Treatment of the dyslipidemia of insulin resistance

The relationship between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and hyperuricaemia

PURPOSE

The ratio of non-high-density lipoprotein cholesterol (non-HDL-c) to high-density lipoprotein cholesterol (HDL-c) (NHHR) is a novel comprehensive lipid index. The aim of this study was to investigate the relationship between the NHHR and the prevalence of hyperuricaemia (HUA) in the adult population of the U.S.

METHODS

This cross-sectional study collected data from the National Health and Nutrition Examination Survey (NHANES) (2007-2018). HUA was defined as a serum uric acid (SUA) concentration ≥ 7 mg/dL in men and ≥ 6 mg/dL in women. Multivariate logistic regression models and the restricted cubic spline (RCS) method were applied to examine the relationship between the NHHR and the risk of developing HUA. Subgroup analyses and interaction tests were also performed.

RESULTS

The prevalence of HUA increased with increasing NHHR values (9.01% vs. 13.38% vs. 17.31% vs. 25.79%, P < 0.001). The NHHR was independently correlated with the risk of developing HUA (OR = 1.10, 95% CI: 1.05-1.16; P < 0.001). Furthermore, the risk of developing HUA was significantly greater among individuals with the highest NHHR quartile than among those with the lowest NHHR quartile (OR = 1.94, 95% CI: 1.62-2.33; P < 0.001). This relationship was consistent across subgroups. According to the RCS analysis, an inverted U-shaped relationship existed between the NHHR and the risk of developing HUA.

CONCLUSIONS

The NHHR was closely associated with an increased risk of developing HUA. Further studies on the NHHR could be beneficial for preventing and treating HUA.

Antipsychotics and metabolics in the post-CATIE era

Schizophrenia patients have high prevalence of cardiovascular (CV) disease risk factors and high CV mortality, with increasing concern over the contribution of antipsychotic medications to cardiometabolic risk. The design of the NIMH-sponsored Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) Schizophrenia Trial was driven by a need to understand the efficacy and safety differences between atypical antipsychotics, and between atypical and typical antipsychotics. The CATIE data indicated differences between olanzapine and other antipsychotics in phase 1 on the primary outcome measure, time to drug discontinuation, yet olanzapine was not superior to risperidone in the phase 2 tolerability arm, and was inferior to clozapine in the phase 2 efficacy arm. However, CATIE provided clear confirmation of the metabolic liability for olanzapine and also quetiapine, particularly on measures associated with insulin resistance: fasting triglycerides and central adiposity. Current research is focused on analyzing the adiposity-independent impact of certain antipsychotics on glucose-insulin homeostasis, and the disease-specific biological factors that predispose schizophrenia patients to metabolic dysfunction. The CATIE data also highlighte the high prevalence of metabolic disorders in chronic schizophrenia patients, and the moderating role of gender and race or ethnicity in antipsychotic-associate metabolic adverse effects. In the post-CATIE era, safety concerns remain the primary driver of antipsychotic prescribing habits. Absent compelling efficacy data that differentiates between antipsychotics for nonrefractory schizophrenia, the CATIE results reinforce the need for additional metabolically neutral antipsy chotic treatment options, and the importance of ongoing physical health monitorin for schizophrenia patients.

The metabolic syndrome and schizophrenia

OBJECTIVE

To summarize the accumulated data on metabolic syndrome prevalence in patients with schizophrenia, examine evidence for a biological contribution of the mental illness to metabolic risk and review novel options available for management of prediabetic states.

METHOD

A Medline search using metabolic syndrome, insulin resistance and insulin sensitivity cross-referenced with schizophrenia was performed on articles published between 1990 and May 2008.

RESULTS

Recent evidence indicates that schizophrenia increases predisposition towards metabolic dysfunction independent of environmental exposure. Both fasting and non-fasting triglycerides have emerged as important indicators of cardiometabolic risk, while metformin, thiazolidinediones and GLP-1 modulators may prove promising tools for managing insulin resistance.

CONCLUSION

Because of lifestyle, disease and medication effects, schizophrenia patients have significant risk for cardiometabolic disease. Routine monitoring, preferential use of metabolically neutral antipsychotics and lifestyle education are critical to minimizing risk, with a possible role for antidiabetic medications for management of insulin resistant states that do not respond to other treatment strategies.

Metabolic syndrome and dyslipidemia in youth

Obesity is a well-known risk factor for metabolic syndrome. Although the cause or causes of metabolic syndrome are debated, insulin resistance, dyslipidemia, and hypertension are increasingly recognized in children and adolescents, especially those who are overweight or obese. Although adoption of a healthy lifestyle early in life offers the best long-term solution, many children and adolescents are currently at risk for future cardiovascular disease. Although long-term outcome data are lacking, the dyslipidemic triad commonly seen in youth with metabolic syndrome (elevated triglycerides, low high-density lipoprotein, and small dense low-density lipoprotein) is likely to significantly contribute to future vascular disease. Surrogate markers (carotid intima-media thickness and flow-mediated vasodilatation) for the precursors of cardiovascular disease are increased in obese youth, consistent with early vascular damage. In this work, we review the features of metabolic syndrome in children and adolescents, including age- and gender-specific norms for lipid values. Diagnostic criteria and modifications of screening guidelines unique to youth are discussed. Although recommendations for lifestyle modification are suggested for all, many youth at high risk of future cardiovascular risk may need more aggressive medical interventions to improve insulin sensitivity, achieve a less atherogenic lipid profile, and lower blood pressure.