Socio-economic position as a moderator of cardiometabolic outcomes in patients receiving psychotropic treatment associated with weight gain: results from a prospective 12-month inception cohort study and a large population-based cohort

Céline Dubath,Zoltan Kutalik,Nuria Saigi-Morgui,Anaïs Glatard,Armin Von Gunten,Axel Levier,Jennifer Sjaarda,Kerstin Jessica Plessen,Alessandra Solida,Christoph U Correll,Radoslaw Panczak,Mehdi Gholam-Rezaee,Chin B Eap,Philippe Conus,Aurélie Delacrétaz

doi:10.1038/s41398-021-01482-9

Abstract

Weight gain and metabolic complications are major adverse effects of many psychotropic drugs. We aimed to understand how socio-economic status (SES), defined as the Swiss socio-economic position (SSEP), is associated with cardiometabolic parameters after initiation of psychotropic medications known to induce weight gain. Cardiometabolic parameters were collected in two Swiss cohorts following the prescription of psychotropic medications. The SSEP integrated neighborhood-based income, education, occupation, and housing condition. The results were then validated in an independent replication sample (UKBiobank), using educational attainment (EA) as a proxy for SES. Adult patients with a low SSEP had a higher risk of developing metabolic syndrome over one year versus patients with a high SSEP (Hazard ratio (95% CI) = 3.1 (1.5–6.5), n = 366). During the first 6 months of follow-up, a significant negative association between SSEP and body mass index (BMI), weight change, and waist circumference change was observed (25 ≤ age < 65, n = 526), which was particularly important in adults receiving medications with the highest risk of weight gain, with a BMI difference of 0.86 kg/m2 between patients with low versus high SSEP (95% CI: 0.03–1.70, n = 99). Eventually, a causal effect of EA on BMI was revealed using Mendelian randomization in the UKBiobank, which was notably strong in high-risk medication users (beta: −0.47 SD EA per 1 SD BMI; 95% CI: −0.46 to −0.27, n = 11,314). An additional aspect of personalized medicine was highlighted, suggesting the patients’ SES represents a significant risk factor. Particular attention should be paid to patients with low SES when initiating high cardiometabolic risk psychotropic medications.

Highlights

In psychiatric populations life expectancy is reduced by about ≥10 years versus the general population
The proportion of smokers was higher in the low than in the high Swiss socio-economic position (SSEP) group (52% versus 46%), the difference did not reach significance
This study revealed that during the first year of observed psychotropic treatment with cardiometabolic risk potential, adults aged 25–65 years with a low SSEP were three times more susceptible to developing metabolic syndrome compared to patients with high SSEP

Summary

Introduction

In psychiatric populations (comprising schizophrenia, bipolar disorder, major depressive disorder, and their related spectrum disorders) life expectancy is reduced by about ≥10 years versus the general population. Two-thirds of this mortality is attributed to cardiovascular diseases [1]. This increase in cardiometabolic-related health problems is multidetermined, including psychiatric illness, lifestyle, and diet behaviors, resulting in a high prevalence of obesity and other cardiometabolic risk factors [2]. 1234567890();,: Social factors, such as low educational attainment (EA) or low paliperidone, lithium, mirtazapine, zuclopenthixol, and levomepromaincome, have been associated with poor mental health outcomes and depression [3]. Some studies linked socio-economic zine), and high-risk (e.g., valproate, olanzapine, and clozapine) as previously described [13]

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