A Comparative Study Of Effects Of Antipsychotic Drugs On Cardiovascular Risk Factors

Objective: Schizophrenia is a chronic disorder with serious physical, social and economic consequences.Antipsychotics can effectively improve the symptoms of schizophrenia but with some adverse effects,especially in the cardiovascular system.It maybe causes serious cardiovascular events or even death.The purpose of this study was to identify the relevance of five antipsychotics with the cardiovascular risk factors during the treatment for schizophrenia.The most relevant cardiovascular risk factors were investigated during the treatment with anti-schizophrenia drugs,so that it make efficiently detect the clinical abnormal in time,and make individuation strategy of the safety and effective treatment for patients with schizophrenia.Methods: A representative sample of schizophrenic patients,who were under treatment from October 2013 to November 2014,was obtained at Shijiazhuang Mental Health Center. All selected patients met the Chinese Classification of Mental Disorders 3rd Edition(CCMD-3) diagnostic criteria for schizophrenia,either diagnosed for the first time with schizophrenia or with a withdrawal time longer than 2 weeks.Pre hospitalizing,patients’ ECG and cardiac enzymes were normal and they signed informed consent.We excluded patients with physical or organic diseases,with alcohol or drug addicts as well as the ones with allergies.Pregnant or breast-feeding women or patients with a serious aggression or self-injury attempt were also excluded.We did not consider patients who were infected,died,or suffered from heart disease during hospitalization and follow-up.Patients showing ECG abnormalities before treatment or taking other drugs causing myocardial damage were also not in the sample.Using self-made survey forms,we collected the general information of patients qualified as valid sample including gender,age,course of the disease,current medications,and the intake time of the drugs under investigation.Immediately after the patients were hospitalized,the ECG was taken,blood samples for measuring cardiac enzymes,fasting blood glucose,and blood lipids were collected,and blood pressure was also measured.All test results are recorded in the customized tables.After the treatment was started,all previously mentioned tests were normally conducted in the 2nd,4th,8th,and 12 th week and the results were recorded.Within 12 weeks,at least one measurement champagne was performed.If the patient was discharged,we collected the data through outpatient follow-up.SPSS12.0 was used for statistical data processing.P<0.05 was considered as statistical significance.Results: 183 patients were enrolled and random divided into five groups,which treated with clozapine,olanzapine,quetiapine,risperidone and aripiprazole,respectively.In the treatment for 12 weeks follow-up were performed,the results shown that:1 All five kinds of antipsychotic drugs cause ECG abnormalities:ST-T changes and sinus tachycardia were most common;the next followed by block and sinus bradycardia;there was one case with QT prolongation triggered by risperidone.ECG abnormalities appeared in patients either with one symptom or with two or more coexisting.2 Effects of antipsychotic drugs on fasting blood glucose:four drugs could cause a slight increase in fasting blood glucose levels:in average clozapine increased the blood glucose by 0.22mmol/L,olanzapine by 0.20mmol/L,quetiapine by 0.13mmol/L,and risperidone by 0.13mmol/L,respectively.For the four kinds of antipsychotic groups,which increased the glucose levels,the pairwise difference in the increased amount was not statistically significant. However,the aripiprazole group,which in average decreased the fasting blood glucose level by 0.15mmol/L,showed a significant difference(P<0.01) with the other four antipsychotic groups.3 Effects of antipsychotic drugs on lipids:Olanzapine elevated triglyceride(TG) levels most in comparison with the other four groups,showing a statistical significance.Clozapine elevated TG slightly more than risperidone,not showing a statistical significance.Aripiprazole elevated total cholesterol(TC) at least,risperidone elevated TC slightly more than aripiprazole,and olanzapine slightly more than risperidone.Overall,the pairwise difference in risperidone,quetiapine,clozapine,and olanzapine was not statistically significant.Among all five drugs,clozapine and quetiapine,elevated low-density lipoprotein(LDL).However,aripiprazole increased LDL least.For increasing high-density lipoprotein,aripiprazole showed significant differences compared with the other four antipsychotics.4 Effects of antipsychotic drugs on blood pressure:All five kinds of antipsychotic drugs have no significant changes in blood pressure.Conclusion: This study suggests that there are differences in the relevance and correlation of five different antipsychotic drugs with cardiovascular risk factors.Therefore,It should regularly examine patients’ response to glucose,blood lipids and ECG to avoid adverse clinical events in time during the antipsychotic treatment.For the patients with high cardiovascular risk factors schizophrenia with fewer side effects on the electrocardiogram and metabolism should be taken for reducing the adverse events of cardiovascular diseases.