Psyllium husk has therapeutic effects in hyperlipidemia
Psyllium husk has therapeutic effects in hyperlipidemia
INTRODUCTION
Despite substantial medical progress in the past two decades, coronary heart disease (CHD) remain the major health problem in most of the industrialized countries (Anderson et al; 2000). The disease remains a common cause of morbidity and mortality throughout the world. The incidence of CHD in Pakistan is as high as in the western world (Karira et al; 2000).
Elevated serums total and low density lipoprotein (LDL) Cholesterol concentrations are powerful risk factors for CHD, with oxidation of LDL potentially playing a major role in atherogenesis and development of CHD. Each 1 % increase in the serum cholesterol concentration results in 2-3% increase in CHD risk (Anderson et al; 2000). The levels below 200 mg/dl are classified as desirable blood cholesterol, those 200 to 239 mg/dl as borderline high blood cholesterol and those 240 mg/dl and above as high blood cholesterol. The cut point that defines high blood cholesterol (240 mg/dl) is a value above which risk of CHD rises steeply. The cut points recommended are uniform for adult men and women of all ages (Kostner GM; et al 1989). Regarding management of primary hyperlipidemia, diet restriction, bile acid resins, statins, clofibrate, Psyllium hydrophilic mucilloid and nicotinic acid play an important role(Timmis AD; 1991). Furthermore in primary and secondary prevential trials, a reduction in total and LDL cholesterol concentrations improved the function of the coronary endothelium and decreased the risk of CHD (Mayes, 1993). Consumption of soluble fibers significantly lowers serum total and LDL-Cholesterol concentration. Such fibers may provide an alternative to drug therapy. For some patients of the viscous soluble fibres, psyllium husk fibres appear to be one of the most effective, with the least adverse effects. Short term placebo controlled studies showed that consumption of 7-10 gm of Psyllium/day lowers serum total cholesterol concentration 4-11 % below placebo control concentration. (Edington, 1987).psyllium does not significantly affect blood pressure or levels of high-density cholesterol, triglycerides, serum glucose, or iron (Bell et al; 1989).
Psyllium is naturally occurring water-soluble gel forming fiber. It is common household remedy in Pakistan for constipation. Cholesterol lowering efficacy of diet can be considerably improved if a soluble fiber content of food is increased and this can be achieved by judicious selection of food or by supplementation with Psyllium (Memon, 2001, Spence et al; 1995).
PATIENTS AND METHODS
This study was conducted at department of Pharmacology and therapeutics, Basic Medical Sciences Institute, Jinnah Postgraduate Medical Centre, Karachi, from January to July 2002.Forty patients of primary hyperlipidemia were initially enrolled in this study, selected from ward and OPD of National Institute of Cardiovascular Diseases, Karachi. Newly diagnosed and untreated primary hyperlipidemic patients of either sex, age range from 17 to 70 years were randomly selected. Patients with diabetes mellitus, peptic ulcer, renal disease, hepatic disease, hypothyroidism and alcoholism were excluded from the study by available laboratory investigation, history and clinical examination. After explaining the limitations, written consent was obtained from all participants. The study period consisted of 90 days with fortnightly follow up visits. The required information such as name, age, sex, occupation, address, previous medication, date of follow up visit and laboratory investigations, etc of each patient was recorded on a proforma, especially designed for this study. Initially a detailed medical history and physical examination of all patients were carried out. All the base line assessments were taken on the day of inclusion (Day-0) in the study and a similar assessment was taken on Day-90 of research design. After fulfilling the inclusion criteria patients were randomly divided into two groups, i.e.Drug-1(Psyllium husk 10gm/day) and Drug-2(placebo capsules, containing equal amounts of partly grinded wheat) groups. Patients of drug-1 group were advised to take Psyllium husk (ISPAGHOL) 10 gm daily in three divided times after or before each meal. Patients of drug-2 group were provided placebo capsules, i.e. one capsule, TID, after meal for 90 days. Patients were called every 2 weeks for follow up to check blood pressure, weight, pulse rate and general appearance of the individual. Drug compliance to the regimen was monitored by interview and counseling at each clinical visits. Serum LDL-cholesterol was calculated by Friedwald formula (LDL-Cholesterol = Total Cholesterol-(Triglycerides/5
