatry. 2001;62 Suppl 7:11-21
11346191
Prev Chronic Dis. 2006 Apr;3(2):A42
16539783
Schizophr Res. 2009 Jun;111(1-3):9-16
19398192
Br J Psychiatry. 2005 Dec;187:537-43
16319406
Arch Gen Psychiatry. 2001 Jun;58(6):565-72
11386985
Am J Psychiatry. 2003 Feb;160(2):284-9
12562574
Diabet Med. 2007 May;24(5):481-5
17381506
World Psychiatry. 2009 Feb;8(1):15-22
19293950
Schizophr Bull. 2010 Jan;36(1):71-93
19955390
Lancet. 2009 Aug 22;374(9690):620-7
19595447
Schizophr Res. 2010 Aug;121(1-3):199-202
20538429