School of Psychiatry, University of New South Wales, Sydney, NSW 2052, Australia.
Keeping the Body in Mind Program, South Eastern Sydney Local Health District, 15 The Kingsway & Kareena Road, Kogarah, NSW 2217, Australia..
Schizophr Res. 2018 Sep;199:367-373. doi: 10.1016/j.schres.2018.02.035. Epub 2018 Feb 24.
To comprehensively assess cardio-metabolic risk factors and their management in a large sample of outpatients treated with clozapine.
Observational cross-sectional study of all clozapine users attending specialized clozapine monitoring outpatient clinics in three public hospitals in Sydney, Australia were approached to participate over the one-year period 01/10/2015-30/09/2016. Cardio-metabolic risk factors including metabolic syndrome, risk for future development of diabetes, smoking, physical activity, nutrition, and prescribed medications were assessed at face-to-face interview and through medical record review. Among patients who had cardio-metabolic risk factors, the proportion receiving appropriate management was assessed.
Of 451 registered clozapine clinic attenders, 92.2% completed questionnaires and anthropometric measurements. 58.3% met criteria for metabolic syndrome. 79.6% were overweight or obese. 55.9% had blood pressure meeting metabolic syndrome criteria. 46.6% had elevated fasting blood glucose and 55.2% had elevated blood triglycerides. 43.6% were current smokers. Only 10% achieved recommended weekly physical activity levels. Unhealthy food categories were highly consumed. 32.1% were on additional antipsychotics. In the majority of individuals, cardio-metabolic risk factors were untreated or under-treated.
Clozapine use was associated with very high rates of cardiovascular and metabolic risk factors, which were frequently under-treated. Management of both physical and mental health should be prioritized. Polypharmacy should be rationalized. Future research should investigate the effectiveness of smoking cessation and lifestyle interventions in this high-risk population.
全面评估大样本接受氯氮平治疗的门诊患者的心血管代谢危险因素及其管理情况。
在澳大利亚悉尼的三家公立医院的专门氯氮平监测门诊就诊的所有氯氮平使用者中进行了一项观察性横断面研究，邀请他们在 2015 年 10 月 1 日至 2016 年 9 月 30 日的一年期间参加。通过面对面访谈和病历回顾评估心血管代谢危险因素，包括代谢综合征、未来发生糖尿病的风险、吸烟、身体活动、营养和处方药物。在有心血管代谢危险因素的患者中，评估了接受适当管理的比例。
在 451 名登记的氯氮平诊所就诊者中，92.2%完成了问卷调查和人体测量。58.3%符合代谢综合征标准。79.6%超重或肥胖。55.9%血压符合代谢综合征标准。46.6%空腹血糖升高，55.2%血甘油三酯升高。43.6%是当前吸烟者。只有 10%达到了每周推荐的体力活动水平。不健康的食物类别摄入量很高。32.1%正在服用其他抗精神病药物。在大多数患者中，心血管代谢危险因素未得到治疗或治疗不足。
氯氮平的使用与极高的心血管和代谢危险因素相关，且这些危险因素经常治疗不足。应优先考虑身体和心理健康的管理。应合理化联合用药。未来的研究应调查在这一高危人群中戒烟和生活方式干预的有效性。
