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.
Methods: Patients who underwent coronary angiography between January to August 2013
were included. The indication for coronary angiography was positive non invasive test or
symptoms indicating coronary artery disease (CAD). The exclusion criteria include
incomplete data, infection, anemia, chronic statin treatment and previous coronary inter-
vention. Routine laboratory examinations (including hemoglobin, red cell distribution
width, white blood cell count, platelet, fasting blood glucose [FBG], lipid profile and
creatinine) were analyzed to identify their relation to the severity of coronary artery lesion
based on modified gensini score. Statistical analyses were done using SPSS 17.0 software. P
value <0.05 was considered statistically significant.
Results: A total 101 patients were included in this study. From these, 86 patients (85.15%)
were male. Hypertension, diabetes and dyslipidemia were found in 60 patients (59.41%),
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),
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
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
independent predictor of moderate to severe lesion (modified gensini score >7) (OR¼
2.59, P value <0.001). From the Receiver Operating Curve (ROC) analysis, the most
effective cutoff values for TC/HDL ratio to predict CAD (Area Under the Curve [AUC]¼
0.76; P value¼0.008) and moderate to severe lesion (AUC¼ 0.73; P value <0.001) are 3.91
(sensitivity 82.4% and specificity 70%) and 5.22 (sensitivity 70.6% and specificity 72%)
respectively.
Conclusion: TC/HDL ratio demonstrates strongest correlation with the severity of coronary
artery lesions. TC/HDL ratio independently predicts patients with CAD and predicts more
severe lesion.
Disclosure of Interest: None Declared
PM273
Lipid Profile of Adult Population in Bangladesh
Md. Abdul K. Akanda*1, Kamrun N. Choudhury2, Md Z. Ali1, Lima A. Saymi1, Reza M. Huda1
1 study tested the feasibility of regional electronic patient database for obtaining information
Cardiology, National Institute of Cardiovascular Diseases, 2Epidemiology, National Centre for
Control of Rheumatic Fever and Heart Disease, Dhaka, Bangladesh
Introduction: Lipid disorder is a major risk factor for the progression of atherosclerosis,
coronary artery disease and stroke. The causal association between plasma lipid level and
risk of coronary artery disease is established. With increasing urbanization and socioeco-
nomic improvement, changing population dynamics is expected to influence disease
pattern with rising trends of Non communicable diseases (NCDs).Thus there is a need to
screen healthy adults for their lipid pattern with high population dynamics in Bangladesh.
Objectives: Present study was aimed to find out the prevalence and 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. Multistage simple random method was used for data
collection. A total of seven hundred sixty eight (768) participants were screened after
obtaining informed consent. Data included socioeconomic information, behavioral risk
factors, anthropometric measurement and biochemical measurement using a pretested
questionnaire.
Results: Between the urban and rural participants, the mean total cholesterol (TC) levels
were 175.237.5 vs. 149.623.8 (mg/dl), mean triglyceride (TG) were 132.535.3
vs.154.734 (mg/dl) and mean low density lipoprotein (LDL) were 104.034.6
vs.79.725.5 (mg/dl), respectively, with a P- value <0.05, which was significantly asso-
ciated. Mean high density lipoprotein (HDL) were 37.08.9 mg/dl and 37.34.9 mg/dl
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-
tween the areas in logistic model. Total Cholesterol level increased with economic status
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
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). Partici-
pants with above 200mg/dl constituted 23.8% in case of total cholesterol and 25.6% in case
of triglyceride.
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 NCDs in the entire population.
Disclosure of Interest: None Declared
PM274
Evidence- NOT epidemiological-based guidelines are needed in diabetic patients
David Colquhoun*1, Antonio Ferreira-Jardim2
1
Cardiology, Wesley Hospital, 2University of Queensland, Brisbane, Australia
Introduction: Currently, risk factor guidelines for diabetic patients are based on arbitrary
cut-points derived from epidemiological studies. There is a general presumption that
aggressive treatment to the following levels will lower CHD risk: HbA1c <6.5%, Systolic BP
<130 mmHG (and <120 if proteinuric) and LDL-C <2.5 mmol/L.
Objectives: To evaluate recent intervention trials in diabetics assessing whether guideline
targets have been validated and if not, to suggest evidence-based targets.
Methods: A systematic review of completed randomised controlled trials via PubMed
involving risk factors in diabetics over the last 30 years. Trials needed to have more than
e116
BP, HbA1c and LDL-C.
Results: More than 20,000 diabetic patients have been assessed in each category. The
lowest CV event rates were seen in patients with an HbA1c of between 7-8%. Aggressive
lowering of HbA1c beyond these limits is neverthless being assessed in more than 10
ongoing intervention trials. The ideal systolic BP was determined to be between 130-140
mmHg (<120 mmHg was associated with increased mortality). LDL-C benefit RRR in
diabetics was the same as non-diabetics with incremental benefit in those with an LDL-C
<1.5 mmol/L.
Conclusion: CHD risk factor guidelines in diabetes should be modified to reflect evidence
from intervention trials. Patients could thus be spared unnecessary drugs or insulin
therapy.
Disclosure of Interest: None Declared
PM275
Evidence-treatment gap in type 2 diabetes care
Tiina Laatikainen*1,2,3, Maija Sikiö4, Hilkka Tirkkonen5, Päivi Kekäläinen3, James Dunbar6,
Markku Tykkyläinen4
1
Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio,
2
Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki,
3
Hospital District of North Karelia, 4Department of Geographical and Historical Studies,
University of Eastern Finland, Joensuu, 5Health Centre of Outokumpu, Outokumpu, Finland,
6
Greater Green Triangle Department of Rural Health, Deakin and Flinders Universities,
Warrnambool, Australia
Introduction: T2DM generates a large burden of work and economic cost for primary
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-
lished region-wide electronic patient database has provided the possibility to assess the
evidence-treatment gap among patients with T2DM.
Objectives: The aim of the study was to assess the quality of care of T2DM in primary
health care comparing guideline recommendations with clinical performance. Besides, the
for assessing the areal variation of quality of T2DM care.
Methods: Data were obtained from the joint patient database of the North Karelian 13
municipalities. Both primary and secondary health care records were investigated to find all
T2DM patients (ICD-10 E11) in the region. Altogether 10,204 patients were identified
corresponding to 6.2% prevalence in the population. Four quality indicators from the
Finnish guidelines where used: laboratory tests for HbA1c and LDL cholesterol,
HbA1c<7.0 % and LDL<2.5mmol/L. All laboratory analyses and their results from years
2011-2012 were retrieved from the database.
Results: The follow-up of T2DM patients showed reasonable levels of follow-up as judged
by measured HbA1c and LDL cholesterol levels. During 2011-2012, HbA1c had been
measured on 83% of patients and LDL among 75%. Of those whose HbA1c was measured,
72% reached the optimal treatment level <7.0 %. The LDL results were not so good; about
55% reached the recommended level <2.5 mmol/L. There was quite marked variation in
both the prevalence of T2DM and the outcomes of treatment between the municipalities
reflecting different processes in screening and management of T2DM patients.
Conclusion: The regional electronic patient database gave important information on
quality of care. The management of T2DM in North Karelia is reasonably good but the
results indicate that there is still room for improvements in both screening and manage-
ment. In brief, the regional patient database can provide efficient statistics to improve
disease management and benchmarking in municipalities.
Disclosure of Interest: None Declared
PM276
Biodiesel Exhaust Exposure Causes Vascular Dysfunction In Healthy Subjects
Jon Unosson*1, Anders Blomberg1, Thomas Sandström1, Mikael Kabele1, Christoffer Boman2,
Andrew J. Lucking3, Nicholas L. Mills3, David E. Newby3, Jeremy P. Langrish3, Jenny A. Bosson1
1
Public Health and Clinical Medicine, 2Department of Applied Physics and Electronics, Umeå
Universitet, Umeå, Sweden, 3University/BHF Centre for Cardiovascular Science, University of
Edinburgh, Edinburgh, United Kingdom
Introduction: Traffic-derived air pollution is associated with cardiorespiratory disease and
mortality, as well as being a major contributor to greenhouse gases. Biodiesel represents
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
are unknown.
Objectives: Controlled exposures to petrodiesel exhaust have consistently resulted in
vascular dysfunction in human subjects. The purpose of this study was to compare the
cardiovascular effects of biodiesel exhaust exposure from a 30% rape seed methyl ester
biodiesel blend (RME30) and 100% rape seed methyl ester biodiesel (RME100) to the well-
known adverse effects of petrodiesel exhaust.
Methods: In two separate studies non-smoking healthy volunteers were exposed to
petrodiesel exhaust or biodiesel exhaust (RME30 and RME100) in a randomised,
controlled, double-blind crossover fashion. In study one, sixteen subjects were exposed to
petrodiesel exhaust (PM10 313.7 mg/m3) and RME30 exhaust (PM10 309.1 mg/m3)
standardized for particle mass. In study two, nineteen subjects were exposed to petro-
diesel exhaust (PM10 309.8 mg/m3) and RME100 exhaust (PM10 165.0 mg/m3) stan-
dardized for emission factor. Exposures lasted one hour during which the subjects
performed intermittent exercise.
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
number one cause of death and disability in the
world. According to World Health Organization
(WHO) data, 36 million people had died globally in
2008 due to NCDs, accounting for 63% of the total
deaths. About 80% of deaths related to NCDs
occurred in low- and middle-income countries.
Among deaths related to NCDs, cardiovascular
diseases were the leading causes. More than 60%
of the total deaths related to NCDs occurred due
to cardiovascular diseases.1
Lipid profile means pattern of lipids in the blood.
A lipid profile usually includes the level of total
cholesterol (TC), triglycerides (TG), low density
(HDL). The increased level of TC, TG and LDL is
found to be associated with the higher risk of
coronary artery disease (CAD) and ischemic
stroke.2-5 On the other hand, population based
studies have consistently demonstrated an inverse
association between HDL level with the risk of
CAD.6
Worldwide, a change in population dynamics is
observed with increasing urbanization and
socioeconomic improvement. This change is
expected to influence disease pattern with rising
trends of non communicable diseases. Several
studies have reported a wide variation in mean
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
of the world.7-9 A steady increase of cholesterol
levels was noted in Asian countries in the last
decades of the 20th century and the trend was
increasing faster in urban areas than in rural
areas.10The problem is expected to extend in a
greater magnitude in developing countries due to
the increasing number of older population and
increasing prevalence of lipid disorders among
older population. So, well understanding of lipid
profile is becoming an issue of a major concern for
the prevention of NCDs like CAD and stroke.
One of the useful strategies for preventing CAD
and stroke include measures to control the risk
factors. To plan such activities, level of these risk
factors like lipid profile must be known. There is a
lack of published data regarding the lipid profile of
Bangladesh. Considering the situation, the present
study was designed to find out the level and
distribution of lipid profile in adult health
population in given communities.
Methods:
This was a cross sectional study, managed from
two co-ordination centres. National Institute of
Cardiovascular Disease (NICVD) was the co-
ordination centre for urban area and Noagoan
Diabetic Society was the co-ordination centre for
rural area. Holdings were selected by simple
random sampling method from all the holding
numbers of the particular block. Household
members, above 18 years, were taken as sampling
units. A pre-tested questionnaire was used for
interviewing the respondents. Another check list
was also used for recording physical examination,
blood pressure, anthropometric measurements and
other findings. Anthropometric measurement was
taken by following standard methods. Body weight
(kg) was to the nearest 0.1 kg, with wearing light
clothing, no shoes. Height (cm) was measured with
a measuring tape to the nearest 0.5 cm. Waist
circumference was measured at the level of the
umbilicus by trained data collector. Systolic and
diastolic blood pressures were measured using a
sphygmomanometer. All patients had a
registration number and contact with concerned
co-ordination centres. Next day blood was collected
from laboratory division. Twelve-hour fasting blood
in the morning had drawn from all of the subjects.
Blood was obtained and biochemical measurements
were conducted in a routine manner in the
129
Md. Abdul Kader Akanda et al.
specified laboratory. The serum lipid profile and
the fasting serum glucose concentration were
measured in enzymatic methods. All laboratory
report was recorded in the questionnaire. Same
process was followed for both urban and rural area.
Lipids levels were classified according to the
classification recommended by National
Cholesterol Education Program (NCEP) and Adult
Treatment Panel III (ATP III) guidelines. 11
Desirable level of TC was < 200 mg/dl, borderline
high was between 200-239 mg/dl and high TC was
considered when the level was >240 mg/dl. LDL
was defined as optimal level when it was < 100
mg/dl, near optimal level between 100-129 mg/dl,
borderline high between 130-159 mg/dl, high
between 160-189 mg/dl and very high when it was
>190 mg/dl. TG level was considered as normal
when it was < 150 mg/dl, borderline high between
150-199 mg/dl, high between 200-499 mg/dl and
very high when it was >500 mg/dl. Desirable HDL
was considered when it was >40 mg/dl and low
when it was < 40 mg/dl.
For the convenience and simplicity, lipid profile
data were represented in two classes - either
normal or high. TC level of < 240 mg/dl was
considered as normal and TC level of >240 mg/dl
was considered as high. LDL was considered
normal when it was < 160 mg/dl and high when it
was >160 mg/dl. TG level of < 200 mg/dl was
considered as normal and TG level of >200 mg/dl
was considered as high. HDL was considered
normal when it was >40 mg/dl and high when it
was < 40 mg/dl.
After collection, data was checked for completeness
and consistencies by the investigators. Statistical
Package for Social Science (SPSS) for windows
version 13 was used for data analysis. Data was
expressed in percentage, frequency, means and
standard deviation. Result was reported as mean
± standard deviation (SD) for qualitative variables
and categorical variables was presented as absolute
frequencies and percentage. Continuous variable
was compared through the student’s t-test and for
the categorical variable the chi-square test. Suitable
test of significance was applied for the results to
see the correlation between level of lipid profile
with behavioural risk factors of adult healthy
population and also dyslipidaemia. Significance will
be accepted where the p-value <0.05.
Cardiovascular Journal Volume 8, No. 2, 2016

The study protocol was reviewed and approved by
the Bangladesh Medical Research Council (BMRC)
Ethical Committee [BMRC/NREC/2010-2013/655(1-
10)]. Written informed consent was obtained from
each participant.
Results:
A total of 768 participants were screened with an
equal distribution in urban and rural areas. The
general characteristics of the study population in
urban and rural areas are summarized in Table I.
Between urban and rural participants, there was
also no significant difference in mean age, male
female distribution, body mass index (BMI) and
fruits intake. However, there was significant
difference between urban and rural participants
in terms of tobacco use, vegetable intake, blood
pressure, fasting blood sugar and lipid profile.
Compared to the participants of rural areas, the
mean TC and LDL levels were significantly higher
among participants of urban areas. Between the
urban and rural participants, the mean TC level
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

130
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),
respectively, with a p-value <0.05, which was
significantly associated. Conversely, the mean TG
level was significantly higher among participants
of rural areas compared to the participants of urban
areas. Between the urban and rural participants,
mean TG level was 132.5±35.3 vs. 154.7±34 mg/dl,
respectively, with a p-value <0.05, which was
significantly associated. Mean high density
lipoprotein was similar between urban and rural
adults (37.0±8.9 vs. 37.3±4.9 mg/dl, p = 0.68).
The lipid profile among the participants of urban
and rural areas by different age groups is abridged
in Table II and Table III respectively. Among
participants of urban areas, the highest level of
TC was found in 40-49 years group; the highest
level of both TG and HDL was found in 50-59 years
group; and the highest level of LDL was found in
30-39 years group. Among participants of rural
areas, the highest level of TC was found in 50-59
years group; the highest level of both TG and HDL
was found in 30-39 years group; and the highest
level of LDL was found in 40-49 years group.
Lipid profile of the total study population by normal
and high level is presented in Figure 1. 76.2% of
the participants were within normal level of TC
and 23.80% were high level of TC. In case of TG,
74.4% and 25.6% were normal and high level
respectively. 77.0% of the participants were within
normal level of LDL and 23.0% were high level of
LDL. In case of HDL, 40.2% had high and 59.8%
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

131
Cardiovascular Journal Volume 8, No. 2, 2016

income earning participants were more risk to

Fig-1: Lipid profile of study population by normal
and high level.
Age of the respondents, monthly income, use of
tobacco, physical activity, food habit, body mass
index and waist circumference showed significant
association with dyslipidaemia (Table IV). Higher
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)
were higher risk to develop dyslipidaemia and the
participants who had body mass index more than
29, they were also higher risk OR=4.01 (CI=3.42-
6.76) to develop dyslipidaemia who had BMI lower
than 29. Waist circumference OR=4.01 (CI=3.42-
6.76) showed significant result. Similar result
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)*

132
Study of Lipid Profile in Adult Population of Bangladesh
Discussion:
The present study found that the mean TC and
LDL levels were significantly higher among
participants of urban areas compared to the
participants of rural areas (p=0.001). On the other
hand, the mean TG level was found to be
significantly higher among participants of rural
areas compared to the participants of urban areas
(p=0.001). Mean high density lipoprotein was
similar between urban and rural adults. Several
factors might be associated with these biochemical
differences between the two population groups.
These populations vary by their socio-economic
status, dietary habits, physical activity, and means
of livelihood. Rural populations in Bangladesh are
usually dependent on agro-based economy and they
are required to work in agricultural fields, whereas
urban people are less exposed to perform such
strenuous physical activities. Such activities are
the major influencing factors that regulate the body
anabolic and catabolic functions including
metabolism of carbohydrate, protein and fat.
Earlier studies also reported that modernization
related reduced physical activity among urban
populations was associated with higher level of
plasma cholesterol than their rural
counterparts.12-15 Dietary habit is another factor
recognized to be associated with lipoprotein
status.16 In Bangladesh, rural population generally
consume plant protein more often than animal
protein due to easy access to locally-grown, fresh,
and low-cost vegetables. On the other hand, urban
populations, usually with higher income, consume
higher amounts of animal protein. Vegetable diets
contain less saturated fat and cholesterol, and
greater amounts of dietary fibre, and their
consumption helps lower the level of serum
cholesterol.17 Present study documents the lipid
profile of adult population residing urban and rural
areas. However, nationwide, randomized, large
scale survey is recommended.
Conclusion:
Dyslipidaemia can be modified either by proper
life style changes or medical management or by
the combination of the both. The result of the
present study will be useful for lifestyle
intervention program to maintain the normal level
of lipid profile and to achieve primary prevention
133
Md. Abdul Kader Akanda et al.
of coronary artery disease and associated non
communicable diseases in the entire population.
Acknowledgments:
Authors are very grateful to all the participants
for the study. The authors felt immense thanks to
physicians, pathologists and pathological staff of
the concerned organizations.
Conflict of Interest - None.
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region. Int J Epidemiol 2003; 32(4):563-572.
3. Nordestgaard BG, Varbo A. Triglycerides and
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4. Howard BV, Robbins DC, Sievers ML, Lee ET, Rhoades
D, Devereux RB, et al. LDL cholesterol as a strong
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Rai G, et al. Lipid profile of adult Nepalese population.
Nepal Med Coll J 2008; 10(1):4-7.
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Lipids and coronary artery disease in Asia.
Atherosclerosis 2003; 169(1):1-10.
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Program (NCEP) Expert Panel on Detection,
Evaluation, and Treatment of High Blood Cholesterol
in Adults (Adult Treatment Panel III) final report.
Circulation 2002; 106:3143-3421.
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VP. Secular trends in cholesterol lipoproteins and
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triglycerides and prevalence of dyslipidemias in an urban
Indian population. Lipids Health Dis 2008; 7:40.
13. Das SK, Golam Faruque AS, Chowdhury AK, Chisti
MJ, Hossain MA, Salam MA, et al. Lipoprotein status
among urban populations in Bangladesh.
Atherosclerosis 2012;223(2):454-457.
14. Nongkynrih B, Acharya A, Ramakrishnan L, Ritvik,
Anand K, Shah B. Profile of biochemical risk factors for
non communicable diseases in urban, rural and
periurban Haryana, India. J Assoc Physicians India
2008; 56:165-170.
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15. Njelekela M1, Sato T, Nara Y, Miki T, Kuga S, Noguchi
T, et al. Nutritional variation and cardiovascular risk
factors in Tanzania-rural-urban difference. S Afr Med
J 2003; 93(4):295-299.
16. Djoussé L, Arnett DK, Coon H, Province MA, Moore
LL, Ellison RC. Fruit and vegetable consumption and
LDL cholesterol: the National Heart, Lung, and Blood
Institute Family Heart Study. Am J Clin Nutr. 2004;
79(2):213-217.
17. Craig WJ. Nutrition concerns and health effects of
vegetarian diets. Nutr Clin Pract 2010;25(6):613-620.
See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/220047849

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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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
Background: Hypothyroidism is defined as a deficiency of
the thyroid hormone and an increase in the thyroid stimulating
hormone (TSH) levels in patients, which has been associated
with elevated levels of serum cholesterol in some populations.
Sylhet has been described as the one of the wealthiest cities
in Bangladesh and its population leads a life of relative luxury
than in most other parts of the country. Lifestyle plays an
important role in obesity, lipid profile, and thyroid profile related
diseases, but no data are available regarding the thyroid status
and the lipid profile in this Sylheti population. The aim of the
present study was to assess whether hypothyroidism which was
associated with abnormal lipid levels in the population of Sylhet,
Bangladesh.
Materials and Methods: The data from adults older than 25
years, who did not previously have a diagnosis of hypothyroidism
or those who were not taking thyroid replacement medication,
were analyzed at the Women’s Medical College and Hospital,
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
process of thyroid hormone synthesis begins in the hypothalamus.
The hypothalamus releases the thyrotropin releasing hormone
(TRH). The TRH travels through the bloodstream to the pituitary
gland. The pituitary gland then releases the thyroid-stimulating
hormone (TSH) into the blood. The TSH stimulates the thyroid
gland to produce the two main thyroid hormones, thyroxine (T4)
and triiodothyronine (T3).
It is well known that alterations in the thyroid function can result in
changes in the composition and in the transport of lipoproteins [1].
Specifically, the thyroid hormone stimulates the hepatic de novo
cholesterol synthesis by inducing the HMG-CoA reductase that
catalyzes the conversion of HMG-CoA to Mevalonate, which is the
first step in the biosynthesis of cholesterol [2]. This results in an
enhanced intracellular cholesterol concentration in hyperthyroidism
and a decreased one in hypothyroidism. Additionally, thyroid
hormones activate the LDL receptors. The promoter of the LDL
receptor gene contains a thyroid hormone responsive element
(TRE) which allows T3 to upregulate the gene expression of the
LDL receptor. Moreover, thyroid hormones stimulate the cholesteryl
ester transfer protein (CETP), an enzyme which transports
cholesteryl esters from HDL2 to the very low density lipoproteins
(VLDL) and triglycerides in the opposite direction. Finally, thyroid
hormones stimulate the lipoprotein lipase (LPL) which catabolizes
Journal of Clinical and Diagnostic Research. 2011 November (Suppl-2), Vol-5(7): 1347-1351
Original Article
Sylhet. Thyroid stimulating hormone (TSH), thyroxine (T4), serum
total cholesterol (TC), low-density lipoprotein cholesterol (LDL),
high-density lipoprotein cholesterol (HDL) and triglyceride (TG)
levels were measured.
Results: In this study, it was found that hypothyroidism was more
common in women (p=0.039) and in the advanced age group
(p=0.038). The persons who met the criteria for hypothyroidism
had higher mean cholesterol levels (209.89 vs. 191.49 mg/dl,
p=0.038) and higher rates of elevated cholesterol levels (60.5%
vs. 40.4%, p=0.024) than the euthyroid control group, but there
were no significant differences in their LDL or HDL levels. The
mean TG levels (186.04 vs. 231.47 mg/dl, p=0.013) and the rates
of the elevated TG levels (50.6% vs. 68.4%) were higher in the
hypothyroid group.
Conclusion: Hypothyroidism appears to be associated with
abnormalities in the serum cholesterol or triglyceride levels
in the Sylheti population. There might be a potential link
between hypothyroidism and cardiovascular diseases such as
hydrolyzes HDL2 to HDL3 [3].
There is a substantial evidence that overt hypothyroidism alters
several of the traditional risk factors for cardiovascular disease.
Hypercholesterolaemia in hypothyroidism, characterized by
elevated levels of LDL-C and Apo B, is caused by a decreased
catabolism of LDL due to a reduction in the number of LDL
receptors on the liver cell surfaces [1]. Hypothyroidism can also
increase cardiovascular risk by causing diastolic hypertension.
The potential mechanisms for reversible diastolic and systolic
hypertension in hypothyroidism include increases in the peripheral
vascular resistance [4] and arterial stiffness [5], respectively.
Studies have shown that 70% of the community in Sylhet relies on
the remittance which is sent from relatives abroad and thus, the
population leads a relatively luxurious lifestyle than in other parts
of the country. However, to the best of our knowledge, no studies
have examined whether a relationship exists between thyroid
profile and lipid profile in this Sylheti population. The purpose of
the present study was to explore the association between the
thyroid hormones and the abnormal lipid profile, including that in
cardiovascular diseases.
MATERIALS A METHO S
This study was conducted at the Women’s Medical College and
Hospital, Sylhet during December 2009 to May 2010. Samples were
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
[Table/Fig-2d]: Comparisons of four different parameters between
hypothyroid and euthyroid groups: sex(a), age groups(b), mean
values of lipid profile(c) and clinical range of TC and TG(d).
have been identified for other risk factors for atherosclerosis,
including hyperhomocysteinaemia, elevated C-reactive protein
(CRP) levels, coagulation abnormalities, endothelial dysfunction,
and insulin resistance in individuals with overt hypothyroidism and,
in some cases, subclinical hypothyroidism [23].
The present study indicated that hypothyroidism was associated
with an abnormal lipid profile, especially with respect to the levels
of TC and TG. Hence, persons suffering from hypothyroidism
should make lifestyle and dietary adjustments to avoid future
cardiovascular complications. A large-scale study is warranted to
further validate the findings of the present study.
ACKNOWLEDGEMENT
The authors are grateful to the Women’s Medical College and
Hospital for providing the facilities to perform this study. We are
grateful to the technologists who are working in the Biochemistry
Department of the hospital, for helping with the sample collection.
We are also thankful to Professor Susanta Kumar Das and
Professor Yasmeen Haque (Department of Physics, Shahjalal
University of Science and Technology, Sylhet-3114, Bangladesh)
for their valuable discussions which were related to this research.
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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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 Vascular Health and Risk Management
Open Access Full Text Article
Serum lipid profile and its association
with hypertension in Bangladesh
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Kamrun Nahar Choudhury 1
AKM Mainuddin 2
Mohammad Wahiduzzaman 3
Sheikh Mohammed Shariful
For personal use only.
Islam 4,5
1
Department of Epidemiology,
National Centre for Control of
Rheumatic Fever and Heart Disease,
2
Center for Communicable Diseases,
International Center for Diarrheal
Disease Research, 3Department of
Cardiology, Bangladesh Institute of
Health Science, Bangladesh, Dhaka,
Bangladesh; 4Center for Control
of Chronic Diseases, International
Center for Diarrheal Disease
Research, Bangladesh, Dhaka,
Bangladesh; 5Center for International
Health, University of Munich, Munich,
Germany
Correspondence: Sheikh Mohammed
Shariful Islam
Center for Control of Chronic Diseases,
International Center for Diarrheal
Disease Research, Bangladesh,
68, Shaheed Tajuddin Ahmed Sarani,
Mohakhali, Dhaka 1212, Bangladesh
Tel +880 2 1939 366 930
Email shariful.islam@icddrb.org
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Original Research
This article was published in the following Dove Press journal:
Vascular Health and Risk Management
30 June 2014
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Background: Hypertension and dyslipidemia are major risk factors for cardiovascular ­disease,
accounting for the highest morbidity and mortality among the Bangladeshi ­population. The
objective of this study was to determine the association between serum lipid profiles in hyper-
tensive patients with normotensive control subjects in Bangladesh.
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
National Centre for Control of Rheumatic Fever and Heart Disease in Dhaka, Bangladesh. Data
were collected on sociodemographic factors, anthropometric measurements, blood pressure, and
lipid profile including total cholesterol (TC), triglyceride (TG), low density lipoprotein (LDL),
and high density lipoprotein (HDL).
Results: The mean (± standard deviation) systolic blood pressure and diastolic blood pres-
sure of the participants were 137.94±9.58 and 94.42±8.81, respectively, which were higher
in the hypertensive patients (P,0.001). The serum levels of TC, TG, and LDL were higher
while HDL levels were lower in hypertensive subjects compared to normotensives, which was
statistically significant (P,0.001). Age, waist circumference, and body mass index showed
significant association with hypertensive patients (P,0.001) but not with normotensives. The
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
of CVD in Southeast Asia, including Bangladesh.3 It is widely accepted that CVD is
associated with hypertension and increased blood levels of low-density lipoprotein
(LDL), total cholesterol (TC), and triglycerides (TG). In contrast, a low level of high
density lipoprotein (HDL) is a risk factor for mortality from CVD.4 Epidemiological
studies have established a strong association between hypertension and coronary
artery disease.5
Vascular Health and Risk Management 2014:10 327–332 327
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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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 Choudhury et al
The noncommunicable disease risk factor survey con-
ducted in 2010 in Bangladesh estimated the prevalence of
hypertension among adults to be from 16% to 20%.6 The
Bangladesh Health, Nutrition and Demographic Survey in
2011 found the prevalence of hypertension among adults to
be 34%.7,8 A meta-analysis of the prevalence of hyperten-
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sion in Bangladesh from 1995 to 2009 among 6,430 adults
was estimated to be 13.5%, with a 95% confidence interval
(CI) ranging from 12.7% to 14.2%.6 Another meta-analysis
of prevalence of CVD and type 2 diabetes between 1995
and 2010 found the pooled prevalence of hypertension to
be 13.7% (12.1%–15.3%), with an increasing trend and
higher rate in urban areas versus rural (22.2% versus 14.3%,
respectively).9 However, these numbers are estimated from
several studies and are likely not to account for silent and
other asymptomatic CVD and hypertension.
CVD is the leading cause of disability and death worldwide,
and a great majority of CVDs are associated with dyslipidemia.
For personal use only.
Worldwide, there is broad variation in serum lipid profile levels
among different population groups. Increased serum levels of
TC, TG, LDL, and decreased HDL are known to be associated
with major risk factors for CVD. Dyslipidemia, comprising
altered ratio of high TC level and isolated evaluation of the
LDL or TG, is usually associated with increased blood pressure
(BP) levels. There is a strong relationship between total LDL
cholesterol concentrations and CVD risk. Patterns of lipid
abnormalities among Asians and their relative impact on
cardiovascular risk have not been well characterized.10 Low
HDL is increasingly recognized as an independent risk factor
for adverse CVD outcomes, irrespective of levels of LDL.
Although sporadic reports suggest that the prevalence of low
HDL-cholesterol is substantial, we lack detailed data on the
true prevalence of this condition among patients receiving
treatment for dyslipidemia.11 These data strongly suggest that
low HDL is a clinically significant problem.
In Bangladesh, consumption of saturated fat and red meat
is a known risk factor for CVD, especially hypertension.12
However, data about the relationship between hypertension
and lipid profile among Bangladeshi patients are rare in
the literature. The purpose of the study was to compare the
blood lipid levels in hypertensive patients with normoten-
sive control subjects and determine its association between
hypertension and lipid profile.
Materials and methods
Study design and population
A cross sectional study was conducted among 234 participants,
159 newly diagnosed hypertensive patients and 75 ­participants
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with normal BP (normotensives), attending the National
Centre for Control of Rheumatic Fever and Heart Disease
(NCCRF&HD) in Dhaka, Bangladesh for a routine health
check-up between January and December 2012. All the partici-
pants were residents of surrounding areas in Dhaka and aged
between 30–60 years. Participants were selected consecutively
from the outpatient department by the attending physician.
Patients with features of any cardiac, renal, or hepatic compli-
cations or major medical problems were excluded. Also, those
on lipid lowering and antihypertensive medication were also
excluded. After obtaining oral and written informed consent,
data was collected through face-to-face interviews, anthropo-
metric measurements, clinical examinations, and blood tests
for serum lipid profile by trained research assistants.
Measurements
Height and body weight were measured with participants
standing without shoes and heavy outer garments. Body mass
index (BMI) was calculated as weight in kilograms, divided
by height in meters squared (kg/m2). Waist circumference
(WC) was measured from midway between the lowest rib
and the iliac crest using a Gullick II tape with subjects in
the standing position and at the end of a normal expiration.
Two measurements were taken from each subject, and the
mean value was used for the analysis. All anthropometric
measurements were collected by the same individual.
BP was measured by a physician using standard BP mea-
surement protocol after the patient had rested for 10 minutes.
Two measurements were taken by a mercury sphygmoma-
nometer, with at least a 5-minute interval between successive
measurements. The mean of two measurements of Korotkoff
phase I was recorded for systolic blood pressure (SBP). The
mean of two values of Korotkoff phase IV was recorded for
diastolic blood pressure (DBP). Hypertension was defined as
an average SBP $140 mmHg and DBP $90 mmHg without
antihypertensive medication according to the seventh report
of the Joint National Committee on Prevention, Detection,
Evaluation and Treatment of High Blood Pressure (JNC-7).13
In this study, hypertensive patients refer to those participants
who demonstrated the JNC-7 criteria.
Biochemical analysis
A volume of 5 mL of venous blood was collected in the
morning after an overnight fast, and serum was used for
biochemical tests. All tests were carried out at the labora-
tory of the NCCRF&HD in Dhaka, Bangladesh. Lipid
parameters (TC, TG, LDL, and HDL) were estimated by
enzymatic colorimetric methods. Dyslipidemia was defined
Vascular Health and Risk Management 2014:10
 Dovepress
according to the Evaluation and Treatment of High Blood
Cholesterol in Adults executive summary of the third report
of the National Cholesterol Education Program Expert Panel
on Detection, Evaluation and Treatment of High Blood
Cholesterol in Adults (Adult Treatment Panel III): LDL
cholesterol (mg/dl) ,100= optimal, 100–129= near optimal/
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above optimal, 130–159=borderline high, 160–189= high,
190= very high; total cholesterol (mg/dl) ,200= desirable,
200–239= borderline high, 240= very high; HDL
cholesterol (mg/dl) ,40=low, 60= high; triglyceride
(mg/dl) ,150= normal (goal), 150–199= borderline high,
200–499= high, 500=very high.14
Ethics
Ethical clearance was obtained from the NCCRF&HD.
Participants were informed about the study, and both verbal
and written informed consent was obtained. The Helsinki
Declaration was strictly followed for data collection.15
For personal use only.
Data analysis
Data were analyzed using Statistical Package for Social
­Sciences software, version 16.0 (SPSS Inc., Chicago, IL,
USA). Descriptive statistics was used to present the demo-
graphic characteristics of the study participants. Continuous
variables were presented as mean ± standard deviation (SD)
and were compared using independent group Student’s t-tests.
Binary logistic regression analysis was performed to measure
the relationship of lipid profile among the hypertensive and
normotensive patients after adjusting for age, BMI, sex, and
BP. A P-value ,0.05 was considered statistically significant.
Results
The study included 234 participants with a mean age ± SD of
44.7±5.7 years and BMI of 25.2±3.8 kg/m2. The mean SBP and
DBP were 137.9±9.6 mmHg and 94.4±8.8 mmHg, respectively.
The mean BMI, TC, HDL, and LDL were higher for males
compared to females, which was statistically significant
(P,0.05). The mean WC was higher in males, which was
not statistically significant (P=0.051) (Table 1).
The mean age ± SD of hypertensive patients and nor-
motensives were 47.6±4.2 and 38.4±3.7 years, ­respectively.
Serum levels of TC, TG, and LDL were 238.3±3.4, 178.3±6.3,
and 151.3±7.8 mg/dL, respectively, in hypertensive sub-
jects while in normotensive subjects, they were 187±6.2,
141.5±11.2, and 110.3±6.3 mg/dL, respectively, which were
significantly higher in hypertensive patients (P,0.001). The
serum HDL was significantly lower (P,0.001) in hyperten-
sive patients (41.2±3.2 mg/dL) than in normotensive subjects
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Hypertension and serum lipid profile in Bangladesh
(44.3±5.6 mg/dL). The mean SBPs of hypertensives and
normotensives were 146.8±8.5 mmHg versus 119.2±9.3
mmHg, respectively, and mean DBPs were 98.9±7.3 mmHg
versus 84.9±5.3 mmHg, respectively. The mean SBP and
DBP of hypertensives were higher than those of normoten-
sives (P,0.001). Age, WC, and BMI showed significant
association with hypertensive patients (P,0.001) but not
with normotensive subjects (Table 2).
Binary logistic regression analysis showed TC was
significantly associated with hypertensive patients and the
odds ratio (OR) was 1.1, 95% CI 0.91–1.77, P,0.002. TG
and LDL were significantly associated with hypertensive
patients (OR 1.1, 95% CI 0.49–1.44, P,0.05 and OR
1.2, 95% CI 0.69–1.66, P,0.001, respectively). HDL was
also associated with hypertensive patients (OR 1.08, 95%
CI 0.77–1.52, P,0.05). DBP showed significant associa-
tion with hypertensive patients (OR 1.7, 95% CI 0.33–3.29,
P,0.05) (Table 3).
Discussion
In this study, we investigated the relationship between serum
lipid profile and hypertension among an urban population
in Bangladesh. Results of this study revealed that the mean
values of serum TC, TG, and LDL were significantly higher
and statistically significant among the hypertensive patients
compared to normotensives. The mean HDL level was lower
in the hypertensives compared to normotensives and was
statistically significant.
Hypertension is recognized globally as a major risk factor
for CVD, stroke, diabetes, and renal diseases.16 About 80%
of hypertensive persons have comorbidities such as obesity,
glucose intolerance, abnormalities in lipid metabolism,
among others. A prospective study in the northern region of
Bangladesh comparing lipid profile status in hypertensive
patients as compared to healthy normotensive controls found
high serum TC, TG, and LDL, similar to our study.17 Our
findings of increased levels of TC in hypertensive patients are
similar to the findings of some other studies.16,18,19 However,
few studies measured the strong association of hypertension
and dyslipidemia among the Bangladeshi population.
Analysis from the INTERHEART study shows that among
both cases and controls, mean LDL levels were about 10 mg/
dL lower in Asians compared with non-Asians.10 A greater
proportion of Asian cases and controls had LDL #100 mg/
dL. HDL levels were slightly lower among Asians compared
with non-Asians, a population who require further study and
targeted intervention.10 Several studies have shown that most
of the hypertensive patients undergo inconsistent treatment,
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 Choudhury et al Dovepress

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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countries, and showed that diabetic patients had lower HDL
(1.22±0.37 mmol/L versus 1.35±0.44 mmol/L, P,0.001)
and higher TG (2.32±2.10 mmol/L versus 1.85±1.60
mmol/L, P,0.001) than nondiabetic patients. 24 More
diabetic compared to nondiabetic patients had low HDL
(45% versus 30%, respectively), high TG ($1.7 mmol/L;
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57% versus 42%, respectively), or both (32% versus 19%,
respectively). HDL ,0.9  mmol/L was found in 18% of
diabetic and 12% of nondiabetic subjects.24
Previous studies showed the high rate of CVD ­mortality
among South-East Asian compared to the rest of the world
and that majority of CVD deaths occur below the age
of 70.25–28 A wide range of risk factors for CVD has been
studied in Bangladesh, but few studies have measured the
association of CVD risk with hypertension and lipid pro-
file. A study in rural areas of Bangladesh reported that the
prevalence of “high” TC concentration (.240 mg/dL or
.6.2 mmol/L) in Bangladesh is about 17%, “high” LDL
For personal use only.
($160 mg/dL or $4.2 mmol/L) is about 2%, and “low” HDL
(,40 mg/dL or ,1.04 mmol/L) is about 67%.29
Limitations
Our study has several limitations. First, the sample size was
obtained from an urban hospital and may not be representa-
tive of all hypertensive patients in Bangladesh. Second, our
sample size was small, and the control group was selected
purposively, not age and sex matched. In addition, we could
not compare the effects of lipid profile variation due to diet,
physical activity, medication, or other factors.
Conclusion
The results of this study demonstrate that patients with hyper-
tension are more likely than normotensive patients to exhibit
dyslipidemia, including elevated TC, LDL, TG, and reduced
HDL cholesterol levels. Our results suggest that elevated BP
may predict certain disturbances in lipoprotein metabolism.
This association will help to develop future strategies for
preventing both hypertension and dyslipidemia through
proper lifestyle changes or medical management or by the
combination of both. Hypertensive patients need measure-
ment of BP and lipid profile at regular intervals throughout
their primary health care to prevent CVD and stroke.
Acknowledgments
We express our sincere thanks to all the participants in
this study. We also thank all the physicians, pathologists,
and staff of the NCCRF&HD who provided support for
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Hypertension and serum lipid profile in Bangladesh
this study. We are grateful to Mr SM Majedul Karim,
Ludwig-Maximilians University of Munich, Germany for
reviewing this manuscript and providing feedback.
Disclosure
The authors report no conflicts of interest in this work.
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is common in European type 2 diabetic patients receiving treatment
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2007;24(4):388–391.
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risk factors associated with myocardial infarction in 52 countries (the
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937–952.
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Vascular Health and Risk Management 2014:10
 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-
●
▶ HDL cholesterol tigating the relationship between lipid distur-
●
▶ LDL cholesterol bances and hypertension it is necessary to use
local data on blood lipid profile in each region.
Unfortunately, there is no literature report-
ing the lipid profile in hypertensive patients in
coastal region of Bangladesh. The present study
was conducted as a case-control study with 100
hypertensive patients as cases and equal number
of normotensive individuals as controls. Socio-
demographic, anthropometric and clinical data
of both patients and controls were collected.
Serum lipid parameters were analyzed biochem-
ically. Independent sample t-test, Chi-Square test
and Pearson’s correlation test were done for the
statistical analysis using the statistical software
(p < 0.05) whereas the level of HDL cholesterol
was significantly lower in hypertensive patients
as compared to control subjects (p < 0.05). Pear-
son’s correlation analysis reveals that HDL cho-
lesterol was inversely correlated with systolic
and diastolic blood pressure in both patient and
control groups. But serum TC, TG, LDL and HDL
cholesterol were directly correlated with systo-
lic and diastolic blood pressure in both groups.
This study explored that hypertensive patients
have higher level of TC, TG, LDL and VLDL cho-
lesterol but lower level of HDL cholesterol than
the normotensive subjects. Routine investigation
of lipid profile in hypertensive patients may help
to prevent further aggravation and risks of coro-
nary artery diseases.

received 12.08.2013
accepted 16.10.2013 Introduction than whites and it increases with age in all

Bibliography
DOI http://dx.doi.org/
10.1055/s-0033-1358704
Published online:
November 13, 2013
Drug Res 2014;
64: 353–357
© Georg Thieme Verlag KG
Stuttgart · New York
ISSN 2194-9379
Correspondence
Dr. M. S. Islam
Associate Professor
Department of Pharmacy
Noakhali Science and
Technology University
Noakhali-3814
Bangladesh
Tel.: + 88/321/71 483 (Office)
+ 88/171/4165 107 (Mobile)
Fax: + 88/321/62 788
research_safiq@yahoo.com
▼ groups [5]. The most important risk factors of
Hypertension is the most common cardiovascu-
lar disease and is one of the 10 leading causes of
mortality through the world [1]. Hypertension is
defined as a sustained elevation of blood pres-
sures with systolic pressure to or greater than
160 mm Hg and/or diastolic pressure equal to or
greater than 90 mm Hg [2]. It is sometimes
known as “silent killer” because it may exist for
prolonged periods in the individual without
symptoms and may manifest only after causing
serious irreversible pathology and complications
[3]. The prevalence of hypertension was esti-
mated to be 26.6 % in men and 26.1 % in women in
2000 which may be increased to 29.0 % in men
and 29.5 % in women by 2025 [4]. It has also been
suggested that around two-thirds (639 million)
hypertensive populations were living in develop-
ing countries in 2000 which would rise to three-
quarters (1.15 billion) by 2025. The incidence of
hypertension is higher among black individuals
this disorder are obesity, increased salt intake,
cigarette smoking, lack of physical exercise,
genetic factors and stress and strain [6].
Lipid parameters are major risk factor for cardio-
vascular diseases (CVDs) which are strongly
linked with the occurrence of CVDs. [7]. Dyslipi-
demia is a strong predictor for cardiovascular
diseases which causes endothelial damage. The
loss of physiological vasomotor activity resulting
from endothelial damage may be manifested as
elevated blood pressure. Thus, factors like dysli-
pidemia causing endothelial dysfunction may
lead to hypertension [8]. It has also been docu-
mented that presence of hyperlipidemia substan-
tially worsens the prognosis in hypertensive
patients [9]. Assessment of serum lipids such as
total cholesterol (TC), triglyceride (TG), low den-
sity lipoprotein (LDL) cholesterol, and high den-
sity lipoprotein (HDL) cholesterol has found
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
mellitus [10, 11]. The diagnosis and treatment of hypercholeste-
rolemia have also approved to show the risk of cardiovascular
diseases based on these operations. So, for the prevention and
clinical management of cardiovascular disease, the evaluation of
plasma lipids and lipoproteins levels have been approved as
compulsory.
There are sufficient evidences which reported that serum lipids
are controlled by multi-factorial combinations where both
genetic and environmental factors influence the levels of these
parameters [12, 13]. Therefore, the level of several lipid parame-
ters in hypertensive patients living in coastal region of Bangla-
desh may be different. The objective of the present study was to
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.
Methods
▼ This study comprised of 100 hypertensive patients as cases and
Atherogenic index (AIX) was calculated as the ratio of LDL to HDL
according to Glueck and Segal [17]. Serum concentration of creati-
nine was measured by commonly used laboratory procedure [18].
Statistical analysis
Statistical analysis was performed using the statistical software
package SPSS version 16.0 (SPSS, Inc., Chicago, IL). All data were
expressed as mean ± standard error mean (mean ± SEM). Simple
descriptive statistics and Chi-Square test was used to express the
socio-demographic characteristics of the study populations.
Independent sample t-test was used to determine the level of
significance. Pearson’s correlation analysis was used to find the
correlation among the various lipid parameters.
Results and Discussion
▼
Results
General characteristics of subjects

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Study design and data collection
The study was conducted as a case-control study from January
to August, 2012, with 100 hypertensive (HT) patients as cases
and 100 normotensive (NT) individuals as controls. The study
100 normotensive individuals as controls. It was observed that
mean age of the patients and controls were 46.98 ± 2.11 and
44.84 ± 2.07 years respectively. Socio-demographic features of
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,
Bangladesh. All study subjects were briefed about the purpose of
the study and written consent was obtained from each of them
prior to their inclusion in the study. Initially, a pilot study was
carried out with small number of patients using structured
questionnaires to set the variables of the study. Then according
to the purpose of the study, necessary modification was done in
Anthropometric and clinical characteristics of subjects
The mean values of body mass index (BMI), systolic and
diastolic blood pressure (SBP and DBP respectively) were
24.81 ± 0.50 kg/m2, 159.9 ± 3.12 mm Hg and 102.60 ± 1.79 mm Hg
for patient group and 23.55 ± 0.35 kg/m2, 119.40 ± 1.26 mm Hg
and 81.30 ± 0.91 mm Hg for the healthy control group respec-
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
and control groups but no such differences were observed for
serum creatinine level between 2 groups (p > 0.05).
Serum lipid profile
The mean serum total cholesterol levels were 222.20 ± 8.75
and 166.92 ± 4.88 mg/dl and serum triglyceride levels were
188.48 ± 6.64 and 143.73 ± 3.62 mg/dl in hypertensive and nor-
motensive subjects respectively, which has been indicated
tively. The ratio of TC to HDL and LDL to HDL was 7.03 ± 0.36 and
4.48 ± 0.22 in patient group whereas 4.30 ± 0.18 and 2.59 ± 0.10
control group respectively. Statistical analysis reveals that serum
level of TC, TG, LDL, VLDL, TC/HDL ratio and LDL/HDL ratio was
significantly higher (P < 0.05) but serum level of HDL was signifi-
cantly lower (P < 0.05) in hypertensive patients than in the nor-
motensive subjects. The data were further analyzed in order to
establish the correlation of various lipid parameters with SBP
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

Downloaded by: University of Georgia Libraries. Copyrighted material.

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
ischemic stroke. Malhotra et al. [32] stated that individuals with
high triglycerides usually have a cluster of abnormalities such as
hypertension, insulin resistance and obesity that is known as
metabolic syndrome or syndrome X. Our result reported signifi-
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
serum triglycerides of 180.88 mg/dl. The slight difference
between Kumar et al. [30] result and ours may be due to ethnic
variation.
Alteration in lipid metabolism including a decrease in HDL cho-
lesterol may cause endothelial damage and trigger an increase in
blood pressure which may partially account for its strong pre-
dictive power for CHD [34]. Carbohydrate-rich diet, smoking and
sedentary life-style are the most common causes of low HDL
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-
moting cholesterol efflux by a process known as reverse choles-
terol transport from foam cells of the atherosclerotic plaque
depots in blood vessels to the liver for excretion. HDL cholesterol
also serves to inhibit the atherogenic process because it has
potential anti-inflammatory and antioxidant effects [35, 36].
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
hypertensive patients compared to the controls which supports
the report of other studies [38, 39].
Increased LDL cholesterol level in the hypertensive patients may
worsens the disease state because LDL particle has a role in
transporting cholesterol from the liver cells to body cells which
may cause atherosclerosis and heart attack [38]. Elevated level of
LDL has a direct association to cause endothelial cell dysfunction
through increased production of free radicals. These fat particles
usually gather within the intima at the site of increased endothe-
lial permeability [40]. Free radical induced changes in the lipid
of the arterial wall causes increased production of oxidized LDL
cholesterol which is ingested by macrophages through scaven-
gers receptor distinct from LDL receptor, that leads to formation
of foam cells [41]. Oxidation in LDL cholesterol may also causes
increased accumulation of monocytes in lesion and stimulation
of growth factors release. This causes subsequent migration and
proliferation of smooth muscle cells from the media into the
intima and conversion of fatty substances into a mature fibro-
fatty atheroma. All these events play a significant role in the pro-
gressive growth of atherosclerotic plaque that is considered as
the basic cause of cardiovascular disease [40, 41]. This study
found significantly higher LDL cholesterol in hypertensive sub-
jects as compared with controls (p < 0.05) which is consistent
with previous reports [30, 42].
The lipids ratios that include information on at least 2 measures
might have a more integrated explanation than single lipid
measures such as TG or HDL cholesterol [43]. Kawamoto et al.
[44] indicated that lipid ratios can be considered as clinically
simple and useful indicators of hyperinsulinemia or insulin
resistance. But Sumner et al. [45] and Hoffman et al. [46] found
that the TG/HDL ratio was not significantly associated with insu-
lin resistance in black adults and adolescents. LDL to HDL ratio is
an important measurement to determine the atherogenic index
(AIX). Increased AIX in hypertensive patients may interrupt the
membrane fluidity leading to altered membrane function. This
Sarwar MS et al. Lipid Profile in Hypertensive Patients … Drug Res 2014; 64: 353–357
effect can be linked with the harmful effect of reactive oxygen
species leading to disruption of membrane lipids [47]. In our
study, we observed a significantly higher value for both AIX
(LDL/HDL) and TC/HDL in hypertensive patients than the control
subjects (p < 0.05) that confirms an earlier study [38].
Conclusion
▼
Our study explored that hypertensive patients have high level of
serum cholesterol, triglyceride, LDL and VLDL cholesterol but
low level of HDL cholesterol than the healthy control subjects, all
of which may contribute to increased risk of several cardiovas-
cular complications. We thus recommend routine investigation
of lipid profile in all patients with hypertension to prevent fur-
ther aggravation and risks of coronary artery diseases.
Acknowledgements
▼
Downloaded by: University of Georgia Libraries. Copyrighted material.
The authors would like to thank all the participants of this study.
The authors are also thankful to all the staffs, nurses and physi-
cians of the Farid Diagnostic Centre and Hospital Limited, Laxmi-
pur, Bangladesh for their necessary supports.
Conflict of Interest
▼
The authors declare that they have no conflict of interest.
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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.
Lipid Research Clinics Program (1984). The lipid research clinics coronary primary prevention trial results-2. JAMA. 251:
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
disease. A prospective case-control study. Lancet 1: 965-968.

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.

WHO (1978) Classification of hypertension. Report of WHO Scientific Group, Technical Report Series, 657: 87-95.

Williams G H and Braunwald E (1987) Hypertensive vascular disease. In: Harrison’s Principles of Internal Medicine.
Prentice Hall.

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:
Diabetes is one of our greatest public health prob-
lems, primarily because of the dramatic increase in
type2 diabetes, also known as age-related diabetes,
which now represents a global threat to human
health. Worldwide there are in excess of 100 million
people with type2 diabetes and in most developing
countries at least one in ten deaths in adults aged 35
to 64 is attributable to diabetes.
Lipid abnormalities and diabetes have been recog-
nized as independent risk factors for coronary artery
disease (CAD) events and atherosclerosis. Type2 dia-
betes has been frequently observed to be associated
with dyslipidemia whereas type1 diabetes has serum
lipid levels similar to those of non-diabetic popula-
tion. The presence of dyslipidemia in association with
type2 diabetes puts the patient at higher risk of CAD.
The link between elevated low-density lipoprotein
cholesterol (LDL-C) and coronary artery disease
1
(CAD) is now firmly established . Evidence also
supports an independent link between low levels of
2
high-density lipoprotein cholesterol (HDL-C) and
3,4
high levels of triglycerides (TG) and atherosclero-
sis and CAD. CAD and type2 diabetes may be sig-
nificantly linked by the presence of dyslipidemia
which is characterized by low HDL-C with high
LDL-C and TG. Such a pattern of dyslipidemia has
been frequently observed in patients with type2 dia-
betes. A study has shown that the prevalence of
hyperlipidemia in type2 diabetes can be as high as
5
70% whereas an Indian study has shown dyslipi-
demia in 25 – 60% of diabetic hypertensive popula-
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
Majority of group 1 (45%) and group 2 (41%) had
desirable TG levels. 16% of type 2 diabetics were
found to have a borderline high serum TG levels
while 37% had a high serum TG levels and only 4%
had higher TG levels (Table V).
Most of the healthy controls and type2 diabetic
patients had less than desirable HDL-C levels (71%
and 69% respectively) whereas 23% (group 1) and
27% (group 2) had desirable serum HDL-C levels
(Table VI).
Among the type2 diabetic patients the serum TG lev-
els of male were found to be higher than that of
female whereas serum total cholesterol, HDL-C and
LDL-C levels of male were less than that of female
(Table VII).
The mean serum TG levels of males were found to
be higher than that of females while Total
Cholesterol, HDL-C and LDL-C levels of males
were very close to that of females (Table VIII).
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
large body of evidence for the relationship between
serum cholesterol level and the risk of CAD. In the
multiple risk factor intervention trial, CAD risk
declined with progressively lower cholesterol levels
14
. Further support for the relationship between CAD
risk and high lipid levels comes from various recent
primary and secondary prevention trials with lipid
lowering therapy. The heart protection study has
shown that cholesterol lowering with statin therapy
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
15
CAD risk . Similarly, the Pravastatin or Atorvastatin
Evaluation and Infection-Thrombolysis in
Myocardial Infarction trial has demonstrated that
intensive LDL-C lowering will reduce the major
16
coronary events .
Various epidemiological data have shown a log-lin-
ear relationship between LDL-C and CAD risk17.
The NCEP ATP III guidelines recommend a LDL-C
[13]
goal of < 100mg/dl in those with type-2 diabetics .
However, on the basis of recent landmark studies,
the recommendation for the optimal goal of
<70mg/dl, whereas <100mg/dl is considered as min-
imal goal for therapy18. Recent other studies indicate
that for every 1% reduction in LDL-C levels, the rel-
ative risk for major CAD events is reduced by
approximately 1% .
19
Framingham study20 has demonstrated the correla-
tion between low HDL-C and CAD as an independ-
ent risk factor. Also the elevated triglyceride level
References
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risk of coronary heart disease. The Framingham
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association between dyslipidemia and type2 diabetes
that may influence the mechanism by which type2
diabetes is associated with increased CAD risk. The
presence of type2 diabetes alone is taken as an indi-
cation for lipid lowering therapy as a primary CAD
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13
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Acknowledgement
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 JOURNAL OF CLINICAL AND EXPERIMENTAL HEPATOLOGY
end point being to observe for any adverse events related
to treatment.
Results: Treatment naïve patients with HCV cirrhosis
either due to genotype 1 or genotype 3 were divided into
two groups: group A (compensated cirrhosis), group B
(decompensated cirrhosis). SVR12 in group A was 91.66%
(33/37) and in group, B was 73.17% (30/41). Baseline
mean liver stiffness measurement (LSM) in group A was
16.81 ± 3.57 kPa which decreased to 11.19 ± 1.75 kPa at
SVR12 (p-value < 0.0001). Baseline mean APRI and FIB-4
Score in group A were 1.228 ± 0.499 & 2.61 ± 1.06 and
in group B were 2.156 ± 1.10 & 5.71 ± 2.06 respectively
which decrease to 0.415 ± 0.115 & 1.25 ± 0.46 in group A,
to 0.759 ± 0.275 & 2.60 ± 1.12 in group B following SVR12
(p value < .0001). Mean MELD-Na improved from base-
line 9.93 ± 2.04, 20.70 ± 4.52 to 7.21 ± 0.92, 14.23 ± 4.51
respectively in group A and B at SVR12 (p-value < .0001).
CTP Score improved by 1 in 27.27% (9/33) and ≥2 in
76.67% (23/30) of patients in group A and group B respec-
tively.
Conclusions: There was a significant improvement in
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
The authors have none to declare.
http://dx.doi.org/10.1016/j.jceh.2018.06.362
2
TREATMENT OUTCOME OF HEPATIC
ENCEPHALOPATHY IN LIVER
CIRRHOSIS
Nandu Poudyal Silwal ∗ , Sudhamsu Kc,
Sitaram Chaudhary, Mukesh Sharma
National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
E-mail address: nandupoudyal@gmail.com (N.P. Silwal).
Background and Aims: Hepatic encephalopathy (HE)
is a common cause of hospital admission in patients with
liver cirrhosis (LC). Various precipitating factors are seen
in patients with HE. The aims of this study were to evaluate
the precipitant factors and to analyze treatment outcome
of HE in liver cirrhosis.
Methods: A randomized prospective trial was con-
ducted amongst LC patients presenting with HE from
August 2016 to July 2017. They were randomized into
three groups: group A received lactulose only, group B
received lactulose plus L ornithine L asparte (LOLA) and
group C received lactulose plus rifaximin. The primary end
points were mortality and hospital stay.
Journal of Clinical and Experimental Hepatology July 2018 Vol. 8 No. S1
Results: A total of 132 cases (mean age 49.2 ± 10.2
years; male/ female ratio 103:29) were studied. The most
common precipitating factor of HE identified was infec-
tion 65 (49.2%), followed by electrolyte imbalance as
hyponatremia 54 (41%) and hypokalemia 18 (13.6%), con-
stipation 44 (33.33%) and gastrointestinal bleeding 21
(16%) patients. Thirty eight (28.8%) and 94 (71.2%) patients
were in CTP class B and class C respectively. Mean CTP
score was 10.24 ± 1.85, MELD score was 22.2 ± 7.54. At
the time of admission, 29 (22%), 76 (57.5%), 21 (16%) and
6 (4.5%) patients had grade I, II, III, and IV HE respectively.
The difference in mortality was not statistically signifi-
cant (p = 0.269) in three groups [group B (13.6%) and group
C (13.6%) vs. group A 10 (22.7%)] but the hospital stay
was shorter among patients in the group B and C than
group A patients (7.36 ± 4.58 and 7 ± 3.69, 9.64 ± 5.28 days
respectively, p = 0.015).
Conclusions: Infection was the commonest precipitat-
ing factor of HE. Addition of LOLA or rifaximin was more
effective than lactulose alone in the treatment of acute HE
but without any difference in mortality.
CONFLICTS OF INTEREST
The authors have none to declare.
CIRRHOSIS AND COMPLICATIONS
http://dx.doi.org/10.1016/j.jceh.2018.06.363
3
STUDY ON LIPID PROFILE AMONG
ADULTS WITH HBV AND HCV RELATED
CHRONIC LIVER DISEASES IN
BANGLADESH-REPORT FROM A
TERTIARY CENTRE
Mohd Harun Or Rashid 1,∗ , Md Khalilur Rahman 1 ,
Mahbubur Rahman Khan 1 , Mamun Al Mahtab 2 ,
Md Nahid Hasan 2 , Humaira Rashid 3 ,
Alaksar Sazid Hasan 4 , Abdul Alim 4
1 Rajshahi Medical College, Bangladesh
2 Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
3 Brac University, Dhaka, Bangladesh
4 Gono Bishwabidyalay, Dhaka, Bangladesh
E-mail address: drharun bd@yahoo.com (M.H.O. Rashid).
Background and Aims: Chronic Hepatitis B and C
are the major causes of cirrhosis of Liver and Hepatocel-
lular carcinoma in Bangladesh. Development of cirrhosis
of liver result in derangement of metabolic functions. This
study was conducted to find out the changes of lipid profile
among adult with Chronic Viral Hepatitis B and C.
Methods: This was cross sectional descriptive study in
Medicine Inpatient Department of Rajshahi Medical Col-
S51
 CIRRHOSIS AND COMPLICATIONS
lege Hospital from June 2015 to july 2016. Total Number
of Patients were 130. Among them 114 Chronic Hepatitis
B and 16 patients chronic Hepatitis C. Age 18–65 years.
Male 107, female 23. There were no comorbidities of these
patients.
Results: Among 130 Patients (116 Child’s Pugh A &
14 Child’s Pugh B). In HBV group Male 96, Female 18
and in HCV group Male 11, Female 05. Serum Total
cholesterol, HDL, LDL and Serum Triglyceride were done
in all patients in six monthly intervals. The results were
reduction of Serum Total Cholesterol and HDL in 45
(39.47%) and increased Serum Triglyceride in 11 (09.65%)
patients in HBV group. In HCV group increased Serum
Total cholesterol and Serum Triglyceride in 07 (43.75%)
and reduction of HDL in 03 (18.75%) patients.
Conclusion: Developing countries like Bangladesh are
likely to face an enormous burden of CLD and prevention
and early diagnosis is essential to reduce economic loss and
health system burden. Dyslipidemia is frequent in CLD &
found with severity of the disease. Moreover, it may acts
as a good predictor of CLD management. Till now, no
needful studies are available in Bangladesh.
Understanding the pattern of Dyslipidemia of hepatitis
B & C related CLD in Bangladesh may enrich the clinician
and may act as a baseline study for further research.
CIRRHOSIS AND COMPLICATIONS
CONFLICTS OF INTEREST
The authors have none to declare.
http://dx.doi.org/10.1016/j.jceh.2018.06.364
4 WILSON’S DISEASE: THE SPECTRE OF
MIDODRINE FOR DIURETIC
INTRACTABLE ASCITES WITH
HYPONATREMIA
Pathik Parikh
Zydus Hospitals, Ahmedabad, India
E-mail address: pathik269@gmail.com.
Background and Aims: Midodrine hydrochloride is
an orally available, ␣-adrenergic agonist that increases
effective circulating blood volume and renal perfusion by
increasing systemic and splanchnic blood pressure. There
is scanty data besides the study from North India, on use
of midodrine in patients with cirrhosis and ascites with
an additional component persistent hyponatremia and
hypotension.
Methods: In this single center observational study
patients with diuretic intractable ascites (EASL crite-
ria) with persistent hyponatremia (Serum Sodium
<130 mEq/L) even after withholding the diuretics and
albumin replacement (100 ml 20% per day) for 3 consec-
S52
utive days were started on Midodrine 5 mg three times a
day. The dose was increased to 7.5 mg three times a day at
the end of 7 days if mean arterial pressure (MAP) remained
less than 80. Tolvaptan 15 mg once a day was added at 15
days if serum sodium remained <125 mEq/L at 2 weeks. We
excluded patients if there was proven sepsis or renal dys-
function (serum creatinine 1 mg/dl). Serum sodium was
measured every week.
Results: Ten patients were included (7 NASH, 3 ALD).
The Mean age was 49 ± 2.1 years, with pretreatment MAP
73 mm of Hg (Range 70–78) serum sodium of 127 mEq/L
(Range 118–130). At the end of six weeks, 6 patients were
on 5 mg dose while 4 patients were on 7.5 mg dose. Only
one patient required tolvaptan for 14 days (stopped once
serum sodium reached 140). The mean arterial pressure
was 86 mg of Hg (P < 0.05) and mean serum sodium levels
were 136 mEq/L (Range 132–139) (p < 0.05). We were able
to reintroduce low dose diuretics in 4 patients.
Conclusions: Midodrine use can successfully reverse
hyponatremia related diuretic intractable refractory
ascites in 40% cases besides significantly improving serum
sodium levels and mean arterial blood pressures.
CONFLICTS OF INTEREST
The author has none to declare.
http://dx.doi.org/10.1016/j.jceh.2018.06.365
5
STROKE IN A YOUNG PATIENT WITH
‘RE BALANCED HEMOSTASIS’
Khalid Javid, Sridhar Cg ∗ , Juned Khan,
Ramesh Kumar Ts, Ramcharan Reddy
GEM Hospital and Research Center, Coimbtore, Tamil Nadu, Coimbatore, India
E-mail address: drkhalidjavid@gmail.com (S. Cg).
Background: Coagulopathy is an essential component
of the liver cell failure and reflects the central role of liver
function in hemostasis.
Case Summary: We present a seven-year old boy, a
known case Wilson’s disease who presented with jaundice
and abdominal distension for two weeks with history of
repeated episodes of hypoglycemia for last five days. He
was on Penicillamine 500 mg thrice daily. On examination
he was found to have chronic liver disease, decompen-
sated with grade I hepatic encephalopathy and minimal
ascites. Laboratory investigations showed thrombocy-
topenia (64,000/mm3 ), Blood sugar of 52 mg/dl, Serum
albumin; 2.5 mg/dl, Bilirubin; 17 mg/dl, Serum Alanine
transaminase; 52 IU/L, Aspartate transaminase; 153 IU/L,
Alkaline phosphatase; 211 IU/L, and international nor-