What is the clinical evidence from this study?

Study design: Review. Population: Schizophrenia. Intervention: Selective serotonin reuptake inhibitors (SSRIs) vs. Antipsychotics alone. Primary outcome: Metabolic parameters and cardiovascular risk.

July 15, 2021Open Access

Selective serotonin reuptake inhibitors and risk reduction for cardiovascular disease in patients with schizophrenia: A controversial but promising approach

Key Result

Selective serotonin reuptake inhibitors have an undetermined overall impact on cardiovascular risk in schizophrenia, as fluvoxamine improves metabolic factors while other SSRIs slightly worsen them.

Structured PICO

Does the use of SSRIs reduce the risk for cardiovascular disease in patients with schizophrenia?

Population

Patients with schizophrenia (SCZ) at high risk of cardiovascular disease

Intervention

Selective serotonin reuptake inhibitors (SSRIs), including fluvoxamine combined with clozapine

Outcome

Cardiovascular risk and metabolic parameters (total cholesterol, low-density lipoprotein, and triglyceride)surrogate

Current evidence is insufficient to determine whether SSRIs increase or decrease cardiovascular risk in patients with schizophrenia, highlighting the need for further studies.

Limitations

Methodology of some included studies did not allow excluding the potential impact of diet
Lack of access to non-psychotropic medications being taken by patients such as statins or insulin
Small number of patients in some trials
Short duration of some studies

Abstract

Patients with schizophrenia (SCZ) are at high risk of cardiovascular disease (CVD) due to an inherited predisposition, a sedentary life style and the use of antipsychotic medications. Several approaches have been taken to minimize this risk but results continue to be unsatisfactory. A potential alternative is prescribing selective serotonin reuptake inhibitors (SSRIs). SSRIs decrease platelet aggregation and reduce the risk of coronary heart disease in patients with depression. We therefore aim to investigate whether there is evidence that supports the use of SSRIs to reduce the risk for CVD in SCZ. A review of the literature revealed five published reports relating to the impact of SSRIs on CV risk in SCZ. Three trials assessed the influence on metabolic parameters of fluvoxamine when combined with clozapine. Two of those studies found improvements with fluvoxamine. Of the other two reports, one indicates SSRIs as a group caused minimal but statistically significant increments in total cholesterol, low-density lipoprotein and triglyceride. The second report suggests that when SSRIs are combined with antipsychotics, the metabolic impact depends on the antipsychotic prescribed. While there are promising results, no conclusions can be made currently on whether SSRIs increase or decrease CV risk in SCZ. Further studies are needed to resolve this matter.

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