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A hypothesized mechanism for the cardiovascular risk associated with antipsychotic drug exposure and a potential preventive treatment

Molecular Psychiatry volume 19, pages 12–13 (2014)Cite this article

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To help identify effective interventions to limit the cardiovascular side effects of antipsychotics, a three-part hypothesis is described: (1) risk factors for heart disease correlated with antipsychotic drug treatment require an intervention that targets the antipsychotic-related mechanism of risk; (2) antipsychotic drugs cause weight gain and dyslipidemia at least in part via upregulation of the SREBP transcription factor in the liver and the genes under its control; and (3) Chinese herbal remedies that downregulate SREBP can limit weight gain and dyslipidemia caused by antipsychotics and prevent progression of coronary artery disease.

Antipsychotic drugs increase risk for type 2 diabetes and heart disease. Heart disease is the reason why most individuals with schizophrenia live short lives. Life expectancy is reduced by an average of 15 years and 50–75% of individuals with schizophrenia die from coronary heart disease. Drug-switching trials have confirmed a causal relationship between commonly prescribed antipsychotic drugs (olanzapine, quetiapine or risperidone) and weight gain and dyslipidemia. Both are important risk factors for type 2 diabetes and heart disease. Cognitive-behavioural and psycho-educational interventions to control weight gain in those treated with antipsychotics have shown a modest short-term effect equivalent to a mean 3% change in body weight—not enough to significantly improve cardiovascular health—and not sustained at 1-year follow-up.1 Cardiovascular risk factors that are changed by exposure to antipsychotics may therefore require interventions that target treatment-related mechanisms of risk if we are to change key physical health outcomes of treated psychosis.

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  1. Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia

    D L Foley

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  1. D L Foley
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Correspondence to D L Foley.

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Foley, D. A hypothesized mechanism for the cardiovascular risk associated with antipsychotic drug exposure and a potential preventive treatment. Mol Psychiatry 19, 12–13 (2014). https://doi.org/10.1038/mp.2012.175

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