Dyslipidaemia in chronic acquired distal axonal polyneuropathy

Abstract

The link between hypertriglyceridaemia (HTG) and/or hypercholesterolaemia (HCL) and neuropathy is uncertain. We retrospectively reviewed records of 100 consecutive patients investigated for acquired chronic axonal distal polyneuropathy of unknown cause. Findings were compared with those of 102 consecutive controls. Patients with idiopathic neuropathy were subsequently compared with age-and gender-matched controls. There were more neuropathy patients than controls with HCL, defined as cholesterol levels [5 mmol/L (63 vs. 45.1%; p = 0.011). Neuropathy patients also had higher cholesterol levels than controls (p = 0.04). Cholesterol-lowering drug usage was similar in both groups. HTG (defined as [2 mmol/L) and triglyceride levels were comparable in both groups. HTG ranged from 2.1-4.2 mmol/L in neuropathy patients. A cause for neuropathy was identified in 59 patients. Thirty-one had impaired glucose metabolism. Forty-one had idiopathic neuropathy. No link was demonstrated between idiopathic neuropathy or painful idiopathic neuropathy, and HTG/HCL. Mean triglyceride and cholesterol levels in patients with idiopathic neuropathy were comparable to those of controls. HTG was significantly more common (p = 0.027), and triglyceride levels significantly higher (p = 0.005) in patients with neuropathy due to diabetes/impaired glucose tolerance (IGT)/ alcoholism, than in patients with neuropathy of any other cause. These results suggest HCL [5 mmol/L may represent a cofactor contributing to presence of neuropathy irrespective of the underlying cause. They on the other hand do not support mild/moderate HTG as an independent cause of neuropathy. HTG is common in patients with neuropathy associated with diabetes/IGT/chronic alcoholism, where it may play a role in peripheral nerve damage. As previously reported, IGT was in our cohort frequent, present in one case in three, in the absence of another identifiable aetiology.

Chronic Idiopathic Axonal Polyneuropathy Is Associated With the Metabolic Syndrome

“…Another controlled study found no difference in fasting cholesterol levels in patients with CIAP, but increasing fasting triglycerides level was significantly associated with the likelihood of CIAP after adjusting for BMI, age, and gender (30). A recent, small, controlled study did not demonstrate a significantly higher frequency of dyslipidemia or fasting cholesterol level, but fasting triglycerides level was borderline nonsignificantly lower in patients with idiopathic neuropathy (31). The divergent observations could be explained by markedly higher fasting triglycerides levels in patients and lower levels in controls in the former study when compared with patients and controls in the latter study and our study (30,31).…”

Critical illness polyneuropathy (CIP) in neurological early rehabilitation: clinical and neurophysiological features

“…Therefore, a direct causal link between CIP and increased total cholesterol levels probably is non-existent. However, the role of lipid metabolism is a matter of controversial discussion [37]. …”

LDIflare small fiber function in normal glucose tolerant subjects with and without hypertriglyceridemia

“…They did not report an association with triglycerides, but it must be noted that their cohort with ISFN had higher mean triglycerides. Rajabally and colleagues reviewed retrospectively the records of 100 consecutive patients investigated for acquired chronic axonal distal polyneuropathy and found that mean triglyceride levels in patients with chronic idiopathic axonal polyneuropathy were comparable to those of controls . However, hypertriglyceridemia was significantly more common ( P = 0.027), and triglyceride levels were significantly higher ( P = 0.005) in patients with neuropathy due to diabetes/IGT/alcoholism than in patients with neuropathy of any other cause …”

“…Recently there has been evidence to suggest a link between hypertriglyceridemia and development of distal sensory neuropathy . In a prospective and well controlled investigation into the etiology of chronic idiopathic axonal polyneuropathy (CIAP) presenting with symptoms to a specialist Neurology clinic, Hughes et al reported higher mean triglyceride concentrations in patients than controls .…”