Glucometabolic hormones and cardiovascular risk markers in antipsychotic-treated patients

TY - JOUR

T1 - Glucometabolic hormones and cardiovascular risk markers in antipsychotic-treated patients

AU - Ebdrup, Bjørn H

AU - Knop, Filip K

AU - Madsen, Anna

AU - Mortensen, Henrik B

AU - Søgaard, Birgitte

AU - Holst, Jens Juul

AU - Szecsi, Pal B

AU - Lublin, Henrik

N1 - © Copyright 2014 Physicians Postgraduate Press, Inc.

PY - 2014/9/1

Y1 - 2014/9/1

N2 - Objective: Treatment with antipsychotic drugs is widely associated with metabolic side effects such as weight gain and disturbed glucose metabolism, but the pathophysiologic mechanisms are unclear. Method: Fifty nondiabetic (fasting plasma glucose ≤ 7.0 mmol/L), antipsychotic-treated male patients (ICD-10 diagnosis code F20, F21, F22, F25, F28, or F60; mean±SD age = 33.0±6.7 years; body mass index [BMI; kg/ m2] = 26.0±4.7; waist circumference = 95.9±13.3 cm; glycated hemoglobin A1c [HbA1c] = 5.7%±0.3%) and 93 age- and waist circumference-matched healthy male controls (age = 33±7.3 years; BMI = 26.1±3.9; waist circumference = 94.6±11.9 cm; HbA1c = 5.7%±0.3%) participated in this cross-sectional study. Blood was sampled in the fasting state and 90 minutes after ingestion of a standardized liquid meal (2,268 kJ). The primary outcomes were glucometabolic hormones and cardiovascular risk markers. Data were collected between March 2008 and February 2010. Results: Compared to healthy controls, patients were characterized by elevated fasting levels of proinsulin, C-peptide, and glucose-dependent insulinotropic polypeptide (GIP) (P < .05) and higher postprandial levels of insulin, proinsulin, C-peptide, and GIP (P ≤ .02). Also, patients exhibited elevated plasma levels of C-reactive protein and signs of dyslipidemia. Fasting plasma levels of insulin, glucagon, glucagon-like peptide-1 (GLP-1), ghrelin, leptin, adiponectin, tumor necrosis factor-α, plasminogen activator inhibitor-1, and interleukin-6 and postprandial levels of glucagon, GLP-1, ghrelin, leptin, and adiponectin did not differ between groups. Conclusions: Presenting with an insulin resistant-like pattern, including beta cell hypersecretion and elevated GIP levels, nondiabetic antipsychotic-treated patients display emerging signs of dysmetabolism and a compromised cardiovascular risk profile. The appetite-regulating hormones GLP-1 and ghrelin appear not to be influenced by antipsychotic treatment. Our findings provide new clinical insight into the pathophysiology associated with metabolic side effects of antipsychotic treatment and put emphasis on the importance of implementing metabolic screening into psychiatric practice.

AB - Objective: Treatment with antipsychotic drugs is widely associated with metabolic side effects such as weight gain and disturbed glucose metabolism, but the pathophysiologic mechanisms are unclear. Method: Fifty nondiabetic (fasting plasma glucose ≤ 7.0 mmol/L), antipsychotic-treated male patients (ICD-10 diagnosis code F20, F21, F22, F25, F28, or F60; mean±SD age = 33.0±6.7 years; body mass index [BMI; kg/ m2] = 26.0±4.7; waist circumference = 95.9±13.3 cm; glycated hemoglobin A1c [HbA1c] = 5.7%±0.3%) and 93 age- and waist circumference-matched healthy male controls (age = 33±7.3 years; BMI = 26.1±3.9; waist circumference = 94.6±11.9 cm; HbA1c = 5.7%±0.3%) participated in this cross-sectional study. Blood was sampled in the fasting state and 90 minutes after ingestion of a standardized liquid meal (2,268 kJ). The primary outcomes were glucometabolic hormones and cardiovascular risk markers. Data were collected between March 2008 and February 2010. Results: Compared to healthy controls, patients were characterized by elevated fasting levels of proinsulin, C-peptide, and glucose-dependent insulinotropic polypeptide (GIP) (P < .05) and higher postprandial levels of insulin, proinsulin, C-peptide, and GIP (P ≤ .02). Also, patients exhibited elevated plasma levels of C-reactive protein and signs of dyslipidemia. Fasting plasma levels of insulin, glucagon, glucagon-like peptide-1 (GLP-1), ghrelin, leptin, adiponectin, tumor necrosis factor-α, plasminogen activator inhibitor-1, and interleukin-6 and postprandial levels of glucagon, GLP-1, ghrelin, leptin, and adiponectin did not differ between groups. Conclusions: Presenting with an insulin resistant-like pattern, including beta cell hypersecretion and elevated GIP levels, nondiabetic antipsychotic-treated patients display emerging signs of dysmetabolism and a compromised cardiovascular risk profile. The appetite-regulating hormones GLP-1 and ghrelin appear not to be influenced by antipsychotic treatment. Our findings provide new clinical insight into the pathophysiology associated with metabolic side effects of antipsychotic treatment and put emphasis on the importance of implementing metabolic screening into psychiatric practice.

KW - Adiponectin

KW - Adolescent

KW - Adult

KW - Antipsychotic Agents

KW - C-Peptide

KW - C-Reactive Protein

KW - Cardiovascular Diseases

KW - Case-Control Studies

KW - Cross-Sectional Studies

KW - Gastric Inhibitory Polypeptide

KW - Gastrointestinal Hormones

KW - Ghrelin

KW - Glucagon

KW - Glucose Metabolism Disorders

KW - Humans

KW - Insulin

KW - Interleukin-6

KW - Leptin

KW - Male

KW - Middle Aged

KW - Plasminogen Activator Inhibitor 1

KW - Proinsulin

KW - Risk Factors

KW - Tumor Necrosis Factor-alpha

KW - Young Adult

U2 - 10.4088/jcp.13m08820

DO - 10.4088/jcp.13m08820

M3 - Journal article

C2 - 25295432

SN - 0160-6689

VL - 75

SP - e899-905

JO - Journal of Clinical Psychiatry

JF - Journal of Clinical Psychiatry

IS - 9

ER -