In the Journals

Tourette syndrome, chronic tic disorder increase risk for cardiometabolic disorders

Patients with Tourette syndrome and chronic tic disorder have an increased risk for CV and metabolic disorders, according to a study published in JAMA Neurology.

“The results expand our understanding of the broader health consequences of [Tourette syndrome] and [chronic tic disorder] and have direct implications across health services, including neurology, pediatrics, psychiatry and primary care,” Gustaf Brander, MSc, graduate student at Karolinska Institutet in Stockholm, and colleagues wrote.

Swedish registries

Researchers analyzed data from 14,045,026 patients who lived in Sweden between 1973 and 2013. Information that was assessed included lifetime comorbid psychiatric diagnoses and antipsychotic drugs. CV or metabolic disorders were defined either through diagnoses in a registry or codes for dispensed drugs.

Patients were followed up from birth or 1973 until emigration, death, Dec. 31, 2013, or the date of the outcomes of interest, including CV or metabolic disorders, whichever came first.

During a mean follow-up of 22.2 years, 7,804 patients were diagnosed with Tourette syndrome or chronic tic disorder (median age at first diagnosis, 13.3 years; 76% men). In addition, of the 2,675,482 families with at least two singleton children, 5,141 had clusters of siblings who were discordant for chronic tic disorder or Tourette syndrome.

Compared with the general population, those with Tourette syndrome or chronic tic disorder had an increased risk for cardiometabolic disorder (adjusted HR = 1.99; 95% CI, 1.9-2.09). This was also seen when compared with sibling controls (aHR = 1.37; 95% CI, 1.24-1.51).

Patients with Tourette syndrome or chronic tic disorder had increased risks for type 2 diabetes (aHR = 1.67; 95% CI, 1.42-1.96), obesity (aHR = 2.76; 95% CI, 2.47-3.09) and circulatory system diseases (aHR = 1.76; 95% CI, 1.67-1.86). Compared with women, men had increased risks for any cardiometabolic disorder (aHR = 2.13; 95% CI, 2.01-2.26 vs. aHR = 1.79; 95% CI, 1.64-1.96) and obesity (aHR = 3.24; 95% CI, 2.83-3.7 vs. aHR = 1.97; 95% CI, 1.59-2.44).

Timing of increased risk

The increased risk for any cardiometabolic disorder in patients with Tourette syndrome or chronic tic disorder was significant in childhood at approximately aged 8 years. This risk was significantly reduced aside from patients with comorbid ADHD (aHR = 1.52; 95% CI, 1.42-1.62). The exclusion of other comorbidities did not significantly alter the results.

A significantly increased risk for CV and metabolic disorders were not seen in patients who were treated with antipsychotic medication for up to 1 year (aHR = 0.83; 95% CI, 0.56-1.24). Use of these medications for more than 1 year significantly decreased the risk for CV and metabolic disorders (aHR = 0.27; 95% CI, 0.17-0.43).

“Because this is an observational study, we are careful not to ascribe the reduction of the risk to the medication itself,” Brander and colleagues wrote. “Patients taking medication may represent an inherently different group than those who are not taking medication. Furthermore, patients seen in specialist services are more likely to have frequent follow-ups and receive closer monitoring of their general health. Thus, the findings might mostly reflect the indirect effects of greater medical vigilance. Our results should not be taken as evidence that antipsychotics are free from cardiometabolic adverse effects, and they should continue to be used with caution in this patient group.” – by Darlene Dobkowski

Disclosures: Brander reports he received grants from the Karolinska Institutet PhD stipend outside of the submitted work. Please see the study for all other authors’ relevant financial disclosures.

Patients with Tourette syndrome and chronic tic disorder have an increased risk for CV and metabolic disorders, according to a study published in JAMA Neurology.

“The results expand our understanding of the broader health consequences of [Tourette syndrome] and [chronic tic disorder] and have direct implications across health services, including neurology, pediatrics, psychiatry and primary care,” Gustaf Brander, MSc, graduate student at Karolinska Institutet in Stockholm, and colleagues wrote.

Swedish registries

Researchers analyzed data from 14,045,026 patients who lived in Sweden between 1973 and 2013. Information that was assessed included lifetime comorbid psychiatric diagnoses and antipsychotic drugs. CV or metabolic disorders were defined either through diagnoses in a registry or codes for dispensed drugs.

Patients were followed up from birth or 1973 until emigration, death, Dec. 31, 2013, or the date of the outcomes of interest, including CV or metabolic disorders, whichever came first.

During a mean follow-up of 22.2 years, 7,804 patients were diagnosed with Tourette syndrome or chronic tic disorder (median age at first diagnosis, 13.3 years; 76% men). In addition, of the 2,675,482 families with at least two singleton children, 5,141 had clusters of siblings who were discordant for chronic tic disorder or Tourette syndrome.

Compared with the general population, those with Tourette syndrome or chronic tic disorder had an increased risk for cardiometabolic disorder (adjusted HR = 1.99; 95% CI, 1.9-2.09). This was also seen when compared with sibling controls (aHR = 1.37; 95% CI, 1.24-1.51).

Patients with Tourette syndrome or chronic tic disorder had increased risks for type 2 diabetes (aHR = 1.67; 95% CI, 1.42-1.96), obesity (aHR = 2.76; 95% CI, 2.47-3.09) and circulatory system diseases (aHR = 1.76; 95% CI, 1.67-1.86). Compared with women, men had increased risks for any cardiometabolic disorder (aHR = 2.13; 95% CI, 2.01-2.26 vs. aHR = 1.79; 95% CI, 1.64-1.96) and obesity (aHR = 3.24; 95% CI, 2.83-3.7 vs. aHR = 1.97; 95% CI, 1.59-2.44).

Timing of increased risk

The increased risk for any cardiometabolic disorder in patients with Tourette syndrome or chronic tic disorder was significant in childhood at approximately aged 8 years. This risk was significantly reduced aside from patients with comorbid ADHD (aHR = 1.52; 95% CI, 1.42-1.62). The exclusion of other comorbidities did not significantly alter the results.

A significantly increased risk for CV and metabolic disorders were not seen in patients who were treated with antipsychotic medication for up to 1 year (aHR = 0.83; 95% CI, 0.56-1.24). Use of these medications for more than 1 year significantly decreased the risk for CV and metabolic disorders (aHR = 0.27; 95% CI, 0.17-0.43).

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“Because this is an observational study, we are careful not to ascribe the reduction of the risk to the medication itself,” Brander and colleagues wrote. “Patients taking medication may represent an inherently different group than those who are not taking medication. Furthermore, patients seen in specialist services are more likely to have frequent follow-ups and receive closer monitoring of their general health. Thus, the findings might mostly reflect the indirect effects of greater medical vigilance. Our results should not be taken as evidence that antipsychotics are free from cardiometabolic adverse effects, and they should continue to be used with caution in this patient group.” – by Darlene Dobkowski

Disclosures: Brander reports he received grants from the Karolinska Institutet PhD stipend outside of the submitted work. Please see the study for all other authors’ relevant financial disclosures.