title: Cardiometabolic risk in patients with first-episode schizophrenia spectrum disorders: baseline results from the RAISE-ETP study.
abstract: OBJECTIVE
  The fact that individuals with schizophrenia have high cardiovascular morbidity and mortality is well established. However, risk status and moderators or mediators in the earliest stages of illness are less clear.
  
  
  OBJECTIVE
  To assess cardiometabolic risk in first-episode schizophrenia spectrum disorders (FES) and its relationship to illness duration, antipsychotic treatment duration and type, sex, and race/ethnicity.
  
  
  METHODS
  Baseline results of the Recovery After an Initial Schizophrenia Episode (RAISE) study, collected between July 22, 2010, and July 5, 2012, from 34 community mental health facilities without major research, teaching, or clinical FES programs. Patients were aged 15 to 40 years, had research-confirmed diagnoses of FES, and had less than 6 months of lifetime antipsychotic treatment.
  
  
  METHODS
  Prebaseline antipsychotic treatment was based on the community clinician's and/or patient's decision.
  
  
  METHODS
  Body composition and fasting lipid, glucose, and insulin parameters.
  
  
  RESULTS
  In 394 of 404 patients with cardiometabolic data (mean [SD] age, 23.6 [5.0] years; mean [SD] lifetime antipsychotic treatment, 47.3 [46.1] days), 48.3% were obese or overweight, 50.8% smoked, 56.5% had dyslipidemia, 39.9% had prehypertension, 10.0% had hypertension, and 13.2% had metabolic syndrome. Prediabetes (glucose based, 4.0%; hemoglobin A1c based, 15.4%) and diabetes (glucose based, 3.0%; hemoglobin A1c based, 2.9%) were less frequent. Total psychiatric illness duration correlated significantly with higher body mass index, fat mass, fat percentage, and waist circumference (all P<.01) but not elevated metabolic parameters (except triglycerides to HDL-C ratio [P=.04]). Conversely, antipsychotic treatment duration correlated significantly with higher non-HDL-C, triglycerides, and triglycerides to HDL-C ratio and lower HDL-C and systolic blood pressure (all P≤.01). In multivariable analyses, olanzapine was significantly associated with higher triglycerides, insulin, and insulin resistance, whereas quetiapine fumarate was associated with significantly higher triglycerides to HDL-C ratio (all P≤.02).
  
  
  CONCLUSIONS
  In patients with FES, cardiometabolic risk factors and abnormalities are present early in the illness and likely related to the underlying illness, unhealthy lifestyle, and antipsychotic medications, which interact with each other. Prevention of and early interventions for psychiatric illness and treatment with lower-risk agents, routine antipsychotic adverse effect monitoring, and smoking cessation interventions are needed from the earliest illness phases.
authors.affiliation: Division of Psychiatry Research, North Shore-LIJ Health System, The Zucker Hillside Hospital, Glen Oaks, New York2The Feinstein Institute for Medical Research, Manhasset, New York3Hofstra North Shore-LIJ School of Medicine, Hempstead, New York4Albert Eins.
authors.forename: Christoph U
authors.initials: CU
authors.lastname: Correll
authors.affiliation: Division of Psychiatry Research, North Shore-LIJ Health System, The Zucker Hillside Hospital, Glen Oaks, New York2The Feinstein Institute for Medical Research, Manhasset, New York3Hofstra North Shore-LIJ School of Medicine, Hempstead, New York4Albert Eins.
authors.forename: Delbert G
authors.initials: DG
authors.lastname: Robinson
authors.affiliation: Division of Psychiatry Research, North Shore-LIJ Health System, The Zucker Hillside Hospital, Glen Oaks, New York5State University of New York Downstate Medical Center, New York.
authors.forename: Nina R
authors.initials: NR
authors.lastname: Schooler
authors.affiliation: Geisel School of Medicine at Dartmouth, Dartmouth, New Hampshire7Bureau of Behavioral Health, Department of Health and Human Services, Dartmouth, New Hampshire.
authors.forename: Mary F
authors.initials: MF
authors.lastname: Brunette
authors.affiliation: Department of Occupational Therapy, Center for Psychiatric Rehabilitation, Boston University, Boston, Massachusetts9Department of Psychiatry, Center for Psychiatric Rehabilitation, Boston University, Boston, Massachusetts10Department of Psychology, Center.
authors.forename: Kim T
authors.initials: KT
authors.lastname: Mueser
authors.affiliation: Department of Psychiatry and Epidemiology, Yale University, Princeton, New Jersey12Department of Public Health, Yale University, Princeton, New Jersey.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Rosenheck
authors.affiliation: Division of Psychiatry Research, North Shore-LIJ Health System, The Zucker Hillside Hospital, Glen Oaks, New York2The Feinstein Institute for Medical Research, Manhasset, New York.
authors.forename: Patricia
authors.initials: P
authors.lastname: Marcy
authors.affiliation: Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Jean
authors.initials: J
authors.lastname: Addington
authors.affiliation: Department of Social Medicine, University of North Carolina, Chapel Hill.
authors.forename: Sue E
authors.initials: SE
authors.lastname: Estroff
authors.affiliation: Nathan Kline Institute, Orangeburg, New York.
authors.forename: James
authors.initials: J
authors.lastname: Robinson
authors.affiliation: Department of Psychology, University of North Carolina, Chapel Hill.
authors.forename: David L
authors.initials: DL
authors.lastname: Penn
authors.affiliation: National Institute of Mental Health, Bethesda, Maryland.
authors.forename: Susan
authors.initials: S
authors.lastname: Azrin
authors.affiliation: National Institute of Mental Health, Bethesda, Maryland.
authors.forename: Amy
authors.initials: A
authors.lastname: Goldstein
authors.affiliation: National Institute of Mental Health, Bethesda, Maryland.
authors.forename: Joanne
authors.initials: J
authors.lastname: Severe
authors.affiliation: National Institute of Mental Health, Bethesda, Maryland.
authors.forename: Robert
authors.initials: R
authors.lastname: Heinssen
authors.affiliation: Division of Psychiatry Research, North Shore-LIJ Health System, The Zucker Hillside Hospital, Glen Oaks, New York2The Feinstein Institute for Medical Research, Manhasset, New York3Hofstra North Shore-LIJ School of Medicine, Hempstead, New York4Albert Eins.
authors.forename: John M
authors.initials: JM
authors.lastname: Kane
mesh_terms: D000293:Adolescent; D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects*; D001786:Blood Glucose / Q000378:metabolism; D001823:Body Composition; D002318:Cardiovascular Diseases / Q000139:chemically induced / Q000150:complications / Q000378:metabolism*; D005006:Ethnicity; D005260:Female; D006801:Humans; D007328:Insulin / Q000097:blood; D008055:Lipids / Q000097:blood; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood / Q000139:chemically induced / Q000150:complications / Q000378:metabolism*; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D050177:Overweight / Q000150:complications; D011446:Prospective Studies; D011618:Psychotic Disorders / Q000097:blood / Q000150:complications / Q000378:metabolism*; D012307:Risk Factors; D012559:Schizophrenia / Q000097:blood / Q000150:complications / Q000188:drug therapy / Q000378:metabolism*; D012737:Sex Factors; D013997:Time Factors; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents; D001786:Blood Glucose; D007328:Insulin; D008055:Lipids