Brief Communication
Serum Lipid Concentrations in Obsessive–Compulsive
Disorder Patients With and Without Panic Attacks
Mehmet Yucel Agargun, MD1, Haluk Dulger, MD, PhD2, Rifat Inci, MD3, Hayrettin Kara, MD1,
Omer Akil Ozer, MD4, Mehmet Ramazan Sekeroglu, PhD5, Lutfullah Besiroglu, MD4
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.
Key Words: obsessive–compulsive disorder, biological markers, neurochemistry
A relation between anxiety disorders and serum choles- veterans with chronic PTSD (4). Consequently, it has been
terol level has been noted in contemporary psychiatric
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 age-
PTSD patients as well as in panic disorder patients. Recent
studies also report an association between increased choles-
and sex-matched normal control subjects (2,3). It can be
terol level and generalized anxiety disorder and phobias
speculated that lipoprotein lipase is induced by increased
(5–7).
noradrenalin activity in panic disorder (2). This leads to a sug-
gestion that the elevated cholesterol level is associated with
There are 3 studies of serum cholesterol level in patients with
increased autonomic arousal in panic disorder patients.
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.
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Serum Lipid Concentrations in Obsessive–Compulsive Disorder Patients With and Without Panic Attacks
Table 1 Serum lipid levels across the groups
OCD and
Healthy
Fa
P
Serum lipids (mg daily)
panic attack
Pure OCD
control subjects
(n = 20)
(n = 13)
(n = 33)
High-density lipoprotein, mean (SD)
37.1 (7.4)b
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
Aanalysis of variance
bpost hoc Bonferroni test; OCD and panic attack vs normal control subjects; P < 0.05
OCD = obsessive–compulsive disorder
Panic attacks are also relatively frequent in OCD patients.
1000 g for 1 minute in a refrigerated centrifuge, and the serum
Thus there is a need to clarify whether a high serum choles-
samples were separated from the cells. We determined total
terol level is associated with panic anxiety or whether serum
cholesterol, triglyceride, and high-density lipoprotein (HDL)
lipid concentrations are consistently high regardless of the
levels in the serum, using commercially available kits (Roche
occurrence of panic attacks. In this study, we tested whether
Diagnostic GmbH, Mannheim, Germany) on a Hitachi 747
panic symptoms affect serum lipid concentrations in OCD
autoanalyzer (Hitachi Ltd, Tokyo, Japan). An enzymatic
patients.
colorimetric method was used to determine total cholesterol
and triglyceride. We used the direct HDL cholesterol method
Methods
to measure HDL. Low-density lipoprotein (LDL) was calcu-
We included 33 OCD patients and 33 healthy subjects in this
lated according to the Friedewald formula (12).
study. OCD patients were recruited from consecutively
We used the statistical Package for the Social Sciences (SPSS)
presenting outpatients who sought psychiatric care at the Psy-
for Windows version 9.01 (13) to perform analyses. Group
chiatric Outpatient Clinic of the Yuzuncu Yil University Hos-
data were analyzed using Student’s t test and one-way
pital in Van, Turkey. The patient and control groups were
analysis of variance (ANOVA). We used the post hoc
matched for sex and age. For each group, there were 18 men
Bonferroni test to carry out post hoc comparisons of patient
and 15 women. In each group, the subjects ranged in age from
and normal subject means.
18 to 57 years (mean 29.3, SD 9.5 years).
The OCD patient group was divided into 2 subgroups: OCD
Results
patients with and without panic attacks. We used the Struc-
There was a significant difference between OCD patients and
tured Clinical Interview for DSM-IV Axis I Disorders–
normal control subjects in serum HDL, very-low-density
ClinicianVersion (SCID-CV) (11) to establish OCD diagno-
lipoprotein (VLDL), and tryglyceride levels. HDL level was
sis and the presence of panic attacks without panic disorder.
lower in OCD patients than in normal control subjects (mean
OCD patients with panic attacks were eligible for inclusion
39.3, SD 8.8 vs mean 48.2, SD 12.2; t = 2.84, P = 0.006).
when their panic attacks were associated with obsessions and
Conversely, VLDL and tryglyceride levels were higher (mean
(or) compulsions. In other words, these subjects did not meet
29.4, SD 19.7 vs mean 26.2, SD 7.1; t = 2.04, P = 0.047 and
DSM-IV Criterion D for panic disorder.
mean 154.6, SD 87.1 vs mean 130.1 SD 36.2; t = 2.38, P =
All participants had good physical health, as determined by
0.043, respectively). Total cholesterol level did not differ
physical and laboratory examination, and no history of psy-
between the groups (mean 164.4 SD 37.6 vs mean 173.6 SD
chotic disorders or current substance abuse. No OCD patients
15.5; t = 1.02, P = 0.31).
were treated with antidepressants or benzodiazepines during
As a second step, we classified OCD patients into 2 sub-
the study. We allowed a washout period of at least 2 weeks for
groups: those who had panic attacks (at least 4 monthly) and
psychotropic drugs before blood was collected. The control
those who never had panic attacks during their illness. Table 1
subjects were also drug-free during the study.
shows serum tryglyceride, total cholesterol, HDL, LDL, and
We obtained the subjects’ written informed consent to partici-
VLDL levels across the groups. When we compared OCD
pate in this study after the procedure(s) had been fully
patients with and without panic attacks and normal control
explained. All were requested to avoid medication affecting
subjects, we found a significant difference across the groups
lipid levels (for example beta blockers, diuretics, androgens,
in HDL, VLDL, and tryglyceride levels. Post hoc comparison
estrogens, disulfiram, corticosteroids, levodopa, and amino-
with the Bonferroni test revealed that significant differences
salycylic acid) for at least 2 weeks. All subjects abstained
in HDL, VLDL, and tryglyceride levels exist only between
from a cholesterol-lowering diet. Blood samples were drawn
OCD patients with panic attacks and normal control subjects.
after a night of fasting. Venipuncture was done in a sitting
Interestingly, OCD patients without panic attacks did not dif-
position with a tourniquet. Blood was then centrifuged at
fer from normal control subjects.
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The Canadian Journal of Psychiatry—Brief Communication
Discussion
6. Peter H, Goebel PN, Müller S, Hand I. Clinically relevant cholesterol elevation
in anxiety disorders: a comparison with normal controls. Int J Behav Med
In this study, we found that OCD patients had higher LDL,
1999;6:30 –9.
VLDL, and tryglyceride levels, but lower HDL levels, than
7. Sevincok L, Buyukozturk A, Dereboy F. Serum lipid concentrations in patients
normal control subjects. These findings replicate Peter and
with comorbid generalized anxiety disorder and major depressive disorder. Can J
Psychiatry 2001;46:68 –71.
others’ (9) and Peter and others’ (10) reports. It may be sug-
8. Freedman DS, Byers T, Barrett DH, Stroup NE, Eaker E, Monroe-Blum H.
gested that OCD patients are at risk for coronory artery
Plasma lipid levels and psychological characteristics in men. Am J Epidemiol
disease.
1995;141:507–17.
9. Peter H, Hand I, Hohagen F, Koenig A, Mindermann O, Oeder F, and others.
In our second analysis, we found that only OCD patients with
Serum cholesterol level comparison: control subjects, anxiety disorder patients,
panic attacks had higher serum lipid concentrations when
and obsessive–compulsive disorder patients. Can J Psychiatry 2002;47:557– 61.
compared with normal control subjects. Serum lipid levels of
10. Peter H, Tabrizian S, Hand I. Serum cholesterol in patients with
obsessive–compulsive disorder during treatment with behaviour therapy and
pure OCD patients did not differ from control values. There
SSRI versus placebo. Int J Psychiatry Med 2000;30:27–39.
has been much interest in the clinical and biological overlap of
11. First MB, Spitzer RL, Gibbon M, Williams JBW. Structured Clinical Interview
panic disorder and OCD (14). The present study suggests that
for DSM-IVAxis I Disorders-Clinician Version (SCID-CV).Washington (DC):
the presence of panic symptoms is associated with high lipid
American Psychiatric Press; 1997.
12. Friedewald WT, Levy RI, Fredricskon DS. Estimation of the concentration of the
levels in OCD patients. In a recent study, we suggested that a
low-density lipoprotein cholesterol in plasma, without use of the preparative
low serum cholesterol level might serve as a biological marker
ultracentrifuge. Clin Chem 1972;18:499–502.
of major depression in patients with panic disorder (15). Simi-
13. SPSS Inc. SPSS for Windows. Version 9.01. Chicago (IL): SPSS Inc; 1999.
larly, panic attacks may predict alterations in serum lipid con-
14. Agargun MY, Kara H, Alpkan L, Ucisik M. Obsessive-compulsive symptoms in
centration in OCD patients. A limitation of the present study is
panic disorder. Eur Psychiatry 1996;11:207–8.
that we did not assess depressive symptoms and aggressive-
15. Agargun MY, Algün E, Ôekero?lu R, Kara H, Tarakçio?lu M. Low cholesterol
level in patients with panic disorder: the association with major depression. J
ness in our patients. Future research should focus on the effect
Affect Disord 1998;50:29-32.
of depressive comorbidity and aggressive behaviours on
serum lipid alterations in OCD patients.
Manuscript received September 2003, revised, and accepted January 2004.
1 Professor of Psychiatry, Yuzuncu Yil University School of Medicine
References
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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.
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