Department of Clinical Social and Administrative Sciences, College of Pharmacy, University of Michigan, Ann Arbor, MI 48109, USA.
J Clin Psychopharmacol. 2012 Apr;32(2):261-5. doi: 10.1097/JCP.0b013e3182485888.
Folate has been implicated in cardiovascular disease with atypical antipsychotic (AAPs) use, and individuals with methylenetetrahydrofolate reductase (MTHFR) and catechol-O-methyl transferase (COMT) variants are at greater risk. This study examined the relationship between the MTHFR 677C/T, MTHFR 1298A/C, and COMT Val158Met variants; metabolic syndrome; and lifestyle measures in schizophrenia and bipolar subjects. A total of 237 subjects with bipolar or schizophrenia receiving an antipsychotic for at least 6 months were included in this cross-sectional analysis. Subjects were screened for the metabolic syndrome (National Cholesterol Education Program Adult Treatment Panel III criteria) and MTHFR 677C/T, MTHFR 1298A/C, and Val158Met genotypes. In addition, serum folate and homocysteine were measured along with lifestyle factors. The subject's mean age was 44.7 (SD, 11.7) years; 72% were white, and 51% male; 61% were receiving an AAP; the mean body mass index was 32.6 (SD, 8.2) kg/m, and 48% were current smokers. Overall, 41% met metabolic syndrome criteria (n = 98). There were no differences in age, sex, AAP exposure, or body mass index between genotype groups. Metabolic syndrome was related to age, smoking, and the MTHFR 677T and COMT 158Val alleles (χ = 34.4, P < 0.0001). In addition, AAP use showed a trend association with metabolic syndrome (χ = 3.21, P = 0.07). These data support our previous reports and add more data pointing to folate's role in mediating a link between mental illness and cardiovascular disease. Use of this information clinically may help to reduce the risk for AAP metabolic complications in those whose clinical care necessitates the use of AAPs.
叶酸与使用非典型抗精神病药物（AAP）有关，患有亚甲基四氢叶酸还原酶（MTHFR）和儿茶酚-O-甲基转移酶（COMT）变异的个体风险更高。本研究检查了 MTHFR 677C/T、MTHFR 1298A/C 和 COMT Val158Met 变体；代谢综合征；以及精神分裂症和双相情感障碍患者的生活方式措施之间的关系。共有 237 名接受至少 6 个月抗精神病药物治疗的双相或精神分裂症患者参与了这项横断面分析。对这些患者进行了代谢综合征（国家胆固醇教育计划成人治疗小组 III 标准）和 MTHFR 677C/T、MTHFR 1298A/C 和 Val158Met 基因型的筛查。此外，还测量了血清叶酸和同型半胱氨酸以及生活方式因素。患者的平均年龄为 44.7（标准差，11.7）岁；72%为白人，51%为男性；61%正在服用 AAP；平均体重指数为 32.6（标准差，8.2）kg/m，48%为当前吸烟者。总体而言，41%符合代谢综合征标准（n = 98）。在基因型组之间，年龄、性别、AAP 暴露或体重指数无差异。代谢综合征与年龄、吸烟以及 MTHFR 677T 和 COMT 158Val 等位基因有关（χ=34.4，P<0.0001）。此外，AAP 使用与代谢综合征呈趋势相关（χ=3.21，P=0.07）。这些数据支持我们之前的报告，并增加了更多数据表明叶酸在介导精神疾病和心血管疾病之间的联系中发挥作用。在需要使用 AAP 的临床护理中，临床使用这些信息可能有助于降低 AAP 代谢并发症的风险。
