Concordance of standard and modified NCEP ATP III criteria for identification of metabolic syndrome in outpatients with schizophrenia treated with antipsychotics a corollary from the CLAMORS Study
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Slide 1 :
Schizophrenia Research 99(2008) 23-28 Concordance of standard and modified NCEP ATP III criteria for identification of metabolic syndrome in outpatients with schizophrenia treated with antipsychotics: a corollary from the CLAMORS Study
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Javier Rejas1, Julio Bobes2, Celso Arango3, Pedro Aranda4, Rafael Carmena5, Margarida Garcia-Garcia6 1Health Outcomes Research Department, Medical Unit, Pfizer España, Alcobendas (Madrid), Spain; 2Medicine Department, Psychiatry Area, University of Oviedo, Oviedo (Asturias), Spain; 3Department of Psychiatry, Hospital General Universitario Gregorio Marañón and Red de Enfermedades Mentales, REM-TAP, ISCIII, Madrid, Spain; 4Hypertension and Cardiovascular Unit, Carlos Haya Hospital, Málaga, Spain; 5Department of Endocrinology, Valencia University Clinic Hospital, Valencia, Spain; 6Project Management Department, Biometrica CRO, Barcelona, Spain.
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INTRODUCTION Metabolic syndrome (MS) clinical relevance is evidenced by the apparent association of the syndrome with a high risk of both fatal and nonfatal cardiovascular disease . Recently, a great number of publications have stressed the increased prevalence of MS in different countries in schizophrenia patients on antipsychotics. The National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III (NIH, NCEP-ATP III panel, 2002) have become the most used guideline in routine medical practice to identify MS. It is also possible to use a modified version, which replaces the measurement of waist circumference with a calculation of body mass index. Measuring waist circumference requires the use of a device that is sometimes not available in psychiatric offices and is awkward to perform, while body mass index calculation is easy and familiar within the psychiatric community.
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OBJECTIVE The CLAMORS study analyzes the concordance between standard and modified NCEP-ATP-III criteria for identification of MS in outpatients with schizophrenia treated with the antipsychotics most commonly used in daily practice.
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METHODS The study enrolled consecutive outpatients with a diagnosis of schizophrenia, schizophreniform or schizoaffective disorder according to DSM-IV criteria. All patients had to be receiving oral antipsychotic treatment for at least 12 weeks with only one of the following drugs: risperidone, olanzapine, quetiapine, ziprasidone, amisulpride, or haloperidol. MS was determined using the NCEP-ATP-III guidelines (NIH, NCEP-ATP III panel, 2002), MS was also determined according to the modified NCEP-ATP-III criteria, which replaces the waist circumference criterion with a body mass index (BMI) =28.8 kg/m2. Clinical severity was determined using the PANSS and the CGI-S scales. Kappa agreement and the symmetry Kendall’s tau-b coefficients were calculated to measure concordance in a post-hoc analysis, a long with McNemar test and logistic regression models. Logistic regression was used to explore the intensity of the association of each criterion with MS, either by the standard or the modified method.
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RESULTS Prevalence of metabolic syndrome and its individual criteria according to standard and modified NCEP ATP III guidelines and their individual values. 1Percentages calculated with respect to the total valuable patients by direct method; 2also includes patients receiving triglyceride-lowering medication, antihypertensive drugs or antidiabetic treatment, respectively; 3Calculated according to NCEP-ATP III standard or 4 modified guidelines (National Institutes of Health, 2002). SD = Standard deviation. BMI = Body Mass Index, SBP = systolic blood pressure, DBP = diastolic blood pressure.
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RESULTS Prevalence of metabolic syndrome and its individual criteria according to standard and modified NCEP ATP III guidelines and their individual values.
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RESULTS Concordance of prevalence of metabolic syndrome assessed by NCEP ATP III standard and modified criteria in the overall sample and in different subgroups according to sex In parenthesis 95% confidence interval
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RESULTS Concordance of prevalence of metabolic syndrome assessed by NCEP ATP III standard and modified criteria in the overall sample and in different subgroups according to age. In parenthesis 95% confidence interval
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RESULTS Concordance of prevalence of metabolic syndrome assessed by NCEP ATP III standard and modified criteria in the overall sample and in different subgroups according to CGI-S Scale. In parenthesis 95% confidence interval. Only two patients in category 7 of CGI scale.
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RESULTS Concordance of prevalence of metabolic syndrome assessed by NCEP ATP III standard and modified criteria in the overall sample and in different subgroups according to duration of therapy. In parenthesis 95% confidence interval
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CONCLUSION MS in outpatients with schizophrenia may be assessed by either the standard or the modified NCEP ATP III criteria without losing reliability.
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Acknowledgments Funding source: Pfizer España provided an unrestricted grant for this multicentre, cross-sectional study. Pfizer España contributed to and approved the study design and the final draft of the manuscript. A CRO was recruited by Pfizer España to conduct the study, including logistics, monitoring, data management, and statistical analysis. Pfizer España oversaw the entire study process.
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