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Plantago Fibres Decrease Risk Of Development Of Arteriosclerosis
INTRODUCTION
Arteriosclerosis leading to development of coronary heart diseases is main cause of death in men and women all over the world. Risk factors for arteriosclerosis are smoking, fatty diet, alcoholism, sedendary life style and genetic variations.1 Research reported by medical researchers concludes that the use of plantago is an effective and well-tolerated part of a prudent diet for the treatment of mild to moderate hyperlipidemia. Some rcent studies proved that ispaghula or psyllium incorporated into food products is more effective at reducing blood glucose response than use of a soluble-fiber supplement that is separate from the food.2,3,5,6 Although the cholesterol-reducing and glycemic-response properties of psyllium-containing foods are fairly well documented, the effect of long-term inclusion of ispaghula in the diet has not been determined.4,1-2The bioactive agent of plantago is a soluble, viscous xylan fiber. It is thought that this polysaccharide stimulates the conversion of cholesterol to bile acids and that it stimulates fecal excretion of bile acids. Plantago may also decrease the intestinal absorption of cholesterol.5,7-8Hyperlipidemia may be primary or secondary depending on cause. Hyperlipidemia is the major cause of coronary heart disease (CHD) and atherosclerosis. It is proved that there exists a link between serum cholesterol levels and risk of CHD. A 1% drop in serum cholesterol reduces the risk of CHD by 2%.6Arteriosclerosis of the coronary and peripheral vasculature is the leading cause of death among men and women in the United States and worldwide.7Human body uses cholesterol to produce many hormones, vitamin D, and the bile acids that help to digest fat. It takes only a small amount of cholesterol in the blood to meet these needs.8 If human body have too much cholesterol in bloodstream, the excess is deposited in arteries, including the coronary arteries, where it contributes to the narrowing and blockages that cause the signs and symptoms of heart disease.9-11
PATIENTS&METHOD
Study was conducted in Basic Medical Sciences Institute, Jinnah Postgraduate Medical Centre, Karachi, from January to July 2006.Forty patients of primary hyperlipidemia were enrolled in the study, selected from ward and OPD of National Institute of Cardiovascular Diseases (NICVD), Karachi. Previously diagnosed and untreated primary hyperlipidemic patients of either sex, age range from 21 to 60 years were randomly selected. Patients with peptic ulcer, hepatic disease, alcoholism, hypothyroidism, diabetes mellitus, and renal disease were excluded from the study as these diseases can mask hyperlipidemia in patients.10 Written consent was obtained from all participants. The study period consisted of 90 days with every second week follow up visits. Name of the patient, his/her age, sex, occupation, address, previous medication, date of follow up visit and laboratory investigations, etc of each patient was recorded on a Performa, especially designed for the study. All base line assessments were taken on the day of inclusion (Day-0) in the study and a similar assessment was taken on Day-90 of treatment. After fulfilling the inclusion criteria patients were divided in two groups, i.e.Drug-1 (3 gram of ispaghula husk) and Drug-2 (placebo capsules, containing equal amounts of partly grinded wheat) groups. Twenty hyperlipidemic patients of group-1 were provided packets containing 3 gram of ispaghula husk and were advised to take one packet thrice daily along with diet control and exercise for 40-60 minutes (brisk walk). This regimen was followed for three months.
Twenty hyperlipidemic patients of drug-2 group having moderately ‘high' lipid profile were included in this group taken as control, and were advised to continue on isocaloric weight maintaing diet, i.e. step-1 diet8 and regular brisk walk for next three months. Patients of this group were provided capsules containing equal amount of partly grinded wheat and orange flavor, taken one capsule thrice daily after meal for three months.
Patients were advised to come in OPD, every two weeks for follow up to check blood pressure, weight, pulse rate and general appearance of the individual. Drug compliance to the regimen was monitored by interview and counseling at each clinical visits. Serum total cholesterol was estimated by the enzymatic calorimetric method (Rivelles et al 1994) using kit cat. # 303113050 by Eli Tech Diagnostic, France.10 Triglycerides were also estimated by enzymatic calorimetric method, using kit Cat. # 304710050 by Eli Tech Diagnostic. France. HDL- C was determined by using kit Cat. # 303210040 by Eli Tech Diagnostic, France. Serum LDL-cholesterol was calculated by Friedwald formula described by Davidson et al11 (LDL-Cholesterol = Total Cholesterol-(Triglycerides/5 +HDL-Cholesterol) also quoted by Delong et al (1986)12 and Beamount et al (1970).13 Data were expressed as the mean ± SD and "t" test was applied to determine statistical significance as the difference. A probability value of <0.05 was the limit of significance.
RESULTS
Thirty eight patients completed the over all study period. Two patients withdrew from one group (Ispaghula group) due to metallic taste of ispaghula husk. Tables showing base line and post treatment values are self explanatory. When results were summed up and test parameters were compared, it was seen that, after 90 days of treatment with ispaghula husk, serum total cholesterol decreased from 228.27±4.89 mg/dl to 199.22±2.30 mg/dl, which is highly significant statistically (P<0.001). The overall percentage change from day-0 to day-90 was -12.72, as shown in table no 1. LDL-Cholesterol level in these patients at day-0 was 159.72±5.70 mg/dl, which reduced by 90 days of treatment to 129.55±2.81 mg/dl, which is highly significant statistically (P<0.001). The overall percentage change from day-0 to day-90 was -18.88, as shown in table no 1. In placebo group at day-0, the serum total cholesterol level was 215.95±2.47 mg/dl, which decreased to 208.70±5.38 mg/dl, which is non significant statistically (P>0.05).The overall percentage decrease in the parameter was -3.35 as shown in table no 2. LDL-Cholesterol in placebo group at day-o was 150.75±2.67 mg/dl which reduced to 148.80±2.28 mg/dl, which is non significant statistically (P>0.05) as shown in table no 3.
DISCUSSION
HMG-CoA reductase inhibitors, nicotinic acid, fibrates and Psyllium are important and commonly used lipid lowering drugs.14 Among these Ispaghula has its own remarkable role to decrease serum total cholesterol and LDL- cholesterol.15 In our study, serum total cholesterol decreased 12.72 % in 90 days of treatment with Ispaghula husk in hyperlipidemic patients. Our study matches with the study of Anderson et al5 who observed almost same changes in serum total cholesterol and LDL- Cholesterol of 26 male patients, treated with 3.4 grams of Ispaghula thrice daily for two months. Our study also matches with the study of Maciejko et al6 who observed 12.00 % decrease in serum total cholesterol and 16.12 % decrease in LDL-Cholesterol in 40 hyperlipidemic patients treated with 4 grams Ispaghula husk for the period of four months. Our results regarding decrease in serum total cholesterol level contrasts with the results of research study conducted by Haskell et al7who observed only 6.11 % decrease in total cholesterol levels in 40 hyperlipidemic patients, when they used 2 gram ispaghula husk in 18 female patients for the period of two months. This change in results may be due to changes in gender of patients, and duration of drug used. He has mentioned the mechanism of action of Ispaghula husk that these ispaghula fibers stimulate bile acid synthesis in liver through 7 α-hydroxylase activity. Second mechanism, he described is diversion of hepatic cholesterol for bile acid synthesis. Effect of ispaghula husk on absorption of cholesterol and fat appeared minimal but may make a small contribution to cholesterol lowering. Additional mechanisms such as inhibition of hepatic cholesterol synthesis by propionate and secondary effects of slowing glucose absorption may also play a role.3 In our study placebo group proved 3.35 % reduction in serum total cholesterol and 1.29 % reduction in LDL-Cholesterol. These results matches with the study of Bays H and Stein EA20 who observed same effects of placebo given to 44 male and female hyperlipidemic patients having moderately serum total and LDL-Cholesterol. Their study shows 2.89 % reduction in serum total cholesterol and 2.21 % reduction in LDL-Cholesterol. Results of research study conducted by Jones PJ and AbuMweis SS21 do not match with our results. They observed 5.98 % and 9.97 % reduced levels of serum total cholesterol and LDL-Cholesterol, respectively, in 109 hyperlipidemic patients treated by ispaghula husk 3 gram daily for the period of 24 weeks. These changes in results may be due to their double blind research design, large sample size and environmental factors like in that study all hyperlipidemic patients were admitted at Lipid Research Centre, so were closely observed and advised for brisk walk and to take controlled step-1 diet.8 Drug compliance between our and their study was same, i.e. in our study patients discontinued taking ispaghula due to its metallic taste. In their study eleven patients discontinued to take ispaghula, mostly due to its metallic taste. Another study conducted by Erkkilla AT et al2 also contradicts with our study as they observed only 12.22 % reduction in LDL- Cholesterol when 3 gram ispaghula was administered in 14 female hyperlipidemic patients above the age of 40 years. Our study proved 18.88 % reduction in LDL-Cholesterol levels which is much higher than 12.22 %. Change in these results may be due only female gender and age which was specifically above 4o years in their study. . Our study comprised of both male and female hyperlipidemic patients with age range between 21-60 years.
REFERENCES
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About the Author
Authors:
- Shah Murad, Professor, Pharmacology, Lahore Medical and Dental College, Lahore.
- Ghazi Mahmood, Senior Registrar, ENT, GTTH, LM&DC, Lahore
- Moosa Khan, Assistant Professor, Pharmacology, BMSI, JPMC, Karachi.
- Manzoor Ahmad Unar, Assistant Professor, Pharmacology, CMC, Larkana.
- Amar Lal Ghurbakhshani, Assistant Professor, Physiology, Chandka Medical College, Larkana.
- Samina Karim, Associate Professor, Pharmacology, SIMS, Lahore.
- Aijaz Fatima, Lecturer, Pharmacology at LM&DC, Lahore.