University Psychiatric Centre KU Leuven, Campus Kortenberg, Kortenberg, Belgium.
Am J Psychiatry. 2013 Mar;170(3):265-74. doi: 10.1176/appi.ajp.2012.12050620.
Patients with bipolar disorder have high levels of cardiovascular disease risk factors. The presence of metabolic syndrome significantly influences future cardiovascular disease morbidity and mortality. The authors sought to clarify the prevalence and moderators of metabolic syndrome in bipolar patients, accounting for subgroup differences.
The authors searched MEDLINE, PsycINFO, EMBASE, and CINAHL through April 2012 for research reporting metabolic syndrome prevalence rates in bipolar patients. Medical subject headings "metabolic syndrome" and "bipolar" were used in the title, abstract, or index term fields. Manual searches were conducted using the reference lists from identified articles.
The search yielded 81 articles in 37 publications (N=6,983). The overall metabolic syndrome rate was 37.3% (95% confidence interval [CI]=36.1-39.0) using any standardized metabolic syndrome criteria. Compared with general population groups, bipolar patients had higher metabolic syndrome rates (odds ratio=1.98; 95% CI=1.74-2.25). In bipolar patients, older age had a modest effect on the metabolic syndrome rate. The strongest moderator was the region in which the study took place, with the highest rates observed in New Zealand and Australia (64.2% [95% CI=38.3-83.9]) and North America (49.3% [95% CI=29.7-69.3]). Metabolic syndrome was significantly more prevalent in patients currently treated with antipsychotics (45.3% [95% CI=39.6-50.9] than in patients who were antipsychotic free (32.4% [95% CI=27.5-37.4]; odds ratio=1.72 [95% CI=1.24-2.38]).
These findings strongly support the claim that patients with bipolar disorder are at high risk for metabolic syndrome and related cardiovascular morbidity and mortality and require regular monitoring and adequate preventive efforts and treatment for cardio-metabolic risk factors. These findings further suggest that the risk of metabolic syndrome is greater in bipolar patients taking prescribed antipsychotic medication.
双相障碍患者存在较高水平的心血管疾病危险因素。代谢综合征的存在显著影响未来心血管疾病的发病率和死亡率。作者试图阐明双相患者代谢综合征的患病率及其调节因素，同时考虑到亚组差异。
作者通过 MEDLINE、PsycINFO、EMBASE 和 CINAHL 检索了截至 2012 年 4 月的研究文献，这些文献报告了双相患者代谢综合征的患病率。在标题、摘要或索引词字段中使用了医学主题词“代谢综合征”和“双相”。通过确定文章的参考文献列表进行了手动搜索。
搜索共产生 37 篇出版物中的 81 篇文章（N=6983）。使用任何标准化的代谢综合征标准，总体代谢综合征发生率为 37.3%（95%置信区间[CI]：36.1-39.0）。与一般人群相比，双相患者的代谢综合征发生率更高（比值比=1.98；95%CI：1.74-2.25）。在双相患者中，年龄较大对代谢综合征的发生率有适度影响。最强的调节因素是研究地点所在的区域，其中新西兰和澳大利亚（64.2%[95%CI：38.3-83.9]）和北美（49.3%[95%CI：29.7-69.3]）的发生率最高。目前正在接受抗精神病药物治疗的患者（45.3%[95%CI：39.6-50.9]）的代谢综合征明显更为普遍，而未接受抗精神病药物治疗的患者（32.4%[95%CI：27.5-37.4]）（比值比=1.72[95%CI：1.24-2.38]）。
这些发现有力地支持了以下观点，即双相障碍患者存在较高的代谢综合征和相关心血管发病率和死亡率风险，需要定期监测，并对心血管代谢危险因素进行充分的预防和治疗。这些发现进一步表明，服用处方抗精神病药物的双相患者代谢综合征的风险更高。
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