高脂血症:对心脏不好、对脑部有好处?


  【24drs.com】高血脂症对于心脏可能不好,但是,对精神分裂症患者的脑部有好处。
  
  「Clinical Antipsychotic Trial of Interventional Effectiveness (CATIE)」研究指出,胆固醇及三酸甘油脂值上升与精神分裂症患者的认知功能较佳有关。
  
  Henry A. Nasrallah医师在美国精神科协会(APA)2015年会开幕日发表时表示,这些有悖常理的数据使我们处于困境之中,我们对精神分裂症患者的高血脂标准如何?这个问题不好回答。
  
  密苏里州圣路易大学医学院神经与精神科主任Nasrallah医师表示,神经认知不佳,特别是记忆与执行功能,是精神分裂症的主要特征,会引起功能性失能;目前,精神分裂症的认知问题没有治疗方法,这部分有待加强。
  
  他也指出,第二代抗精神病药物与代谢失调,如体重增加、血脂异常、高血糖症有关,这些会增加心血管风险,不过,有报告认为,抗精神病药物引起的高胆固醇血症可能与认知改善有关。
  
  为了深入探讨,Nasrallah医师等人检视了总胆固醇高、三酸甘油脂高、高密度脂蛋白值低与神经认知的关联,研究资料来自CATIE研究的1,460名精神分裂症患者,平均年龄40岁。
  
  Nasrallah医师报告指出,校正潜在干扰变项的分析中,总胆固醇较高的精神分裂症患者,复合神经认知分数显著优于总胆固醇值低的同侪(P = .002)。
  
  三酸甘油脂高者,神经认知分数也优于那些三酸甘油脂低者(P = .02);高密度脂蛋白值低者的认知分数显著低于那些高密度脂蛋白值高者(P =.04)。
  
  Nasrallah医师认为,脑部有85%是脂质,所以脂质对脑中循环是有好处的。
  
  纽约长老会/哥伦比亚大学医学中心精神科教授、APA理事长当选人,即将于2016年5月就任的Maria A. Oquendo医师对研究结果发表评论时表示,虽然很有意思,我不认为这些数据是可行的!
  
  他在电子邮件中写道,我们须努力揭示疾病的生物基础,重点在于指出,虽然胆固醇和三酸甘油脂与较佳的认知功能可能有关联,我们仍须了解它的因果关系,是否是这些脂质增加改善了认知功能。
  
  Oquendo医师表示,我会建议,在我们有资料显示高脂血症可以引起比较好的认知之前,医师们仍应依据高脂血症的治疗策略。
  
  她指出,虽然我们需要更多信息,这显然是与脑中布满的脂质有关。对神经传导相当重要的神经细胞膜以及髓鞘,都是由胆固醇与其它脂质组成,我们还不知道比较高的外围脂质是否与细胞膜和髓鞘的脂质比例较高有关。如果真是如此,会使神经系统的讯息传导较佳,那么,高脂质血症导致比较好的认知这个论述就是合理的。
  
  资料来源: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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