The importance of diabetes mellitus (DM) as an independent risk factor for CHD is such that the most recent version of the NCEP guidelines has raised DM to the category of a disease equivalent in long-term risk for major coronary events to having established CHD (Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults 2001). Of greater concern is the fact that modest levels of glucose intolerance that do not fall into the diabetic range (fasting glucose 126 mg/dL or greater) can substantially increase the risk for CHD and coronary events. Data from a metaregression analysis of 20 published studies comprising 95,783 individuals followed for 12.4 years revealed that even modest glucose intolerance among nondiabetics (mean fasting glucose 110 mg/dL) increases risk of cardiovascular events 33% compared with those with fasting glucose of 75 mg/dL (Coutinho et al. 1999). A case-control study among nondiabetic Southeast Asians found that, compared to patients whose fasting glucose was under 81 mg/dL, patients with fasting glucose between 95

and 114 mg/dL had over three times the relative risk for MI (Gerstein et al. 1999). Studies employing other peripheral markers of glucose intolerance in nondiabetic patients reveal similar trends (Gerstein et al. 2001).

These data are profoundly concerning for two reasons: 1) The prevalence of DM among patients with schizophrenia is approximately twice that in the general population (Curkendall et al. 2001; Dixon et al. 2000); and 2) there is an association between the use of certain atypical antipsy-chotics, especially the dibenzodiazepine compounds clozapine and olan-zapine, and the development of glucose intolerance or new-onset DM during therapy, at times not associated with significant increases in weight (Haupt et al. 2001; Henderson et al. 2000; Mclntyre et al. 2001). Thus, the finding that patients on olanzapine may experience a 10 mg/dL increase in fasting glucose after one year of treatment implies a significant rise in cardiovascular risk (Meyer 2002). The greatest risk is achieved once the patient meets the criteria for diabetes, with long-term data indicating an incidence of new-onset DM in patients exposed to olanzapine or clozapine of 7% per year (Casey 2000; Henderson et al. 2000).

Delicious Diabetic Recipes

Delicious Diabetic Recipes

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