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up for more than one year. Risk factors evaluated were systolic
POSTER ABSTRACTS
Control of Rheumatic Fever and Heart Disease, Dhaka, 3 Department of Pharmacy, Jahangirnagar
University, Dhaka, 4 International Centre for Diarrhoeal Disease Research, Dhaka,
5 Noagoan Diabetic Society, Noagoan.
Abstract
Keywords: Background: Lipid disorder is a major risk factor for the progression of atherosclerosis. With
increasing urbanization and socioeconomic improvement, changing population dynamics is expected
Lipid profile
to influence disease pattern with rising trends of non communicable diseases. Thus there is a need
to screen healthy adults for their lipid pattern with high population dynamics in Bangladesh.
Present study was aimed to find out the distribution of lipid profile in adult population of Bangladesh.
Methods: A cross-sectional study was carried out among adults age over 18 years residing in an
urban and a rural community. A total of seven hundred sixty eight (768) participants were screened.
Data included socioeconomic information, behavioural risk factors, anthropometric measurement
and biochemical measurement using a pretested questionnaire.
Results: Between the urban and rural participants, the mean total cholesterol level was 175.2±37.5
vs. 149.6±23.8 mg/dl, mean triglyceride was 132.5±35.3 vs. 154.7±34 mg/dl and mean low density
lipoprotein was 104.0±34.6 vs.79.7±25.5 (mg/dl), respectively (p-value <0.05). There was an increase
in total cholesterol with increasing age (OR = 4.53, 95% CI = 3.55-9.52) and economic status between
the areas (p<0.05, OR = 1.88, 95% CI = 0.89-2.37). Total cholesterol was found to be high among
urban participants and triglyceride level was found to be high among rural population (p<0.05).
Factors significantly associated with dyslipidemia were blood pressure, fasting blood sugar and
food habits (p<0.05).
Conclusion: The result will be used for lifestyle intervention program to maintain the normal level
of lipid profile and to achieve primary prevention of coronary artery disease and associated non
communicable diseases in the entire population.
(Cardiovasc. j. 2016; 8(2): 128-134)
Address of correspondence: Dr. Md. Abdul Kader Akanda, Department of Cardiology, National Institute of Cardiovascular
Diseases, Dhaka, Bangladesh. Email: abdulkaderakanda@yahoo.com.
Study of Lipid Profile in Adult Population of Bangladesh Md. Abdul Kader Akanda et al.
of the world.7-9 A steady increase of cholesterol specified laboratory. The serum lipid profile and
levels was noted in Asian countries in the last the fasting serum glucose concentration were
decades of the 20th century and the trend was measured in enzymatic methods. All laboratory
increasing faster in urban areas than in rural report was recorded in the questionnaire. Same
areas.10The problem is expected to extend in a process was followed for both urban and rural area.
greater magnitude in developing countries due to
Lipids levels were classified according to the
the increasing number of older population and
classification recommended by National
increasing prevalence of lipid disorders among
Cholesterol Education Program (NCEP) and Adult
older population. So, well understanding of lipid
Treatment Panel III (ATP III) guidelines. 11
profile is becoming an issue of a major concern for
Desirable level of TC was < 200 mg/dl, borderline
the prevention of NCDs like CAD and stroke.
high was between 200-239 mg/dl and high TC was
One of the useful strategies for preventing CAD considered when the level was >240 mg/dl. LDL
and stroke include measures to control the risk was defined as optimal level when it was < 100
factors. To plan such activities, level of these risk mg/dl, near optimal level between 100-129 mg/dl,
factors like lipid profile must be known. There is a borderline high between 130-159 mg/dl, high
lack of published data regarding the lipid profile of between 160-189 mg/dl and very high when it was
Bangladesh. Considering the situation, the present >190 mg/dl. TG level was considered as normal
study was designed to find out the level and when it was < 150 mg/dl, borderline high between
distribution of lipid profile in adult health 150-199 mg/dl, high between 200-499 mg/dl and
population in given communities. very high when it was >500 mg/dl. Desirable HDL
was considered when it was >40 mg/dl and low
Methods: when it was < 40 mg/dl.
This was a cross sectional study, managed from
two co-ordination centres. National Institute of For the convenience and simplicity, lipid profile
Cardiovascular Disease (NICVD) was the co- data were represented in two classes - either
ordination centre for urban area and Noagoan normal or high. TC level of < 240 mg/dl was
Diabetic Society was the co-ordination centre for considered as normal and TC level of >240 mg/dl
rural area. Holdings were selected by simple was considered as high. LDL was considered
random sampling method from all the holding normal when it was < 160 mg/dl and high when it
numbers of the particular block. Household was >160 mg/dl. TG level of < 200 mg/dl was
members, above 18 years, were taken as sampling considered as normal and TG level of >200 mg/dl
units. A pre-tested questionnaire was used for was considered as high. HDL was considered
interviewing the respondents. Another check list normal when it was >40 mg/dl and high when it
was also used for recording physical examination, was < 40 mg/dl.
blood pressure, anthropometric measurements and After collection, data was checked for completeness
other findings. Anthropometric measurement was and consistencies by the investigators. Statistical
taken by following standard methods. Body weight Package for Social Science (SPSS) for windows
(kg) was to the nearest 0.1 kg, with wearing light version 13 was used for data analysis. Data was
clothing, no shoes. Height (cm) was measured with expressed in percentage, frequency, means and
a measuring tape to the nearest 0.5 cm. Waist standard deviation. Result was reported as mean
circumference was measured at the level of the ± standard deviation (SD) for qualitative variables
umbilicus by trained data collector. Systolic and and categorical variables was presented as absolute
diastolic blood pressures were measured using a frequencies and percentage. Continuous variable
sphygmomanometer. All patients had a was compared through the student’s t-test and for
registration number and contact with concerned the categorical variable the chi-square test. Suitable
co-ordination centres. Next day blood was collected test of significance was applied for the results to
from laboratory division. Twelve-hour fasting blood see the correlation between level of lipid profile
in the morning had drawn from all of the subjects. with behavioural risk factors of adult healthy
Blood was obtained and biochemical measurements population and also dyslipidaemia. Significance will
were conducted in a routine manner in the be accepted where the p-value <0.05.
129
Cardiovascular Journal Volume 8, No. 2, 2016
The study protocol was reviewed and approved by also no significant difference in mean age, male
the Bangladesh Medical Research Council (BMRC) female distribution, body mass index (BMI) and
Ethical Committee [BMRC/NREC/2010-2013/655(1- fruits intake. However, there was significant
10)]. Written informed consent was obtained from difference between urban and rural participants
each participant. in terms of tobacco use, vegetable intake, blood
pressure, fasting blood sugar and lipid profile.
Results:
A total of 768 participants were screened with an Compared to the participants of rural areas, the
equal distribution in urban and rural areas. The mean TC and LDL levels were significantly higher
general characteristics of the study population in among participants of urban areas. Between the
urban and rural areas are summarized in Table I. urban and rural participants, the mean TC level
Between urban and rural participants, there was was 175.2±37.5 vs. 149.6±23.8 mg/dl and mean LDL
Table-I
General characteristics of the study population in urban and rural areas (n=768).
Variables Urban (n=384) Rural (n=384) p value
Age (years) 37.2 ± 6.8 35.5 ± 10.5 0.26
Gender
Male 183 (47.7%) 191 (49.7%) 0.56
Female 201 (52.3%) 193 (50.3%)
Tobacco use
Smoking tobacco 104 (27.1%) 115 (29.9%) 0.05
Chewing tobacco 72 (18.7%) 103 (26.8%) 0.05
Body Mass Index (BMI)
Normal weight (18.5 – 24.9) 210 (54.7%) 280 (73.0%) -
Over weight (25 – 29.9) 138 (35.2%) 52 (13.5%) -
Obese ( e”30) 39 (10.1%) 52 (13.5%) -
Mean BMI 24.6 ± 4.3 24.0 ± 7.5 0.16
Fruits intake
<80gm 296 (77.1%) 227 (59.1%) 0.21
e”80gm 88 (22.9%) 157 (40.9%)
Vegetables intake
<400-500gm 295 (76.8%) 309 (80.5%) 0.001
e”400-500gm 89 (23.2%) 75 (19.5%)
Clinical parameters
Systolic blood pressure (mmHg) 114.2 ± 10.5 107.9 ± 10.6 0.02
Diastolic blood pressure (mmHg) 74.4 ± 8.8 72.8 ± 6.2 0.001
Fasting blood sugar (mg/dl) 104.2 ± 25.6 101.3 ± 54.4 0.001
Lipid profile
Total cholesterol 175.2 ± 37.5 149.6 ± 23.8 0.001
Triglyceride 132.5 ± 35.3 154.7 ± 34 0.001
Low density lipoprotein 104.0 ± 34.6 79.7 ± 25.5 0.001
High density lipoprotein 37.0 ± 8.9 37.3 ± 4.9 0.68
130
Study of Lipid Profile in Adult Population of Bangladesh Md. Abdul Kader Akanda et al.
level was 104.0±34.6 vs.79.7±25.5 (mg/dl), level of both TG and HDL was found in 50-59 years
respectively, with a p-value <0.05, which was group; and the highest level of LDL was found in
significantly associated. Conversely, the mean TG 30-39 years group. Among participants of rural
level was significantly higher among participants areas, the highest level of TC was found in 50-59
of rural areas compared to the participants of urban years group; the highest level of both TG and HDL
areas. Between the urban and rural participants, was found in 30-39 years group; and the highest
mean TG level was 132.5±35.3 vs. 154.7±34 mg/dl, level of LDL was found in 40-49 years group.
respectively, with a p-value <0.05, which was
Lipid profile of the total study population by normal
significantly associated. Mean high density
and high level is presented in Figure 1. 76.2% of
lipoprotein was similar between urban and rural
the participants were within normal level of TC
adults (37.0±8.9 vs. 37.3±4.9 mg/dl, p = 0.68).
and 23.80% were high level of TC. In case of TG,
The lipid profile among the participants of urban 74.4% and 25.6% were normal and high level
and rural areas by different age groups is abridged respectively. 77.0% of the participants were within
in Table II and Table III respectively. Among normal level of LDL and 23.0% were high level of
participants of urban areas, the highest level of LDL. In case of HDL, 40.2% had high and 59.8%
TC was found in 40-49 years group; the highest had low level of HDL.
Table-II
Lipid profile of urban population by different age groups (n=384).
Age in years Total cholesterol Triglyceride Low density High density
(mg/dl) (mg/dl) lipoprotein lipoprotein
(mg/dl) (mg/dl)
18-29 (n=126) 140.4 ± 28.3 132.2 ± 68.2 83.4 ± 22.0 38.6 ± 5.4
30-39 (n=76) 146.0 ± 22.3 121.4 ± 48.9 94.3 ± 28.2 35.8 ± 2.3
40-49 (n=156) 163.1 ± 19.4 136.3 ± 45.2 72.3 ± 25.0 37.0 ± 5.3
50-59 (n=26) 159.0 ± 00.0 193.0 ± 00.0 68.8 ± 00.0 40.3 ± 00.0
Table-III
Lipid profile of rural population by different age groups (n=384).
30-39 (n=164) 136.6 ± 43.2 207.1 ± 87.4 116.2 ± 42.2 39.5 ± 7.9
40-49 (n=133) 153.7 ± 27.8 188.7 ± 88.2 120.0 ± 23.5 33.4 ± 11.5
50-59 (n=10) 158.0 ± 00.0 102.0 ± 00.0 102.0 ± 00.0 36.3 ± 00.0
131
Cardiovascular Journal Volume 8, No. 2, 2016
Table-IV
Results of logistic regression analysis to evaluate risk factors for dyslipidaemia among the total study
population (n=768).
Indicators Binomial logistic model Multivariate logistic model
OR (95%CI) OR (95%CI)
Age group
18-29 1 1
30-39 1.70 (1.12 – 3.92) 1.07 (0.87 – 2.84)
40-49 4.53 (3.55 – 9.52)* 3.89 (3.14 – 8.55)*
50-59 16.31 (8.34 – 22.35)* 12.41 (7.34 – 19.35)*
Income
Low (<10000) 1 1
Middle(10001 – 30000) 1.59 (0.81 – 2.13) 1.28 (0.88 – 2.01)
Higher (>30001) 1.88 (0.89 – 2.37)* 1.29 (0.91 – 2.17)*
Use of tobacco
Non-tobacco user 1 1
Smoker 4.78 (3.62 – 6.32)* 3.47 (2.85 – 5.19)*
Smokeless tobacco 3.62 (2.74 - 4.78)* 3.61 (2.33 - 4.14)*
Physical activity
Light 1 1
Moderate 1.36 (0.59 – 6.13) 1.12 (0.51 – 5.81)
Heavy 2.22 (1.29 – 3.41)* 2.01 (1.02 – 3.11)*
Extra Salt intake (>1 TSF) 1.46 (1.18-2.72)* 1.13 (1.04 - 2.21)*
Low consumption of fruits (<80gm) 1.18 (0.97 – 1.66) 0.99 (0.29 – 1.41)
Low consumption of vegetable(<400gm) 1.07 (0.97 – 1.85)* 0.87 (0.41 – 1.33)*
BMI/obesity
<24.9 1 1
25-28.9 0.56 (0.41 – 0.71) 0.21 (0.17 – 0.97)
>29 2.48 (1.22 – 3.14) 1.97 (1.21 – 2.54)
Waist circumference(M: >90cm,F: >80cm) 4.01 (3.42 – 6.76)* 3.41 (2.81 – 5.29)*
132
Study of Lipid Profile in Adult Population of Bangladesh Md. Abdul Kader Akanda et al.
the major influencing factors that regulate the body 4. Howard BV, Robbins DC, Sievers ML, Lee ET, Rhoades
D, Devereux RB, et al. LDL cholesterol as a strong
anabolic and catabolic functions including
predictor of coronary heart disease in diabetic individuals
metabolism of carbohydrate, protein and fat. with insulin resistance and low LDL: The Strong Heart
Earlier studies also reported that modernization Study. Arterioscl Throm Vas 2000; 20(3):830-835.
related reduced physical activity among urban 5. Bharosay A, Bharosay VV, Bandyopadhyay D, Sodani A,
populations was associated with higher level of Varma M, Baruah H. Effect of lipid profile upon prognosis
plasma cholesterol than their rural in ischemic and haemorrhagic cerebrovascular stroke.
counterparts.12-15 Dietary habit is another factor Indian J Clin Biochem 2014; 29(3):3726.
recognized to be associated with lipoprotein 6. Natarajan P, Ray KK, Cannon CP. High-density
lipoprotein and coronary heart disease: current and future
status.16 In Bangladesh, rural population generally
therapies. J Am Coll Cardiol. 2010; 55(13):1283-1299.
consume plant protein more often than animal
7. Goswami K, Bandyopadhyay A. Lipid profile in middle
protein due to easy access to locally-grown, fresh, class Bengali population of Kolkata. Indian J Clan
and low-cost vegetables. On the other hand, urban Biochem 2003; 18(2):127-130.
populations, usually with higher income, consume 8. Limbu YR, Rai SK, Ono K, Kurokawa M, Yanagida JI,
higher amounts of animal protein. Vegetable diets Rai G, et al. Lipid profile of adult Nepalese population.
contain less saturated fat and cholesterol, and Nepal Med Coll J 2008; 10(1):4-7.
greater amounts of dietary fibre, and their 9. Glew RH, Kassam HA, Bhanji RA, Okorodudu A,
consumption helps lower the level of serum VanderJagt DJ. Serum lipid profiles and risk of
cardiovascular disease in three different male
cholesterol.17 Present study documents the lipid
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profile of adult population residing urban and rural 2002; 20(2):166-174.
areas. However, nationwide, randomized, large
10. Khoo KL, Tan H, Liew YM, Deslypere JP, Janus E.
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11. Third Report of the National Cholesterol Education
Dyslipidaemia can be modified either by proper
Program (NCEP) Expert Panel on Detection,
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the combination of the both. The result of the in Adults (Adult Treatment Panel III) final report.
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of lipid profile and to achieve primary prevention VP. Secular trends in cholesterol lipoproteins and
133
Cardiovascular Journal Volume 8, No. 2, 2016
triglycerides and prevalence of dyslipidemias in an urban 15. Njelekela M1, Sato T, Nara Y, Miki T, Kuga S, Noguchi
Indian population. Lipids Health Dis 2008; 7:40. T, et al. Nutritional variation and cardiovascular risk
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MJ, Hossain MA, Salam MA, et al. Lipoprotein status J 2003; 93(4):295-299.
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2008; 56:165-170. vegetarian diets. Nutr Clin Pract 2010;25(6):613-620.
134
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Thyroid Hormone And Its Correlation With Age, Sex And Serum Lipid Levels In
Hypothyroid And Euthyroid Sylheti Populations In Bangladesh
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Journal of Clinical and Diagnostic Research. 2011 November (Suppl-2), Vol-5(7): 1347-1351 1347
Shakhinur Islam Mondal, et al, The thyroid hormone and its correlation with age, sex and serum lipid levels in hypothyroid and euthyroid populations www.jcdr.net
collected from a total of 204 patients, including 38 hypothyroid and Characteristic / Hypothyroid Euthyroid p value
166 euthyroid individuals and control individuals. Out of the 204 Parameters (n = 38); (n=166);
patients, 41.2% were males and 58.8% were females. The study Male 10 (26.3%) 74 (44.6%) *0.039
was pre-approved by the ethical committee of the institution’s Female 28 (73.7%) 92 (55.4%)
review board. Sex
Young 8 (21.1%) 61(36.7%)
(25-40)
Exclusion criteria: Middle 12(31.6)% 60(36.1%) *0.038
Persons having overt hypothyroidism or those taking medications age
which affected the thyroid function, such as thyroxine and anti- Age (41-54)
thyroid drugs and whose age were less than 25 years were Elderly 18(47.4%) 45(27.1%)
excluded. (≥55)
Mean 209.89± 191.49 *0.038
TC (mg/dL) 60.38 ±45.95
Sample collection and storage: [Ref. Value:
>200 23 (60.5%) 67 (40.4%)
Blood samples were collected with a record of age and sex, from 120-200]
all of the subjects who came for the determination of hormones ≤200 15 (39.5%) 99 (59.6%) *0.024
and the lipid profile. About 7-8 ml of peripheral blood was Mean 231.47± 186.04
TG (mg/dL) 130.01 ±92.46
collected from each individual with the help of an expert. After
[Ref Value:
the centrifugation of the collected blood, the serum samples were >150 26 (68.4%) 84 (50.6%) *0.013
70-150]
collected in microcentrifuge tubes and stored at -20º C. For long ≤150 12 (31.6%) 82 (49.4%) *0.047
term storage, the serum samples were stored in a -80º C freezer. Mean 38.05 ± 36.82 ±
For each sample, the TSH, T4, total cholesterol (TC), TG, HDL and 10.94 8.75
HDL (mg/dL)
LDL levels were measured. ≤35 18 (47.4%) 70 (42.2%) 0.457
[Ref Value:>35]
>35 20 (52.6%) 96 (57.8%) 0.559
Thyroid Profile:
TSH and T4 were measured by using a direct ELISA method. TSH Mean 121.72± 118.95 ±
levels >4.20 µIU/mol and T4 levels <4.5 µg/dl were considered 37.90 38.25
LDL (mg/dL)
suggestive of hypothyroid. >130 17 (44.7%) 60 (36.1%) 0.687
[Ref Value:80-
130]
Lipid Profile: ≤130 21 (55.3%) 106 0.324
TC was measured by an enzymatic endpoint method (cholesterol (63.9%)
oxidase/ peroxidase method). TG and HDL were measured by [Table/Fig-1]: Comparison of various parameters between the hypothy-
enzymatic colourimetric (GPO-POD) methods. The LDL levels were roid and euthyroid groups.
Data are presented as frequency (percentage) and mean ± SD for
calculated by using Friedewald’s formula. parametric value. Pearson Chi-Square-test was performed to analyze
data. *p<0.05 is considered significant. n = Number of study population;
TC = total cholesterol; TG = triglyceride; HDL = High density lipoprotein;
Statistical analysis: LDL = Low density lipoprotein.
The results were expressed as frequency (percentages) and mean
± SD (standard deviation). The data analyses were carried out by 12(31.6%) and 18(47.4%) respondents and in the euthyroid group,
using the Statistical Package for Social Sciences (SPSS) (version 61(36.7%), 60(36.1%) and 45(27.1%) respondents were found to
16.0 for Windows, SPSS Inc., Chicago, USA). For these two be in the young, middle aged and the elderly groups respectively.
groups, the descriptive statistics were computed and bivariate There was a significant difference (p=0.038) in age between these
comparisons by using Chi-square analysis and the F test for mean hypothyroid and euthyroid groups. Subclinical hypothyroidism was
were made. The differences were considered as significant, with a more common in the elderly.
p value which was < 0.05.
The mean TC and TG levels in the hypothyroid group were
significantly higher (191.49±45.95 vs. 209.89±60.38, p= 0.038
RESULTS and 186.04±92.46 vs. 231.47±130.01, p= 0.013) as compared
Of the 204 respondents included in the study, 38 (18.6%) were
to those in the euthyroid group and these values were higher than
found to fit the criteria for hypothyroidism. The study was conducted
the reference values. The HDL and LDL levels were higher in the
on two groups of subjects: the hypothyroid group (n=38) and the
hypothyroid group as compared to those in the euthyroid group
euthyroid group (n= 166) [Table/Fig 1].
(36.82±8.75 vs. 38.05±10.94, p=0.457 and 118.95±38.25 vs.
Data are presented as frequency (percentage) and mean ± SD 121.72±37.90, p=0.687), but not significantly and these values
for parametric value. Pearson Chi-Square-test was performed to were within the reference range.
analyze data. *p<0.05 is considered significant. n = Number of
When these variables were dichotomized into high or low based
study population; TC = total cholesterol; TG = triglyceride; HDL =
on the hospital guidelines, it was observed that persons with
High density lipoprotein; LDL = Low density lipoprotein.
hypothyroid were more likely to have elevated TC levels (60.5%
Out of the 38 hypothyroid subjects, 10 (26.3%) were males and 28 vs. 40.4%, p = 0.024). It was also observed that persons with
(73.7%) were females. On the other hand, out of the 166 euthyroid hypothyroidism were likely to have a significant elevation in their
subjects, 74 (44.6%) subjects were males and 92 (55.4%) were TG levels (68.4% vs. 50.6%; p = 0.047). No statistically significant
females. There was a significant difference (p=0.039) in sex differences were found between the euthyroid group and the
between these hypothyroid and euthyroid groups. Hypothyroidism hypothyroid group with respect to the percentage of respondents
was more common in women. In the hypothyroid group, 8 (21.1%), with HDL levels, or in LDL levels.
1348 Journal of Clinical and Diagnostic Research. 2011 November (Suppl-2), Vol-5(7): 1347-1351
www.jcdr.net Shakhinur Islam Mondal, et al, The thyroid hormone and its correlation with age, sex and serum lipid levels in hypothyroid and euthyroid populations
DISCUSSION
Thyroid disorders are known to influence lipid metabolism and are
common in dyslipidaemic patients [6]. These hormones appear to
serve as a general pacemaker, accelerating the metabolic processes
and they may also be associated with metabolic syndromes [7].
Serum total cholesterol was significantly increased in the [Table/Fig-2a]: Comparisons of four different parameters between
hypothyroid subjects as compared to the euthyroid subjects [Table/ hypothyroid and euthyroid groups: sex(a), age groups(b), mean
Fig 2c]. Some other studies have also supported this finding [15] values of lipid profile(c) and clinical range of TC and TG(d).
[16][17]. Specifically, the thyroid hormone stimulates the hepatic
de novo cholesterol synthesis by inducing HMG-CoA reductase
that catalyzes the conversion of HMG-Co A to Mevalonate, the first
step in the biosynthesis of cholesterol [18].
The serum triglyceride levels were also higher in the subjects with
hypothyroidism than in the euthyroid subjects [Table/Fig 2c] which
concurred with the reports of a previous study [7]. These changes
were attributable to the decreased activity of lipoprotein lipase
(LPL), which resulted in a decreased clearance of triglyceride-rich
lipoproteins [18]. All these abnormalities resolved as the serum T4
concentration became norma [16]. Furthermore, the clearance
of the chylomicron remnants was found to be decreased in
hypothyroidism [22].
Hypothyroidism has been generally considered as a cardiovascular [Table/Fig-2c]: Comparisons of four different parameters between
risk factor in a majority of studies, mainly because of its association hypothyroid and euthyroid groups: sex(a), age groups(b), mean
with elevated serum total and LDL cholesterol. Important associations values of lipid profile(c) and clinical range of TC and TG(d).
Journal of Clinical and Diagnostic Research. 2011 November (Suppl-2), Vol-5(7): 1347-1351 1349
Shakhinur Islam Mondal, et al, The thyroid hormone and its correlation with age, sex and serum lipid levels in hypothyroid and euthyroid populations www.jcdr.net
1350 Journal of Clinical and Diagnostic Research. 2011 November (Suppl-2), Vol-5(7): 1347-1351
www.jcdr.net Shakhinur Islam Mondal, et al, The thyroid hormone and its correlation with age, sex and serum lipid levels in hypothyroid and euthyroid populations
Journal of Clinical and Diagnostic Research. 2011 November (Suppl-2), Vol-5(7): 1347-1351 1351
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Vascular Health and Risk Management Dovepress
open access to scientific and medical research
Kamrun Nahar Choudhury 1 Background: Hypertension and dyslipidemia are major risk factors for cardiovascular disease,
AKM Mainuddin 2 accounting for the highest morbidity and mortality among the Bangladeshi population. The
Mohammad Wahiduzzaman 3 objective of this study was to determine the association between serum lipid profiles in hyper-
Sheikh Mohammed Shariful tensive patients with normotensive control subjects in Bangladesh.
For personal use only.
Islam 4,5 Methods: A cross-sectional study was carried out among 234 participants including
159 hypertensive patients and 75 normotensive controls from January to December 2012 in the
1
Department of Epidemiology,
National Centre for Control of
National Centre for Control of Rheumatic Fever and Heart Disease in Dhaka, Bangladesh. Data
Rheumatic Fever and Heart Disease, were collected on sociodemographic factors, anthropometric measurements, blood pressure, and
2
Center for Communicable Diseases, lipid profile including total cholesterol (TC), triglyceride (TG), low density lipoprotein (LDL),
International Center for Diarrheal
Disease Research, 3Department of and high density lipoprotein (HDL).
Cardiology, Bangladesh Institute of Results: The mean (± standard deviation) systolic blood pressure and diastolic blood pres-
Health Science, Bangladesh, Dhaka, sure of the participants were 137.94±9.58 and 94.42±8.81, respectively, which were higher
Bangladesh; 4Center for Control
of Chronic Diseases, International in the hypertensive patients (P,0.001). The serum levels of TC, TG, and LDL were higher
Center for Diarrheal Disease while HDL levels were lower in hypertensive subjects compared to normotensives, which was
Research, Bangladesh, Dhaka,
statistically significant (P,0.001). Age, waist circumference, and body mass index showed
Bangladesh; 5Center for International
Health, University of Munich, Munich, significant association with hypertensive patients (P,0.001) but not with normotensives. The
Germany logistic regression analysis showed that hypertensive patients had 1.1 times higher TC and TG,
1.2 times higher LDL, and 1.1 times lower HDL than normotensives, which was statistically
significant (P,0.05).
Conclusion: Hypertensive patients in Bangladesh have a close association with dyslipidemia
and need measurement of blood pressure and lipid profile at regular intervals to prevent car-
diovascular disease, stroke, and other comorbidities.
Keywords: Risk factors, cardiovascular diseases, dyslipidemia, blood pressure
Introduction
Hypertension and dyslipidemia are major risk factors for cardiovascular disease
(CVD) and account for more than 80% of deaths and disability in low- and middle-
income countries.1,2 The prevalence of hypertension is projected to increase globally,
especially in the developing countries.2 In recent years, rapid urbanization, increased
life expectancy, unhealthy diet, and lifestyle changes have led to an increased rate
Correspondence: Sheikh Mohammed
Shariful Islam of CVD in Southeast Asia, including Bangladesh.3 It is widely accepted that CVD is
Center for Control of Chronic Diseases, associated with hypertension and increased blood levels of low-density lipoprotein
International Center for Diarrheal
Disease Research, Bangladesh,
(LDL), total cholesterol (TC), and triglycerides (TG). In contrast, a low level of high
68, Shaheed Tajuddin Ahmed Sarani, density lipoprotein (HDL) is a risk factor for mortality from CVD.4 Epidemiological
Mohakhali, Dhaka 1212, Bangladesh
Tel +880 2 1939 366 930
studies have established a strong association between hypertension and coronary
Email shariful.islam@icddrb.org artery disease.5
submit your manuscript | www.dovepress.com Vascular Health and Risk Management 2014:10 327–332 327
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http://dx.doi.org/10.2147/VHRM.S61019
License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further
permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on
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Choudhury et al Dovepress
The noncommunicable disease risk factor survey con- with normal BP (normotensives), attending the National
ducted in 2010 in Bangladesh estimated the prevalence of Centre for Control of Rheumatic Fever and Heart Disease
hypertension among adults to be from 16% to 20%.6 The (NCCRF&HD) in Dhaka, Bangladesh for a routine health
Bangladesh Health, Nutrition and Demographic Survey in check-up between January and December 2012. All the partici-
2011 found the prevalence of hypertension among adults to pants were residents of surrounding areas in Dhaka and aged
be 34%.7,8 A meta-analysis of the prevalence of hyperten- between 30–60 years. Participants were selected consecutively
Vascular Health and Risk Management downloaded from https://www.dovepress.com/ by 46.148.124.28 on 02-Aug-2018
sion in Bangladesh from 1995 to 2009 among 6,430 adults from the outpatient department by the attending physician.
was estimated to be 13.5%, with a 95% confidence interval Patients with features of any cardiac, renal, or hepatic compli-
(CI) ranging from 12.7% to 14.2%.6 Another meta-analysis cations or major medical problems were excluded. Also, those
of prevalence of CVD and type 2 diabetes between 1995 on lipid lowering and antihypertensive medication were also
and 2010 found the pooled prevalence of hypertension to excluded. After obtaining oral and written informed consent,
be 13.7% (12.1%–15.3%), with an increasing trend and data was collected through face-to-face interviews, anthropo-
higher rate in urban areas versus rural (22.2% versus 14.3%, metric measurements, clinical examinations, and blood tests
respectively).9 However, these numbers are estimated from for serum lipid profile by trained research assistants.
several studies and are likely not to account for silent and
other asymptomatic CVD and hypertension. Measurements
CVD is the leading cause of disability and death worldwide, Height and body weight were measured with participants
and a great majority of CVDs are associated with dyslipidemia. standing without shoes and heavy outer garments. Body mass
For personal use only.
Worldwide, there is broad variation in serum lipid profile levels index (BMI) was calculated as weight in kilograms, divided
among different population groups. Increased serum levels of by height in meters squared (kg/m2). Waist circumference
TC, TG, LDL, and decreased HDL are known to be associated (WC) was measured from midway between the lowest rib
with major risk factors for CVD. Dyslipidemia, comprising and the iliac crest using a Gullick II tape with subjects in
altered ratio of high TC level and isolated evaluation of the the standing position and at the end of a normal expiration.
LDL or TG, is usually associated with increased blood pressure Two measurements were taken from each subject, and the
(BP) levels. There is a strong relationship between total LDL mean value was used for the analysis. All anthropometric
cholesterol concentrations and CVD risk. Patterns of lipid measurements were collected by the same individual.
abnormalities among Asians and their relative impact on BP was measured by a physician using standard BP mea-
cardiovascular risk have not been well characterized.10 Low surement protocol after the patient had rested for 10 minutes.
HDL is increasingly recognized as an independent risk factor Two measurements were taken by a mercury sphygmoma-
for adverse CVD outcomes, irrespective of levels of LDL. nometer, with at least a 5-minute interval between successive
Although sporadic reports suggest that the prevalence of low measurements. The mean of two measurements of Korotkoff
HDL-cholesterol is substantial, we lack detailed data on the phase I was recorded for systolic blood pressure (SBP). The
true prevalence of this condition among patients receiving mean of two values of Korotkoff phase IV was recorded for
treatment for dyslipidemia.11 These data strongly suggest that diastolic blood pressure (DBP). Hypertension was defined as
low HDL is a clinically significant problem. an average SBP $140 mmHg and DBP $90 mmHg without
In Bangladesh, consumption of saturated fat and red meat antihypertensive medication according to the seventh report
is a known risk factor for CVD, especially hypertension.12 of the Joint National Committee on Prevention, Detection,
However, data about the relationship between hypertension Evaluation and Treatment of High Blood Pressure (JNC-7).13
and lipid profile among Bangladeshi patients are rare in In this study, hypertensive patients refer to those participants
the literature. The purpose of the study was to compare the who demonstrated the JNC-7 criteria.
blood lipid levels in hypertensive patients with normoten-
sive control subjects and determine its association between Biochemical analysis
hypertension and lipid profile. A volume of 5 mL of venous blood was collected in the
morning after an overnight fast, and serum was used for
Materials and methods biochemical tests. All tests were carried out at the labora-
Study design and population tory of the NCCRF&HD in Dhaka, Bangladesh. Lipid
A cross sectional study was conducted among 234 participants, parameters (TC, TG, LDL, and HDL) were estimated by
159 newly diagnosed hypertensive patients and 75 participants enzymatic colorimetric methods. Dyslipidemia was defined
328 submit your manuscript | www.dovepress.com Vascular Health and Risk Management 2014:10
Dovepress
according to the Evaluation and Treatment of High Blood (44.3±5.6 mg/dL). The mean SBPs of hypertensives and
Cholesterol in Adults executive summary of the third report normotensives were 146.8±8.5 mmHg versus 119.2±9.3
of the National Cholesterol Education Program Expert Panel mmHg, respectively, and mean DBPs were 98.9±7.3 mmHg
on Detection, Evaluation and Treatment of High Blood versus 84.9±5.3 mmHg, respectively. The mean SBP and
Cholesterol in Adults (Adult Treatment Panel III): LDL DBP of hypertensives were higher than those of normoten-
cholesterol (mg/dl) ,100= optimal, 100–129= near optimal/ sives (P,0.001). Age, WC, and BMI showed significant
Vascular Health and Risk Management downloaded from https://www.dovepress.com/ by 46.148.124.28 on 02-Aug-2018
above optimal, 130–159=borderline high, 160–189= high, association with hypertensive patients (P,0.001) but not
190= very high; total cholesterol (mg/dl) ,200= desirable, with normotensive subjects (Table 2).
200–239= borderline high, 240= very high; HDL Binary logistic regression analysis showed TC was
cholesterol (mg/dl) ,40=low, 60= high; triglyceride significantly associated with hypertensive patients and the
(mg/dl) ,150= normal (goal), 150–199= borderline high, odds ratio (OR) was 1.1, 95% CI 0.91–1.77, P,0.002. TG
200–499= high, 500=very high.14 and LDL were significantly associated with hypertensive
patients (OR 1.1, 95% CI 0.49–1.44, P,0.05 and OR
Ethics 1.2, 95% CI 0.69–1.66, P,0.001, respectively). HDL was
Ethical clearance was obtained from the NCCRF&HD. also associated with hypertensive patients (OR 1.08, 95%
Participants were informed about the study, and both verbal CI 0.77–1.52, P,0.05). DBP showed significant associa-
and written informed consent was obtained. The Helsinki tion with hypertensive patients (OR 1.7, 95% CI 0.33–3.29,
Declaration was strictly followed for data collection.15 P,0.05) (Table 3).
For personal use only.
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329
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Age (in years) 47.67 (4.15) 45.48–49.86 38.39 (3.69) 35.53–41.24 0.001
Height (meter) 1.55 (0.54) 1.53–1.57 1.66 (0.59) 1.34–1.73 0.001
Weight (kg) 62.32 (6.33) 60.41–64.23 56.87 (7.78) 54.09–59.65 0.001
WC (cm) 86.01 (5.89) 84.25–87.76 78.27 (6.14) 75.40–81.13 0.001
BMI 25.98 (3.39) 25.10–26.85 23.58 (2.64) 22.58–24.59 0.001
SBP (mmHg) 146.77 (8.51) 141.11–151.42 119.21 (9.31) 117.42–23.01 0.001
DBP (mmHg) 98.92 (7.26) 94.49–101.36 84.89 (5.29) 81.17–87.61 0.001
Total cholesterol 238.31 (3.39) 221.01–242.5 187.01 (6.25) 181.52–191.51 0.001
Triglyceride 178.34 (6.31) 171.51–181.1 141.48 (11.29) 138.82–143.13 0.001
HDL 41.24 (3.22) 39.13–46.35 44.28 (5.63) 42.65–49.91 0.001
LDL 151.28 (7.77) 148.23–155.3 110.31 (6.34) 107.65–114.96 0.001
Male n (%) 113 (71) 32 (42) 0.002*
Smoking n (%) 57 (36) 16 (21) 0.258*
Note: *Represents proportion test.
Abbreviations: BMI, body mass index; CI, confidence interval; DBP, diastolic blood pressure; HDL, high density lipoprotein; LDL, low density lipoprotein; SBP, systolic
blood pressure; SD, standard deviation; WC, waist circumference.
Table 3 Binary logistic regression analysis for hypertensive and practice to prevent CVD and other harmful consequences
normotensive participants of hypertension.22
Indicators Odds Confidence P-value A large scale study conducted in Mexico showed
ratio interval
that the most prevalent abnormality in Mexican urban
Total cholesterol (,200 mg/dL) 1.12 0.91–1.77 0.002
adults, aged 20–69 years, was HDL cholesterol below
Triglyceride (,150 mg/dL) 1.13 0.49–1.44 0.048
HDL (60 mg/dL) 1.08 0.77–1.52 0.031 0.9 mmol/L (46.2% for men and 28.7% for women).
LDL (,100 mg/dL) 1.24 0.69–1.66 0.001 Hypertriglyceridemia (.2.26 mmol/L) was the second
Sex (male) 0.98 0.41–1.12 0.221 most prevalent abnormality (24.3%). Increased LDL
SBP (,140 mmHg) 1.17 0.78–2.11 0.054
($4.21 mmol/L) was observed in 11.2% of the sample.
DBP (,90 mmHg) 1.74 0.33–3.29 0.044
Half of the hypertriglyceridemic subjects had a mixed dys-
Abbreviations: DBP, diastolic blood pressure; HDL, high density lipoprotein;
LDL, low density lipoprotein; SBP, systolic blood pressure. lipidemia or low HDL cholesterol. More than 50% of the
low HDL cases were not related to hypertriglyceridemia.23
and there was significant instability of serum TC, TG, HDL, The pan-European Survey of HDL measured lipids and
and LDL in hypertensive patients.19–21 Therefore, the find- other cardiovascular risk factors in 3,866 patients with
ings from investigations of these parameters may reinforce type 2 diabetes and 4,436 nondiabetic patients under-
routine monitoring of hypertensive patients in daily clinical going treatment for dyslipidemia in eleven European
330 submit your manuscript | www.dovepress.com Vascular Health and Risk Management 2014:10
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countries, and showed that diabetic patients had lower HDL this study. We are grateful to Mr SM Majedul Karim,
(1.22±0.37 mmol/L versus 1.35±0.44 mmol/L, P,0.001) Ludwig-Maximilians University of Munich, Germany for
and higher TG (2.32±2.10 mmol/L versus 1.85±1.60 reviewing this manuscript and providing feedback.
mmol/L, P,0.001) than nondiabetic patients. 24 More
diabetic compared to nondiabetic patients had low HDL Disclosure
(45% versus 30%, respectively), high TG ($1.7 mmol/L; The authors report no conflicts of interest in this work.
Vascular Health and Risk Management downloaded from https://www.dovepress.com/ by 46.148.124.28 on 02-Aug-2018
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331
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16. Saha MS, Sana NK, Shaha RK. Serum lipid profile of hypertensive 23. Aguilar-Salinas CA, Olaiz G, Valles V, et al. High prevalence of low
patients in the northern region of Bangladesh. J Bio-Sci. 2006;14: HDL cholesterol concentrations and mixed hyperlipidemia in a Mexican
93–98. nationwide survey. J Lipid Res. 2001;42(8):1298–1307.
17. Islam AK, Majumder AA. Hypertension in Bangladesh: a review. 24. Bruckert E, Baccara-Dinet M, Eschwege E. Low HDL-cholesterol
Indian Heart J. 2012;64(3):319–323. is common in European type 2 diabetic patients receiving treatment
18. Anjum R, Zahra N, Rehman K, et al. Comparative Analysis of Serum for dyslipidaemia: data from a pan-European survey. Diabet Med.
Lipid Profile between Normotensive and Hypertensive Pakistani 2007;24(4):388–391.
Pregnant Women. J Mol Genet Med. 2013;7:64. 25. Yusuf S, Hawken S, Ounpuu S, et al. Effect of potentially modifiable
19. Bambara R, Mittal Y, Mathur, A. Evaluation of Lipid Profile of North risk factors associated with myocardial infarction in 52 countries (the
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Indian Hypertensive Subjects. Asian Journal of Biomedical and INTERHEART study): case-control study. Lancet. 2004;364(9438):
Pharmaceutical Sciences. 2013;3:38–41. 937–952.
20. Ijeh I, Ejike CE, Okorie U. Serum lipid profile and lipid pro-atherogenic 26. Goyal A, Usuf S. The burden of cardiovascular disease in the Indian
indices of a cohort of Nigerian adults with varying glycemic and blood subcontinent. Indian J Med Res. 2006;124(3):235–244.
pressure phenotypes. International Journal of Biological and Chemical 27. Yusuf S, Reddy S, Ôunpuu S, Anand S. Global burden of cardiovascular
Sciences. 2010;4(6):2102–2112. diseases part II: variations in cardiovascular disease by specific ethnic
21. Isezuo S, Badung S, Omotoso A. Comparative analysis of lipid profiles groups and geographic regions and prevention strategies. Circulation.
among patients with type 2 diabetes mellitus, hypertension and concur- 2001;104:2855–2864.
rent type 2 diabetes, and hypertension: a view of metabolic syndrome. 28. Ghaffar A, Reddy KS, Singhi M. Burden of non-communicable diseases
J Natl Med Assoc. 2003;95:328. in South Asia. BMJ. 2004;328:807–810.
22. Sarkar D, Latif SA, Uddin MM, et al. Studies on serum lipid profile in 29. Zaman MM, Choudhury SR, Ahmed J, et al. Plasma lipids in a rural
hypertensive patient. Mymensingh Med J. 2007;16(1):70–76. population of Bangladesh. Eur J Prev Cardiol. 2006;13:444–448.
For personal use only.
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Key words Abstract package SPSS. Our study found that serum total
●
▶ triglyceride
genetic and environmental factors. When inves- (p < 0.05) whereas the level of HDL cholesterol
●
▶ HDL cholesterol tigating the relationship between lipid distur- was significantly lower in hypertensive patients
●
▶ LDL cholesterol bances and hypertension it is necessary to use as compared to control subjects (p < 0.05). Pear-
local data on blood lipid profile in each region. son’s correlation analysis reveals that HDL cho-
Unfortunately, there is no literature report- lesterol was inversely correlated with systolic
ing the lipid profile in hypertensive patients in and diastolic blood pressure in both patient and
coastal region of Bangladesh. The present study control groups. But serum TC, TG, LDL and HDL
was conducted as a case-control study with 100 cholesterol were directly correlated with systo-
hypertensive patients as cases and equal number lic and diastolic blood pressure in both groups.
of normotensive individuals as controls. Socio- This study explored that hypertensive patients
demographic, anthropometric and clinical data have higher level of TC, TG, LDL and VLDL cho-
of both patients and controls were collected. lesterol but lower level of HDL cholesterol than
Serum lipid parameters were analyzed biochem- the normotensive subjects. Routine investigation
ically. Independent sample t-test, Chi-Square test of lipid profile in hypertensive patients may help
and Pearson’s correlation test were done for the to prevent further aggravation and risks of coro-
statistical analysis using the statistical software nary artery diseases.
received 12.08.2013
accepted 16.10.2013 Introduction than whites and it increases with age in all
Bibliography
▼ groups [5]. The most important risk factors of
Hypertension is the most common cardiovascu- this disorder are obesity, increased salt intake,
DOI http://dx.doi.org/
lar disease and is one of the 10 leading causes of cigarette smoking, lack of physical exercise,
10.1055/s-0033-1358704
Published online: mortality through the world [1]. Hypertension is genetic factors and stress and strain [6].
November 13, 2013 defined as a sustained elevation of blood pres- Lipid parameters are major risk factor for cardio-
Drug Res 2014; sures with systolic pressure to or greater than vascular diseases (CVDs) which are strongly
64: 353–357 160 mm Hg and/or diastolic pressure equal to or linked with the occurrence of CVDs. [7]. Dyslipi-
© Georg Thieme Verlag KG greater than 90 mm Hg [2]. It is sometimes demia is a strong predictor for cardiovascular
Stuttgart · New York
known as “silent killer” because it may exist for diseases which causes endothelial damage. The
ISSN 2194-9379
prolonged periods in the individual without loss of physiological vasomotor activity resulting
symptoms and may manifest only after causing from endothelial damage may be manifested as
Correspondence
Dr. M. S. Islam serious irreversible pathology and complications elevated blood pressure. Thus, factors like dysli-
Associate Professor [3]. The prevalence of hypertension was esti- pidemia causing endothelial dysfunction may
Department of Pharmacy mated to be 26.6 % in men and 26.1 % in women in lead to hypertension [8]. It has also been docu-
Noakhali Science and 2000 which may be increased to 29.0 % in men mented that presence of hyperlipidemia substan-
Technology University and 29.5 % in women by 2025 [4]. It has also been tially worsens the prognosis in hypertensive
Noakhali-3814
suggested that around two-thirds (639 million) patients [9]. Assessment of serum lipids such as
Bangladesh
Tel.: + 88/321/71 483 (Office)
hypertensive populations were living in develop- total cholesterol (TC), triglyceride (TG), low den-
+ 88/171/4165 107 (Mobile) ing countries in 2000 which would rise to three- sity lipoprotein (LDL) cholesterol, and high den-
Fax: + 88/321/62 788 quarters (1.15 billion) by 2025. The incidence of sity lipoprotein (HDL) cholesterol has found
research_safiq@yahoo.com hypertension is higher among black individuals enormous application in patients with cardiovas-
Sarwar MS et al. Lipid Profile in Hypertensive Patients … Drug Res 2014; 64: 353–357
354 Original Article
cular diseases, alcoholics, malnourished children and diabetes Atherogenic index (AIX) was calculated as the ratio of LDL to HDL
mellitus [10, 11]. The diagnosis and treatment of hypercholeste- according to Glueck and Segal [17]. Serum concentration of creati-
rolemia have also approved to show the risk of cardiovascular nine was measured by commonly used laboratory procedure [18].
diseases based on these operations. So, for the prevention and
clinical management of cardiovascular disease, the evaluation of Statistical analysis
plasma lipids and lipoproteins levels have been approved as Statistical analysis was performed using the statistical software
compulsory. package SPSS version 16.0 (SPSS, Inc., Chicago, IL). All data were
There are sufficient evidences which reported that serum lipids expressed as mean ± standard error mean (mean ± SEM). Simple
are controlled by multi-factorial combinations where both descriptive statistics and Chi-Square test was used to express the
genetic and environmental factors influence the levels of these socio-demographic characteristics of the study populations.
parameters [12, 13]. Therefore, the level of several lipid parame- Independent sample t-test was used to determine the level of
ters in hypertensive patients living in coastal region of Bangla- significance. Pearson’s correlation analysis was used to find the
desh may be different. The objective of the present study was to correlation among the various lipid parameters.
assess blood lipids level with a view to investigate the antici-
pated risk of hyperlipidemia among the hypertensive patients in
Laxmipur, a coastal region of Bangladesh. Results and Discussion
▼
Results
Methods General characteristics of subjects
▼ This study comprised of 100 hypertensive patients as cases and
the questionnaires before conducting final study. The inclusion and 0.89 ± 0.02 mg/dl in patient and control groups respectively.
characteristics for the respondents were those experiencing Statistical analysis of these parameters showed that the differ-
from hypertension while those with diabetes, renal failure,
stroke or treated with drugs (diuretics, antihypertensive drugs, Table 1 Socio-demographic profile of the study population.
or lipid lowering agents) were excluded. Patients who disagreed
to donate blood samples were also excluded from this study. Variables HT group (n) NT group (n) p-value
Blood pressure was measured in all subjects as per the recom- Age (mean ± SEM) 46.98 ± 2.11 44.84 ± 2.07 0.470 a
mendations of JNC-VII [14]. Body mass index (BMI) was calculated Sex 0.570 b
from weight (kg) divided by square of height in meters (m2). Male 44 48
Female 56 52
Blood sample collection Area of residence 0.495 b
Rural 76 80
5 mL of venous blood was drawn from each patient and control
Urban 24 20
after 8 h overnight fasting using a plastic syringe fitted with a
Occupation 0.358 b
sterile stainless steel needle and collected into a metal-free plas-
Unemployed 10 4
tic tube. The blood samples were allowed to clot at room tem- Farmer 10 8
perature for half an hour and then centrifuged at 3 000 rpm for Service 6 4
15 min. Finally, the extracted serum was aliquoted into an Business 24 32
Eppendorf tube and analyzed for lipid profile immediately after Housewife 50 52
serum collection. All the steps were carried out in a dust-free Education 0.396 b
environment to avoid the possible interference in the test Illiterate 48 42
readings. Primary 24 32
Secondary 20 22
Analytical procedure Higher study 8 4
Impression of social class 0.229 b
Lipid profile including serum total cholesterol (TC), triglycerides
Low 56 44
(TG) and high density lipoprotein (HDL) cholesterol was per-
Middle 40 50
formed by enzymatic method [12]. Serum low density lipo-
High 4 6
protein (LDL) cholesterol was calculated by using the a
Independent sample t-test
empirical equation of Friedewald et al. [13] [LDL cholesterol = TC – b
Chi-Square test
(HDL + TG/5)] whereas serum level of very low density lipopro- * P > 0.05 (No significant difference between patient and control groups was
tein (VLDL) cholesterol was determined by VLDL = TG/5. observed at 95 % confidence interval)
Sarwar MS et al. Lipid Profile in Hypertensive Patients … Drug Res 2014; 64: 353–357
Original Article 355
ences of SBP and DBP were significant (p < 0.05) between patient tively. The ratio of TC to HDL and LDL to HDL was 7.03 ± 0.36 and
and control groups but no such differences were observed for 4.48 ± 0.22 in patient group whereas 4.30 ± 0.18 and 2.59 ± 0.10
serum creatinine level between 2 groups (p > 0.05). control group respectively. Statistical analysis reveals that serum
level of TC, TG, LDL, VLDL, TC/HDL ratio and LDL/HDL ratio was
Serum lipid profile significantly higher (P < 0.05) but serum level of HDL was signifi-
The mean serum total cholesterol levels were 222.20 ± 8.75 cantly lower (P < 0.05) in hypertensive patients than in the nor-
and 166.92 ± 4.88 mg/dl and serum triglyceride levels were motensive subjects. The data were further analyzed in order to
188.48 ± 6.64 and 143.73 ± 3.62 mg/dl in hypertensive and nor- establish the correlation of various lipid parameters with SBP
motensive subjects respectively, which has been indicated and DBP (● ▶ Table 4). We observed a negative correlation
in ●
▶ Table 3. It was also observed that the serum HDL, LDL and between HDL and SBP (r = − 0.384, p = 0.006), HDL and DBP
VLDL-cholesterol levels were 32.54 ± 0.61, 141.80 ± 5.78 and (r = − 0.244, p = 0.088) but a positive correlation between TC and
38.30 ± 1.33 mg/dl in patient group whereas 40.42 ± 1.12, SBP (r = 0.320, p = 0.023), TC and DBP (r = 0.295, p = 0.037), TG and
102.32 ± 4.04 and 28.75 ± 0.72 mg/dl in control group respec- SBP (r = 0.444, p = 0.001), TG and DBP (r = 0.417, p = 0.003), LDL
and SBP (r = 0.438, p = 0.001), LDL and DBP (r = 0.272, p = 0.056),
VLDL and SBP (r = 0.444, p = 0.001), VLDL and DBP (r = 0.417,
Table 2 Anthropometric and clinical characteristics of the study population.
p = 0.003), TC/HDL and SBP (r = 0.382, p = 0.006), TC/HDL and DBP
Parameters Reference HT group NT group p-value (r = 0.333, p = 0.018), LDL/HDL and SBP (r = 0.491, p = 0.001), LDL/
value HDL and DBP (r = 0.314, p = 0.027) in hypertensive patients.
BMI (kg/m2) 18–24.9 24.81 ± 0.50 23.55 ± 0.35 p < 0.05
SBP (mm Hg) < 140 159.9 ± 3.12 119.40 ± 1.26 p < 0.05
Sarwar MS et al. Lipid Profile in Hypertensive Patients … Drug Res 2014; 64: 353–357
356 Original Article
plaque that block blood flow which may increase the risk for effect can be linked with the harmful effect of reactive oxygen
ischemic stroke. Malhotra et al. [32] stated that individuals with species leading to disruption of membrane lipids [47]. In our
high triglycerides usually have a cluster of abnormalities such as study, we observed a significantly higher value for both AIX
hypertension, insulin resistance and obesity that is known as (LDL/HDL) and TC/HDL in hypertensive patients than the control
metabolic syndrome or syndrome X. Our result reported signifi- subjects (p < 0.05) that confirms an earlier study [38].
cantly higher level of serum triglycerides in hypertensive
patients when compared to control subjects (p < 0.05). This con-
firms an earlier investigation by Kumar et al. who reported Conclusion
serum triglycerides of 180.88 mg/dl. The slight difference ▼
between Kumar et al. [30] result and ours may be due to ethnic Our study explored that hypertensive patients have high level of
variation. serum cholesterol, triglyceride, LDL and VLDL cholesterol but
Alteration in lipid metabolism including a decrease in HDL cho- low level of HDL cholesterol than the healthy control subjects, all
lesterol may cause endothelial damage and trigger an increase in of which may contribute to increased risk of several cardiovas-
blood pressure which may partially account for its strong pre- cular complications. We thus recommend routine investigation
dictive power for CHD [34]. Carbohydrate-rich diet, smoking and of lipid profile in all patients with hypertension to prevent fur-
sedentary life-style are the most common causes of low HDL ther aggravation and risks of coronary artery diseases.
cholesterol [32]. Although the exact mechanism by which a low
HDL cholesterol increases CVD risk is illusive but experimental
studies suggest an undeviating role for HDL cholesterol in pro- Acknowledgements
moting cholesterol efflux by a process known as reverse choles- ▼
Sarwar MS et al. Lipid Profile in Hypertensive Patients … Drug Res 2014; 64: 353–357
Original Article 357
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J. bio-sci. 14: 93-98, 2006 ISSN 1023-8654
Abstract
A prospective study was conducted in the Northern region of Bangladesh, to investigate the serum lipid
profile viz the level of total cholesterol (TC), Triglyceride (TG), HDL-cholesterol and LDL-cholesterol of
hypertensive patients and compares them with levels of control subjects. The results revealed that
serum total cholesterol, triglyceride and LDL-cholesterol were significantly markedly raised (p<0.001)
whereas the level of HDL-cholesterol was significantly lower (p<0.001) in hypertensive patients as
compared to control subjects. No significant changes of serum lipid profile were found between male
and female hypertensive patients, but in control subjects, markedly higher levels of serum lipid profile
was observed in male compared to that of female. It was concluded that hypercholesterolaemia,
hypertrigyceridaemia and low density lipoprotein are the main lipid abnormalities on the incidence of
hypertension in the study area.
Keywords: Hypertension, Total cholesterol (TC), triglyceride (TG), HDL- cholesterol and LDL-cholesterol.
Introduction
Hypertension is the most common of the cardio-vascular diseases which is the leading cause of morbidity
and mortality in the industrial world as well as becoming an increasing common disease in the developing
countries (WHO, 1978). Hypertension in adults is arbitrarily defined as systolic pressure to or greater than
160 mm Hg and or/ or diastolic pressure equal to or greater than 95 mm Hg (WHO, 1978). Hypertension is
one of the 10 leading reported causes of death and about 4% deaths were due to hypertensive complications
(Bangladesh Health Services Report 1998). The prevalence of hypertension is higher among blacks than
whites and it increases with age in all groups (Roberts and Mauer 1977). The most important risk factors for
the development of hypertension are increased salt intake, obesity, cigarette smoking, elevated serum level,
lack of physical exercise, genetic factors and stress and strain (Williams and Braunwald 1987). The blood
lipids and lipoproteins are closely associated with hypertension. The serum lipid level of hypertensive
patients is usually higher and can be lowered either by dietary restriction or by hypolipidemic agents (Lipid
Research Clinics Program 1984 and Burke et al. 1991).
The changes in serum lipid profile level on hypertensive patients should be actively investigated. The findings of
this study may help to understand the effect of renin-angiotensin system in the regulation of blood pressure. The
aim and objectives of the present case-control study were to find out the relationship between serum lipids
levels of the hypertensive patients with controls in the study area i.e. Northern Region of Bangladesh.
The mean serum total cholesterol levels were 182.14 ± 4.45 and 241.25 ± 6.57 mg/dl and serum triglyceride
levels were 142.73± 6.68 and 184.77 ± 5.97 mg/dl in control and hypertensive patients respectively, which
has been shown in Table 2 and Fig. 1. The results presented in Table 2 also demonstrated that the serum
HDL- cholesterol and LDL-cholesterol levels in hypertensive patients were 32.91 ± 1.21 and 154.32 ± 4.22
mg/dl and 42.88 ± 0.93 and 105.73 ± 3.53 mg/dl respectively, in healthy volunteers.
Table 2. Serum lipid profile of group- I (healthy controls) and group-II (hypertensive patients).
Group Total Cholesterol Triglyceride Serum HDL-cholesterol LDL-cholesterol
(mg/dl) (mg/dl) (mg/dl) (mg/dl)
Group-I 182.14 ± 4.45 (110-245) 142.73± 6.68 (85 -210) 42.88 ± 0.93 (40 – 56) 105.73 ± 3.53 (70- 165)
n= 20
Group-II 241.25 ± 6.57 (180 – 310) 184.77 ± 5.97 (140- 240) 32.91 ± 1.21 (32 -52) 154.32 ± 4.22 (110 – 230)
n= 40 P < 0.001 P < 0.001 P < 0.001 P < 0.001
S S S S
Values are mean ± standard error (S.E.), Figures in the parenthesis indicate range, S= Significant.
94
Fig. 1. Histogram showing the serum lipid profile of healthy controls (group 1) and hypertensive patients (group 2).
Among hypertensive patients, the differences of mean serum lipid level in male and female was not
significant as shown in Table 3. On the other hand, significantly higher level of serum lipid was recorded in
male compared to that of female of control patients (Table 4 and Fig. 2).
Male n=25 242.18 ± 6.78 (190-310) 181.53 ± 5.03 (152-240) 31.18 ± 1.12 (36-52) 154.50 ± 5.15 (117-230)
Female n=15 237.15 ± 7.95 (180-295) 175.58 ± 6.12 (140-227) 34.97 ± 1.01 (32-46) 149.45 ± 7.30 (110-217)
Male n=15 193.12 ± 5.28 (130-245) 157.25 ± 8.14 (105-210) 39.51 ± 0.98 (44 - 58) 112.45 ± 4.69 (85-165)
Female n=5 171 ± 74.14 (110-232) 138.21 ± 7.48 (85-192) 46.12 ± 0.73 (40-52) 92.53 ± 4.60 (70-152)
95
Fig 2. Histogram showing the sex differences of serum lipid profile of hypertensive patients (group 2).
Discussion:
In the present study it was found that the frequency of hypertension increases with increasing of age in all
groups which are in accordance with the former studies of Roberts and Mauer (1977) in America and
Mohsen et al. (1999) in Saudi Arabia. The results of our study reveled that the men value of serum
cholesterol, triglyceride and LDL-cholesterol was significantly higher and significantly lower HDL-Cholesterol
level was found in hypertensive patients than those of the control group. The findings of increased total
cholesterol in patients with hypertension are slightly higher than the study of Shahadat et al. (1999) at home
and consistent with the study at abroad (Adedeji and Onitiri1990, Assmann 1982 and Kristensen 1981).
The findings of raised triglyceride level are significantly higher that the study of Bangladesh by Shahadat et
al. (1999) and are in good agreement with the prospective studies carried out in Stockholm (Carlson and
Bottiger 1972), in Finland (Pelkonen 1977) and in Houston (Gotto et al. 1978) but differed with Framingham
(Gordon and Gordon 1977) study where they observed that only post-menopausal females have hyper-
triglyceridemia. Serum HDL-cholesterol level in hypertensive patients was found to be lower than the findings
of Shahadat et al. (1999) at home and of the past (Castilli et al. 1977, Wilson et al. 1980, Person et al.1979
and Miller et al.1977) but serum LDL-cholesterol level corroborated with the study of Shahadat et al. (1999)
96
of Bangladesh, The Framingham Offspring Study (Wilson et al. 1980) and also with the co-operative
phenotyping study (Castilli et al. 1977) in U S A, who demonstrated a positive correlation between the level
of LDL-cholesterol and coronary risk. In our study, no significant difference of serum lipid profile between
male and female hypertensive patients was found but total cholesterol, triglyceride and LDL- cholesterol were
significantly higher in male than female controls whereas HDL-cholesterol was vice-versa.
Based on the results obtained from the present study, we concluded that serum cholesterol; triglyceride and
LDL-cholesterol levels are positively correlated with hypertensive patients whereas HDL-cholesterol has no
significant changes with hypertension. The higher level of serum TC, TG and LDL-cholesterol in the study
population may be due to genetic factors and increased consumption of dietary animal fat, lack of physical
exercise, metabolic disorders like diabetes Mellitus and hypothyroidism, severe stress, increased age, sex as
well as alcohol and tobacco consumption may also be the contributory factors for this phenomenon.
Acknowledgements
The author wishes to thank Dr. Fakrul Islam, Department of Cardiology, Rajshahi Medical College, Rajshahi,
Bangladesh for his valuable suggestion and laboratory help.
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98
Bangladesh Journal of Medical Science Vol. 11 No. 02 April’12
Original Article
Serum Lipid Profile status of Type 2 Diabetic Patients in the cross
section population in Dhaka City of Bangladesh
B C Sarkar1, H R Saha2, A.K. Azad3, N K Sana4, S Choudhury5
Abstract
Objectives: Serum lipid profile viz the level of total cholesterol (TC), Triglyceride (TG), HDL-cholesterol
and LDL-cholesterol of type2 diabetic patients have been studied and compares them with levels of control
subjects. Results: The mean value of the TG level for male diabetics was higher than that for the female
diabetics and the mean values of TC, HDL-C and LDL-C were not found significantly different between
male and female diabetics. Hyperlipidemia has a documented causative relation with CAD, but the major
risk associated with diabetes may be due to the associated hyperlipidemia. The study revealed that dyslipi-
demia is very common in type2 diabetics and the most common abnormality observed was increased serum
triglyceride levels (58%). The next common abnormality was decreased serum high-density lipoprotein cho-
lesterol (HDL-C) levels and increased serum low-density lipoprotein cholesterol (LDL-C) levels. A high
total serum cholesterol levels was found in 41% patients. 39% of the patients examined were overweight,
and 7% were overtly obese. Conclusion: Thus, the study clearly shows the relationship between type2 dia-
betes and hyperlipidemia, which may influence the mechanism by which type2 diabetes is associated with
increased CAD risk.
1. Bidhan Chandra Sarkar, Scientific Officer, Department of Clinical Biochemistry, Haematology and Clinical
Pathology, BIRDEM, 122, Kazi Nazrul Islam Avenue, Shahabag, Dhaka-1000, Bangladesh,
2. Hasi Rani Saha, MSc Student, Department of Biochemistry and Molecular Biology, University of Rajshahi,
Rajshahi-6205, Bangladesh.
3. A.K. Azad, Department of Biochemistry and Molecular Biology, University of Rajshahi, Rajshahi-6205,
Bangladesh.
4. Niranjan Kumar Sana, Professor, Department of Biochemistry and Molecular Biology, University of Rajshahi,
Rajshahi-6205, Bangladesh.
5. Professor Dr. Subhagata Choudhury, Professor of Biochemistry and Director, Laboratory Services, BIRDEM
(Bangladesh Institute of Research & Rehabilitation in Diabetes, Endocrine and Metabolic Disorders)- WHO
Collaborating Centre for Prevention and Control of diabetes in Bangladesh.
Corresponds to: Bidhan Chandra Sarkar, Scientific Officer, Department of Clinical Biochemistry, Haematology and
Clinical Pathology, BIRDEM, 122, Kazi Nazrul Islam Avenue, Shahabag, Dhaka-1000, Bangladesh, E-mail: csbid-
han75@gmail.com
121
Serum Lipid Profile status of Type 2 Diabetic Patients in the cross section population in Dhaka City of Bangladesh
7,8
levels of HDL-C . The aim and objects of the pres- while most of the females were of the age 30 – 40
ent study were to find out the relationship between years (TABLE I).
type2 diabetes and serum lipid profile.
Materials And Methods
All reagent kits for this study were purchased from
Human Laboratories Ltd., Wiesbaden, Germany,
Biotec Laboratories Ltd., Suffolk, U.K. and Randox
Laboratories Ltd., Antrim, U.K.This prospective
study was carried out from July 2007 to June 2008
in the Department of Biochemistry and Molecular
Biology, University of Rajshahi, Bangladesh. A total
of 175 human subjects ranging in age from 30 – 80
years were included in this study. Out of the 175
subjects, 60 (35 males and 25 females) were select- In TABLE II, most of the subjects of group 1, had
ed as healthy controls (group 1). The remaining 115 normal BMI whereas in group 2, 54 % of type2 dia-
subjects (60 males and 55 females) were grouped as betic patients had normal BMI, and 39 % were over-
type-2 diabetic patients (group 2). Blood samples weight. A small proportion (7%) of patients in group
were randomly collected from 115 hospitalized
patients from BIRDEM hospital and five Dhaka city
diagnostic centers. This study design was approved
by 'Research and Ethics Committee' of Department
of Biochemistry and Molecular Biology, Rajshahi
University.
122
B C Sarkar, H R Saha, A.K. Azad, N K Sana, S Choudhury
123
Serum Lipid Profile status of Type 2 Diabetic Patients in the cross section population in Dhaka City of Bangladesh
is efficacious in patients with diabetes to reduce the has recently become an independent predictor of
15
CAD risk . Similarly, the Pravastatin or Atorvastatin CAD risk21.
Evaluation and Infection-Thrombolysis in
Myocardial Infarction trial has demonstrated that In conclusion, the present observation supports the
intensive LDL-C lowering will reduce the major association between dyslipidemia and type2 diabetes
16
coronary events . that may influence the mechanism by which type2
diabetes is associated with increased CAD risk. The
Various epidemiological data have shown a log-lin- presence of type2 diabetes alone is taken as an indi-
ear relationship between LDL-C and CAD risk17. cation for lipid lowering therapy as a primary CAD
The NCEP ATP III guidelines recommend a LDL-C prophylaxis which includes therapeutic lifestyle
[13]
goal of < 100mg/dl in those with type-2 diabetics . changes (TLC) as well as drug therapy 18. The pres-
However, on the basis of recent landmark studies, ence of both dyslipidemia and type2 diabetes war-
the recommendation for the optimal goal of
rants a more intensive drug therapy in addition to
<70mg/dl, whereas <100mg/dl is considered as min-
TLC to successfully achieve the NCEP ATP III rec-
imal goal for therapy18. Recent other studies indicate 13
ommendations .
that for every 1% reduction in LDL-C levels, the rel-
ative risk for major CAD events is reduced by
approximately 1% .
19
Acknowledgement
The authors gratefully acknowledge the research
Framingham study20 has demonstrated the correla- facilities provided by the staffs of the Department of
tion between low HDL-C and CAD as an independ- Clinical Biochemistry Laboratory of BIRDEM and
ent risk factor. Also the elevated triglyceride level five other Diagnostic Centers of Dhaka, Bangladesh.
124
B C Sarkar, H R Saha, A.K. Azad, N K Sana, S Choudhury
11. Enzymatic method to determine the serum HDL-cho- M.A.Pfeffer, A.M.Skene. Differential regulation of
lesterol. T.Gordon, M.Gordon.Am. J. Med1977; human apolipoprotein AI and high-density. N Engl J
62:707-708 Med 2004; 350: 1495-1504 http://dx.doi.org/
10.1056/NEJMoa040583 PMid:15007110
12. W.T.Friedewald, R.I.Levy, D.S.Fredrickson.
Estimation of the concentration of low-density 17. M.R.Law,N.J.Wald,S.G.Thompson.Predicting mor-
lipoprotein cholesterol. Clin. Chem1972; 18:499- tality from cervicalcancer. BMJ1994; 18.
502PMid:4337382 S.M.Grundy, J.I,Cleeman et al. Implications of recent
13. Executive summary of the Third Report of the clinical trials for the National Cholesterol.
National Cholesterol Education Programme (NCEP) Circulation 2004;110:227-39 http://dx.doi.org/
Expert Panel on Detection, Evaluation and Treatment 10.1161/ 01.CIR.0000133317.49796.0E PMid:
of High Blood Cholesterol in Adults (Adult 15249516
Treatment Panel III). JAMA 2001; 285:2486-97
http://dx.doi.org/10.1001/ jama.285.19.2486 19. The long Term Intervention with Pravastatin in
Ischemic Disease (LIPID) Study Group. Prevention
14. J.Stamler, D.Wentworth, J.D.Neaton. Findings in of cardiovascular events and death with pravastatin in
356222 Primary Screeners of the Multiple Risk patients with coronary heart disease and a broad
Factor Intervention Trial (MRFIT).JAMA1985; 256: range of initial cholesterol levels.N Engl J
2823-2828http://dx. doi.org/10.1001/jama.1986. Med1998;339:1349-1357http://dx.doi.org/10.1056/
03380200061022 NEJM199811053391902PMid:9841303
15. Heart Protection Study Collaborative Group, 20. W.P.Castelli. Cholesterol and lipids in the risk of
MRC/BHF. Heart Protection Study of cholesterol coronary artery disease. Can J Cardio1988;
lowering with simvastatin in 20,536 high-risk indi- 4(suppl):5A-10APMid:3179802
viduals: a randomized placebo-controlled trail.
Lancet2002; 360(9326):7-22 http://dx.doi.org 21. Assmann G, Schulte H, von Eckardstein A.
/10.1016/ S0140 6736(02)09327-3 Hypertriglyceridemia and elevated lipoprotein(a) are
risk factors for major coronary diseases. Am J
16. C.P.Cannon, E.Braunwald, C.H.McCabe, D.J.Rader, Cardiol 1992; 70(22):733-37.http://dx.doi.org/
J.L.Rouleau, R.Belder, S.V.Joyal, K.A.Hill, 10.1016/0002-9149(92)90550-I
125
JOURNAL OF CLINICAL AND EXPERIMENTAL HEPATOLOGY
end point being to observe for any adverse events related Results: A total of 132 cases (mean age 49.2 ± 10.2
to treatment. years; male/ female ratio 103:29) were studied. The most
Results: Treatment naïve patients with HCV cirrhosis common precipitating factor of HE identified was infec-
either due to genotype 1 or genotype 3 were divided into tion 65 (49.2%), followed by electrolyte imbalance as
two groups: group A (compensated cirrhosis), group B hyponatremia 54 (41%) and hypokalemia 18 (13.6%), con-
(decompensated cirrhosis). SVR12 in group A was 91.66% stipation 44 (33.33%) and gastrointestinal bleeding 21
(33/37) and in group, B was 73.17% (30/41). Baseline (16%) patients. Thirty eight (28.8%) and 94 (71.2%) patients
mean liver stiffness measurement (LSM) in group A was were in CTP class B and class C respectively. Mean CTP
16.81 ± 3.57 kPa which decreased to 11.19 ± 1.75 kPa at score was 10.24 ± 1.85, MELD score was 22.2 ± 7.54. At
SVR12 (p-value < 0.0001). Baseline mean APRI and FIB-4 the time of admission, 29 (22%), 76 (57.5%), 21 (16%) and
Score in group A were 1.228 ± 0.499 & 2.61 ± 1.06 and 6 (4.5%) patients had grade I, II, III, and IV HE respectively.
in group B were 2.156 ± 1.10 & 5.71 ± 2.06 respectively The difference in mortality was not statistically signifi-
which decrease to 0.415 ± 0.115 & 1.25 ± 0.46 in group A, cant (p = 0.269) in three groups [group B (13.6%) and group
to 0.759 ± 0.275 & 2.60 ± 1.12 in group B following SVR12 C (13.6%) vs. group A 10 (22.7%)] but the hospital stay
(p value < .0001). Mean MELD-Na improved from base- was shorter among patients in the group B and C than
line 9.93 ± 2.04, 20.70 ± 4.52 to 7.21 ± 0.92, 14.23 ± 4.51 group A patients (7.36 ± 4.58 and 7 ± 3.69, 9.64 ± 5.28 days
respectively in group A and B at SVR12 (p-value < .0001). respectively, p = 0.015).
CTP Score improved by 1 in 27.27% (9/33) and ≥2 in Conclusions: Infection was the commonest precipitat-
76.67% (23/30) of patients in group A and group B respec- ing factor of HE. Addition of LOLA or rifaximin was more
tively. effective than lactulose alone in the treatment of acute HE
Conclusions: There was a significant improvement in but without any difference in mortality.
severity of liver disease as depicted by the decrease in LSM
and other noninvasive marker of fibrosis in patients who
achieved SVR12 on DAA therapy. CONFLICTS OF INTEREST
http://dx.doi.org/10.1016/j.jceh.2018.06.362 3
STUDY ON LIPID PROFILE AMONG
2
ADULTS WITH HBV AND HCV RELATED
TREATMENT OUTCOME OF HEPATIC CHRONIC LIVER DISEASES IN
ENCEPHALOPATHY IN LIVER BANGLADESH-REPORT FROM A
CIRRHOSIS TERTIARY CENTRE
Nandu Poudyal Silwal ∗ , Sudhamsu Kc, Mohd Harun Or Rashid 1,∗ , Md Khalilur Rahman 1 ,
Sitaram Chaudhary, Mukesh Sharma Mahbubur Rahman Khan 1 , Mamun Al Mahtab 2 ,
Md Nahid Hasan 2 , Humaira Rashid 3 ,
National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
Alaksar Sazid Hasan 4 , Abdul Alim 4
E-mail address: nandupoudyal@gmail.com (N.P. Silwal).
1 Rajshahi Medical College, Bangladesh
Background and Aims: Hepatic encephalopathy (HE) 2 Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
is a common cause of hospital admission in patients with 3 Brac University, Dhaka, Bangladesh
liver cirrhosis (LC). Various precipitating factors are seen 4 Gono Bishwabidyalay, Dhaka, Bangladesh
in patients with HE. The aims of this study were to evaluate E-mail address: drharun bd@yahoo.com (M.H.O. Rashid).
the precipitant factors and to analyze treatment outcome
of HE in liver cirrhosis. Background and Aims: Chronic Hepatitis B and C
Methods: A randomized prospective trial was con- are the major causes of cirrhosis of Liver and Hepatocel-
ducted amongst LC patients presenting with HE from lular carcinoma in Bangladesh. Development of cirrhosis
August 2016 to July 2017. They were randomized into of liver result in derangement of metabolic functions. This
three groups: group A received lactulose only, group B study was conducted to find out the changes of lipid profile
received lactulose plus L ornithine L asparte (LOLA) and among adult with Chronic Viral Hepatitis B and C.
group C received lactulose plus rifaximin. The primary end Methods: This was cross sectional descriptive study in
points were mortality and hospital stay. Medicine Inpatient Department of Rajshahi Medical Col-
Journal of Clinical and Experimental Hepatology July 2018 Vol. 8 No. S1 S51
CIRRHOSIS AND COMPLICATIONS
lege Hospital from June 2015 to july 2016. Total Number utive days were started on Midodrine 5 mg three times a
of Patients were 130. Among them 114 Chronic Hepatitis day. The dose was increased to 7.5 mg three times a day at
B and 16 patients chronic Hepatitis C. Age 18–65 years. the end of 7 days if mean arterial pressure (MAP) remained
Male 107, female 23. There were no comorbidities of these less than 80. Tolvaptan 15 mg once a day was added at 15
patients. days if serum sodium remained <125 mEq/L at 2 weeks. We
Results: Among 130 Patients (116 Child’s Pugh A & excluded patients if there was proven sepsis or renal dys-
14 Child’s Pugh B). In HBV group Male 96, Female 18 function (serum creatinine 1 mg/dl). Serum sodium was
and in HCV group Male 11, Female 05. Serum Total measured every week.
cholesterol, HDL, LDL and Serum Triglyceride were done Results: Ten patients were included (7 NASH, 3 ALD).
in all patients in six monthly intervals. The results were The Mean age was 49 ± 2.1 years, with pretreatment MAP
reduction of Serum Total Cholesterol and HDL in 45 73 mm of Hg (Range 70–78) serum sodium of 127 mEq/L
(39.47%) and increased Serum Triglyceride in 11 (09.65%) (Range 118–130). At the end of six weeks, 6 patients were
patients in HBV group. In HCV group increased Serum on 5 mg dose while 4 patients were on 7.5 mg dose. Only
Total cholesterol and Serum Triglyceride in 07 (43.75%) one patient required tolvaptan for 14 days (stopped once
and reduction of HDL in 03 (18.75%) patients. serum sodium reached 140). The mean arterial pressure
Conclusion: Developing countries like Bangladesh are was 86 mg of Hg (P < 0.05) and mean serum sodium levels
likely to face an enormous burden of CLD and prevention were 136 mEq/L (Range 132–139) (p < 0.05). We were able
and early diagnosis is essential to reduce economic loss and to reintroduce low dose diuretics in 4 patients.
health system burden. Dyslipidemia is frequent in CLD & Conclusions: Midodrine use can successfully reverse
found with severity of the disease. Moreover, it may acts hyponatremia related diuretic intractable refractory
as a good predictor of CLD management. Till now, no ascites in 40% cases besides significantly improving serum
needful studies are available in Bangladesh. sodium levels and mean arterial blood pressures.
Understanding the pattern of Dyslipidemia of hepatitis
B & C related CLD in Bangladesh may enrich the clinician CONFLICTS OF INTEREST
and may act as a baseline study for further research.
The author has none to declare.
CIRRHOSIS AND COMPLICATIONS
CONFLICTS OF INTEREST
http://dx.doi.org/10.1016/j.jceh.2018.06.365
The authors have none to declare.
5
http://dx.doi.org/10.1016/j.jceh.2018.06.364
STROKE IN A YOUNG PATIENT WITH
4 WILSON’S DISEASE: THE SPECTRE OF
‘RE BALANCED HEMOSTASIS’
MIDODRINE FOR DIURETIC
Khalid Javid, Sridhar Cg ∗ , Juned Khan,
INTRACTABLE ASCITES WITH
Ramesh Kumar Ts, Ramcharan Reddy
HYPONATREMIA
GEM Hospital and Research Center, Coimbtore, Tamil Nadu, Coimbatore, India
Pathik Parikh
E-mail address: drkhalidjavid@gmail.com (S. Cg).
Zydus Hospitals, Ahmedabad, India
E-mail address: pathik269@gmail.com. Background: Coagulopathy is an essential component
of the liver cell failure and reflects the central role of liver
Background and Aims: Midodrine hydrochloride is function in hemostasis.
an orally available, ␣-adrenergic agonist that increases Case Summary: We present a seven-year old boy, a
effective circulating blood volume and renal perfusion by known case Wilson’s disease who presented with jaundice
increasing systemic and splanchnic blood pressure. There and abdominal distension for two weeks with history of
is scanty data besides the study from North India, on use repeated episodes of hypoglycemia for last five days. He
of midodrine in patients with cirrhosis and ascites with was on Penicillamine 500 mg thrice daily. On examination
an additional component persistent hyponatremia and he was found to have chronic liver disease, decompen-
hypotension. sated with grade I hepatic encephalopathy and minimal
Methods: In this single center observational study ascites. Laboratory investigations showed thrombocy-
patients with diuretic intractable ascites (EASL crite- topenia (64,000/mm3 ), Blood sugar of 52 mg/dl, Serum
ria) with persistent hyponatremia (Serum Sodium albumin; 2.5 mg/dl, Bilirubin; 17 mg/dl, Serum Alanine
<130 mEq/L) even after withholding the diuretics and transaminase; 52 IU/L, Aspartate transaminase; 153 IU/L,
albumin replacement (100 ml 20% per day) for 3 consec- Alkaline phosphatase; 211 IU/L, and international nor-
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