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OBJECTIVE: Patients with serious mental illnesses such as schizophrenia and bipolar disorder have a 25- to 30-year shorter life span, and the main reason of increased risks of morbidity and mortality is cardiovascular disease (CVD) and stroke compared to the general population1-2. Epidemiologic investigations suggest that these patients have an increased prevalence of cardiometabolic risk factors, such as overweight and obesity, dyslipidemia, diabetes, hypertension, and smoking. Treatment with second-generation (atypical) antipsychotic medication can also be associated with adverse metabolic effects. Some of them are associated with substantial weight gain and adverse metabolic effects, while others have less prominent effects on these aspects. Arterial stiffness has been identified as an independent risk factor for atherosclerosis and cardiovascular disease. Several indices have been developed to characterize arterial stiffness, of which pulse wave velocity (PWV) is the most recognized and established index3 , because it is very evidential and measurable by commercially available devices. The parameter of real spreading of the pulse wave in the arterial system is pulse wave velocity (PWV) or pulse transit time (PTT), related according to PWV=L / PTT. L is the longitudinal distance of two points between which the velocity is measured. The PWV and PTT increase as large arteries stiffen with age or disease processes. In this paper we examine the vascular indices as PWV, PTT (Pulse Transit Time) in patients with schizophrenia and bipolar disorder who widely use antipsychotics that are known to be associated with adverse weight and metabolic effects.
MATERIAL AND METHODS: Patients with diagnosis of schizophrenia or bipolar disorder judged to be clinically stable on treatment with oral quetiapine (QUET n=16), risperidone (RISP n=13), olanzapine (OLZ n=15) and aripiprazole (ARP n=13) for at least 6 months and controls (n=40) were recruited into the study. Mean upper limb vascular indices (PWV, PTT), pulse rate, SDB (systolic blood pressure), and DBP (diastolic blood pressure) were compared by Independent sample test in all patients and medicine groups and were also compared to the control group. The pulse waves were recorded via a pulse oximeter transducer using the Neuro-MEP-Micro (v.2009) electromyography device (Neurosoft Medical diagnostic equipment, Ivanovo, Russia), in supine resting condition. The distance between the sternal notch and the index finger pulp was measured in meters. The upper limb pulse wave velocity was calculated by dividing distance by pulse transit time.
RESULTS: The subjects in the psychiatric disorders group had a mixture of diagnoses as follows: schizophrenia (n=18) and bipolar disorder (n=39).The differences between the age and gender compositions of the patient and control groups were not significant (p>0.05). Most of the patients’ (n=50) FRS score were in Group 1, 4 of them were in group 2, and 1 of them was in group3 . Pulse rate, SBP, DBP, and PWV were higher, RRI (R-R Interval) was lower in the all patient group than in controls (p≤0.05). Pulse rate was higher in drug groups except ARP group, HDL cholesterol and SBP were higher in RISP group, total cholesterol was higher in QUET group, DBP was higher in all drug groups. PWV was higher in all medication groups but statistically significant in QUET and OLZ groups. (p≤ 0.05).
CONCLUSIONS: The presence of psychiatric diagnoses and use of atypical antipsychotic drugs is associated with changed vascular indices. Measuring arterial stiffness using the PWV values is a noninvasive, cheap and easy-to-apply clinical approach to determine early vascular changes in this group of patients and may be an important surrogate marker to assess subclinical atherosclerosis and the worsening of arteriosclerosis during treatment in psychiatric patients.