Serum Lipid Concentrations in Obsessive–Compulsive Disorder ...

Brief Communication
Serum Lipid Concentrations in Obsessive–Compulsive
Disorder Patients With and Without Panic Attacks
Mehmet Yucel Agargun, MD 1 , Haluk Dulger, MD, PhD 2 , Rifat Inci, MD 3 , Hayrettin Kara, MD 1 ,
Omer Akil Ozer, MD 4 , Mehmet Ramazan Sekeroglu, PhD 5 , Lutfullah Besiroglu, MD 4
Key Words: obsessive–compulsive disorder, biological markers, neurochemistry
Arelation between anxiety disorders and serum cholesterol
level has been noted in contemporary psychiatric
veterans with chronic PTSD (4). Consequently, it has been
hypothesized that increased catecholamine level or increased
literature since 1989 (1). Panic disorder patients have signifi- noradrenalin activity is related to lipoprotein lipase activity in
cantly higher serum cholesterol levels, compared with ageand
sex-matched normal control subjects (2,3). It can be
speculated that lipoprotein lipase is induced by increased
noradrenalin activity in panic disorder (2). This leads to a suggestion
that the elevated cholesterol level is associated with
increased autonomic arousal in panic disorder patients.
PTSD patients as well as in panic disorder patients. Recent
studies also report an association between increased cholesterol
level and generalized anxiety disorder and phobias
(5–7).
There are 3 studies of serum cholesterol level in patients with
obsessive–compulsive disorder (OCD). Freedman and others
found normal cholesterol levels in OCD (8), whereas Peter
An elevated serum cholesterol level was also found in and others (9) and Peter and others (10) reported increased
posttraumatic stress disorder (PTSD) patients. Recently, cholesterol values in OCD patients, compared with control
Kagan and others reported elevated lipid levels in Vietnam subjects. In our opinion, this issue needs further investigation.
776
Objective: To examine serum lipid levels in patients with obsessive–compulsive disorder
(OCD) and to test whether panic symptoms affect lipid concentrations in OCD patients.
Methods: We assessed 33 OCD patients and 33 healthy control subjects matched for sex
and age.
Results: OCD patients had higher low-density lipoprotein, very-low-density lipoprotein,
and tryglyceride levels, but lower high-density lipoprotein levels, than normal control
subjects. We also found that only OCD patients with panic attacks had higher serum lipid
concentrations, compared with normal control subjects. Serum lipid levels of pure OCD
patients did not differ from control values.
Conclusion: These findings suggest that high serum lipid concentrations are related to
panic anxiety rather than other symptoms of the illness.
(Can J Psychiatry 2004;49:776–778)
Information on author affiliations appears at the end of the article.
Clinical Implications
� Obsessive–compulsive disorder (OCD) patients have higher serum lipid concentrations than
do healthy control subjects.
� Panic attacks may predict alterations in serum lipid concentration in OCD patients.
� These findings may suggest that OCD patients are at risk for coronory artery disease.
Limitations
� The findings were from a relatively small group of patients.
� Depressive symptoms and aggressiveness were not assessed in the patients.
� We did not use an obssessive–compulsive scale to examine the relation between illness
severity and serum lipid levels.
� Can J Psychiatry, Vol 49, No 11, November 2004

Serum Lipid Concentrations in Obsessive–Compulsive Disorder Patients With and Without Panic Attacks
Table 1 Serum lipid levels across the groups
Serum lipids (mg daily)
OCD and
panic attack
(n = 20)
High-density lipoprotein, mean (SD) 37.1 (7.4) b
Panic attacks are also relatively frequent in OCD patients.
Thus there is a need to clarify whether a high serum cholesterol
level is associated with panic anxiety or whether serum
lipid concentrations are consistently high regardless of the
occurrence of panic attacks. In this study, we tested whether
panic symptoms affect serum lipid concentrations in OCD
patients.
Methods
We included 33 OCD patients and 33 healthy subjects in this
study. OCD patients were recruited from consecutively
presenting outpatients who sought psychiatric care at the Psychiatric
Outpatient Clinic of the Yuzuncu Yil University Hospital
in Van, Turkey. The patient and control groups were
matched for sex and age. For each group, there were 18 men
and 15 women. In each group, the subjects ranged in age from
18 to 57 years (mean 29.3, SD 9.5 years).
The OCD patient group was divided into 2 subgroups: OCD
patients with and without panic attacks. We used the Structured
Clinical Interview for DSM-IV Axis I Disorders–
ClinicianVersion (SCID-CV) (11) to establish OCD diagnosis
and the presence of panic attacks without panic disorder.
OCD patients with panic attacks were eligible for inclusion
when their panic attacks were associated with obsessions and
(or) compulsions. In other words, these subjects did not meet
DSM-IV Criterion D for panic disorder.
All participants had good physical health, as determined by
physical and laboratory examination, and no history of psychotic
disorders or current substance abuse. No OCD patients
were treated with antidepressants or benzodiazepines during
the study. We allowed a washout period of at least 2 weeks for
psychotropic drugs before blood was collected. The control
subjects were also drug-free during the study.
We obtained the subjects’ written informed consent to participate
in this study after the procedure(s) had been fully
explained. All were requested to avoid medication affecting
lipid levels (for example beta blockers, diuretics, androgens,
estrogens, disulfiram, corticosteroids, levodopa, and aminosalycylic
acid) for at least 2 weeks. All subjects abstained
from a cholesterol-lowering diet. Blood samples were drawn
after a night of fasting. Venipuncture was done in a sitting
position with a tourniquet. Blood was then centrifuged at
Pure OCD
(n = 13)
Healthy
control subjects
(n = 33)
42.6 (10.3) 48.2 (12.3) 4.6 0.014
Low-density lipoprotein, mean (SD) 89.3 (25.3) 83.5 (14.2) 98.4 (25.9) 1.47 0.28
Very-low-density lipoprotein, mean (SD) 35.1 (22.2) b
24.5 (16.1) 22.4 (7.7) 3.67 0.032
Total cholesterol, mean (SD) 173.6 (39.8) 155.9 (29.2) 168.6 (20.7) 1.47 0.23
Triglyseride, mean (SD) 158.1 (93.5) b
129.4 (79.4) 111.8 (38.8) 2.98 0.05
A analysis of variance
b post hoc Bonferroni test; OCD and panic attack vs normal control subjects; P < 0.05
OCD = obsessive–compulsive disorder
1000 g for 1 minute in a refrigerated centrifuge, and the serum
samples were separated from the cells. We determined total
cholesterol, triglyceride, and high-density lipoprotein (HDL)
levels in the serum, using commercially available kits (Roche
Diagnostic GmbH, Mannheim, Germany) on a Hitachi 747
autoanalyzer (Hitachi Ltd, Tokyo, Japan). An enzymatic
colorimetric method was used to determine total cholesterol
and triglyceride. We used the direct HDL cholesterol method
to measure HDL. Low-density lipoprotein (LDL) was calculated
according to the Friedewald formula (12).
We used the statistical Package for the Social Sciences (SPSS)
for Windows version 9.01 (13) to perform analyses. Group
data were analyzed using Student’s t test and one-way
analysis of variance (ANOVA). We used the post hoc
Bonferroni test to carry out post hoc comparisons of patient
and normal subject means.
Results
There was a significant difference between OCD patients and
normal control subjects in serum HDL, very-low-density
lipoprotein (VLDL), and tryglyceride levels. HDL level was
lower in OCD patients than in normal control subjects (mean
39.3, SD 8.8 vs mean 48.2, SD 12.2; t = 2.84, P = 0.006).
Conversely, VLDL and tryglyceride levels were higher (mean
29.4, SD 19.7 vs mean 26.2, SD 7.1; t = 2.04, P = 0.047 and
mean 154.6, SD 87.1 vs mean 130.1 SD 36.2; t = 2.38, P =
0.043, respectively). Total cholesterol level did not differ
between the groups (mean 164.4 SD 37.6 vs mean 173.6 SD
15.5; t = 1.02, P = 0.31).
As a second step, we classified OCD patients into 2 subgroups:
those who had panic attacks (at least 4 monthly) and
those who never had panic attacks during their illness. Table 1
shows serum tryglyceride, total cholesterol, HDL, LDL, and
VLDL levels across the groups. When we compared OCD
patients with and without panic attacks and normal control
subjects, we found a significant difference across the groups
in HDL, VLDL, and tryglyceride levels. Post hoc comparison
with the Bonferroni test revealed that significant differences
in HDL, VLDL, and tryglyceride levels exist only between
OCD patients with panic attacks and normal control subjects.
Interestingly, OCD patients without panic attacks did not differ
from normal control subjects.
Can J Psychiatry, Vol 49, No 11, November 2004 � 777
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The Canadian Journal of Psychiatry—Brief Communication
Discussion
In this study, we found that OCD patients had higher LDL,
VLDL, and tryglyceride levels, but lower HDL levels, than
normal control subjects. These findings replicate Peter and
others’ (9) and Peter and others’ (10) reports. It may be suggested
that OCD patients are at risk for coronory artery
disease.
In our second analysis, we found that only OCD patients with
panic attacks had higher serum lipid concentrations when
compared with normal control subjects. Serum lipid levels of
pure OCD patients did not differ from control values. There
has been much interest in the clinical and biological overlap of
panic disorder and OCD (14). The present study suggests that
the presence of panic symptoms is associated with high lipid
levels in OCD patients. In a recent study, we suggested that a
low serum cholesterol level might serve as a biological marker
of major depression in patients with panic disorder (15). Similarly,
panic attacks may predict alterations in serum lipid concentration
in OCD patients. A limitation of the present study is
that we did not assess depressive symptoms and aggressiveness
in our patients. Future research should focus on the effect
of depressive comorbidity and aggressive behaviours on
serum lipid alterations in OCD patients.
References
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Manuscript received September 2003, revised, and accepted January 2004.
1 Professor of Psychiatry, Yuzuncu Yil University School of Medicine
Department of Psychiatry, Van, Turkey.
2 Assistant Professor of Biochemistry, Yuzuncu Yil University School of
Medicine Department of Biochemistry, Van, Turkey.
3 Psychiatry Resident, Yuzuncu Yil University School of Medicine
Department of Psychiatry, Van, Turkey.
4 Assistant Professor of Psychiatry, Yuzuncu Yil University School of
Medicine Department of Psychiatry, Van, Turkey.
5 Professor of Biochemistry, Yuzuncu Yil University School of Medicine
Department of Biochemistry, Van, Turkey.
Address for correspondence: Dr MY Agargun, Yuzuncu Yil University,
School of Medicine, Department of Psychiatry and Neuroscience Research
Center Van 65200, Turkey
e-mail: myagargun@kure.com.tr
Résumé : Concentrations de lipide sérique chez les patients souffrant du trouble
obsessionnel-compulsif avec et sans crises de panique
Objectif : Examiner les niveaux de lipide sérique chez les patients souffrant du trouble
obsessionnel-compulsif (TOC) et vérifier si les symptômes de panique influent sur les concentrations
de lipide sérique chez les patients souffrant du TOC.
Méthodes : Nous avons évalué 33 patients souffrant du TOC et 33 sujets témoins en santé assortis
selon l’âge et le sexe.
Résultats : Les patients souffrant du TOC avaient des niveaux plus élevés de lipoprotéines de basse
densité, de lipoprotéines de très faible densité et de triglycérides, mais des niveaux plus faibles de
lipoprotéines de haute densité que les sujets témoins normaux. Nous avons également constaté que
seuls les patients souffrant du TOC avec crises de panique avaient des concentrations de lipide sérique
plus élevées, comparativement aux sujets témoins normaux. Les niveaux de lipide sérique des patients
souffrant seulement du TOC ne différaient pas des valeurs témoins.
Conclusion : Ces résultats indiquent que les concentrations élevées de liquide sérique sont reliées à
l’anxiété panique plutôt qu’à d’autres symptômes de la maladie.
� Can J Psychiatry, Vol 49, No 11, November 2004