Our analysis suggests that this is a population with high rates of comorbidities, both mental and physical. The high number of patients under antidepressant treatment might indicate an increased prevalence of depression, which is a phenomenon often observed in samples of patients with schizophrenia.19
The high prevalence of tobacco smoking and sedentariness, despite also being frequent among those patients, raises serious concerns, since both habits are implicated in increased risk for CVDs. In fact, we found a high prevalence of several other risk factors for CVDs in our sample, including a large number of overweight patients, inadequate lipid profiles, and high levels of fasting blood glucose. Such increased prevalence of risk factors for CVDs is highlighted when contrasted with findings from the healthy Brazilian population, as described in a large epidemiologic study.20
In this sample, the prevalence of obesity was 11.3% among men and 11.2% among women, whereas in our sample, such proportions were 29.7% and 35.3%. Also, the prevalence of dyslipidemia was 16.5%, whereas in our sample, its prevalence was 73.2%.
This significant increase in risk factors was also found in a similar population in Brazil, in a study conducted by the Federal University of Rio Grande do Sul, Porto Alegre, Brazil.21
Another Brazilian study also addressed the prevalence of metabolic disorders among patients with psychiatric disorders and showed elevated rates of this condition (31.8% in schizophrenic disorder, 38.3% in bipolar disorders, and 48.1% in depression), though neither the psychiatric diagnosis nor the use of antipsychotics was associated with metabolic syndrome after logistic regression analysis, which was probably due to the small sample size.22
Patients on different types of antipsychotics showed no difference regarding metabolic risk, nor with the use of polypharmacy, as suggested by other studies.23
The nonsignificant lower levels of LDL seen in patients using polypharmacy in comparison with the FGA patients (P
= 0.07) might be explained by patients with polypharmacy having a more severe form of the disorder in comparison with patients with FGAs, which might imply more-frequent clinical appointments and evaluations, hence more attention and lifestyle counseling (diet, exercises, etc), and thus decreased risk factors for CVDs.
Although worse lipid profiles were associated with patient age, which is expected in the general population,24
the duration of the disorder was not associated with different lipid profiles or BMI. Some studies have revealed that the metabolic alterations due to use of antipsychotics (especially lipid profile changes and weight gain) occur in a matter of months, reaching a plateau after approximately 9 months of use.25
Concerning the analysis of an early event in a sample of chronically ill patients, it comes as no surprise that we found no association between metabolic parameters and duration of the disorder. Nevertheless, it is clear that the exposure to antipsychotic medications is a risk, in this population, for development of metabolic disorders at a very early stage, resulting in a large population of individuals chronically exposed to several risk factors for CVDs and other diseases.27
It is important to notice that only a small proportion of patients in our sample was under pharmacological treatment for physical diseases, which, given the high prevalence of metabolic disorders and increased risk for CVDs, suggests poor access to medical or health care and/or poor compliance with treatment. This phenomenon is extensively described in the scientific literature as a worldwide problem concerning patients with schizophrenia.2
The main limitation of our study is its cross-sectional design, which did not allow any conclusions regarding causal effects of the variables analyzed. Furthermore, we did not include a control group, and some variables had only a few subjects allocated, such as “physically active” or “pharmacological medical treatment,” making the analysis difficult. A better investigation on the matter might be done by choosing the sample and controlling it using physical activities as a parameter, as was done in other studies with positive results.30
However, we believe that the naturalistic nature of the present study and the relatively large sample might create a reliable portrait of the population of outpatients under treatment, revealing a high prevalence of cardiovascular risk factors, physical comorbidities, and the need for clinical assessment and liaison with the general practitioner for adequate clinical treatment. This reinforces the results found in the study by Leitão-Azevedo et al.21