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Objectives: To investigate the correlation between routine laboratory parameters with 1000 patients and followed up for more

up for more than one year. Risk factors evaluated were systolic
POSTER ABSTRACTS

severity of coronary artery lesions. BP, HbA1c and LDL-C.


Methods: Patients who underwent coronary angiography between January to August 2013 Results: More than 20,000 diabetic patients have been assessed in each category. The
were included. The indication for coronary angiography was positive non invasive test or lowest CV event rates were seen in patients with an HbA1c of between 7-8%. Aggressive
symptoms indicating coronary artery disease (CAD). The exclusion criteria include lowering of HbA1c beyond these limits is neverthless being assessed in more than 10
incomplete data, infection, anemia, chronic statin treatment and previous coronary inter- ongoing intervention trials. The ideal systolic BP was determined to be between 130-140
vention. Routine laboratory examinations (including hemoglobin, red cell distribution mmHg (<120 mmHg was associated with increased mortality). LDL-C benefit RRR in
width, white blood cell count, platelet, fasting blood glucose [FBG], lipid profile and diabetics was the same as non-diabetics with incremental benefit in those with an LDL-C
creatinine) were analyzed to identify their relation to the severity of coronary artery lesion <1.5 mmol/L.
based on modified gensini score. Statistical analyses were done using SPSS 17.0 software. P Conclusion: CHD risk factor guidelines in diabetes should be modified to reflect evidence
value <0.05 was considered statistically significant. from intervention trials. Patients could thus be spared unnecessary drugs or insulin
Results: A total 101 patients were included in this study. From these, 86 patients (85.15%) therapy.
were male. Hypertension, diabetes and dyslipidemia were found in 60 patients (59.41%), Disclosure of Interest: None Declared
31 patients (30.69%), and 85 patients (84.16%) respectively. There is significant correla-
tion between total cholesterol (r¼0.316; P value¼ 0.001), LDL (r¼0.246; P value¼0.013), PM275
HDL (r¼-0.222; P value¼0.025), FBG (r¼0.295; P value¼ 0.003), LDL/HDL ratio
(r¼0.290; P value¼0.003), and total cholesterol/HDL (TC/HDL) ratio (r¼0.336; P value¼ Evidence-treatment gap in type 2 diabetes care
0.001) with the severity of coronary artery lesion. In multivariate analysis, TC/HDL ratio is
the only independent predictor of CAD (OR¼ 1.79, P value¼ 0.024) and the strongest Tiina Laatikainen*1,2,3, Maija Sikiö4, Hilkka Tirkkonen5, Päivi Kekäläinen3, James Dunbar6,
independent predictor of moderate to severe lesion (modified gensini score >7) (OR¼ Markku Tykkyläinen4
1
2.59, P value <0.001). From the Receiver Operating Curve (ROC) analysis, the most Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio,
2
effective cutoff values for TC/HDL ratio to predict CAD (Area Under the Curve [AUC]¼ Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki,
0.76; P value¼0.008) and moderate to severe lesion (AUC¼ 0.73; P value <0.001) are 3.91 3
Hospital District of North Karelia, 4Department of Geographical and Historical Studies,
(sensitivity 82.4% and specificity 70%) and 5.22 (sensitivity 70.6% and specificity 72%) University of Eastern Finland, Joensuu, 5Health Centre of Outokumpu, Outokumpu, Finland,
respectively. 6
Greater Green Triangle Department of Rural Health, Deakin and Flinders Universities,
Conclusion: TC/HDL ratio demonstrates strongest correlation with the severity of coronary
Warrnambool, Australia
artery lesions. TC/HDL ratio independently predicts patients with CAD and predicts more
severe lesion. Introduction: T2DM generates a large burden of work and economic cost for primary
Disclosure of Interest: None Declared health care. Only limited information is available about the quality of care of non-
communicable diseases in different countries. In North Karelia, Finland, a recently estab-
PM273 lished region-wide electronic patient database has provided the possibility to assess the
evidence-treatment gap among patients with T2DM.
Lipid Profile of Adult Population in Bangladesh Objectives: The aim of the study was to assess the quality of care of T2DM in primary
Md. Abdul K. Akanda*1, Kamrun N. Choudhury2, Md Z. Ali1, Lima A. Saymi1, Reza M. Huda1 health care comparing guideline recommendations with clinical performance. Besides, the
1 study tested the feasibility of regional electronic patient database for obtaining information
Cardiology, National Institute of Cardiovascular Diseases, 2Epidemiology, National Centre for
for assessing the areal variation of quality of T2DM care.
Control of Rheumatic Fever and Heart Disease, Dhaka, Bangladesh Methods: Data were obtained from the joint patient database of the North Karelian 13
Introduction: Lipid disorder is a major risk factor for the progression of atherosclerosis, municipalities. Both primary and secondary health care records were investigated to find all
coronary artery disease and stroke. The causal association between plasma lipid level and T2DM patients (ICD-10 E11) in the region. Altogether 10,204 patients were identified
risk of coronary artery disease is established. With increasing urbanization and socioeco- corresponding to 6.2% prevalence in the population. Four quality indicators from the
nomic improvement, changing population dynamics is expected to influence disease Finnish guidelines where used: laboratory tests for HbA1c and LDL cholesterol,
pattern with rising trends of Non communicable diseases (NCDs).Thus there is a need to HbA1c<7.0 % and LDL<2.5mmol/L. All laboratory analyses and their results from years
screen healthy adults for their lipid pattern with high population dynamics in Bangladesh. 2011-2012 were retrieved from the database.
Objectives: Present study was aimed to find out the prevalence and distribution of lipid Results: The follow-up of T2DM patients showed reasonable levels of follow-up as judged
profile in adult population of Bangladesh. by measured HbA1c and LDL cholesterol levels. During 2011-2012, HbA1c had been
Methods: A cross-sectional study was carried out among adults age over 18 years residing measured on 83% of patients and LDL among 75%. Of those whose HbA1c was measured,
in an urban and a rural community. Multistage simple random method was used for data 72% reached the optimal treatment level <7.0 %. The LDL results were not so good; about
collection. A total of seven hundred sixty eight (768) participants were screened after 55% reached the recommended level <2.5 mmol/L. There was quite marked variation in
obtaining informed consent. Data included socioeconomic information, behavioral risk both the prevalence of T2DM and the outcomes of treatment between the municipalities
factors, anthropometric measurement and biochemical measurement using a pretested reflecting different processes in screening and management of T2DM patients.
questionnaire. Conclusion: The regional electronic patient database gave important information on
Results: Between the urban and rural participants, the mean total cholesterol (TC) levels quality of care. The management of T2DM in North Karelia is reasonably good but the
were 175.237.5 vs. 149.623.8 (mg/dl), mean triglyceride (TG) were 132.535.3 results indicate that there is still room for improvements in both screening and manage-
vs.154.734 (mg/dl) and mean low density lipoprotein (LDL) were 104.034.6 ment. In brief, the regional patient database can provide efficient statistics to improve
vs.79.725.5 (mg/dl), respectively, with a P- value <0.05, which was significantly asso- disease management and benchmarking in municipalities.
ciated. Mean high density lipoprotein (HDL) were 37.08.9 mg/dl and 37.34.9 mg/dl Disclosure of Interest: None Declared
and similar between urban and rural adults. There was an increase in total cholesterol with
increasing age OR¼4.53 (95% C I¼ 3.55-9.52) and with p-value less than (p<0.05) be- PM276
tween the areas in logistic model. Total Cholesterol level increased with economic status
Biodiesel Exhaust Exposure Causes Vascular Dysfunction In Healthy Subjects
between the areas and significantly associated (p<0.05), OR¼ 1.88 (95% CI¼ 0.89-2.37).
Total cholesterol was found to be high among urban participants and triglyceride level was Jon Unosson*1, Anders Blomberg1, Thomas Sandström1, Mikael Kabele1, Christoffer Boman2,
found to be high among rural population (p<0.05). Factors significantly associated with Andrew J. Lucking3, Nicholas L. Mills3, David E. Newby3, Jeremy P. Langrish3, Jenny A. Bosson1
dyslipidemia were blood pressure, fasting blood sugar and food habits (p<0.05). Partici- 1
Public Health and Clinical Medicine, 2Department of Applied Physics and Electronics, Umeå
pants with above 200mg/dl constituted 23.8% in case of total cholesterol and 25.6% in case
Universitet, Umeå, Sweden, 3University/BHF Centre for Cardiovascular Science, University of
of triglyceride.
Conclusion: The result will be used for lifestyle intervention program to maintain the Edinburgh, Edinburgh, United Kingdom
normal level of lipid profile and to achieve primary prevention of coronary artery disease Introduction: Traffic-derived air pollution is associated with cardiorespiratory disease and
and associated NCDs in the entire population. mortality, as well as being a major contributor to greenhouse gases. Biodiesel represents
Disclosure of Interest: None Declared one of the most established biofuels on the global marketplace and whilst replacing pet-
rodiesel with biodiesel may have beneficial ecological impacts, the resulting health effects
PM274 are unknown.
Objectives: Controlled exposures to petrodiesel exhaust have consistently resulted in
Evidence- NOT epidemiological-based guidelines are needed in diabetic patients
vascular dysfunction in human subjects. The purpose of this study was to compare the
David Colquhoun*1, Antonio Ferreira-Jardim2 cardiovascular effects of biodiesel exhaust exposure from a 30% rape seed methyl ester
1
Cardiology, Wesley Hospital, 2University of Queensland, Brisbane, Australia biodiesel blend (RME30) and 100% rape seed methyl ester biodiesel (RME100) to the well-
known adverse effects of petrodiesel exhaust.
Introduction: Currently, risk factor guidelines for diabetic patients are based on arbitrary Methods: In two separate studies non-smoking healthy volunteers were exposed to
cut-points derived from epidemiological studies. There is a general presumption that petrodiesel exhaust or biodiesel exhaust (RME30 and RME100) in a randomised,
aggressive treatment to the following levels will lower CHD risk: HbA1c <6.5%, Systolic BP controlled, double-blind crossover fashion. In study one, sixteen subjects were exposed to
<130 mmHG (and <120 if proteinuric) and LDL-C <2.5 mmol/L. petrodiesel exhaust (PM10 313.7 mg/m3) and RME30 exhaust (PM10 309.1 mg/m3)
Objectives: To evaluate recent intervention trials in diabetics assessing whether guideline standardized for particle mass. In study two, nineteen subjects were exposed to petro-
targets have been validated and if not, to suggest evidence-based targets. diesel exhaust (PM10 309.8 mg/m3) and RME100 exhaust (PM10 165.0 mg/m3) stan-
Methods: A systematic review of completed randomised controlled trials via PubMed dardized for emission factor. Exposures lasted one hour during which the subjects
involving risk factors in diabetics over the last 30 years. Trials needed to have more than performed intermittent exercise.

e116 GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters


Study of Lipid Profile in Adult Population of
Bangladesh
Md. Abdul Kader Akanda1, Zulfikar Ali1, Kamrun Nahar Choudhury2, Lima Asrin Sayami1, Reaz
Mahmud Huda1, Shauket Hossain3, Minhazul Mohsin4, Md. Asahaque Ali5
1 Department of Cardiology, NICVD, Dhaka, 2 Department of Epidemiology, National Centre for

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)

Introduction: lipoprotein (LDL) and high density lipoprotein


Non-communicable diseases (NCDs) are the (HDL). The increased level of TC, TG and LDL is
number one cause of death and disability in the found to be associated with the higher risk of
world. According to World Health Organization coronary artery disease (CAD) and ischemic
(WHO) data, 36 million people had died globally in stroke.2-5 On the other hand, population based
2008 due to NCDs, accounting for 63% of the total studies have consistently demonstrated an inverse
deaths. About 80% of deaths related to NCDs association between HDL level with the risk of
occurred in low- and middle-income countries. CAD.6
Among deaths related to NCDs, cardiovascular Worldwide, a change in population dynamics is
diseases were the leading causes. More than 60% observed with increasing urbanization and
of the total deaths related to NCDs occurred due socioeconomic improvement. This change is
to cardiovascular diseases.1 expected to influence disease pattern with rising
Lipid profile means pattern of lipids in the blood. trends of non communicable diseases. Several
A lipid profile usually includes the level of total studies have reported a wide variation in mean
cholesterol (TC), triglycerides (TG), low density population cholesterol levels in different regions

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.

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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

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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

Total 175.2 ± 37.5 132.5 ± 35.3 104 ± 34.6 37.0 ± 8.9

Table-III
Lipid profile of rural 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=77) 130.4 ± 31.7 179.6 ± 96.2 100.4 ± 31.7 38.1 ± 1.4

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

Total 149.6 ± 23.8 154.7 ± 34 79.7 ± 25.5 37.3 ± 4.9

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Cardiovascular Journal Volume 8, No. 2, 2016

income earning participants were more risk to


develop higher cholesterol than low or middle
income group participants, OR=1.88 (CI=0.89-2.37)
and showed significant result in multivariate
logistic model, OR=1.29(CI=o.91-2.17). The
participants who are smoker they were higher risk
OR=4.78 (CI=3.62-6.32) and also who used to
smokeless tobacco, OR=3.62(CI=2.74-4.78). Similar
result found in multivariate logistic model in both
smoker and smokeless tobacco user. Low
consumption of vegetable OR=1.07 (CI=0.97-1.85)
Fig-1: Lipid profile of study population by normal were higher risk to develop dyslipidaemia and the
and high level. participants who had body mass index more than
29, they were also higher risk OR=4.01 (CI=3.42-
Age of the respondents, monthly income, use of 6.76) to develop dyslipidaemia who had BMI lower
tobacco, physical activity, food habit, body mass than 29. Waist circumference OR=4.01 (CI=3.42-
index and waist circumference showed significant 6.76) showed significant result. Similar result
association with dyslipidaemia (Table IV). Higher showed in multivariate logistic model.

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)*

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Study of Lipid Profile in Adult Population of Bangladesh Md. Abdul Kader Akanda et al.

Discussion: of coronary artery disease and associated non


The present study found that the mean TC and communicable diseases in the entire population.
LDL levels were significantly higher among
participants of urban areas compared to the Acknowledgments:
participants of rural areas (p=0.001). On the other Authors are very grateful to all the participants
for the study. The authors felt immense thanks to
hand, the mean TG level was found to be
physicians, pathologists and pathological staff of
significantly higher among participants of rural
the concerned organizations.
areas compared to the participants of urban areas
(p=0.001). Mean high density lipoprotein was
Conflict of Interest - None.
similar between urban and rural adults. Several
factors might be associated with these biochemical
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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

Article  in  Journal of Clinical and Diagnostic Research · November 2011

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Original Article

Thyroid Hormone And Its Correlation With


Biochemistry

Age, Sex And Serum Lipid Levels In Hypothyroid


And Euthyroid Sylheti Populations In Bangladesh
SHAKHINUR ISLAM MONDAL, SUDIPTA ARKA DAS, ARZUBA AKTER, RAKIBUL HASAN, SAIMON AHMAD TALUKDAR, MD SALMAN REZA

ABSTRACT Sylhet. Thyroid stimulating hormone (TSH), thyroxine (T4), serum


Background: Hypothyroidism is defined as a deficiency of total cholesterol (TC), low-density lipoprotein cholesterol (LDL),
the thyroid hormone and an increase in the thyroid stimulating high-density lipoprotein cholesterol (HDL) and triglyceride (TG)
hormone (TSH) levels in patients, which has been associated levels were measured.
with elevated levels of serum cholesterol in some populations. Results: In this study, it was found that hypothyroidism was more
Sylhet has been described as the one of the wealthiest cities common in women (p=0.039) and in the advanced age group
in Bangladesh and its population leads a life of relative luxury (p=0.038). The persons who met the criteria for hypothyroidism
than in most other parts of the country. Lifestyle plays an had higher mean cholesterol levels (209.89 vs. 191.49 mg/dl,
important role in obesity, lipid profile, and thyroid profile related p=0.038) and higher rates of elevated cholesterol levels (60.5%
diseases, but no data are available regarding the thyroid status vs. 40.4%, p=0.024) than the euthyroid control group, but there
and the lipid profile in this Sylheti population. The aim of the were no significant differences in their LDL or HDL levels. The
present study was to assess whether hypothyroidism which was mean TG levels (186.04 vs. 231.47 mg/dl, p=0.013) and the rates
associated with abnormal lipid levels in the population of Sylhet, of the elevated TG levels (50.6% vs. 68.4%) were higher in the
Bangladesh. hypothyroid group.
Materials and Methods: The data from adults older than 25 Conclusion: Hypothyroidism appears to be associated with
years, who did not previously have a diagnosis of hypothyroidism abnormalities in the serum cholesterol or triglyceride levels
or those who were not taking thyroid replacement medication, in the Sylheti population. There might be a potential link
were analyzed at the Women’s Medical College and Hospital, between hypothyroidism and cardiovascular diseases such as

Key Words: Thyroid stimulating hormone, Hypothyroidism, Euthyroidism, Atherosclerosis

In du n the triglyceride-rich lipoproteins and the hepatic lipase (HL), which


The thyroid is one of the largest endocrine glands of the body. The hydrolyzes HDL2 to HDL3 [3].
process of thyroid hormone synthesis begins in the hypothalamus. There is a substantial evidence that overt hypothyroidism alters
The hypothalamus releases the thyrotropin releasing hormone several of the traditional risk factors for cardiovascular disease.
(TRH). The TRH travels through the bloodstream to the pituitary Hypercholesterolaemia in hypothyroidism, characterized by
gland. The pituitary gland then releases the thyroid-stimulating elevated levels of LDL-C and Apo B, is caused by a decreased
hormone (TSH) into the blood. The TSH stimulates the thyroid catabolism of LDL due to a reduction in the number of LDL
gland to produce the two main thyroid hormones, thyroxine (T4) receptors on the liver cell surfaces [1]. Hypothyroidism can also
and triiodothyronine (T3). increase cardiovascular risk by causing diastolic hypertension.
It is well known that alterations in the thyroid function can result in The potential mechanisms for reversible diastolic and systolic
changes in the composition and in the transport of lipoproteins [1]. hypertension in hypothyroidism include increases in the peripheral
Specifically, the thyroid hormone stimulates the hepatic de novo vascular resistance [4] and arterial stiffness [5], respectively.
cholesterol synthesis by inducing the HMG-CoA reductase that Studies have shown that 70% of the community in Sylhet relies on
catalyzes the conversion of HMG-CoA to Mevalonate, which is the the remittance which is sent from relatives abroad and thus, the
first step in the biosynthesis of cholesterol [2]. This results in an population leads a relatively luxurious lifestyle than in other parts
enhanced intracellular cholesterol concentration in hyperthyroidism of the country. However, to the best of our knowledge, no studies
and a decreased one in hypothyroidism. Additionally, thyroid have examined whether a relationship exists between thyroid
hormones activate the LDL receptors. The promoter of the LDL profile and lipid profile in this Sylheti population. The purpose of
receptor gene contains a thyroid hormone responsive element the present study was to explore the association between the
(TRE) which allows T3 to upregulate the gene expression of the thyroid hormones and the abnormal lipid profile, including that in
LDL receptor. Moreover, thyroid hormones stimulate the cholesteryl cardiovascular diseases.
ester transfer protein (CETP), an enzyme which transports
cholesteryl esters from HDL2 to the very low density lipoproteins
MATERIALS A METHO S
(VLDL) and triglycerides in the opposite direction. Finally, thyroid
This study was conducted at the Women’s Medical College and
hormones stimulate the lipoprotein lipase (LPL) which catabolizes
Hospital, Sylhet during December 2009 to May 2010. Samples were

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].

The serum cholesterol level generally varies inversely with the


thyroid activity [8][9]. This condition is more common in the elderly
[10][11][12]. Also, women are more likely than men to develop
thyroid disease [13][14]. In this study, the percentage of female
subjects in the hypothyroid group was significantly higher than that
of the male subjects [Table/Fig 2a].

Moreover, the hypothyroid respondents were more commonly


found in the elderly group rather than in the young or the middle
aged groups [Table/Fig 2b]. These results corroborated with the
findings of other research groups [13][10][14][11][12].

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].

Despite the reduced activity of HMG-CoA reductase,


hypercholesterolaemia in hypothyroidism probably results from
the reduced catabolism of lipoproteins, a phenomenon that may
be explained by a decreased expression of lipoprotein receptors
and LDL cholesterol [19]. The magnitude of elevation in the
serum cholesterol concentrations is correlated with the degree of
hypothyroidism [20]. Hypothyroid patients usually exhibit elevated
levels of HDL, mainly due to the decreased activity of the cholesterol
ester transfer protein (CETP), resulting in reduced transfer of
cholesteryl esters from HDL to VLDL, thus increasing the HDL
cholesterol levels. Furthermore, the decreased activity of hepatic
lipase (HL) leads to the decreased catabolism of HDL2 HDL OR
HDL2 Particles [7]. In this study, it was found that the levels of
LDL and HDL were elevated in the hypothyroid group as compared
[Table/Fig-2b]: Comparisons of four different parameters between
to those in the euthyroid group [Table/Fig 2c]. But no significant
hypothyroid and euthyroid groups: sex(a), age groups(b), mean
difference was found between these groups and the values
values of lipid profile(c) and clinical range of TC and TG(d).
remained within the reference range. This result corroborated the
findings of a previous study [10]. But other studies found significant
elevations in the serum LDL concentrations in hypothyroid subjects
[21].

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].

It was also observed that the percentage of the hyperlipidaemia


patients was more common in the hypothyroidism group for TC
and TG. But no significant relation was found for HDL and LDL
[Table/Fig 2d].

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

hypothyroidism. J Clin Invest 1958; 9: 502–10.


  [5] Obuobie K, Smith J, Evans LM, John R, Davies JS, Lazarus JH.
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patients with primary and secondary hypothyroidism. Mayo Clin Proc
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ACKNOWLEDGEMENT [18] Nikkilia EA, Kekki M. Plasma triglyceride metabolism in thyroid disease.
The authors are grateful to the Women’s Medical College and J Clin Invest 1972; 51:2103-14.
Hospital for providing the facilities to perform this study. We are [19] Thompson GR, Soutar AK, Spengel FA, Jadhav A, Gavigan SJ, Myant
grateful to the technologists who are working in the Biochemistry NB. Defects of receptor-mediated low density lipoprotein catabolism
in homozygous familial hypercholesterolemia and hypothyroidism in
Department of the hospital, for helping with the sample collection. vivo. Proc Natl Acad Sci 1981; 78:2591–95.
We are also thankful to Professor Susanta Kumar Das and [20] Dichek HL, Agrawal N, EI Andaloussi N, Qian K. Attenuated
Professor Yasmeen Haque (Department of Physics, Shahjalal corticosterone response to chronic ACTH stimulation in hepatic
University of Science and Technology, Sylhet-3114, Bangladesh) lipase-deficient mice: evidence for a role for hepatic lipase in adrenal
physiology. Am. J. Physiol. Endocrinol. Metab 2006; 290 (5): E908–
for their valuable discussions which were related to this research. 15.
[21] Monsourian AR, Ghaemi E, Ahmadi AR, Marjani A, Saifi A.
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JW. Stimulation of hepatic ™-hydroxy-methyl-glutaryl Coenzyme A [22] Weintraub M, Grosskopf I, Trostanesky Y, Charach G, Rubinstein
reductase in hypophysectomized rats by L-triiodothyronine. Proc Natl A, Stern N. Thyroxine replacement therapy enhances the clearance
Acad Sci USA 1973; 70: 3839-42. of chylomicron remnants in patients with hypothyroidism. J Clin
  [3] Kussi T, Sacrinen P, Nikkila EA. Evidence for the role of hepatic Endocrinol Metab 1999; 84:2532-36.
endothelial lipase in the metabolism of plasma high density lipoprotein [23] Papaioannou GI, Lagasse M, Mather JF, Thompson PD. Treating
2 in man. Atherosclerosis 1980; 36: 589-93. hypothyroidism improves endothelial function. Metabolism 2004; 53:
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A correlation of clinical and haemodynamic studies in patients with

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

AUTHOR(S): NAME, ADDRESS, TELEPHONE, E-MAIL ID OF THE


1. Shakhinur Islam Mondal CORRESPONDING AUTHOR:
2. Sudipta Arka Das Shakhinur Islam Mondal
3. Arzuba Akter Assistant Professor, Genetic Engineering & Biotechnology
4. Rakibul Hasan Department, Shahjalal University of Science & Technology, Sylhet
5. Saimon Ahmad Talukdar 3114, Bangladesh
6. Md Salman Reza E-mail : shakhin2000@yahoo.com
Telephone : +880-821-713491 (Ext-411)
PARTICULARS OF CONTRIBUTORS:
Fax : +880-821-725050
1. MS, Genetic Engineering & Biotechnology Department,
Shahjalal University of Science & Technology, Sylhet 3114, DECLARATION ON COMPETING INTERESTS:
Bangladesh No conflicting Interests.
2. BSc (HONS), Biochemistry and Molecular Biology
Department, Dhaka University, Bangladesh
3. MS, Biochemistry and Molecular Biology Department,
Shahjalal University of Science & Technology, Sylhet 3114,
Bangladesh
4. MS, Genetic Engineering & Biotechnology Department,
Shahjalal University of Science & Technology, Sylhet 3114,
Bangladesh
5. MS, Genetic Engineering & Biotechnology Department,
Shahjalal University of Science & Technology, Sylhet 3114,
Bangladesh Date of Submission: Apr 10, 2011
6. MS, Genetic Engineering & Biotechnology Department, Date of peer review: Jul 08, 2011
Shahjalal University of Science & Technology, Sylhet 3114, Date of acceptance: Jul 15, 2011
Date of Publishing: Nov 30, 2011
Bangladesh

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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

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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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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
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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

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Dovepress Hypertension and serum lipid profile in Bangladesh

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
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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.

Data analysis Discussion


Data were analyzed using Statistical Package for Social
In this study, we investigated the relationship between serum
­Sciences software, version 16.0 (SPSS Inc., Chicago, IL,
lipid profile and hypertension among an urban population
USA). Descriptive statistics was used to present the demo-
in Bangladesh. Results of this study revealed that the mean
graphic characteristics of the study participants. Continuous
values of serum TC, TG, and LDL were significantly higher
variables were presented as mean ± standard deviation (SD)
and statistically significant among the hypertensive patients
and were compared using independent group Student’s t-tests.
compared to normotensives. The mean HDL level was lower
Binary logistic regression analysis was performed to measure
in the hypertensives compared to normotensives and was
the relationship of lipid profile among the hypertensive and
statistically significant.
normotensive patients after adjusting for age, BMI, sex, and
Hypertension is recognized globally as a major risk factor
BP. A P-value ,0.05 was considered statistically significant.
for CVD, stroke, diabetes, and renal diseases.16 About 80%
of hypertensive persons have comorbidities such as obesity,
Results glucose intolerance, abnormalities in lipid metabolism,
The study included 234 participants with a mean age ± SD of among others. A prospective study in the northern region of
44.7±5.7 years and BMI of 25.2±3.8 kg/m2. The mean SBP and Bangladesh comparing lipid profile status in hypertensive
DBP were 137.9±9.6 mmHg and 94.4±8.8 mmHg, respectively. patients as compared to healthy normotensive controls found
The mean BMI, TC, HDL, and LDL were higher for males high serum TC, TG, and LDL, similar to our study.17 Our
compared to females, which was statistically significant findings of increased levels of TC in hypertensive patients are
(P,0.05). The mean WC was higher in males, which was similar to the findings of some other studies.16,18,19 However,
not statistically significant (P=0.051) (Table 1). few studies measured the strong association of hypertension
The mean age ± SD of hypertensive patients and nor- and dyslipidemia among the Bangladeshi population.
motensives were 47.6±4.2 and 38.4±3.7 years, ­respectively. Analysis from the INTERHEART study shows that among
Serum levels of TC, TG, and LDL were 238.3±3.4, 178.3±6.3, both cases and controls, mean LDL levels were about 10 mg/
and 151.3±7.8 mg/dL, respectively, in hypertensive sub- dL lower in Asians compared with non-Asians.10 A greater
jects while in normotensive subjects, they were 187±6.2, proportion of Asian cases and controls had LDL #100 mg/
141.5±11.2, and 110.3±6.3 mg/dL, respectively, which were dL. HDL levels were slightly lower among Asians compared
significantly higher in hypertensive patients (P,0.001). The with non-Asians, a population who require further study and
serum HDL was significantly lower (P,0.001) in hyperten- targeted intervention.10 Several studies have shown that most
sive patients (41.2±3.2 mg/dL) than in normotensive subjects of the hypertensive patients undergo inconsistent treatment,

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Table 1 Characteristics of the respondents


Indicators Total (n=234) Ranges Male (n=128) Female (n=106) P-value
mean (SD) mean (SD) mean (SD)
Age (in years) 44.70 (5.71) (38–51) 46.21 (4.48) 43.19 (6.14) 0.278
Height (meter) 1.55 (0.58) (1–2.03) 1.49 (0.49) 1.61 (0.63) 0.061
Education (in years) 7 (3.01) (0–12) 8 (2.99) 6 (3.26) 0.872
Weight (kg) 60.57 (7.21) (41–72) 69.21 (6.36) 51.93 (8.11) 0.074
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WC (cm) 83.53 (6.3) (64–91) 88.89 (5.55) 78.17 (6.35) 0.051


BMI 25.21 (3.81) (21–28) 25.88 (3.61) 24.54 (2.97) 0.022
SBP (mmHg) 137.94 (9.58) (107–153) 139.12 (11.23) 136.76 (10.22) 0.047
DBP (mmHg) 94.42 (8.81) (86–111) 92.14 (7.58) 96.7 (8.39) 0.012
Total cholesterol 221.87 (4.14) (211–229) 224 (4.85) 219.74 (3.94) 0.032
Triglyceride 166.53 (7.38) (152–174) 169.21 (6.58) 163.85 (6.97) 0.004
HDL 42.21 (3.68) (37–46) 46.21 (4.01) 38.21 (3.33) 0.001
LDL 138.15 (5.25) (131–144) 141.11 (4.69) 135.19 (3.74) 0.014
Abbreviations: BMI, body mass index; DBP, diastolic blood pressure; HDL, high density lipoprotein; LDL, low density lipoprotein; SBP, systolic blood pressure; SD, standard
deviation; WC, waist circumference.

Table 2 Anthropometric and biochemical characteristics of participants


Indicators Hypertensive =159 Normotensive =75 P-value
Mean (SD) 95% CI Mean (SD) 95% CI
For personal use only.

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

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Dovepress Hypertension and serum lipid profile in Bangladesh

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.
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57% versus 42%, respectively), or both (32% versus 19%,


respectively). HDL ,0.9  mmol/L was found in 18% of References
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Original Article 353

Evaluation of Serum Lipid Profile in Patients with


Hypertension Living in a Coastal Region of Bangladesh

Authors M. S. Sarwar1, T. Adnan1, M. D. Hossain1, S. M. N. Uddin1, M. S. Hossain1, S. M. E. Al Baker2, M. N. Uddin3,


M. S. Islam1
1
Affiliations Department of Pharmacy, Noakhali Science and Technology University, Noakhali, Bangladesh
2
Department of Cardiology, Laksham Upazilla Health Complex, Comilla, Bangladesh
3
Department of Applied Mathematics, Noakhali Science and Technology University, Noakhali, Bangladesh

Key words Abstract package SPSS. Our study found that serum total

Downloaded by: University of Georgia Libraries. Copyrighted material.



▶ hypertension
▼ cholesterol (TC), triglyceride (TG), LDL, VLDL,

▶ lipid profile
Serum lipid levels are greatly controlled by TC/HDL, LDL/HDL were significantly higher

▶ total cholesterol


▶ 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

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Study design and data collection 100 normotensive individuals as controls. It was observed that
The study was conducted as a case-control study from January mean age of the patients and controls were 46.98 ± 2.11 and
to August, 2012, with 100 hypertensive (HT) patients as cases 44.84 ± 2.07 years respectively. Socio-demographic features of
and 100 normotensive (NT) individuals as controls. The study the cases and controls are represented in ●
▶ Table 1.

protocol was approved by the Institutional Ethical Committee of


the Farid Diagnostic Centre and Hospital Limited, Laxmipur, Anthropometric and clinical characteristics of subjects
Bangladesh. All study subjects were briefed about the purpose of The mean values of body mass index (BMI), systolic and
the study and written consent was obtained from each of them diastolic blood pressure (SBP and DBP respectively) were
prior to their inclusion in the study. Initially, a pilot study was 24.81 ± 0.50 kg/m2, 159.9 ± 3.12 mm Hg and 102.60 ± 1.79 mm Hg
carried out with small number of patients using structured for patient group and 23.55 ± 0.35 kg/m2, 119.40 ± 1.26 mm Hg
questionnaires to set the variables of the study. Then according and 81.30 ± 0.91 mm Hg for the healthy control group respec-
to the purpose of the study, necessary modification was done in tively (●
▶ Table 2). The levels of creatinine were found 0.96 ± 0.03

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

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DBP (mm Hg) < 90 102.60 ± 1.79 81.30 ± 0.91 p < 0.05 Discussion
Creatinine (mg/dl) 0.5–1.2 0.96 ± 0.03 0.89 ± 0.02 p > 0.05 ▼
All values are expressed in Mean ± SEM Experimental and epidemiological studies reported that lipid
*P < 0.05 (Significant difference between patient and control groups at 95 % confi- profile is an important predictor for metabolic disturbances
dence interval) including diabetes, dyslipidaemia, hyperinsulinaemia and car-
diovascular diseases [19]. There are sufficient evidences estab-
lishing the relationship between serum lipids and blood pressure
Table 3 Distribution of lipid profile in the study population.
[20, 21]. But lipid concentrations may differ on the basis of eth-
Parameters Reference HT group NT group p-value nic or genetic variation. So, we conducted this study in Laxmi-
value
pur, a coastal area of Bangladesh to determine the serum lipids
in hypertensive patients. Our study found significantly higher
TC (mg/dl) < 200 222.20 ± 8.75 166.92 ± 4.88 p < 0.05
level of serum TC, TG, LDL, VLDL, TC/HDL and AIX but signifi-
TG (mg/dl) 50–150 188.48 ± 6.64 143.73 ± 3.62 p < 0.05
HDL (mg/dl) > 40 32.54 ± 0.61 40.42 ± 1.12 p < 0.05 cantly lower level of HDL in hypertensive patients than in con-
LDL (mg/dl) 50–130 141.80 ± 5.78 102.32 ± 4.04 p < 0.05 trol subjects (p < 0.05). This is agreement with previous reports
VLDL (mg/dl) 2–38 38.30 ± 1.33 28.75 ± 0.72 p < 0.05 in other countries of the world [22–24] and in another region of
TC/HDL 4–5 7.03 ± 0.36 4.30 ± 0.18 p < 0.05 Bangladesh [5]. Several other studies documented that the level
LDL/HDL (AIX) 3.3–4.4 4.48 ± 0.22 2.59 ± 0.10 p < 0.05 of TG, TC and LDL cholesterol was relatively higher in newly diag-
All values are expressed in Mean ± SEM nosed hypertensive patients in comparison to normal control
*P < 0.05 (Significant difference between patient and control groups at 95 % confi- subjects, but they found no significant difference for these
dence interval) parameters between these 2 groups [25, 26].
High level of serum total cholesterol is responsible for increasing
the risk of several macrovascular complications such as coronary
Table 4 Correlation study between lipid profile and blood pressure in the
heart disease (CHD) and stroke [27]. Several previous studies
study population.
showed a progressive increase in CHD risk if the serum TC
Correlation HT group NT group exceeds 200 mg/dl [28, 29]. Study conducted by Akuyam et al. [1]
parameters r p r p found a positive and significant correlation of serum TC with
TC and SBP 0.320* 0.023 0.306 0.031* systolic and diastolic blood pressure in both hypertensive
TC and DBP 0.295* 0.037 0.155 0.282 patients and normotensive controls. They suggested that blood
TG and SBP 0.444** 0.001 0.236 0.099 pressure increases with the increase in serum TC. However, high
TG and DBP 0.417** 0.003 0.064 0.658 serum TC levels in hypertensive patients compared with control
HDL and SBP − 0.384** 0.006 − 0.347* 0.014 subjects (p < 0.05), as found in the current study may be due to
HDL and DBP − 0.244 0.088 − 0.326* 0.021 variety of causes such as stress, increased consumption of ani-
LDL and SBP 0.438** 0.001 0.010 0.945 mal fats, lack of physical exercise and genetic factors. This find-
LDL and DBP 0.272 0.056 0.169 0.239 ing complies with results of previous studies [1, 30].
VLDL and SBP 0.444** 0.001 0.236 0.099
Excessive serum triglyceride level has an association with abnor-
VLDL and DBP 0.417** 0.003 0.064 0.658
mal lipoprotein metabolism which may serve as CHD risk factors
TC/HDL and SBP 0.382** 0.006 0.403** 0.004
TC/HDL and DBP 0.333* 0.018 0.272 0.056
including diabetes mellitus, obesity, insulin resistance, and
LDL/HDL and SBP 0.491** 0.001 0.223 0.120 depleted level of HDL cholesterol [31]. Triglycerides are usually
LDL/HDL and DBP 0.314* 0.027 0.321* 0.023 found in fats and excessive triglycerides increase the concentra-
Values with negative sign indicate an inverse correlation tions of 2 types of fatty substances – chylomicrons and VLDL
* p < 0.05, Correlation is significant at 0.05 level (2-tailed) cholesterol. Both of these fatty substances may contribute to the
** p < 0.01, Correlation is significant at 0.01 level (2-tailed) fat deposition and serves as a component of atheromatous

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- ▼

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terol transport from foam cells of the atherosclerotic plaque The authors would like to thank all the participants of this study.
depots in blood vessels to the liver for excretion. HDL cholesterol The authors are also thankful to all the staffs, nurses and physi-
also serves to inhibit the atherogenic process because it has cians of the Farid Diagnostic Centre and Hospital Limited, Laxmi-
potential anti-inflammatory and antioxidant effects [35, 36]. pur, Bangladesh for their necessary supports.
Gordon et al. [37] reported that a 1 % reduction in HDL choles-
terol is associated with a 2-3 % increase in CHD risk. This study
showed a significant decrease in serum HDL cholesterol of Conflict of Interest
hypertensive patients compared to the controls which supports ▼
the report of other studies [38, 39]. The authors declare that they have no conflict of interest.
Increased LDL cholesterol level in the hypertensive patients may
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Sarwar MS et al. Lipid Profile in Hypertensive Patients … Drug Res 2014; 64: 353–357
J. bio-sci. 14: 93-98, 2006 ISSN 1023-8654

SERUM LIPID PROFILE OF HYPERTENSIVE PATEINTS IN THE NORTHERN


REGION OF BANGLADESH
M S Saha, N K Sana and Ranajit Kumar Shaha*

Department of Biochemistry & Molecular Biology,


University of Rajshahi, Rajshahi 6205, Bangladesh

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.

* To whom all correspondence should be addressed.


Materials and Methods
This prospective study carried out from November 2001 to July 2002 in the Department of Biochemistry and
Molecular Biology, University of Rajshahi, Rajshahi, Bangladesh. A total numbers of 60 human subjects of
age ranging from 33-60 years were included in this study. Out of the 60 subjects, 20 normo-tensive
volunteers (15 Males and 5 females) were selected as control (group1). The remaining 40 subjects (25 Males
and 15 Females) were grouped as hypertensive (group 2). The body mss index (BMI) was calculated in all
the subjects as it indicates the nutritional status. The study patients were randomly selected from the
Coronary Care Unit (CCU) and the Department of Medicine, Rajshahi Medical College Hospital, Rajshahi.
Serum total cholesterol levels was determined by enzymatic (CHOD-PAP) colorimetric method (Allain et al.
1974) and triglyceride by enzymatic (GPO-PAP) method of (Jacobs and Van demark (1960). HDL-cholesterol
and LDL-cholesterol were estimated using precipitant (Gordon and Gordon 1977) and Friedewald formula
(Friedewald 1972). Above all parameters under investigation were determined in the serum of patients and
controls using commercially available reagent kits. All values were expressed as mean ± S.E. Statistical
significance of differences between control and study groups were evaluated by student’s “ t ” test.
Results
In the present study, maximum numbers of patients of both sexes were between 50-60 years of age and the
percentage had declined sharply below these ages (Table 1).
Table 1. The age distribution of hypertensive patients.
Sl. No. Αge Group (years) Male (%) Female (%)
1 < 40 3 (7.5) 2 (5)
2 41-49 7 (17.5) 5 (12.5)
3 50-60 15 (37.5) 8 (20)
Total n=40 25 (62.5) 15 (37.5)

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).

Table 3. Sex differences of serum lipid profile of group 2 (Hypertensive patients).

Sex Total Cholesterol Triglyceride Serum HDL-cholesterol LDL-cholesterol


(mg/dl) (mg/dl) (mg/dl) (mg/dl)

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)

p>0.6, N S p>0.4, N S p>0.1, N S p>0.5, N S


Values are mean ± standard error (S.E.), Figures in the parenthesis indicate range, N.S = Not significant

Table 4. Sex differences of serum lipid profile of group 1 (Healthy control).

Sex Total cholesterol Triglyceride Serum HDL- cholesterol LDL-cholesterol


(mg/dl) (mg/dl) (mg/dl) (mg/dl)

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)

P< 0.02 P< 0.01 P < 0.05 P < 0.05


S S S S
Values are mean ± standard error (S.E.), S= Significant.

95
Fig 2. Histogram showing the sex differences of serum lipid profile of hypertensive patients (group 2).

Table 5. Characteristics of control and hypertensive patients.


Characters Group 1 (n=20) Group 2 (n=40)
Sex (Male and Female) (n=20) (n=40)
Age (Years) 46.47 ±1.10 (33- 57) 54.25 ± 1.43 (35- 63)
BMI 21.53 ±0.26 (19.05 – 24.65) 22.01 ±0.2 (20.01 – 24.80)
Systolic BP (mm Hg) 121.50 ± 2.11 (110 -130) 150.50 ± 3.53 (130-165)
Diastolic BP (mm Hg) 81.50 ± 2.11 (70-90) 103 ±2.26 (90- 110)
Values are mean ± standard error (S.E.).

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.

References
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Allain C C, Poon I S, Chan C H G, Richmond W and Fu P C (1974) Enzymatic determination of serum total cholesterol.
Clin. Chem. 20: 470-471.
Assmann G (1982) Lipid metabolism and atherosclerosis. Schattauer verlag , Stuttgart, Germany.
Bangladesh Health Services Report (1998) Cause of death and morbidity profile. Directorate General Health Services,
Government of Bangladesh.
Burke G L, Sprafka J M, Folsom A R, Hahn I P, Luepker R V and Blackburn H (1991) Trends of serum cholesterol levels
from 1980 to 1987. The Minnesota Heart Survey. N. Eng. Med. J. 342 (14): 941-946.
Carlson L A and Bottiger L E (1972) Ischemic heart disease in relation to fasting values of plasma triglycerides and
cholesterol in Stockholm prospective study. Lancet. 1: 865-868.
Castilli W P, Doyle J T, Gordon T, Hames C J, Hjortland M C, Hullay S B, Kagan A and Zukel W K (1977) HDL-cholesterol
and other lipid in coronary heart disease. The cooperative phenotyping study. Circulation 55 (5): 767-772.
Friedewald W T, Levy R I and Fredrickson D S (1972) Estimation of the concentration of LDL-cholesterol. Clin. Chem. 18
(6): 499-515.
Gordon T and Gordon M (1977) Enzymatic method to determine the serum HDL-cholesterol. Am. J. Med. 62: 707-708.
Gotto A M, Gorry G A and Thomson J R (1978) Relationship between plasma lipid concentration and coronary artery
disease in 496 patients. Circulation 56 (5): 875-883.
Jacobs N J and VanDenmark P J (1960) Enzymatic determination of serum triglyceride.ch. Biochem. Biophys. 88: 250-255.
Kristensen B O (1981) Triglycerides and HDL-cholesterol in essential hypertension. Acta. Med. Scand. (suppl), 646: 31-42.
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365-374.

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Miller N E, Thelle D S, Finde O H and Mjos O D (1977) The Thromo Heart Study in HDL-cholesterol and coronary heart
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Mohsen A F, El-Hazmi and Arjmand S Warsy (1999) Hypertension in Saudi Arabia. Saud. J. Kid. Dis. Transplant 10 (3):
365-371.

Pelkonen R, Nikkila E A, Koskinen S, Penttinen K and Sarna S (1977) Association of serum lipids and obesity with
cardiovascular mortality. BMJ. 2: 1185-1187.

Person T A, Bulkley B H, Achuff S C and Gordis L (1979) Association of low levels of HDL-cholesterol and
arteriografically defined coronary artery disease. Am. J. Epidemiol. 109: 285-291.

Shahadat H, Maliha R, Iqbal A and Suhrab A (1999) Study of serum lipid profile in essential hypertensive patients. Mym.
Med. J. 8(1): 22-25.

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Williams G H and Braunwald E (1987) Hypertensive vascular disease. In: Harrison’s Principles of Internal Medicine.
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Wilson P W, Garroson R J, Castilli W P, Feinleib M, McMamara P M and Kannel W B (1980) Prevalence of CHD in the
Framingham Offsping study. Role of lipoprotein cholesterols. Am. J. Cardiol. 46: 649-654.

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.

Key words: Diabetes, Lipid profile, Dyslipidemia, Coronary artery disease.


Introduction: The link between elevated low-density lipoprotein
Diabetes is one of our greatest public health prob- cholesterol (LDL-C) and coronary artery disease
lems, primarily because of the dramatic increase in 1
(CAD) is now firmly established . Evidence also
type2 diabetes, also known as age-related diabetes,
supports an independent link between low levels of
which now represents a global threat to human 2
health. Worldwide there are in excess of 100 million high-density lipoprotein cholesterol (HDL-C) and
3,4
people with type2 diabetes and in most developing high levels of triglycerides (TG) and atherosclero-
countries at least one in ten deaths in adults aged 35 sis and CAD. CAD and type2 diabetes may be sig-
to 64 is attributable to diabetes. nificantly linked by the presence of dyslipidemia
which is characterized by low HDL-C with high
Lipid abnormalities and diabetes have been recog- LDL-C and TG. Such a pattern of dyslipidemia has
nized as independent risk factors for coronary artery been frequently observed in patients with type2 dia-
disease (CAD) events and atherosclerosis. Type2 dia- betes. A study has shown that the prevalence of
betes has been frequently observed to be associated hyperlipidemia in type2 diabetes can be as high as
with dyslipidemia whereas type1 diabetes has serum 5
70% whereas an Indian study has shown dyslipi-
lipid levels similar to those of non-diabetic popula- demia in 25 – 60% of diabetic hypertensive popula-
tion. The presence of dyslipidemia in association with
type2 diabetes puts the patient at higher risk of CAD. tion 6. Such Asian patients are shown to have lower

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.

Serum lipid profile was measured after an overnight


fasting of at least 10 hours. Serum total cholesterol
levels was determined 9
by enzymatic (CHOD-PAP)
calorimetric method and triglyceride by enzymatic
(GPO-PAP) method of Jacobs and Van demark 10.
HDL-C and LDL-C were estimated using precipitant
11 and Friedewald formula 12. All the above parame- 2 was found to be obese.
ters under investigation were determined in the Most of the patients of group 1 and group 2 had
serum of patients and controls. All values were desirable levels of serum total cholesterol, i.e., 66%
and 59% respectively. 25% of group 1 and 20% of
expressed as mean ± S.E. Statistical significance of
group 2 had borderline levels whereas only 20% of
differences between control and study groups were the type2 diabetic patients had high serum choles-
evaluated by student’s “t” test. terol levels (TABLE III).
A detailed clinical workup including height, weight
and body mass index (BMI) was taken. 2
BMI was
calculated as weight (kg)/height (m) . BMI of 18 to
25 was considered normal, 26 to 29 as overweight
and 30 and above as obese. Classification of differ-
ent components of serum lipid was followed 13accord-
ing to the recommendation of NCEP ATP III .

Ethical & legal Procodure: The Studey was


approved by ‘ethics committee’ of depart of
Biochemistry & Molecular Biology, University of
Rajshahi.
In Table IV, 30% of group 1 and 29% of group 2 had
Results And Discussion desirable LDL-C levels respectively. 35% of type 2
Most of the patients with type2 diabetes were in the
age group 30 – 40 years (35.6%). The next largest diabetic patients were found to have above optimal
group was 41 – 50 years (34.7%). Most of the type2 levels of LDL-C whereas 15% had borderline levels
diabetic males were of the age group 41 – 50 years and 19% had high LDL-C levels.

122
B C Sarkar, H R Saha, A.K. Azad, N K Sana, S Choudhury

The mean serum TG levels of males were found to


Majority of group 1 (45%) and group 2 (41%) had be higher than that of females while Total
desirable TG levels. 16% of type 2 diabetics were Cholesterol, HDL-C and LDL-C levels of males
found to have a borderline high serum TG levels were very close to that of females (Table VIII).
while 37% had a high serum TG levels and only 4%
had higher TG levels (Table V). The association of dyslipidemia in type2 diabetics is
evident in this study. The most common lipid abnor-
mality trend detected in type2 diabetics was an
increased serum triglyceride (58%) with a concomi-
tant decreased serum HDL-C and increased serum
LDL-C. A slight majority of patients had desirable
serum total cholesterol levels.

Elevated serum cholesterol levels increase the car-


diovascular morbidity associated with type2 dia-
betes and can be an important causative link in
majority of cases. Epidemiological studies provide a
Most of the healthy controls and type2 diabetic large body of evidence for the relationship between
patients had less than desirable HDL-C levels (71% serum cholesterol level and the risk of CAD. In the
and 69% respectively) whereas 23% (group 1) and multiple risk factor intervention trial, CAD risk
27% (group 2) had desirable serum HDL-C levels declined with progressively lower cholesterol levels
(Table VI). 14
. Further support for the relationship between CAD
Among the type2 diabetic patients the serum TG lev- risk and high lipid levels comes from various recent
els of male were found to be higher than that of primary and secondary prevention trials with lipid
female whereas serum total cholesterol, HDL-C and lowering therapy. The heart protection study has
LDL-C levels of male were less than that of female shown that cholesterol lowering with statin therapy
(Table VII).

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.

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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

CONFLICTS OF INTEREST The authors have none to declare.

CIRRHOSIS AND COMPLICATIONS


The authors have none to declare. http://dx.doi.org/10.1016/j.jceh.2018.06.363

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-

S52