高脂血症:對心臟不好、對腦部有好處?


  【24drs.com】高血脂症對於心臟可能不好,但是,對精神分裂症患者的腦部有好處。
  
  「Clinical Antipsychotic Trial of Interventional Effectiveness (CATIE)」研究指出,膽固醇及三酸甘油脂值上升與精神分裂症患者的認知功能較佳有關。
  
  Henry A. Nasrallah醫師在美國精神科協會(APA)2015年會開幕日發表時表示,這些有悖常理的數據使我們處於困境之中,我們對精神分裂症患者的高血脂標準如何?這個問題不好回答。
  
  密蘇里州聖路易大學醫學院神經與精神科主任Nasrallah醫師表示,神經認知不佳,特別是記憶與執行功能,是精神分裂症的主要特徵,會引起功能性失能;目前,精神分裂症的認知問題沒有治療方法,這部分有待加強。
  
  他也指出,第二代抗精神病藥物與代謝失調,如體重增加、血脂異常、高血糖症有關,這些會增加心血管風險,不過,有報告認為,抗精神病藥物引起的高膽固醇血症可能與認知改善有關。
  
  為了深入探討,Nasrallah醫師等人檢視了總膽固醇高、三酸甘油脂高、高密度脂蛋白值低與神經認知的關聯,研究資料來自CATIE研究的1,460名精神分裂症患者,平均年齡40歲。
  
  Nasrallah醫師報告指出,校正潛在干擾變項的分析中,總膽固醇較高的精神分裂症患者,複合神經認知分數顯著優於總膽固醇值低的同儕(P = .002)。
  
  三酸甘油脂高者,神經認知分數也優於那些三酸甘油脂低者(P = .02);高密度脂蛋白值低者的認知分數顯著低於那些高密度脂蛋白值高者(P =.04)。
  
  Nasrallah醫師認為,腦部有85%是脂質,所以脂質對腦中循環是有好處的。
  
  紐約長老會/哥倫比亞大學醫學中心精神科教授、APA理事長當選人,即將於2016年5月就任的Maria A. Oquendo醫師對研究結果發表評論時表示,雖然很有意思,我不認為這些數據是可行的!
  
  他在電子郵件中寫道,我們須努力揭示疾病的生物基礎,重點在於指出,雖然膽固醇和三酸甘油脂與較佳的認知功能可能有關聯,我們仍須瞭解它的因果關係,是否是這些脂質增加改善了認知功能。
  
  Oquendo醫師表示,我會建議,在我們有資料顯示高脂血症可以引起比較好的認知之前,醫師們仍應依據高脂血症的治療策略。
  
  她指出,雖然我們需要更多資訊,這顯然是與腦中佈滿的脂質有關。對神經傳導相當重要的神經細胞膜以及髓鞘,都是由膽固醇與其他脂質組成,我們還不知道比較高的週邊脂質是否與細胞膜和髓鞘的脂質比例較高有關。如果真是如此,會使神經系統的訊息傳導較佳,那麼,高脂質血症導致比較好的認知這個論述就是合理的。
  
  資料來源:http://www.24drs.com/
  
  Native link:Hyperlipidemia: Bad for the Heart, Good for the Brain?

Hyperlipidemia: Bad for the Heart, Good for the Brain?

By Megan Brooks
Medscape Medical News

TORONTO, Canada — Hyperlipidemia may be bad for the heart but good for the brain in patients with schizophrenia.

Elevated cholesterol and triglyceride levels were associated with better cognitive function in patients with schizophrenia in the Clinical Antipsychotic Trial of Interventional Effectiveness (CATIE) study.

"These counterintuitive data put us in a bind; how much do we attack high lipids in patients with schizophrenia? There are no easy answers," said Henry A. Nasrallah, MD, in a presentation here on opening day of the American Psychiatric Association (APA) 2015 Annual Meeting.

Neurocognitive impairment, particularly in memory and executive function, is a core feature of schizophrenia, one that causes functional disability, said Dr Nasrallah, chair of the Department of Neurology & Psychiatry, Saint Louis University School of Medicine in Missouri. At this time, there is no treatment for cognitive problems in schizophrenia. "It's a huge unmet need," he told attendees.

He also noted that second-generation antipsychotics are associated with metabolic dysregulation such as weight gain, dyslipidemia, and hyperglycemia, which raise cardiovascular risk. However, there are reports suggesting that antipsychotic-induced hypercholesterolemia may be associated with cognitive improvement.

To investigate further, Dr Nasrallah and a colleague examined the relationship between high total cholesterol, high triglyceride levels, and low high-density lipoprotein levels, with neurocognition, using data from 1460 patients with schizophrenia in the CATIE study. Their mean age was 40 years.

In analyses adjusted for potential confounding variables, patients with schizophrenia with high total cholesterol had significantly better composite neurocognitive scores (P = .002) than their peers with low total cholesterol levels, Dr Nasrallah reported.

Those with high triglycerides also had better neurocognitive scores (P = .02) relative to those with low triglyceride levels. Patients with low high-density lipoprotein levels had significantly worse cognitive scores (P = .04) than those with high high-density lipoprotein levels.

"The brain is 85% lipids, so lipids may be good for circuitry in the brain," Dr Nasrallah commented.

Actionable Data? Not So Fast

Commenting on the findings for Medscape Medical News, Maria A. Oquendo, MD, professor of psychiatry, New York-Presbyterian/Columbia University Medical Center, and APA president-elect, who starts her term in May 2016, said "while very interesting, I don't think these data are actionable yet."

"We need work to uncover the biological bases of disease. It is important to note that while there may be an association of cholesterol and triglycerides with better cognitive function, we still need to know if this is causal or whether increasing levels of these lipids improves cognitive function," she said by email.

"I would suggest that until we have data showing that hyperlipidemia causes better cognition, clinicians should still follow the usual medical strategies for managing hyperlipidemia," said Dr Oquendo.

"Although we need more information, it is certainly the case that the brain is chock-a-bloc with lipids. Neuronal cell membranes as well as myelin, so critical to nerve conduction, are comprised of both cholesterol and other lipids. We do not yet know if higher peripheral lipid levels are linked to a higher proportion of lipids in cell membranes and myelin. If this is the case, and this leads to better conduction of signals in the nervous system, then it is plausible for hyperlipidemia to lead to better cognition," she added.

Dr Nasrallah reports serving as a consultant/advisor to Boehringer Ingelheim Pharmaceuticals, Genentech, Janssen, Merck & Co, Otsuka Pharmaceuticals, Sunovion Pharmaceuticals Inc, Teva Pharmaceuticals, Alkermes, and Lundbeck and is on the speakers bureau of Genentech, Janssen, Otsuka Pharmaceuticals, Sunovion Pharmaceuticals Inc, and Alkermes.

American Psychiatric Association (APA) 2015 Annual Meeting. Presented May 16, 2015.

    
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