Baseline cardiometabolic assessment was performed in youths aged 12-17 years with
FEP entering the Tolerability and Efficacy of
Antipsychotics (
TEA) trial and matched healthy controls. Patients were included between June 10, 2010, and January 29, 2014. ICD-10 was used as the diagnostic classification system. Cardiometabolic risk markers were compared between patients versus controls and
antipsychotic-naive versus
antipsychotic-exposed patients.
RESULTS: Comparing 113 youths with
FEP (age ± SD = 15.74 ± 1.36 years, males = 30.1%,
schizophrenia-spectrum disorders = 92.9%,
antipsychotic-naive: n = 57) to 60 controls, patients had higher waist circumference (WC) z scores (1.13 ± 1.65 vs 0.42 ± 1.27, P = .018),
cholesterol (4.10 ± 0.71 vs 3.79 ± 0.49 mmol/L, P = .014),
low-density lipoproteins (2.37 ± 0.56 vs 2.13 ± 0.51, P = .012), and non-
high-density lipoproteins (2.58 ± 1.60 vs 2.52 ± 0.52, P = .018). More patients than controls (42.9% vs 20.3%, P = .019) and
antipsychotic-naive than
antipsychotic-exposed (51.9% vs 34.0%, P = .023) had a WC > 90th percentile.
Hypercholesterolemia (34.0% vs 12.5%, P = .015) was more frequent in patients, while decreased
high-density lipoprotein cholesterol was more frequent in controls (32.5% vs 19.0%, P = .032). Family history of
type 2 diabetes mellitus was associated with increased body mass index (BMI) z score (P < .001), WC z score (P = .001),
insulin (P = .038), and homeostatic model assessment of
insulin resistance (HOMA-IR; P = .025).
Dyslipidemia was associated with significantly increased
insulin (P = .041), HOMA-IR (P = .032), and
low-density lipoprotein cholesterol (P = .041). Previous
antipsychotic exposure was not associated with increased cardiometabolic risk. Early age at onset predicted increased BMI and WC z scores, while diagnosis of
schizophrenia and higher Clinical Global Impression-Severity score were associated with increased blood
lipids.
CONCLUSIONS: Youths with
FEP had significantly greater WC and
lipid abnormalities than matched controls, regardless of
antipsychotic exposure. In youths with
FEP, elevated metabolic risk predates
antipsychotic exposure.
TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01119014; European Clinical Trials Database (EudraCT): 2009-016715-38.