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Randomized Controlled Trial
. 2008 Oct;105(1-3):175-87.
doi: 10.1016/j.schres.2008.07.006. Epub 2008 Sep 4.

Antipsychotic effects on estimated 10-year coronary heart disease risk in the CATIE schizophrenia study

Gail L Daumit  1 , Donald C Goff, Jonathan M Meyer, Vicki G Davis, Henry A Nasrallah, Joseph P McEvoy, Robert Rosenheck, Sonia M Davis, John K Hsiao, T Scott Stroup, Jeffrey A Lieberman
Affiliations
Randomized Controlled Trial

Antipsychotic effects on estimated 10-year coronary heart disease risk in the CATIE schizophrenia study

Gail L Daumit et al. Schizophr Res. 2008 Oct.

Abstract

Objective: Persons with schizophrenia die earlier than the general population, in large part due to cardiovascular disease. The study objective was to examine effects of different antipsychotic treatments on estimates of 10-year coronary heart disease (CHD) risk calculated by the Framingham Heart Study formula.

Method: Change in 10-year risk for CHD was compared between treatment groups in 1125 patients followed for 18 months or until treatment discontinuation in the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) Schizophrenia Trial.

Results: The covariate-adjusted mean change in 10-year CHD risk differed significantly between treatments. Olanzapine was associated with a 0.5% (SE 0.3) increase and quetiapine, a 0.3% (SE 0.3) increase; whereas risk decreased in patients treated with perphenazine, -0.5% (SE 0.3), risperidone, -0.6% (SE 0.3), and ziprasidone -0.6% (SE 0.4). The difference in 10-year CHD risk between olanzapine and risperidone was statistically significant (p=0.004). Differences in estimated 10-year CHD risk between drugs were most marked in the tertile of subjects with a baseline CHD risk of at least 10%. Among individual CHD risk factors used in the Framingham formula, only total and HDL cholesterol levels differed between treatments.

Conclusions: These results indicate that the impact on 10-year CHD risk differs significantly between antipsychotic agents, with olanzapine producing the largest elevation in CHD risk of the agents studied in CATIE.

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Figures

Figure 1
Figure 1. Change in 10 year Coronary Heart Disease (CHD) Risk by Baseline CHD Risk Categories
ANCOVA least squares adjusted results with Mean +/− SE. Model includes baseline risk, time to treatment discontinuation, and fasting status at baseline and end of phase 1. b Difference in risk numerically different but not statistically significant with Bonferroni correction (p=0.008).
Figure 2
Figure 2. Repeated Measures Estimates of Total Cholesterol Changes
Olanzapine shown in red; perphenazine shown in blue; quetiapine shown in green; risperidone shown in yellow; ziprasidone shown in black dashed line. Between group differences significant for olanzapine vs. risperidone (p<.001), olanzapine vs. ziprasidone (p<.001) and quetiapine vs. risperidone (p=.001). Change numerically different for olanzapine vs. perphenazine, but not statistically significant with Bonferroni correction (p=.009).
Sample sizes by visit and treatment group are:
visitolanzapineperphenazinequetiapinerisperidoneziprasidone
3269208257261140
620013016317574
121578510912655
1812966649737
Figure 3
Figure 3. Repeated Measures Estimates of HDL Cholesterol Changes for Whites
Olanzapine shown in red; perphenazine shown in blue; quetiapine shown in green; risperidone shown in yellow; ziprasidone shown in black dashed line. Between group differences significant in whites for perphenazine vs. olanzapine (p<.001), quetiapine (p=.002), and risperidone (p=.003).
Sample sizes by visit and treatment group are:
visitolanzapineperphenazinequetiapinerisperidoneziprasidone
316112217915789
61178210810843
129649727935
187941456324
Figure 4
Figure 4. Repeated Measures Estimates of HDL Cholesterol Changes for Other Races
Olanzapine shown in red; perphenazine shown in blue; quetiapine shown in green; risperidone shown in yellow; ziprasidone shown in black dashed line. Between group differences significant in other races for ziprasidone vs. olanzapine (p<.001) and perphenazine (p=.002).
Sample sizes by visit and treatment group are:
visitolanzapineperphenazinequetiapinerisperidoneziprasidone
3108867810449
68348556730
126136374720
185025193413
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