Metabolic Disease Research Roundup From AACE 2015

Obesity is one of the most important risk factors for cardiometabolic diseases. Waist circumference is often used as a surrogate marker for abdominal fat mass and a predictor for metabolic risk. This study evaluated whether neck circumference independently contributes to the prediction of metabolic risk beyond waist circumference. Kamenov ZA, Assyov YS. Neck circumference – a more informative indicator for metabolic disturbances compared to waist circumference? Presented at AACE 24th Annual Scientific & Clinical Congress; May 13-17, 2015. More information, here.

The study included 168 obese patients, median age 52 years, median BMI 35 kg/m2. 41% of the patients had T2DM; 42% had prediabetes. Prevalence of metabolic syndrome was 87%.

The overall risk (OR) for metabolic syndrome was 1.35 for neck circumference and 1.06 for waist circumference in females. The ORs for insulin resistance were 1.24 neck circumference and 1.07 for waist circumference in females. The ORs for T2DM were 1.30 for neck circumference and 1.05 for waist circumference in females. Similar, but weaker, correlations were observed in males.

Diabetic dyslipidemia is the most prominent risk factor for atherosclerosis and cardiovascular disease. Saroglitazar is a novel dual peroxisome proliferator-activated receptors-α/γagonist and the first glitazar approved for the treatment of diabetic dyslipidemia, approved in June 2013 in India. It effectively reduces diabetic dyslipidemia, free of side effects, especially with no increase of body weight.Saboo BD, Joshi SR. Clinical observational study evaluating efficacy of saroglitazar in type 2 DM patients having hypertriglyceridemia at a tertiary care center in India. Presented at AACE 24th Annual Scientific & Clinical Congress; May 13-17, 2015. More information, here.

787 patients (mean age, 53 years) were prescribed 4 mg of saroglitazar daily for treatment of diabetic dyslipidemia; half of the patients were taking statins and 92% were taking ongoing antidiabetic medications.

After 9 months of treatment, triglycerides were reduced by 44%, non-HDL cholesterol dropped 30%, and HbA1C percentage fell from 8.5% to 7%. Fasting glucose decreased 28% and postprandial plasma glucose dropped by 35%. No weight gain observed.

Statins are the treatment of choice to prevent CVD in T2DM. A retrospective cohort study examined adults with T2DM who were at very high risk for CVD. Quek RG et al. Lipid-lowering treatment trends among diabetes patients with very high cardiovascular disease risk: a real-world study. Presented at: AACE 24th Annual Scientific & Clinical Congress; May 13-17, 2015. More information, here.

A total of 9823 patients with prior CVD and 62,049 patients with no prior CVD but with 2 risk factors (age and hypertension) were included for analysis. Among patients under age 65, 90% were prescribed statin monotherapy and 66%-78% a moderate-intensity statin.

In cohorts 1 and 2, 20% and 25%, respectively, reinitiated same lipid-lowering therapy, and 13% and 17% switched to a new statin. About 12% in both cohorts permanently discontinued all lipid-lowering therapy and about 2% in each cohort switched to a non-statin lipid-lowering therapy. In addition, from 44% to 52% of patients with 1 treatment modification had a second treatment modification. A similar trend was observed among patients aged 65 and older.

Although at very high CVD risk, less than one-quarter of T2DM patients initiated treatment with a high-intensity statin. More than three-quarters of patients who initiated statin therapy modified their index treatment. Among T2DM patients at very high CVD risk, index statin treatment modifications potentially imply statin intolerability and/or ineffectiveness.

Neck circumference might be of greater value than waist circumference as an indicator for metabolic risk; adds to metabolic risk evaluation beyond waist circumference and is easier to measure. Saroglitazar appears to be an effective therapeutic option for patients with diabetic dyslipidemia who are not controlled by statins and is weight-neutral. Among T2DM patients at very high CVD risk, index statin treatment modifications potentially imply statin intolerability and/or ineffectiveness.