Abnormal Lipid Parameters and Herbs
 
Shah Murad1, Seema2, A Ghaffar3, G Mujtaba Abbasi4, Ijaz Ur Rehman5, Abdul Qadir6
1Pharmacology and Therapeutics Department, IMDC Islamabad
2Gynecology Department, NMC Karachi, Pakistan
3CWO at DANTH/IMDC Isd Pakistan
4Director Hospital at DANTH Islamabad Pakistan
5Urologist at DHQ Hospital, DIK Pakistan
6CM Deptt at KIMS Pakistan

*Corresponding Author E-mail: shahhmurad65@imdcollege.edu.pk, shahhmurad65@gmail.com

 

ABSTRACT:

Too much cholesterol can build up in your blood vessels. This build-up can narrow vessels and lead to a blockage, preventing blood from getting to certain parts of your body. When this happens in your heart vessels, it is called coronary heart disease and can cause a heart attack. In people with chronic kidney disease (CKD), heart disease is very common, and is the number one cause of death in this group. It is suggested that people with CKD have their cholesterol tested every year. Your doctor may want to do them more often if something has changed with your health. Most people have high levels of fat in their blood because they eat too much high-fat food. Some people have high fat levels because they have an inherited disorder. High lipid levels may also be caused by medical conditions such as diabetes, hypothyroidism, alcoholism, kidney disease, liver disease and stress. In some people, certain medicines, such as birth control pills, steroids and blood pressure medicines, can cause high lipid levels. Normally in human body lipids are used to synthesize cell walls and hormones but if they get excess in serum can cause illnesses. Dyslipidemia is considered as independent risk for coronary artery disease (CAD). Hypolipidemic agents can prevent hyperlipidemic patients to be sufferer of coronary artery disease. This study was conducted to compare hypolipidemic effects of Niacin and indian fruit (Jujube) in primary as well as secondary hyperlipidemic patients. Study was conducted from June to September 2019 at Jinnah Hospital Lahore, Pakistan. Sixty participants were enrolled of both gender male and female hyperlipidemic patients age range from 20 to 70 years. Written and explained consent was taken from all patients. They were divided in two groups. Group-I was advised to take two grams Niacin in divided doses for the period of two months. Group-II was advised to take 500 grams of fruit Jujube daily for the period of two months. Their baseline LDL and HDL cholesterol was determined by conventional method of measuring Lipid Profile. After two months therapy, their post treatment lipid profile was measured and mean values with±SEM were analyzed biostatistically. Group-I which was on Niacin their LDL cholesterol decreased significantly and HDL cholesterol was increased significantly. In group-II patients LDL cholesterol was decreased significantly but HDL increase was not significant with p-value of >0.05. It was concluded from the research work that Niacin is potent in lowering LDL and increasing HDL cholesterol, while Jujube has significant effect as LDL cholesterol lowering agent, but it does not increase HDL cholesterol significantly.

 

KEYWORDS: Abnormal Lipid Parameters, Herbs

 

 


INTRODUCTION:

Medicines are available for lowering LDL cholesterol and triglycerides, but heart disease medicines work the best when diet and lifestyle changes have already been made. Three kinds of lipoproteins, (also called cholesterol), re in your blood: (1) high-density (also called HDL, for short) cholesterol, (2) low-density (also called LDL) cholesterol and (3) very low-density (VLDL) cholesterol. HDL is sometimes called the “good cholesterol” because it keeps cholesterol from buiding up in your arteries. (You can remember this is the “good” cholesterol if you think “H is for healthy.”) LDL can be thought of as the “bad” cholesterol because high LDL levels can increase your risk of heart attack or stroke. Statins, fibrates, niacin and BABR (bile acid binding resins) are well proved agents used as hypolipidemic medications. These drugs are used in prevention of ischemia, myocardial infarction, vascular diseases in periphery, congestive cardiac failure, cardiac arrhythmias1. Strongly recommended medications for treatment of dyslipidemia in allopathy are statins. But unfortunately all these agents have potential to cause unwanted effects in human body making low compliance2. Vitamin B-3 which is also known as niacin when given in sufficient hypolipidemic doses i.e. more than two grams per day it causes partial inhibition of release of free fatty acids from adipose tissue, and increased lipoprotein lipase activity, which may increase the rate of Chylomicrons triglyceride removal from plasma. Niacin decreases the rate of hepatic synthesis of VLDL and LDL by formation of apoproteins (proteins carrying free lipids in plasma) which are integral part of low density lipoprotein and very low density lipoprotein’s structure3. Many of the herbs have been proved to reduce plasma lipids in human body. Jujubes or Ziziphus jujube, commonly called BAIR in urdu, punjabi, pothoharee, hazarvi, siraiki, and hindi languages in Pakistan and India. These jujubes have hypolipidemic, hypotensive as well as hypoglycemic effects4. Jujube fruit is flavorful and contain considerable amount of phenolic compounds like caffeic acid, chlorogenic acid, garlic acid, and protocatechuic acid5. These polyphenolic componds are capable of interacting with free radicals formed in human body in many biotransformatory reactions. This will decrease oxidative stress in human body. Hepatoprotective features of jujubes are proved in many research studies. Many researchers supported presence of biochemical compounds present in this fruit, which protect hepatocytes to be damaged by free radicals6.

 

Some studies evaluated the effect of Jujubes fruit in controlling dyslipidemia in obese young hyperlipidemic patients. A placebo-controlled study trial on eighty-six obese hyperlipidemic young adults age range from 12 to 18 years proved its effects on plasma lipids, labeling this fruit as hypolipidemic. It was observed by researchers that fruit was well tolerated, tasty for the hyperlipidemic patients which normalized lipid profile parameters in these patients7. Effects of its hydro-alcoholic extract on peripheral blood vessels, monocytes, neutrophils and lymphocytes is proved in many phase-II and phase-III drug’s safety trials. Fruit reduced monocytes and neutrophils and increased lymphocytes8. Jujubes powder was formed by drying and grinding it then used in obese patients with high plasma lipid levels. It reduced all parameters of lipid profile except increase in high density lipoprotein cholesterol. In this research study fruit did not show any harmful effect on liver functions measured by alanine transaminase and aspartate transaminase9. These two hypolipidemic agents have lesser adverse effects and good compliance because Niacin is well known vitamin B-3, and Indian dates are fruit commonly used in Indian and Pakistani ethnic group of human population10. Two important lipids, cholesterol and triglycerides, are transported in the blood by lipoprotein particles11. Each particle contains a combination of protein, cholesterol, triglyceride, and phospholipid molecules. The particles measured with a lipid profile are classified by their density into high-density lipoproteins (HDL), low-density lipoproteins (LDL), and very low-density lipoproteins12.

 

PATIENTS AND METHOD:

Research was conducted from June to September 2019. Sixty hyperlipidemic patients were selected from Jinnah Hospital Lahore-Pakistan to compare hypolipidemic effects of Niacin and commonly used fruit in winter season in Pakistan i.e. indian dates (Jujube). Both male and female patients suffering from primary or secondary hyperlipidemia were selected. The age limit for patients was 20 to 70 years. Alcoholic addictive patients, cigarette smokers, habitual to enjoy sedentary life, with impaired liver or renal functions were excluded from the research study. Written/approved/well explained consent was taken from all participants. Baseline Lipid Profile was determined in Biochemistry lab of the Hospital. Serum cholesterol was estimated by enzymatic method using kit Cat. No: 303113050 by Eli Tech Diagnostic, France. Serum HDL-cholesterol was determined by using kit Cat No: 303210040 by Elli Tech Diagnostic, France. Chylomicrons, low density lipoprotein and very low-density lipoprotein are specially precipitated with phosphotungstic acid and magnesium ions can then be removed by centrifugation, while high density lipoproteins remain in the supernatant. Cholesterol included in this phase is measured by an enzymatic method. LDL-cholesterol was calculated according to Friedwald formula3 ie; LDL= TC-(TG/5+ HDL-C).

 

PATIENTS GROUPING:

Patients were divided in two groups, 3o patients in each group. Group-I was on Tab. Niacin 2 grams daily in three divided doses. Group-II was on Jujube 500 grams daily in three divided times to eat. They were advised to take this fruit for two months.

 

 

STATISICAL ANALYSIS:

Mean values ± SEM were taken for statistical analysis using SPSS version 26 (2015). Paired ‘t’ test was applied to get significance changes in parameters before and after treatment. P-value >0.05 was considered as non-significant change, p-value <0.01 was considered as significant and p-value <0.001 was considered as highly significant change in the tested parameter.

 

RESULTS:

27 hyperlipidemic patients when used niacin for two months, they reduced LDL-cholesterol 29.2 mg/dl and HDL increase in this group was 7.3 mg/dl. In group-2 (n=30) two months therapy by Indian dates (Jujubes) reduced LDL-cholesterol from 198.82±2.17 mg/dl to 190.91±1.73 mg/dl, which is 7.9 mg/dl change in the parameter. HDL-cholesterol in this group increased from 38.6±2.19 mg/dl to 41.9±2.97 mg/dl, which is 3.3 mg/dl change in the parameter. Biostatistically it is non-significant change in the tested parameter.

 

TABLE SHOWING mean values with ± SEM and statistical significance (p-values) in hyperlipidemic patients when treated with Niacin and Indian dates

Features/parameters

LDL-cholesterol

HDL-cholesterol

At day-0

Niacin group= 210.16±2.11

ID group= 198.82±2.17

Niacin = 37.9±1.91

ID= 38.6±2.19

At day-60

Niacin= 180.97±2.22

ID= 190.91±1.73

Niacin = 45.2±2.19

ID = 41.9±2.97

Change in mg/dl

Niacin= 29.2

ID= 7.9

Niacin= 7.3

ID= 3.3

Change in%

Niacin= 13.9 %

ID= 4.0 %

Niacin = 16.2 %

GID= 7.9 %

Statistical significance

Niacin= p-value <0.001

ID= p-value <0.01

Niacin= p-value <0.001

ID = p-value >0.05

KEY: ± stands for Standard Error of Mean values, p-value >0.05 is non-significant change, p-value <0.01 is significant change in parameter, and p-value <0.001 is highly significant change in tested parameter. n = sample size. G1 (n= 27) is group on Niacin, G2 (n= 30) is group on Indian date (ID).

 

DISCUSSION:

Too much concentration of blood lipids, especially LDL-cholesterol, there are chances of LDL oxidation due to presence of free radicals, which make macrophages to attach with these oxidized LDL particles. This process is initiative step for development of atherogenesis, causing CAD. Hypolipidemic drugs decrease chances of LDL particles available for oxidation, so prevent CAD. Niacin is commonly used drug which inhibit lipoprotein lipase activity, so lesser formation of free fatty acids will be available which are main sources of TG-rich lipoproteins (VLDL) formation. Lesser amount of VLDL lead to lesser synthesis of LDL particles which are rich in cholesterol. In our results Niacin 2 grams daily intake for two months decreased LDL-cholesterol about 13.9 % which is highly significant changes. HDL-cholesterol in this group increased about 16.2 % which is again highly significant change. ZQ Zhu et al14 and W Cao et al15 proved same results when they used 2 grams of Niacin in 66 hyperlipidemic patients, but WB Yao et al16 observed lesser effects of Niacin on HDL cholesterol, i.e. only 4.4 % increase in HDL cholesterol. Hung PG et al17 explained different mechanisms of hypolipidemic response of Nicotinic acid on persons with different genetic code. One of the favorable mechanism for patients with CAD they described is fibrinolytic activity of Niacin. In our results Jujube fruit decreased LDL cholesterol is 7.9 mg/dl, which is significant change in the parameter. HDL cholesterol is not increased significantly in our results with p-value of >0.05. Tan H et al18 and Tripathi M et al19 observed same reason of Jujube on LDL and HDL-cholesterol, which augment our results. Tschesche R et al20 observed more effects of Jujube as we observed in low density lipoprotein cholesterol. Um S et al21 proved that LDL cholesterol is much decreased as compared to our results. KB Kang et al22 observed too less effects of Jujube fruit in 5 hyperlipidemic patients. Difference in these results are due to difference in number of patients. Makkari FM et al23 described that natural therapies in this era are getting popularity due to their good compliance. Furooka ST et al24 warned about use of vitamin B-3 in liver impaired functions in human populations.

 

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Received on 25.06.2019        Accepted on 14.07.2019

© Asian Pharma Press All Right Reserved

Asian J. Pharm. Res. 2019; 9(3):155-158.

DOI: 10.5958/2231-5691.2019.00024.8