Clozapine, Diabetes Mellitus, Hyperlipidemia, and Cardiovascular Risks and Mortality: Results of a 10-Year Naturalistic Study

David C. Henderson, MD; Dana D. Nguyen, PhD; Paul M. Copeland, MD; Doug L. Hayden, MA; Christina P. Borba, MPH; Pearl M. Louie, MD; Oliver Freudenreich, MD; A. Eden Evins, MD; Corrine Cather, PhD; and Donald C. Goff, MD

Published: September 15, 2005

Article Abstract

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 diabetes mellitus.

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, and hyperlipidemia.’ ‹

Volume: 66

Quick Links: Psychotic Disorders , Schizophrenia and Schizoaffective Disorders

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