Metabolic syndrome among substance dependent men: A study from north India

Effects of Substance Use Disorder on In-Hospital Outcomes of Young Patients Presenting With a Cardiovascular Event: A Nationwide Analysis

Background

Substance use is widely prevalent among young adults and is associated with increased cardiovascular morbidity and mortality such as sudden cardiac arrest, acute coronary syndrome, arrhythmias, and cardiomyopathy. However, they are limited studies analyzing the impact of substance use disorder on in-hospital outcomes among young patients with cardiovascular events.

Methods

All patients aged 18-39 years admitted primarily for major cardiovascular events including acute myocardial infarction (AMI), arrhythmia, cardiac arrest, acute ischemic stroke, and venous thromboembolic events in 2019 were identified in the National Inpatient Sample database. They were then categorized into those with and without concomitant substance use disorder (SUD). The primary outcome was in-hospital mortality. Unadjusted and adjusted analysis was performed on appropriate variables of interest.

Results

Of 57,985 hospitalizations with cardiac events, 12,115 (20%) of young adults had concomitant SUD. SUD was significantly associated with cardiac arrest (OR 3.3; CI 2.4-4.4), atrial fibrillation (OR 1.5; CI 1.3-1.7), AMI (OR 1.3; CI 1.2-1.6), heart failure (OR 2.6; CI 2.4-3.0) (all p<0.05) despite a lower prevalence of traditional cardiovascular risk factors than non-users. Logistic regression showed acute kidney injury (aOR 1.5; CI 1.3-1.8; p<0.001) and inpatient mortality (aOR 1.6; CI 1.2-2.2; p<0.001) were also significantly higher in young patients presenting with cardiac events and concomitant SUD. There was no difference in the length of stay or incidence of gastrointestinal bleed between the two groups.

Conclusion

In young patients presenting with a cardiovascular event, concurrent substance use disorder was associated with increased in-hospital mortality despite significantly lower comorbidities.

A neuroimaging investigation into the role of peripheral metabolic biomarkers in the anticipation of reward in alcohol use

BACKGROUND

The relationship between alcohol use and metabolism has focused on the effects of alcohol use on metabolic factors. Metabolic factors, such as triglycerides, cholesterol, and glucose, have been shown to be associated with increased risk for heavy alcohol consumption and alcohol use disorder (AUD). It's been suggested that changes in metabolic factors may play a role in reward seeking behaviors and pathways. Studies on feeding behavior and obesity revealed the role of triglycerides in neural response to food cues in neurocircuitry regulating reward and feeding behaviors. This study aimed to explore the relationship of peripheral metabolism, alcohol use, and reward processing in individuals that use alcohol.

METHODS

Ninety participants from a previously collected dataset were included in the analysis. Participants were treatment seeking, detoxified individuals with AUD and healthy individuals without AUD, with the following metabolic biomarkers: triglyceride, glucose, high- and low-density cholesterol, and HbA1c levels. Participants completed a neuroimaging version of the Monetary Incentive Delay task (MID).

RESULTS

Correlations on peripheral metabolic biomarkers, alcohol use, and neural activity during reward anticipation and outcome during the MID task were not significant. Mediation models revealed triglycerides and high-density cholesterol had significant effects on left anterior insula during anticipation of potential monetary loss and this effect was not mediated by alcohol use.

CONCLUSION

Limbic recruitment by anticipation of monetary rewards revealed an independent relationship with peripheral metabolism and was not affected by individual differences in alcohol use, despite the effects of alcohol use on metabolic markers and reward processing neural circuitry.

The Interplay between Alcoholic Liver Disease, Obesity, and the Metabolic Syndrome

Background

Fatty liver may be the result of several factors. The two main contributors are nonalcoholic fatty liver disease (NAFLD) and alcoholic liver disease (ALD).

Summary

NAFLD is the hepatic manifestation of the metabolic syndrome (MetS) and is the major cause of chronic liver disease worldwide as a result of the obesity epidemic. ALD is also a common cause of chronic liver disease. Obesity is a major contributory factor to MetS and is also common in individuals who consume large amounts of alcohol. There is a similar hepatic pathology and both can result in severe fibrosis, cirrhosis, and its complications including hepatocellular carcinoma. This review discusses the etiology, pathogenesis, and genetics of both NAFLD and ALD and their interaction. It is necessary to understand this better in order to prevent and treat these important causes of liver disease worldwide.

Key Message

Obesity, MetS, and alcohol consumption are linked to the development and progression of fatty liver disease. The coexistence of these factors in many patients requires a reassessment of many aspects of treatment of fatty liver disease.

Which Criteria to Use to Identify Metabolic Syndrome among Patients with Addictive Disorders?: Observations among Patients with Alcohol and Opioid Dependence Syndrome

In spite of various psychoactive substances (including tobacco, alcohol, and opioids) being closely associated with development of metabolic syndrome (MS), little research exists on the prevalence of MS among persons with addictive disorders. The criteria used to diagnose MS varied across these studies, and part of the variation in the prevalence rate (5.1%-30.6%) could be attributable to this fact. The current study aimed to assess the prevalence of MS in patients with alcohol dependence syndrome (ADS) and opioid dependence syndrome (ODS) using revised National Cholesterol Education Programme Adult Treatment Panel (NCEP ATP-III) criteria and International Diabetes Federation (IDF) criteria. We tried to assess the impact of the choice of the diagnostic criteria on the prevalence rate of MS in the persons with ADS and ODS. This was a cross-sectional observational study. Semi-structured pro forma was used to collect information on the sociodemographic profile and clinical profile. Anthropometric measurements included waist circumference, height, weight, and body mass index (BMI). The systolic and diastolic blood pressure, fasting blood sugar (FBS), serum triglycerides, and serum high-density lipoprotein were measured. Patients were diagnosed as having MS by using revised NCEP ATP-III and IDF criteria. Statistical analysis was done by Chi-square (Fischer's exact test), independent sample Student's t-test, and Cohen's kappa. Among the individuals with ADS, the prevalence of MS was found to be 20.8% and 9.9% according to revised NCEP ATP III criteria and IDF criteria, respectively. Among individuals with ODS, the prevalence of MS was found to be 20.3% and 5.1% according to revised NCEP ATP III criteria IDF criteria, respectively. While there was a good degree of concordance between IDF and modified NCEP-ATP III criteria for MS for ADS (n = 256) (κ = 0.649, P < 0.001), the concordance was only fair for ODS (κ = 0.333, P < 0.001). The findings of our study thereby support the recommendation that revised NCEP ATP-III criteria is better choice than IDF criteria for identification of MS in individuals having addictive disorders, especially opioid dependence.

Metabolic syndrome in drug naïve patients with substance use disorder

INTRODUCTION AND OBJECTIVE OF THE STUDY

Metabolic syndrome is a combination of insulin resistance, impaired glucose regulation, dyslipidemia, hypertension, microalbuminuria and obesity and this increases the risk for diabetes, myocardial infarction and thus increases the risk of mortality. Substance dependence is considered as a prominent risk factor for metabolic syndrome, but not much work has been done in this field. Thus this study is aimed to know the prevalence of metabolic syndrome in drug naïve substance users.

MATERIALS AND METHODS

A total of 50 consecutive indoor drug naive patients with substance dependence (as per ICD 10) were included. Metabolic syndrome was assessed as per WHO criteria for metabolic syndrome. Statistical analysis was done using SPSS version 17.0 software and Chi square test was applied.

RESULTS

Of the 50 subjects (46% used alcohol; 26% used opioid and 28% were multiple substance users), a total of 20% of the subjects met the WHO criteria for metabolic syndrome and all of them were only alcoholics. Commonest abnormalities were low HDL (48%), raised SBP/DBP (26%/22%) and TG's (18%). Age, weight, height, DBP and BMI were significant predictors of metabolic syndrome.

CONCLUSION

Metabolic syndrome is a common entity seen in patients with substance abuse, especially in patients with alcohol use disorder, as seen in our study.

The metabolic syndrome in patients with alcohol dependency: Current research and clinical implications

The relationship between alcohol dependency and disorders such as liver disease and cancer has been thoroughly researched. However, the effects of alcohol on cardiometabolic health remain controversial. Several reports found low to moderate alcohol consumption to be associated with a lower risk for cardiometabolic disorders. In contrast, excessive alcohol consumption has been related to an increased risk. Most of these studies were performed in non-clinical populations, therefore limiting the explanatory power to non-dependent patients. Only a few studies examined cardiovascular disorders and cardiovascular risk factors, in particular the metabolic syndrome (MetS), in alcohol dependent patients. We here present a narrative review of studies performed so far on the MetS in alcohol dependency, and provide current hypotheses on the association of alcohol dependency, appetite regulation and the development of the MetS.

The Prevalence of Metabolic Syndrome in Alcohol Use Disorders: A Systematic Review and Meta-analysis

AIMS

People with alcohol use disorders (AUDs) have a double increased risk for cardiovascular diseases (CVD) and associated premature mortality. Metabolic syndrome (MetS) and its components are highly predictive of CVD. The primary aim of this meta-analysis was to describe pooled rates of MetS and its components in people with AUDs taking into account variations in demographic and clinical variables.

METHODS

Medline, Embase and CINAHL were searched until 03/2016 for cross-sectional and baseline data of longitudinal studies in adults with AUDs. Two independent reviewers extracted data. Random effects meta-analysis with a relative risk, subgroups and meta-regression analyses were employed.

RESULTS

The pooled MetS prevalence after adjusting for publication bias was 21.8% (95% CI = 19.1%-24.8%; N studies = 5; n participants = 865; age range = 34.8-51.1 years). Abdominal obesity was observed in 38.3% (N = 4, n = 389; 95%CI = 30.2%-47.0%), hyperglycemia in 14.3% (N = 4, n = 389; 95% CI = 3.7%-42.3%), hypertriglyceridemia in 43.9% (N = 4, n = 389; 95% CI = 31.7%-56.8%), low high-density lipoprotein cholesterol in 7.6% (N = 4, n = 389; 95% CI = 4.3%-13.2%) and hypertension in 46.5% (95% CI = 21.7%-73.1%). The MetS prevalence was similar across settings. A separate meta-regression analysis revealed that a higher MetS frequency was moderated by a higher percentage of psychiatric co-morbidity (coefficient = 3.651; standard error = 1.10, 95% CI = 1.50 to 5.80, z = 3.3, P < 0.001), CONCLUSIONS: Routine screening and multidisciplinary management of metabolic abnormalities in people with AUD is needed. Special attention should be given to people with AUDs with psychiatric co-morbidities. Future research should focus on how cardio-metabolic outcomes are moderated by clinical characteristics.

SHORT SUMMARY

The metabolic syndrome (MetS) and its components are highly predictive of cardiovascular diseases. Our meta-analysis demonstrates that more than 1 in 5 persons with alcohol use disorder (AUDs) has the MetS. Routine screening and multidisciplinary management of metabolic abnormalities should be an integral part of the multidisciplinary treatment of AUDs.