Psychotic disorder is an independent risk factor for increased fasting glucose and waist circumference

Abstract

Background. Psychosis is associated with excess cardiovascular morbidity and mortality. Aims. To determine the prevalence of cardiovascular risk factors in patients with psychotic disorders compared with the population. Methods. 731 consecutive patients with psychosis recruited from psychiatric outpatient clinics in Stockholm County, Sweden, were compared with 5580 individuals from a population study performed in the same area. The main outcome measures were waist circumference, body mass index (BMI) and fasting glucose. Results. Mean waist circumference in patients vs. controls was for males 106 and 94 cm, respectively, and for females 97 and 85 cm, respectively (P < 0.001); mean fasting glucose in patients vs. controls was for males 5.8 and 5.2 mmol/l, respectively, and for females 5.6 and 4.8 mmol/l, respectively (P < 0.001). Comparisons were controlled for differences in age and family history of diabetes. Increased waist circumference was more common in psychotic patients compared with controls (OR = 3.99; 95% CI 3.09–5.15), controlling for fasting insulin, differences in gender, blood pressure, fasting glucose, family history of diabetes, age and tobacco use. Increased fasting blood glucose was also more common in psychotic patients (OR = 2.41; 95% CI 1.84–3.14) controlling for the same factors with the exception of fasting glucose and with the addition of increased waist circumference. Conclusion. Our study shows that the psychosis illness per se can be considered as a cardiovascular risk factor, independent of the traditional risk factors such as age and smoking.

• Diabetes
• Metabolic syndrome
• Psychosis
• Schizophrenia

Acknowledgements

Dr Helena Ring, Dr Sören Akselsson and Dr Deanne Mannelid are acknowledged for contributions in organizing the study and in recruiting patients. Professor Martin Schalling is acknowledged for his contribution to the design and planning of the study. We thank research assistant Carina Schmidt for qualified administration of patient samples. The Swedish Study of Metabolic Risks in Psychosis (SMP) was supported by ALF Grants 20060100 and 20080022 from Stockholm County Council and Karolinska Institutet, and by grants from the Department of Drug Management and Informatics, Stockholm County Council, and from Söderström-Königska Hospital. The Stockholm Diabetes Prevention Program (SDPP) was supported by grants from Stockholm County Council, the Swedish Research Council, the Swedish Council for Working Life and Social Research, the Swedish Diabetes Association and Novo Nordisk Scandinavia. This study was also supported by a grant from PRIMA Child and Adult Psychiatry Inc. No sponsor had any role in design and conduct of the study; collection, management, analysis, and interpretation of the data; or in preparation, review or approval of the manuscript.

Disclosure of interest: UÖ has received honoraria as a speaker, advisor or for attending congresses from AstraZeneca, Bristol-Myers Squibb, Janssen-Cilag, Eli Lilly, and Pfizer, and grant support from Bristol-Myers Squibb and Janssen-Cilag. CGÖ has received honoraria as a speaker or advisor from AstraZeneca, Eli Lilly, GlaxoSmithKline, Hoffman-La Roche, MSD, Novo Nordisk Scandinavia and Pfizer. EO, SVE, GE and AH—none declared. The authors alone are responsible for the content and writing of the paper.