Coronary Heart Disease Risk Among Antipsychotics

Certain antipsychotics, particularly olanzapine and quetiapine, are associated with an increased risk of coronary heart disease (CHD), whereas others—like perphenazine, risperidone and ziprasidone—lead to a decreased risk of CHD, results of a new study in the Journal of Schizophrenia Research show.

Gail Daumit, MD, MHS, lead author on the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) and colleagues at Johns Hopkins University Bloomberg School of Public Health examined 1,125 patients for 18 months, coAmparing 10-year risk for CHD in those taking a variety of antipsychotics.

Patients with a pre-existing risk for CHD of at least 10% showed the greatest difference in the 10-year risk of CHD examined in the study, the researchers found. Patients taking olanzapine showed the greatest increase in CHD risk. Older patients also showed a change in risk for CHD depending on what medication they were taking.

“We found particular benefit in CHD risk reduction in those patients with greater than 10 percent CHD risk at baseline treated with perphenazine, risperidone, and ziprasidone,” Daumit said. “Using these medications could have positive consequences in patients who already have clinical risk for coronary disease.”

Researchers used the Framingham Heart Study formula to calculate the 10-year risk of CHD for the five drugs that patients involved in the study were taking. Factors involved in the formula included age, total and HDL cholesterol, blood-pressure stage, presence of diabetes mellitus, and smoking status.

Only total and HDL cholesterol levels differed between treatments among individual CHD risk factors used in the Framingham formula. Secondary outcomes of the study included changes in diabetes, smoking status, high blood pressure, total cholesterol, and HDL, depending on which antipsychotics patients were taking.

The authors said their findings could be clinically relevant in several ways. “The absolute magnitude of changes in CHD risk found with antipsychotic medications are comparable to those seen in an intensive lifestyle modification program for adults with cardiac risk factors and thus should be clinically important,” the authors said. “When initiating or changing antipsychotic therapy, clinicians should consider these changes in likelihood of coronary heart disease, particularly for older patients and those with baseline coronary risk factors.”

Read an article on the study at the APA website.