title: Metabolic Syndrome in South African Patients with Severe Mental Illness: Prevalence and Associated Risk Factors.
abstract: BACKGROUND
  There is a surge of cardiovascular disease (CVD) in Africa. CVD is the leading cause of mortality among patients with severe mental illness (SMI) in developed countries, with little evidence from the African context.
  
  
  OBJECTIVE
  To determine the prevalence and risk factors for MetS among South African patients with SMI.
  
  
  METHODS
  In a cross sectional study, individuals with SMI treated with antipsychotics and a control group without a mental illness, matched for age, gender and ethnicity were evaluated for MetS using the 2009 Joint Interim statement (JIS) criteria.
  
  
  RESULTS
  Of the 276 study group subjects, 65.9% were male, 84.1% black African, 9.1% white, 5.4% of Indian descent and 1.5% coloured (mixed race) with a mean age of 34.7 years (±12.5). Schizophrenia was the most common diagnosis (73.2%) and 40% were taking first generation antipsychotics. The prevalence of MetS was 23.2% (M: 15.4%, F: 38.3%) in the study group and 19.9% (M: 11.9%, F: 36.3%) in the control group (p = 0.4). MetS prevalence was significantly higher in study subjects over 55 years compared to controls (p = 0.03). Increased waist circumference (p< 0.001) and low high density lipoprotein (HDL) cholesterol (p = 0.003) were significantly more prevalent in study subjects compared to controls. In study subjects, risk factors associated with MetS included age (OR: 1.09, 95% CI 1.06-1.12, p < 0.001), female gender (OR: 2.19, 95% CI 1.06-4.55, p = 0.035) and Indian descent (OR: 5.84, 95% CI 1.66-20.52, p = 0.006) but not class of antipsychotic (p = 0.26).
  
  
  CONCLUSIONS
  The overall MetS prevalence was not increased in patients with SMI compared to controls; however, the higher prevalence of the individual components (HDL cholesterol and waist circumference) suggests an increased risk for CVD, especially in patients over 55 years.
authors.affiliation: Department of Psychiatry, Nelson R Mandela School of Medicine, University of KwaZulu - Natal, Durban, South Africa.
authors.forename: Shamima
authors.initials: S
authors.lastname: Saloojee
authors.affiliation: Department of Psychiatry, Nelson R Mandela School of Medicine, University of KwaZulu - Natal, Durban, South Africa.
authors.forename: Jonathan K
authors.initials: JK
authors.lastname: Burns
authors.affiliation: Department of Diabetes and Endocrinology, Nelson R Mandela School of Medicine, University of KwaZulu - Natal, Durban, South Africa.
authors.forename: Ayesha A
authors.initials: AA
authors.lastname: Motala
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D003710:Demography; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology*; D024821:Metabolic Syndrome / Q000150:complications* / Q000453:epidemiology*; D015999:Multivariate Analysis; D015995:Prevalence; D012307:Risk Factors; D013019:South Africa / Q000453:epidemiology
chemical_list: D014150:Antipsychotic Agents