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Case study

Effect of smoking on lipid profile


R.S.Trivedi1,A.K.Anand2- Jamnagar( Gujarat)

Introduction mellitus,(5) Hypothyroidism(6) Renal diseases: Renal


The habit of smoking is increasing particularly in developing failure, Nephrotic syndrome,(7) Liver diseases: Obstructive
nations. There is considerable evidence that tobacco liver diseases, Acute hepatitis,(8) Drugs: Estrogen,
consumption either in smokable or in smokeless form is Progesterone, - Blockers, Glucocorticoids etc. (9) Systemic
associated with increased risk of cardiovascular disease lupus erythematosus (SLE),(10) Multiple myeloma,
(CVD). The present study was conducted to find out Lymphoma. Complete detailed history of each subject
differences in the serum lipoprotein profile between smokers including weight and height, number of cigarettes smoked per
and nonsmokers. Study included 50 smokers and 50 non day, duration of smoking, types of cigarettes taken, any
smokers. Smokers were divided into three classes- Mild (1-10 specific symptoms (if any) were noted as shown in Performa.
cigarettes per day), Moderate (11-20 cigarettes per day) and After detail history, pulse and blood pressure were recorded in
Heavy (more than 20 cigarettes per day). The mean serum supine position after rest for five minutes in each person.
total cholesterol was significantly higher in smokers than non General and systemic examinations were done thoroughly.
smokers. The mean serum HDL-cholesterol was significantly Venous blood were collected after overnight fasting of 12
lower in smokers than non smokers. The mean serum LDL, hours in all the subjects for estimation of serum total
mean serum triglyceride and mean serum VLDL were cholesterol, HDL cholesterol, LDL cholesterol, VLDL
significantly higher in smokers than non smokers although cholesterol and serum triglycerides. Serum was separated
the increase was insignificant in mild smoking. In present from blood samples by centrifugation. Serum cholesterol,
study, the overall assessment has been that smoking is serum triglyceride and serum HDL were measured. LDL and
associated with an unfavorable serum lipid profile. India is VLDL cholesterol were calculated from these three values.
world's third largest tobacco-producer and its product After taking complete detailed history and performing
consumer, after China and United States. Tobacco is smoked complete clinical examination, venous blood was collected
and chewed in variety of ways and all forms of tobacco use are (after overnight fasting) in all the subjects and estimation of
reported to carry equal serious health consequences. serum total cholesterol, triglycerides, HDL-cholesterol, LDL
However, most Indian smokers, particularly in the lower and VLDL-cholesterol were done.All the subjects were
socio-economic classes, smoke bidis. Bidis (the "Indian divided into four groups according to the number of cigarettes
Cigarettes") are made from tobacco which is rolled by hand in / bidis smoked per day.3, Group I:Non smoker: Subjects who
a tendu leaf. Now the habit of cigarette smoking is rising in never smoked, Group II: Mild smoker: Subjects smoking 1-10
rural India. Key words: Smoking, Lipid profile cigarettes or 1-15 bidis per day, Group III : Moderate smoker:
Material and methods Subjects smoking 11-20 cigarettes or 16-30 bidis per day,
The study was carried out in Department of Physiology, M.P. Group IV: Heavy smoker: Subjects smoking more than 20
Shah Medical College and Guru Gobind Singh Hospital, cigarettes or 30 bidis per day. The data collected were
Jamnagar. 50 healthy smokers and 50 healthy non smoker statistically analyzed.
subjects were included in the study. All the subjects in both the Results and observations
samples were in the age group 30 to 60 years belonging to The study, which was carried out on 50 healthy smokers and
middle socio-economic class. The control groups (non- 50 healthy non smokers, showed following results: General
smokers) were comparable in age, sex, physical activity and examination and systemic examination of all the subjects
body mass index to study group (smokers). For studying were normal. Neither smokers nor nonsmokers were obese,
exclusively the effect of smoking on lipid profile, the subjects the body mass index (BMI) being less than 26.4 in smokers
having risk factors that affect lipid profile, were excluded.1 and 26.2 in nonsmokers. The changes in mean age, pulse rate
Exclusion criteria Persons having any of following criteria and blood pressure in smokers and non smokers were non-
were excluded. (1)Alcohol intake,(2) Ex-smoker,(3) Obesity significant statistically. i) Mean level of total cholesterol, LDL
(BMI 30 in males and 28.6 in females)2,(4) Diabetes cholesterol, VLDL Cholesterol and triglycerides were

1
Associate Professor Physiology,2Ex Prof & Head Physiology, M.P.Shah Govt. Medical College Jamnagar

13 National Journal of Otorhinolaryngology and Head & Neck Surgery, Vol. 1(10) No. 2, August 2013
significantly increased (p< 0.01) in smokers than non- of age, height, weight, body mass index and dietary habits.
smokers.ii) Mean level of HDL-cholesterol was significantly The mean age (in years) of smokers was 46.2 10.2 and that of
low (p< 0.01) in smokers (43.5 5.6 mg/dl) than non-smokers non smokers was 45.0 11.4 which was not significant
(47.0 6.8 mg/dl).iii) Mean level of serum triglyceride and statistically (P>0.05). Neither the smokers nor the non-
VLDL were much more significantly increased (p< 0.001) in smokers were obese. General examination and systemic
smokers as compared to other values.iv) Mean total examination of all the subjects were normal. The exact
cholesterol was 15.0 mg/dl and 6.5 mg/dl higher in heavy mechanism by which smoking induces atherosclerosis is not
smokers as compared to mild and moderate smokers.v)Mean clear. Many studies have shown that cigarette smoking leads
HDL-cholesterol was 3.4 mg/dl and 2.1 mg/dl lower in heavy to increased serum level of total cholesterol, LDL cholesterol,
smokers as compared to mild and moderate smokers. triglyceride level and decreased level of antiatherogenic
vi) Mean LDL-cholesterol was 12.5 mg/dl and 2.4 mg/dl HDL. Even exposure to environmental tobacco smoke i.e.
higher in heavy smokers as compared to mild and moderate passive smoking result in decreased levels of HDL cholesterol
smokers.vii) Mean triglyceride was 36.2 mg/dl and 16.5 in children of smoker parents. The mechanism by which
mg/dl higher in heavy smokers as compared to mild and smoking alters lipoprotein metabolism is not clear. The
moderate smokers. various mechanisms postulated are: Cigarette smoking -
viii) Mean VLDL was 6.6 mg/dl and 3.4 mg/dl higher in Absorption of nicotine into the body-Secretion of
heavy smokers as compared to mild and moderate catecholamine and other hormones (cortisol, growth
smokers.ix) Although the values of total cholesterol, LDL- hormone)-Activation of Adenyl cyclase in adipose tissue-
cholesterol, triglyceride and VLDL-cholesterol were higher Release of free fatty acids from adipose tissue into plasma
in mild smokers than non smokers but increase were bound to albumin-Increased synthesis of triglycerides and
statistically insignificant.x) The increased value of total VLDL by liver-Decreased HDL.(1) Nicotine by stimulating
cholesterol, LDL-cholesterol, triglyceride and VLDL- sympathoadrenal system leads to lipolysis, increased serum
cholesterol in moderate and heavy smokers were statistically free fatty acid (FFA) levels and increased synthesis of
significant. VLDL.(2) Smoking has an additional indirect effect on
xi) The decreased level of HDL-cholesterol in mild, moderate lipoprotein metabolism by affecting lipoprotein lipase, which
and heavy smokers than non smokers was statistically is an important factor in the metabolism of cholesterol and
significant. triglycerides. (3) Repressive action of smoking on the
Lipid profile of non smokers and smokers of mean 8 years estrogen level which in turn leads to increased cholesterol.
Duration of various categories-i) There was increased in the Lower levels of estrogen are noted in smoking women as a
level of mean total cholesterol (173.0 34.6 mg/dl), LDL - result of accelerated estrogen catabolism and formation.
cholesterol (96.5 24.4 mg/dl), triglyceride (140.2 30.6 Postmenopausal women taking estrogens have lower serum
mg/dl) and VLDL (30.4 8.2 mg/dl) in mild smokers than non estrogen levels if they smoke cigarettes. (4) Smokers are
smokers but statistically insignificant.ii) There was decrease known to consume diet rich in fat and cholesterol and poorer
in the level of mean HDL-cholesterol in mild smokers (45.0 in fibre and cereals.(5)Difference in oral fat handling between
3.8 mg/dl) than non smokers (47.0 6.8 mg/dl) but statistically smokers and non smokers (6) An antigenic glycoprotein
insignificant.iii) There was significant decrease in the level of component of cigarette smoke, associated with immune
mean HDL-cholesterol in moderate smokers (42.5 4.2 mg/dl) reactions, may also produce endothelial injury along with
than mild smokers (45.0 3.8 mg/dl) and non smoker (47.0 other factors. Smoking reduces HDL cholesterol which is
6.8 mg/dl).iv) Increase in the level of total cholesterol in considered the best predictor of atherosclerotic events.
moderate smokers (179.2 30.8 mg/dl) than mild smokers Smoking cessation trials have documented a significant rise
(173.0 34.6 mg/dl) and non smokers (164.0 16.8 mg/dl) was in HDL after smoking cessation, and the expected rise after
statistically insignificant.v) Increase in the level of serum continued cessation is 6 to 8 mg/dL Comparison of serum
triglyceride, LDL and VLDL-cholesterol in moderate cholesterol:The mean serum total cholesterol value among
smokers (154.0 28.2, 109.0 20.2, 32.5 7.2 mg/dl) than mild non smokers was 164.0 16.8 mg/dl while in smokers it was
smokers (140.2 30.6, 96.5 24.4, 30.4 8.2 mg/dl) and non 180.0 29.4 mg/dl. The values are significantly higher in
smokers (129.0 28.6 ,92.8 20.4, 27.2 8.8 mg/dl) were smokers. These findings are comparable with the
statistically significant. observations of other workers. Sinha et al4 observed
Discussion significant changes in cholesterol level in smokers and that is
Both the smokers and non smokers were comparable in terms comparable with present study.Rastogi et al3 found high level

14 National Journal of Otorhinolaryngology and Head & Neck Surgery, Vol. 1(10) No. 2, August 2013
of serum cholesterol because it was estimated by different insignificant in mild smokers. The mean serum VLDL was
method.Brischetto et al5 did not found much difference of significantly higher in smokers than non smokers. Therefore,
serum cholesterol in mild smokers than non smokers but in it can be concluded that alteration in lipid profile are higher in
moderate and heavy smokers, it was significantly raised than persons smoking greater than 20 cigarettes per day (heavy
non smokers.Bulliya G.6 observed significant increase in smokers) and those smoking 11-20 cigarettes per day
cholesterol level than non smokers. Comparison of serum hdl- (moderate smokers) than those smoking 1-10 cigarettes per
cholesterol:The mean serum HDL-cholesterol level in non day (mild smokers)
smokers was 47.0 6.8 mg/dl and that of smokers was 43.5 5.6 References
mg/dl. The value was significantly lower in smokers.The 1. Ginsberg HN, Goldberg IJ. Disorders of lipoprotein
findings suggest that serum HDL-cholesterol is significantly metabolism, In: Harrison's principles of Internal
lower in smokers as compared to non smokers and also it is Medicine, 15th edition, Vol. 2, McGraw Hill, New York
significantly lower in moderate (42.1 4.6 mg/dl) and heavy 2000; pp. 2245-57.
smokers (40.0 4.1 mg/dl) as compared to mild smoker (43.4 2. K Park. Obesity In: Park's Textbook of preventive and
5.4 mg/dl). These findings are in accordance to the social medicine, 15th edition, M/s Banarsidas Bhanot,
observations made in other studies. Comparison of serum Jabalpur 1997: pp. 292-4.
ldl:The mean LDL-cholesterol level was 92.8 20.4 mg/dl in 3. Rastogi R, Shrivastava SSL, Mehrotra TN, Singh VS,
non smokers and 103.4 29.8 mg/dl in smokers which was Gupta MK. Lipid profile in smokers. J Assoc Physicians
significant statistically. The increase in LDL-cholesterol in India 1989; 37: 764-6.
mild smokers (97.5 20.8 mg/dl) was insignificant as 4. Sinha AK, Misra GC, Patel DK. Effect of cigarette
compared to non smokers where as in moderate (107.6 22.6 smoking on lipid profile in the young. J Assoc physicians
mg/dl) and heavy smokers (110.0 8.4 mg/dl), the change India 1995 ; 43 : 18
were significant.Sinha et al4 observed that changes in LDL- 5. Brischetto CS, Connor WE. Plasma lipid and lipoprotein
cholesterol in mild smokers as compared to non smokers was profile of cigarette smokers from randomly selected
insignificant whereas in moderate and heavy smokers that families: Enhancement of hyperlipidemia and
were significant as in present study. Comparison of serum depression of high density lipoprotein. Am J Cardio
triglycerides: Rastogi et al3 observed that changes in value of 1983; 52: 675-80
S. VLDL is significant in mild smokers as compared to non 6. Bulliya G. Blood pressure and serum lipid profile in
smokers but changes were significant in moderate and heavy smokers and non smokers - A comparative study. The
smokers as in present study. Indian Practitioner 2002; 55: 363-8.
Conclusions 7. Baldwa VS, Gupta MC, Maheshwari VD, Bhansali A.
Our study included 50 smokers and 50 non smokers. All were Effect of prolonged smoking and alcohol on lipid profile,
healthy and non-obese. The means age of smokers was 46.2 separately and in combination. J Assoc Physicians India
10.4 years and that of non smokers was 45.0 11.4 years. The 1983 ; 31 : 573-5
mean pulse rate in non smokers was 74.2 5.2 per minute 8. Muscat JE, Harris RE, Haley NJ, Wynder EL. Cigarette
where as in smokers it was 77.4 6.0 per minute. The higher smoking and plasma cholesterol. Am Heart J 1991; 121:
pulse rate in smokers suggests increased sympatho adrenal 141-7.
drive. The mean blood pressure in smokers was 118.6 12.4 /
76.2 9.2 mm of Hg whereas in non smoker it was 116.8 12.8 / Address for correspondence
75.6 8.8 mm of Hg. The change was not statistically Dr. R.S.Trivedi
significant. The mean serum total cholesterol was Associate Professor Physiology
significantly higher in smokers than non smokers. The M .P. Shah Govt. Medical College
increase was insignificant in mild smokers whereas it was Jamnagar, Gujarat
significant in moderate and heavy smokers. The mean serum Cell +91 9426465897
HDL-cholesterol was significantly lower in smokers than non E-mail: drrstrivedi@yahoo.com
smokers. The mean serum LDL was significantly higher in
smokers than non smokers although the increase was
insignificant in mild smokers. The mean serum triglyceride
was much significantly higher in smokers. The increase was

15 National Journal of Otorhinolaryngology and Head & Neck Surgery, Vol. 1(10) No. 2, August 2013