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May 15, 2015Current Drug SafetyOpen Access

Prevalence of Cardiovascular and Metabolic Events in Patients Prescribed Clozapine: A Retrospective Observational, Clinical Cohort Study

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Why the study?

What are the risk factors for cardiovascular and metabolic adverse events in patients prescribed clozapine?

Population

355 patients prescribed clozapine enrolled in the Barwon Health Clozapine Program at Geelong Hospital…

Design

Cohort

Authors

NHNatalie K. HydeRoyal Children's HospitalSDSeetal DoddLouisiana State UniversityKVKamalesh VenugopalGovernment of South Australia

Discussion

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Implication

Supports age-stratified CV monitoring in clozapine users; leaves open causal risks and optimal strategies in observational data.

Key Points

  • To determine the prevalence of clozapine-induced cardiovascular and metabolic abnormalities and identify key risk factors associated with their development in patients with schizophrenia.
  • Retrospective observational clinical cohort study of 355 patients enrolled in the Barwon Health Clozapine Program at Geelong Hospital, Victoria, Australia, between 2008 and 2012.
  • Multivariate logistic regression analysis of medical records to evaluate associations between patient characteristics and adverse cardiovascular and metabolic outcomes.
  • Older age at clozapine initiation consistently increased the odds of cardiovascular abnormalities, except for tachycardia where older age was protective (OR: 0.97; 95% CI: 0.95, 0.99).
  • Older commencement age significantly correlated with abnormal HDL cholesterol (OR: 1.03; 95% CI: 1.01, 1.07) and elevated fasting glucose (OR: 1.04; 95% CI: 1.02, 1.07).
  • Males had significantly higher odds of most metabolic disturbances but lower odds of obesity (BMI ≥ 30; OR: 0.45; 95% CI: 0.24, 0.85), while rising BMI was consistently linked to all metabolic events.

Structured PICO

What are the risk factors for cardiovascular and metabolic adverse events in patients prescribed clozapine?

P
Population
355 patients prescribed clozapine enrolled in the Barwon Health Clozapine Program at Geelong Hospital, Victoria, Australia, between 2008-2012.
I
Intervention
Clozapine therapy
O
Outcome
Prevalence of clozapine-induced cardiovascular and metabolic eventssafety

In patients prescribed clozapine, older age at treatment commencement and male sex are associated with an increased risk of adverse cardiovascular and metabolic events.

Limitations

  • Lack of a matched case-control design

Cite This Study

Hyde et al. (2015) studied this question.

synapsesocial.com/papers/6a741f3de39f0b3cc6eafe59https://doi.org/10.2174/157488631002150515120209

Topics

Women and heart disease
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Adverse Cardiac Effects Associated With Clozapine2005 · 200 citations
  2. 2A New Monitoring Protocol for Clozapine-Induced Myocarditis Based on an Analysis of 75 Cases and 94 Controls2011 · 233 citations
  3. 3Effects of clozapine on cerebral catecholaminergic neurone systems1972 · 125 citations
  4. 4The metabolic syndrome—a new worldwide definition2005 · 9,355 citations
  5. 5Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of schizophrenia and related disorders2005 · 383 citations