Abstract: Background: Latest studies in patients with first episode psychosis (FEP) have shown alter-ations in cardiovascular, immune and endocrinological systems. These findings could indicatea systemic onset alteration in the metabolic disease as opposed to justifying these findingsexclusively by antipsychotics' side effects and long-term lifestyle consequences. In any case,this population is considered at higher risk for developing cardiometabolic disorders than theirage-matched peers.Methods: This is a prospective longitudinal study. Metabolic syndrome (MetS) prevalencebetween 244 subjects with FEP and 166 controls at 3 years was compared. Additionally, weexplored whether baseline differences in any of the MetS components according to AdultTreatment Panel III definition and prescribed antipsychotic could help to predict the MetSdevelopment at 3 years. Results: Patients with FEP present a similar baseline prevalence of MetS (6.6% vs 5.4%,p = 0.320), according to ATP-III criteria. but with a higher prevalence of metabolic alterationsthan controls before the start of antipsychotic treatment. At 3-years follow-up the MetS preva-lence had increased from 6.6% to 18.3% in the FEP group, while only from 5.4% to 8.1% in thecontrol group. The multivariate model showed that, before antipsychotic exposure, a base-line altered waist circumference WC (OR = 1.1, p = 0.011), triglycerides (OR = 1.1, p = 0.043) andhigh-density lipoprotein HDL (OR = 0.9, p = 0.008) significantly predicted the presence of MetSat 3-years. We propose a predictive model of MetS at 3 years in 244 drug-naïve FEP patients.Conclusion: We found that altered WC, HDL and triglycerides at baseline predicted the presenceof full MetS after 3-years of initiating antipsychotic treatment. Our findings support the needfor interventions to improve factors related to the physical health of FEP individuals.

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