Clozapine, Diabetes Mellitus, Hyperlipidemia, and Cardiovascular Risks and Mortality: Results of a 10-Year Naturalistic Study
J Clin Psychiatry 2005;66(9):1116-1121
© Copyright 2017 Physicians Postgraduate Press, Inc.
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Objective: The goal of this 10-year
naturalistic study was to examine, in clozapine-treated
patients, the change in cardiovascular risk
factors following clozapine initiation and the
mortality estimates from cardiovascular disease.
Method: Data were collected from
medical records from January 1992 to December 2003
and included age, gender, race, diagnosis, family
history of diabetes, and age at clozapine
initiation for clozapine-treated patients with
schizophrenia or schizoaffective disorder (DSM-IV
criteria). Clozapine dosage and laboratory results
were recorded at 12-month intervals.
Results: At the time of clozapine
initiation, the mean ± SD age of the 96 patients studied
was 36.5 ± 7.9 years; 28% (N = 27) were women.
The Kaplan-Meier estimate for 10-year mortality
from cardiovascular disease was 9%. African
American and Hispanic American patients exhibited
elevated risk of cardiovascular disease-related
mortality (odds ratio [OR] = 7.2, p = .09; OR = 11.3, p = .04, respectively) compared to white
patients. Body mass index (BMI) significantly
increased the odds ratio of mortality (OR = 1.2,
p < .01). The Kaplan-Meier estimate for new-onset
diabetes mellitus was approximately 43%, and Hispanic American (OR = 4.3, p = .027) and
African American (OR = 11.5, p = .0001) patients
showed elevated risks of developing diabetes
mellitus compared to white patients. Additionally,
BMI (OR = 1.11, p = .0006), total cholesterol level (OR = 1.006, p = .04), and serum
triglyceride level (OR = 1.002, p = .04) modestly
increased the odds ratio for the development of
Conclusions: These results support the
hypothesis that clozapine-treated patients appear
to be at risk for death from cardiovascular
disease secondary to clozapine-associated medical
disorders such as obesity, diabetes, hypertension,