Abstract

BackgroundPatients with schizophrenia have an increased prevalence of metabolic disturbances compared with the general population. However, the mechanisms underlying the metabolic side effects of antipsychotics are unknown. The aim of the present study was to compare the levels of high-density lipoprotein (HDL)-cholesterol in Japanese schizophrenia patients medicated with olanzapine, risperidone, or aripiprazole monotherapy.MethodsThis study was a post-hoc analysis of a nationwide survey, which included 433 Japanese outpatients with schizophrenia and 674 inpatients. A brief questionnaire was compiled that covered demographic data, systolic blood pressure, diastolic blood pressure, and HDL-cholesterol after reviewing the relevant literature and guidelines. To compare demographic and clinical characteristics, analysis of variance was performed for continuous variables and the chi-square test was performed for categorical variables. For comparisons of HDL-cholesterol levels among the three antipsychotic groups, analysis of covariance was carried out with age, diastolic blood pressure, chlorpromazine-equivalent dosage, and waist circumference as confounding variables after stratification by body mass index (BMI) for each outpatient group and inpatient group.ResultsThe mean age was 57.9 ± 14.0 years and the mean BMI was 23.4 ± 4.5 kg/m2. HDL-cholesterol levels when stratified by BMI differed significantly (p = 0.019) between the three antipsychotic groups after age, diastolic blood pressure, chlorpromazine-equivalent dosage, and waist circumference in inpatients. A significant difference in HDL-cholesterol levels was only found in the overweight inpatient group, and no significant differences in HDL-cholesterol levels were found among the three antipsychotics for outpatients of all BMI stratifications or inpatients that were underweight or of normal weight. For post-hoc analysis of HDL-cholesterol levels in overweight inpatients, HDL-cholesterol was significantly lower in the olanzapine group than in the aripiprazole group (p = 0.023).ConclusionsThis study reveals a difference in HDL-cholesterol levels in overweight Japanese inpatients with schizophrenia resulting from the use of different antipsychotics. In the post-hoc analysis of HDL-cholesterol levels in overweight inpatients, HDL-cholesterol was significantly lower in the olanzapine group than in the aripiprazole group. Further studies incorporating more detailed evaluations, including diet and physical activity, are needed to clarify the differences in HDL-cholesterol according to antipsychotic use.

Highlights

  • Patients with schizophrenia have an increased prevalence of metabolic disturbances compared with the general population

  • For post-hoc analysis of high-density lipoprotein (HDL)-cholesterol levels in overweight inpatients among the three antipsychotic groups, HDL-cholesterol was significantly lower in the olanzapine group than in the aripiprazole group (p = 0.023), and HDL-cholesterol levels were similar between the olanzapine and risperidone groups (p = 0.160)

  • No significant differences in HDL-cholesterol levels were found among the three antipsychotics for outpatients of all body mass index (BMI) stratifications (Table 3)

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Summary

Introduction

Patients with schizophrenia have an increased prevalence of metabolic disturbances compared with the general population. The aim of the present study was to compare the levels of high-density lipoprotein (HDL)-cholesterol in Japanese schizophrenia patients medicated with olanzapine, risperidone, or aripiprazole monotherapy. Patients with schizophrenia have an increased prevalence of cardiometabolic risk factors such as obesity, diabetes type 2, hypertension, hyperglycemia, and dyslipidemia compared with the normal population [2,3,4]. Low high-density lipoprotein (HDL)-cholesterol level, a cardiometabolic risk factor, is strongly and inversely associated with the risk of coronary heart disease [5]. Apart from the effects of antipsychotics related to lipid abnormalities, patients with schizophrenia who are antipsychotic drug-naïve, or drug-free, have low levels of HDL-cholesterol and are at high risk for metabolic syndrome [13]

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