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Coronary Heart Disease Risk Increases Over Time in Patients With Mood Disorders: Presented at CPA

By Thomas S. May

VANCOUVER -- September 8, 2008 -- Patients diagnosed with and treated for mood disorders such as major depression and bipolar disorder are also at increased risk of developing coronary heart disease (CHD), regardless of the class of medication they used, according to research presented here at the 58th Annual Meeting of the Canadian Psychiatric Association (CPA).

Patients with schizophrenia who are treated with second-generation antipsychotics are known to be at increased risk of CHD, due mainly to higher rates of overweight and diabetes in these patients compared with the general population.

"We have found some concerning trends with respect to weight change and cardiovascular illness that occurs early on in therapy," said lead investigator Valerie Taylor, MD, McMaster University, Hamilton, Ontario. "Weight change was the initial trigger that, after about 2 years, seemed to precipitate other metabolic changes."

In her presentation on September 6, Dr. Taylor presented results of a longitudinal study that assessed the physical health of 30 patients newly diagnosed with major depressive disorder (MDD) and 24 with newly diagnosed bipolar disorder (BD). These patients were evaluated prior to starting their first course of treatment and over 4 years of follow-up.

The researchers calculated 10-year risk for CHD and incidence of the metabolic syndrome at baseline and several times during the 4-year follow-up period. The impact of medication was also assessed. Data on age- and gender-matched controls were obtained from the National Health and Nutrition Examination Survey (NHANES) III dataset.

Researchers showed that 11.2% of patients met the diagnostic criteria for metabolic syndrome at baseline; this number increased to 16.8% after 4 years.

Risk of CHD increased from 3.6% at baseline to 4.0% at 10 years for men, and from 1.6% to 2.8% for women. There were no corresponding increases in the control population.

The observed changes in CHD risk and metabolic criteria were not associated with the patient's specific type of pharmacotherapy, as all antipsychotic drug classes appeared to increase risk.

"It is also interesting that initially, a slight weight gain was associated with clinical improvement," Dr. Taylor said. "There seems to be a point, however, when this protective effect is lost," she added.


[Presentation title: A Longitudinal Study of the Development of Metabolic Syndrome and Cardiovascular Disease in First-Presentation Adults with Mood Disorders. Abstract P05]

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