Cardiometabolic Risk in Patients With First-Episode Schizophrenia Spectrum Disorders: Baseline Results From the RAISE-ETP Study
Abstract
IMPORTANCE: 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. DESIGN, SETTING, AND PARTICIPANTS: 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. EXPOSURE: Prebaseline antipsychotic treatment was based on the community clinician's and/or patient's decision. MAIN OUTCOMES AND MEASURES: 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 AND RELEVANCE: 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.
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In patients with first-episode schizophrenia spectrum disorders, cardiometabolic risk factors were present early in the illness, related to the underlying disorder, unhealthy lifestyle and antipsychotic medications, which interact with each other.
“In patients with first-episode schizophrenia spectrum disorders, cardiometabolic risk factors were present early in the illness; this was related to the underlying disorder, unhealthy lifestyle and antipsychotic medications, which interact with each other.437”
From 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias (2016) · cites this paper as [437]
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Galderisi, S., Binder, M. D., Prato, S. D., Fagiolini, A. M., Gorwood, P. A. P. M., Leucht, S., Maggioni, A. P., Mucci, A., & Arango, C. (2021) · European Psychiatry · doi:10.1192/j.eurpsy.2020.115 · Cited by 35 · see citing works
Drug repurposing and emerging adjunctive treatments for schizophrenia
Bumb, J. M., Enning, F., & Leweke, F. M. (2015) · Expert Opinion on Pharmacotherapy · doi:10.1517/14656566.2015.1032248 · Cited by 34 · see citing works
Clinical management of comorbid diabetes and psychotic disorders
Chwastiak, L., Freudenreich, O., Tek, C., McKibbin, C. L., Han, J., McCarron, R. M., & Wisse, B. E. (2015) · The Lancet Psychiatry · doi:10.1016/s2215-0366(15)00105-4 · Cited by 33 · see citing works
Cardiometabolic health in young people with psychosis
Shiers, D., & Curtis, J. (2014) · The Lancet Psychiatry · doi:10.1016/s2215-0366(14)00072-8 · Cited by 33 · see citing works
Prevalence of underweight in patients with schizophrenia: A meta-analysis
Sugawara, N., Maruo, K., Sugai, T., Suzuki, Y., Ozeki, Y., Shimoda, K., Someya, T., & Yasui‐Furukori, N. (2017) · Schizophrenia Research · doi:10.1016/j.schres.2017.10.017 · Cited by 33 · see citing works
Treatment following myocardial infarction in patients with schizophrenia
Attar, R., Johansen, M. B., Valentin, J. B., Aagaard, J., & Jensen, S. E. (2017) · PLoS ONE · doi:10.1371/journal.pone.0189289 · Cited by 33 · see citing works
Second to none: rationale, timing, and clinical management of clozapine use in schizophrenia
Qubad, M., & Bittner, R. A. (2023) · Therapeutic Advances in Psychopharmacology · doi:10.1177/20451253231158152 · Cited by 33 · see citing works
- Authors
- Correll, C. U., Robinson, D. G., Schooler, N. R., Brunette, M. F., Mueser, K. T., Rosenheck, R. A., Marcy, P., Addington, J., Estroff, S. E., Robinson, J., Penn, D. L., Azrin, S., Goldstein, A., Severe, J., Heinssen, R., & Kane, J. M.
- Affiliations
- Northwell Health (US)
- Geisel School of Medicine at Dartmouth, Dartmouth, New Hampshire7Bureau of Behavioral Health, Department of Health and Human Services, Dartmouth, New Hampshire
- Boston University (US)
- Yale University (US)
- University of Calgary (CA)
- University of North Carolina at Chapel Hill (US)
- Nathan Kline Institute for Psychiatric Research (US)
- National Institute of Mental Health (US)
- ORCID
- Venue
- JAMA Psychiatry
- Publisher
- American Medical Association (AMA)
- Published
- 2014-12-01
- Volume
- 71
- Issue
- 12
- Pages
- 1350
- ISSN
- 2168-622X (ISSN-L)
- OpenAlex
- W2134164029
- Cited by
- 384
- References
- 88
- Citations by year
- 2026: 11 · 2025: 18 · 2024: 27 · 2023: 22 · 2022: 33 · 2021: 35 · 2020: 40 · 2019: 31 · 2018: 39 · 2017: 45 · 2016: 39 · 2015: 39 · 2014: 2 · 2013: 1
- FWCI
- 31.79
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JAMA Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- U.S. Public Health Service (HHSN271200900019C)
- National Institute of Mental Health (R03MH112053)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Emergency Medicine › HIV-related health complications and treatments
- Keywords
- cardiometabolic risk, first-episode schizophrenia, schizophrenia spectrum disorders, antipsychotic treatment duration, olanzapine, metabolic syndrome, dyslipidemia, insulin resistance, prediabetes, obesity, smoking, hypertension, body composition, HDL cholesterol
- MeSH terms
- Adolescent, Adult, Blood Glucose, Body Composition, Cardiovascular Diseases, Ethnicity, Female, Humans, Insulin, Lipids, Male, Middle Aged, Obesity, Prospective Studies, Psychotic Disorders, Risk Factors, Schizophrenia, Sex Factors, Time Factors, Antipsychotic Agents, Metabolic Syndrome, Overweight, Young Adult
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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