Early changes of blood lipid levels during psychotropic drug treatment as predictors of long-term lipid changes and of new onset dyslipidemia

Abstract

Early modifications of blood lipid levels following prescription of psychotropic drugs inducing dyslipidemia should therefore raise questions on clinical strategies to control long-term dyslipidemia.

Lipid Disturbances in Adolescents Treated With Second-Generation Antipsychotics

“…In the present study, almost half of the adolescents had early lipid changes of ≥ 5% (i.e. 49%, 43%, 36%, 28%, and 45% for TC, LDL-C, TG, HDL-C, and non-HDL-C, respectively), which is comparable with the proportions previously observed in adults (43%, 43%, 57%, 42%, and 47%, respectively) 31 . Adolescent patients whose lipid levels changed by ≥ 5% during the first month appeared to have higher changes of lipid levels and a greater tendency to develop hypercholesterolemia during the course of a long-term treatment, as compared to patients whose early lipid levels changed by < 5%.…”

“…A Spanish pediatric study observed a higher proportion of hypercholesterolemia at baseline (26%) 36 , possibly attributable to less stringent criterion used to define hypercholesterolemia (i.e., ≥170 mg/dL; corresponding to 4.4 mmol/l). In adult patients included in our department, a much higher prevalence of baseline hypercholesterolemia was observed (38% 31 ), which can be explained by a longer duration of illness and of lifetime exposure to psychotropic treatment.…”

“…within 6 hours following the last meal) were excluded only for triglyceride (TG) analysis (not for total (TC), HDL-(HDL-C), LDL-(LDL-C) and non-HDL-(non-HDL-C) cholesterol) 40,41 . As mentioned previously, 16 patients ≤ 18 years included in the present study were already included in a recent study designed to determine the best early thresholds for predicting further important lipid worsening 31 . However, this number was insufficient to conduct additional analyses specifically in young patients.…”

“…Recent studies recognized that components of the metabolic syndrome may develop early during psychotropic treatment and may initiate a steady process leading to cardiometabolic diseases in the long term 19,20,[30][31][32] . In particular, lipogenic adverse effects may occur very early during treatment and may even precede weight gain 13,19,[33][34][35] .…”

“…In particular, lipogenic adverse effects may occur very early during treatment and may even precede weight gain 13,19,[33][34][35] . Our research group recently demonstrated the importance of early (i.e., after one month of treatment) changes of lipid levels to predict worsening of the lipid profile and development of dyslipidemia in the longer term of treatment (≥3 months of treatment) 31 . In particular, patients whose lipid levels increased by 5% or more during the first month of psychotropic treatment were more prone to have a considerable worsening of their lipid profiles after three months of treatment and to develop dyslipidemia, as compared to other patients 31 .…”