title: Effects of switching from olanzapine, quetiapine, and risperidone to aripiprazole on 10-year coronary heart disease risk and metabolic syndrome status: results from a randomized controlled trial.
abstract: OBJECTIVE
  This study examined the clinical significance of switching from olanzapine, quetiapine, or risperidone to aripiprazole by examining changes in predicted risk of cardiovascular disease (CVD) according to the Framingham Risk Score (FRS) and metabolic syndrome status. FRS estimates 10-year risk of "hard" coronary heart disease (CHD) outcomes (myocardial infarction and coronary death) while metabolic syndrome is associated with increased risk of CVD, stroke, and diabetes mellitus.
  
  
  METHODS
  Changes in FRS and metabolic syndrome status were compared between patients with BMI ≥ 27 and non-HDL-C ≥ 130 mg/dL randomly assigned to stay on stable current treatment (olanzapine, quetiapine, or risperidone) or switch to treatment with aripiprazole with 24 weeks of follow-up. All study participants were enrolled in a behavioral program that promoted healthy diet and exercise.
  
  
  RESULTS
  The pre-specified analyses included 89 switchers and 98 stayers who had post-baseline measurements needed to assess changes. Least squares mean estimates of 10-year CHD risk decreased more for the switch (from 7.0% to 5.2%) than the stay group (from 7.4% to 6.4%) (p = 0.0429). The odds ratio for having metabolic syndrome (stay vs. switch) at the last observation was 1.748 (95% CI 0.919, 3.324, p = 0.0885).
  
  
  CONCLUSIONS
  Switching from olanzapine, quetiapine, or risperidone to aripiprazole was associated with larger reductions in predicted 10-year risk of CHD than the behavioral program alone. The advantage of switching on metabolic syndrome was not statistically significant. The benefits of switching must be balanced against its risks, which in this study included more discontinuations of the study treatment but no significant increase in symptoms or hospitalizations.
authors: Columbia University College of Physicians and Surgeons, United States. stroups@nyspi.columbia.edu
authors: T Scott
authors: TS
authors: Stroup
authors: Matthew J
authors: MJ
authors: Byerly
authors: Henry A
authors: HA
authors: Nasrallah
authors: Neepa
authors: N
authors: Ray
authors: Ahsan Y
authors: AY
authors: Khan
authors: J Steven
authors: JS
authors: Lamberti
authors: Ira D
authors: ID
authors: Glick
authors: Richard M
authors: RM
authors: Steinbook
authors: Joseph P
authors: JP
authors: McEvoy
authors: Robert M
authors: RM
authors: Hamer
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects*; D000068180:Aripiprazole; D001569:Benzodiazepines / Q000009:adverse effects; D003324:Coronary Artery Disease / Q000139:chemically induced*; D003987:Dibenzothiazepines / Q000009:adverse effects; D057915:Drug Substitution / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D024821:Metabolic Syndrome / Q000139:chemically induced*; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D016017:Odds Ratio; D000077152:Olanzapine; D010879:Piperazines / Q000009:adverse effects; D000069348:Quetiapine Fumarate; D015363:Quinolones / Q000009:adverse effects; D018967:Risperidone / Q000009:adverse effects
chemical_list: D014150:Antipsychotic Agents; D003987:Dibenzothiazepines; D010879:Piperazines; D015363:Quinolones; D001569:Benzodiazepines; D000069348:Quetiapine Fumarate; D000068180:Aripiprazole; D018967:Risperidone; D000077152:Olanzapine