A comparative study of lipid profile in IHD patients and healthy controls

 

Pandit Kishanrao Deshmukh¹, Manohar Shankarrao Chavan^2*

 

¹Assistant Professor, ²Associate Professor, Department of General Medicine, Mahavir Institute of Medical Sciences(MIMS), Shivareddypet(V), Vikarabad, Telangana, INDIA.

 

Abstract              Background: The World Health Organisation (WHO) has drawn attention to the fact that IHD is our modern "epidemic" that affects populations. Hypercholesterolaemia and hypertriglyceridaemia are considered the independent risk factors for Ischemic heart disease. Aim and objective: To compare the lipid profile of Ischaemic Heart Disease patients and matched healthy controls Methodology: Present study was a case control study carried out in patients diagnosed as Ischaemic Heart Disease patients and healthy controls. Data was collected with pretested questionnaire. Data included demographic characters, clinical history (significant past or family history) of the patients and lipid profile. Fasting and postprandial Blood cholesterol, triglyceride, high density lipoprotein (HDL) cholesterol, low density lipoprotein (LDL) cholesterol, very low density lipoprotein (VLDL) cholesterol were estimated in both cases and controls. Results: Fasting levels of triglycerides (170.65 mg/dl), serum VLDL(34.64 mg/dl) and total cholesterol(187.5 mg/dl) in patients of IHD are significantly higher as compared to those in controls (120.42 mg/dl, 23.78 mg/dl,167.54 mg/dl respectively).The triglyceride level raised significantly from fasting to postprandial with a mean difference of 16.92 mg/dl in controls and it raised significantly from fasting to postprandial with a mean difference of 65.1 mg/Dl (P = 0.0001). VLDL levels increased significantly from fasting to postprandial (mean difference: 12.48 mg/dl, P <0.000) in IHD patients and it increased by 2.61 mg/dl in control. The levels of total cholesterol (mean difference 12.27mg/dl), HDL (4.62mg/dl) and LDL (20.41mg/dl) decreased from fasting to postprandial in IHD patients. Similarly it decreased by 2.61mg/dl, 2.11mg/dl and 4.01mg/dl in controls respectively.

Key Word: lipid profile in IHD.

 

INTRODUCTION

Ischemic heart disease is a condition in which there is an inadequate supply of blood and oxygen to a portion of the myocardium resulting from imbalance between myocardial oxygen supply and demand.¹ In more than 90% of cases, the cause of myocardial ischemia is reduced blood flow due to obstructive atherosclerotic lesions in the coronary arteries, thus IHD is often termed coronary artery disease (CAD) or Coronary Heart Disease (CHD).² Cardiovascular diseases especially coronary heart diseases (CHD) are epidemic in India. The Registrar General of India reported that CHD led to 17% of total deaths and 26% of adult deaths in 2001-2003, which increased to 23% of total and 32% of adult deaths in 2010-2013. ³ The World Health Organization (WHO) and Global Burden of Disease Study also have highlighted increasing trends in years of life lost (YLLs) and disability adjusted life years (DALYs) from CHD in India. ⁴ Urbanization in countries mainly South Asian countries, especially India and the Middle East, with increasing economies and growing middle class, elements of the energy-rich Western diet are being adopted. As a result, the prevalence of risk factors for IHD and the prevalence of IHD itself are both increasing rapidly. Risk factors for IHD included non modifiable risk factors like age, gender, family history and modifiable risk factors like Elevated blood cholesterol. High triglyceride (TG) with low HDL, Hypertension, smoking, Diabetes mellitus, unhealthy diet, obesity, physical inactivity, excessive alcohol and stress. ^5-11 Diet rich in saturated fats result in increased serum cholesterol. Body accumulates too much of cholesterol it will deposit in the walls of arteries, which become damaged and may become blocked. LDL cholesterol is deposited in the walls of arteries and causes atherosclerosis. Present study was conducted to compare the lipid profile of patients with normal healthy individuals.

 

MATERIAL AND METHODS

 Present study was a case control study carried out in department of Medicine at a tertiary health care centre. Study population was patients diagnosed as Ischaemic Heart Disease patients and healthy controls. Inclusion criteria: 1. Patients diagnosed with IHD based on history, physical examination and investigations 2. Patients above 30 years 3. Healthy controls matched with cases

Exclusion criteria: 1. Patients below 30 years 2. Unstable IHD patients with deranged vital parameters like altered sensorium, fever, tachycardia or bradycardia, hypotension. 3. Hemodynamically unstable patients 4. Patients with cardiomyopathies, rheumatic heart disease and congenital heart disease  The study was approved by the ethical committee of the institute. A valid written consent was taken from patients and controls after explaining study to them. Study was carried out in two groups. First group consisted of 100 healthy individuals without IHD and risk factors for IHD and were considered as controls, second group consisted of 150 patients diagnosed as having IHD. Both the groups are matched with various variables like age, sex. Data was collected with pretested questionnaire. Data included demographic characters, clinical history (significant past or family history) of the patients. A through clinical examination was done for all patients. for confirmation of diagnosis of ischaemic heart disease all patients underwent ECG and 2 D echo of selected patients.

For assessment of lipid profile, blood samples were taken from all patients. Venous blood sample was collected after an overnight fast of 8-12 hours. Postprandial sample was collected 2 hours after meal. Blood cholesterol, triglyceride, high density lipoprotein (HDL) cholesterol, low density lipoprotein (LDL) cholesterol, very low density lipoprotein (VLDL) cholesterol were estimated in both cases and controls. cases and controls were also evaluated with routine haemogram and biochemical studies like random blood sugar level, liver function test and kidney function test. Data was analysed with software IBM SPSS version 21.0 and MS Excel sheet and by using percentage, chi square, and Student’s t test for proportion. P value < 0.05 was considered as significant.

Given Study is ethical approved by ethical committee of Institution.

 

RESULTS

Out of 100 patients 59 were males and 41 were females in each group. In our study IHD was found more in males.

Table 1 showed age wise distribution of controls and IHD patients. Majority of the patients and controls were from age group of 51-60 years (33.5%) followed by 61-70 years (27.5%). Patients and controls in the age group of 41-50 years contributed 22.5% of all study population. 10.5% study population was above 70 years and 6% was below 40 years.

Among the IHD patients 50% were diagnosed with stable angina and 48% were diagnosed to have myocardial infarction. Only 2 patients had unstable angina. Table 3 shows comparison of lipid profile in controls and cases. In our study mean value of TC in healthy controls was 167.54 mg/dl in fasting state, 164.93 mg/dl in postprandial state and in IHD cases was 187.50 mg/dl in fasting state, 175.23mg/dl in postprandial state. Mean for TG in healthy controls was 120.42 mg/dl in fasting state, 137.34 mg/dl in postprandial state and in IHD cases was 170.65 mg/dl in fasting state, 235.75 mg/dl in postprandial state. Mean for HDL in healthy controls was 41.65 mg/dl in fasting state, 39.54 mg/dl in postprandial state and in IHD cases was 42.41 mg/dl in fasting state, 37.78 mg/dl in postprandial state. Mean for LDL in healthy controls was 104.30 mg/dl in fasting state, 100.29 mg/dl in postprandial state and in IHD cases was 113.47 mg/dl in fasting state, 93.07 mg/dl in postprandial state. Mean for VLDL in healthy controls was 23.78 mg/dl 1 in fasting state, 27.23 mg/dl in postprandial state and in IHD cases was 34.64 mg/dl in fasting state, 47.12 mg/dl in postprandial state. In our study Fasting levels of triglycerides (170.65 mg/dl), serum VLDL(34.64 mg/dl) and total cholesterol(187.5 mg/dl) in patients of IHD are significantly higher as compared to those in controls (120.42 mg/dl, 23.78 mg/dl,167.54 mg/dl respectively) difference between them is statistically significant (p < 0.001). Fasting serum HDL in IHD patients(42.41mg/dl) is slightly more as compared to that in controls(41.65 mg/dl) but statistically not significant. Serum LDL is increased significantly in IHD patients (113.47 mg/dl) as compared to controls 104.30 mg/dl) in fasting state. The triglyceride level raised significantly from fasting to postprandial with a mean difference of 16.92 mg/dl in controls and it raised significantly from fasting to postprandial with a mean difference of 65.1 mg/Dl (P = 0.0001). VLDL levels increased significantly from fasting to postprandial (mean difference: 12.48 mg/dl, P <0.000) in IHD patients and it increased by 2.61 mg/dl in control. The levels of total cholesterol (mean difference 12.27mg/dl), HDL (4.62mg/dl) and LDL (20.41mg/dl) decreased from fasting to postprandial in IHD patients. Similarly it decreased by 2.61mg/dl, 2.11mg/dl and 4.01mg/dl in controls respectively. (table4 and 5) Postprandially, TG levels in IHD patients are found to be raised significantly as compared to controls (p < 0.05) and fasting state (p < 0.001). Total cholesterol is high postprandially as compared to controls (p < 0.001) but decreased as compared to fasting in both controls (p > 0.05) and study group (p < 0.001).