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TOPLINE:

Use of psychotropic medication was associated with significantly higher BMI than nonuse, new research showed. Among psychotropic users, those with a high polygenic score for BMI (PGS-BMI) and an unhealthy lifestyle had more than triple the risk for cardiovascular disease (CVD) compared with nonusers with a low PGS-BMI and healthy lifestyle. Interestingly, investigators reported that a psychiatric diagnosis may have mediated the association between psychotropics and CVD risk.

METHODOLOGY:

• Researchers analyzed data for nearly 497,000 participants in the UK Biobank cohort study (mean age, 56.5 years; 54% women).
• They examined associations of increased BMI and incident CVD with the use of psychotropic medications (antipsychotics, antidepressants, and mood stabilizers); low-to-high PGS-BMI; and healthy, moderately healthy, and unhealthy lifestyle behaviors.
• Participants were followed from baseline (2006-2010) until the first diagnosis of CVD, death, or January 26, 2021, whichever occurred first.
• Psychiatric diagnoses were identified from hospital records, and the analysis was adjusted for age, sex, and 10 genetic principal components.

TAKEAWAY:

• Use of any psychotropic medication was associated with a 5.42% higher BMI than nonuse (P < 2.2 × 10^-308), with antidepressants and antipsychotics showing comparable associations (5.43% and 5.40% increases in BMI, respectively).
• Among psychotropic users, intermediate and unhealthy lifestyles were linked to a higher risk for CVD than a healthy lifestyle (hazard ratios [HRs], 1.20 and 1.69, respectively), and high and intermediate PGS-BMIs were associated with a higher CVD risk than a low PGS-BMI (HRs, 1.35 and 1.16).
• Psychotropic users with both a high PGS-BMI and an unhealthy lifestyle had the highest risk for CVD (HR, 3.33), whereas those with a low PGS-BMI and healthy lifestyle had the lowest risk.
• In participants with a psychiatric diagnosis, the use of psychotropic medications was not linked to increased risk for CVD compared with nonuse.

IN PRACTICE:

“To our knowledge, no study had explored relationships between a range of psychotropics, lifestyle factors, genetic risk, and CVD incidence or BMI in a study population of this magnitude,” the investigators wrote.

“Future studies may elucidate causal relationships in more culturally diverse study populations, additionally including CVD markers (such as hypertension and dyslipidemia), clinically validated psychiatric diagnoses, lifetime exposure to psychotropic medication use, and dosages,” they added.

SOURCE:

The study was led by Nini de Boer, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, Netherlands. It was published online on May 6 in Nature Mental Health.

LIMITATIONS:

Too few participants of diverse ancestries were available to run trans-ancestry analyses of genetic risk, limiting generalizability. Follow-up data were also missing on certain clinical characteristics, and most participants using psychotropics had no psychiatric diagnosis, possibly due to unrecorded mental illness or use of low-dose psychotropics for other conditions. Additionally, lifestyle factors were self-reported, which may have introduced recall bias.

DISCLOSURES:

Funding information was not provided for the study. Disclosure information for the study investigators is available in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.