Atypical Antipsychotic Agents, Retinopathy, Nephropathy, and Cardiovascular Disease

This is the seventh and final in a series of articles on presentations at the American Diabetes Association Annual Meeting, San Diego, California, 10–14 June 2005. Diabetes and atypical antipsychotic agentsJohn Newcomer (St. Louis, MO) discussed changes in adiposity and insulin sensitivity with the atypical antipsychotic agents ziprasidone, risperidone, aripiprazole, quetiapine, clozapine, and olanzapine, addressing the diabetes risk seen during treatment. Among persons with schizophrenia, approximately half are obese, half to three-quarters smoke, 10–14% have diabetes, particularly with coexisting depression, and there are also increased prevalences of hypertension and dyslipidemia. Metabolic syndrome, Newcomer stated, is present in ∼40% of persons with schizophrenia. Persons with schizophrenia have increased rates of cardiovascular disease (CVD). The mortality due to myocardial infarction is 19% greater among persons with any mental illness and is 34% greater among persons with schizophrenia (1) than in a control population. CVD, then, is of similar importance to suicide as a cause of death in these patients, whose overall mortality is increased by half, leading to a 20% shorter lifespan than in persons without schizophrenia (2).A major issue is weight gain with the atypical antipsychotic agents. Although weight gain occurs with conventional antipsychotic agents such as haloperidol, greater weight gain definitely occurs with chlorpromazine, olanzapine, and clozapine and may occur with risperidone and quetiapine. A meta-analysis of weight change during randomized, controlled, 10-week trials showed that olanzapine and clozapine were associated with a 4-kg weight gain, while haloperidol and risperidone were associated with a 2-kg weight gain (3). Quetiapine leads to ∼4-fold and olanzapine ∼10-fold weight gain, while other antipsychotic agents give 2-fold greater rates of weight gain than those seen in nontreated schizophrenic persons. In 1-year studies, ziprasidone, risperidone, quetiapine, and olanzapine are associated with weight gains of ∼1, 2, 4, and 6 kg. The degree of weight gain appears to …