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psyllium husk has therapeutic effects on hyperlipidemia

INTRODUCTION

Despite progress Significant doctors over the past two decades, coronary heart disease (CHD) remains the major health problem in industrialized countries (Anderson et al, 2000). The disease remains a major cause of morbidity and mortality worldwide. The incidence of coronary heart disease in Pakistan is as high in the Western world (Karira et al, 2000).

Elevated levels of total serum high density lipoprotein cholesterol and low (LDL) cholesterol are strong risk factors for coronary heart disease, with the oxidation of LDL plays a potentially important role in atherogenesis and the development of coronary artery disease. Each 1% increase in the concentration of serum cholesterol results in 2-3% increase in the risk of disease coronary heart disease (Anderson et al, 2000). Levels below 200 mg / dl are classified as desirable blood cholesterol, 200-239 mg dl on the rate limit high cholesterol and 240 mg / dl and over, like high cholesterol. The threshold for defining high cholesterol (240 mg / dl) a value above which greatly increases the risk of CHD. The recommended cutoff points are the same for men and women adults of all ages (Kostner GM, et al 1989). On the management of primary hyperlipidemia restriction of diet, bile acid resins, statins, clofibrate, psyllium mucilloid nicotinic acid hydrophilic and play an important role (AD Timmis, 1991). In addition, primary and secondary tests prevential, the reduction in total cholesterol and LDL improves coronary endothelial function and reduces the risk of coronary heart disease (Mayes, 1993). Consumption of soluble fiber reduces serum total and LDL-cholesterol. These fibers can be taken as an alternative to drug therapy. For some patients, viscous soluble fiber, the fibers of the husk Psyllium appears to be one of the most effective, with minor effects effects. In the short-term placebo-controlled studies have shown that consumption of 7-10 g of psyllium per day decreased the total serum cholesterol 4-11% below the concentration of placebo control. (Edington, 1987.) Psyllium does no significant blood pressure or cholesterol, high density, triglycerides, glucose, or iron (Bell et al, 1989).

Psyllium is naturally water soluble gel forming fibers. It is the common household remedy for constipation in Pakistan. effective cholesterol Food can be significantly improved fiber content of food is increased and this can be achieved by selection wise food or supplementation with psyllium (Memon, 2001, Spence et al, 1995).

Patients and methods

This study was conducted in the Department of Pharmacology and Therapeutics, Institute of Medical Sciences fundamental, Jinnah Postgraduate Medical Center, Karachi, from January to July primary hyperlipidemia 2002.Forty patients were initially included in this study, selected from the Hall Institute and OPD National target = "_new"> Cardiovascular Diseases, Karachi. Newly diagnosed untreated primary hyperlipidemic patients of both sexes, age 17-70 years were selected randomly. Patients with diabetes mellitus, peptic ulcer, kidney disease, liver disease, hypothyroidism and alcoholism were excluded from the study of information laboratory research, medical history and examination. After explaining the limits we have obtained the written consent of all participants. The study period was 90 days with follow-up visits every two weeks. The information required as such as name, age, sex, occupation, addresses, previous medication, the date of the visit and laboratory surveillance, etc. of each patient were recorded on a form specially designed for this study. Initially a detailed medical history and physical examination of all patients were conducted. All initial evaluations were taken on the day of inclusion (day 0) in the study and a similar assessment was made 90-day research design. Having met the criteria for including patients were divided randomly into two groups, ieDrug-1 (envelope 10gm/day psyllium) and drug-2 (placebo capsules, which contain equal quantities of wheat milled in part) groups. Patients with drug-1 group is advised to take psyllium husk (ISPAGHOL) 10 g per day three times before or after each meal. Patients in Drug-2 capsule group received a placebo, or capsules, three times daily after meals for 90 days. The patients were called every two weeks during follow-up to check blood pressure, weight, pulse and general appearance of the individual. Drug compliance was followed by an interview system and advice on each visit the clinic. Serum LDL cholesterol was calculated by the Friedewald formula (LDL-C = total cholesterol-(triglycerides / 5 + HDL cholesterol) described by Delong et al (1986) and Beamount et al (1970) 11.Data were expressed as mean ± SD and T-test was applied to determine the significance statistic as the difference. A probability <0.05 was the limit of significance.

RESULTS

Of the 40 patients, 38 completed the study period at all. Two patients withdrew from a group (group of psyllium husk), for failure Compliance is psyllium.They complaint about the test after taking psyllium metal. Tables 1, 2 and 3 show the results. When results are summarized and compared the test parameters are found after 90 days of treatment with psyllium husk, LDL-cholesterol decreased of 159.72 ± 5.70 mg / dl to 129.55 ± 2.81 mg / dl, which is highly significant (P <0.001). The overall percentage change from day to day was -18.88 0-90, as shown in Table 1. In the placebo group on day 0, LDL cholesterol was 150.75 ± 2.67 mg / dl, which decreased to 148.80 ± 2.28 mg / dl, which is not significant (P> 0.05). The percentage decrease in general-is the difference between 1.29.The average values between the placebo and niacin group is 17.59, which is highly significant (P <0.001)

DISCUSSION

This study demonstrates that significant changes in serum LDL-cholesterol following administration psyllium husk for the period of three months.

LDL-cholesterol was reduced by 18.8% during this period, which is highly significant (P <0.001). Our study is consistent with the study Anderson et al (1988) who observed changes almost equal in LDL-cholesterol of 26 male patients, treated with 3.4 g of psyllium three times daily for eight weeks. Our study results contrast with the results of the study by Kris-Etherton et al (1999) who observed changes in lipid profile percentile less hyperlipidemic patients. They observed the reduction of LDL-cholesterol psyllium of 10.2% in 70 male patients, if the treatment period was 4 weeks. This contrast may be due to larger sample size and shorter duration treatment in their study. I even saw an increase in HDL-cholesterol% in the placebo group, but the treatment of psyllium HDL-cholesterol was reduced to that of 0.3%. They do not mention the mechanism by which the placebo group increased HDL-cholesterol and psyllium reduced. They discussed various mechanisms by which psyllium to lower cholesterol. One of the mechanisms that psyllium stimulates the synthesis of bile acids (7 -?-Hydroxylase activity). Second was the shift mechanism of hepatic cholesterol in bile acid production. Effects of psyllium on absorption of cholesterol and lipids appears to be minimal, but it can make a small contribution to the reduction of cholesterol. other mechanisms, such as inhibition of the synthesis hepatic cholesterol propionate and the side effects of slower glucose absorption may also play a role.

REFERENCES

1. Anderson JW Davidson MH, Blonde L, et al (2000). The long term effects of psyllium to reduce cholesterol in addition of dietary treatment in the treatment of hypercholesterolemia.Am. J. Clin, 71: 1433-8.

2. Beamount JL, Carlson LA, Cooper GR (1970). Classification of hyperlipidemia. Bull. WHO 43: 891-908.

3. LP Bell, Hectorne K, Reynolds H, Balm TK, Hunninghake DB (1989). cholesterol-lowering effects of psyllium hydrophilic mucilloid. JAMA, 261, 3419-3423.

4. Delong DM, Delong ER, Wood PD, Lippel K Rifkind BM (1986). A comparison of methods for estimating plasma and very low

5. The Edington, M geekier, Carter R et al (1987). Effects of dietary cholesterol on plasma cholesterol concentration in the areas of materials reduced-fat diet rich in fiber. BMJ 294: 333-336.

6. Karira KA, Shah SMA, Salahuddin et al (2000). The incidence of lipid disorders in the offspring of patients suffering from early myocardial infarction. Medical website, 6: 9-12

7. Kostner GM, Gavish D, Leopold B, Bolzano K, Weintraub MS, Breslow JL (1989). HMG-CoA reductase reduce LDL cholesterol without reducing Lp (a).

8. Kris-Etherton PM, Pearson TA, Wan Y et al (1999). a diet high in monounsaturated fatty acids reduce plasma cholesterol and the concentration of glycerol. Am J Clin. Nutr, 70: 1009-1015.

9. Mayes PA (1993). cholesterol synthesis, transport and excretion. In: Biochemistry of Harper. Murray RK, DK Grann, Mayes PA, Rodwell VW. Eds. (23rd edition), Appleton and Lange, Connecticut, pp. 266-278.

10. Memon MA (2001). mucilloid efficacy, safety and tolerability of psyllium hydrophilic mild to moderate hypercholesterolemia. Medical website, 7: 37-40.

11. Spence JD, Huff MW, Heidenheim P, et al (1995). Combination therapy with colestipol and psyllium mucilloid in patients with hyperlipidemia. Ann. Intern. Med 123 493-499.

12. Timmis AD (1991). Early diagnosis of myocardial infarction. BMJ, 7: 309-310.

About the Author

Shah Murad,Professor, Pharmacology,Lahore Medical and Dental College, Lahore, pakistan
Muhsin Turab,Assistant Professor, Pharmacology, Hamdard College of Medicine & Dentistry, Karachi, Pakistan
Mehjabeen,Assistant Professor, Physiology,Hamdard College of Medicine & Dentistry, Karachi, Pakistan

M Ashraf Memon,Professor, Pharmacology, Sardar Ghulam Muhammad Mahar Medical College, Sukkur, Pakistan
Ghulam Rasool Bhurgari,Assistant Professor,Pharmacology, Muhammad Medical College, Mirpurkhas,Pakistan

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