Cited by 384Schizophrenia research and treatmentDiabetes, Cardiovascular Risks, and LipoproteinsHIV-related health complications and treatments

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Cardiometabolic Risk in Patients With First-Episode Schizophrenia Spectrum Disorders: Baseline Results From the RAISE-ETP Study

Correll, Christoph U., Robinson, Delbert G., Schooler, Nina R., Brunette, Mary F., Mueser, Kim T., Rosenheck, Robert A., Marcy, Patricia, Addington, Jean, Estroff, Sue E., Robinson, James, Penn, David L., Azrin, Susan, Goldstein, Amy, Severe, Joanne, Heinssen, Robert, Kane, John M.·2014·JAMA Psychiatry

DOI 10.1001/jamapsychiatry.2014.1314

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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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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: Correll, Christoph U.
Robinson, Delbert G.
Schooler, Nina R.
Brunette, Mary F.
Mueser, Kim T.
Rosenheck, Robert A.
Marcy, Patricia
Addington, Jean
Penn, David L.
Goldstein, Amy
Kane, John M.
Venue: JAMA Psychiatry
Publisher: American Medical Association (AMA)
Published: 2014-12-01
Volume: 71
Issue: 12
Pages: 1350
ISSN: 2168-622X (ISSN-L)
DOI: 10.1001/jamapsychiatry.2014.1314
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
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 › Infectious Diseases › 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

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Cardiometabolic Risk in Patients With First-Episode Schizophrenia Spectrum Disorders: Baseline Results From the RAISE-ETP Study

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