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NEW WAYS TO LOOK AT NUTRACEUTICALS (Research Article)

In children, a high level of Lp(a) is a leading risk factor for strokes but strokes are very rare in any child, even those with a high level of Lp(a). Analysis of the lipid content in the oxidatively modified LDL from hyper lipidemic patients revealed that the level of lysophosphatidylcholine was greatly elevated, and the high level of the lysolipid was shown to impair the endothelium-dependent relaxation of the blood vessels. In alllopathy blood lipid levels are normalized by statins, fibrates, niacin and bile acid binding resins (BABRs). All of these allopathy related drugs have low compliance ranges from mild compliance due to metalic taste of BABRs to severe side effects like rhabdomyolysis by fibrates and statins. Cardiovascular diseases are leading cause of death in western and eastern countries of the world. Hyperlipidemia is one of the strong risk fractions for heart diseases. To evaluate hypolipidemic drugs efficacy, the study was conducted at Ghurki trust teaching hospital, Lahore Pakistan from January 2018 to August 2018. Ninty hyperlipidemic patients were selected from cardiology and medical wards of the hospital. They were divided in three groups, one at placebo therapy, another on Kalonji and third one on Vitamin B3. After one and half month, significant changes (p value ranging from <0.05 to <0.001) were observed in their LDL and HDL-cholesterol. Conclusion of the study was to recommend use of herbal medicine and vitamin B3 for prevention of any heart diseases with good patient compliance.


INTRODUCTION
Due to low compliance and adverse effects of conventionally used hypolipidemic agents, herbal medicines are going to be famous among Physicians, and Cardiologists. Medicinal herbs like Curcuma Longa, Fenugreek, and Lemon contents are being used as mild to moderate hypolipidemic agents. Curcuma Longa commonly known as Haldi in India and Pakistan is used to lower plasma lipids, in view of their contents. It contains Curcuminoids (curcumin, demethoxycurcumin, and bisdemethoxycurcumin), turmerone, atlantone, zingiberene, proteins, and resins. Coronary artery disease (CAD)occurs when the inside (the lumen) of one or more coronary arteries narrows, limiting the flow of oxygen-rich blood to surrounding heart muscle tissue. Atherosclerosis is the process that causes the artery wall to get thick and stiff. It can lead to complete blockage of the artery, which can cause a heart attack 1 . The disease process begins when LDL deposits cholesterol in the artery wall. The body has an immune response to protect itself and sends white blood cells called macrophages to engulf the invading cholesterol in the artery wall. When the macrophages are full of cholesterol, they are called foam cellsbecause of their appearance. As more foam cells collect in the artery wall, a fatty streak develops between the intima and the media. If the process is not stopped, the fatty streak becomes a plaque, which pushes the intima into the lumen, narrowing the blood flow 2-6 . Withfew exceptions, low HDL is an independent risk factor for CAD in casecontrol and prospective observational studies 7 . In contrast, high HDL levels are associated with longevity and are protective against the development of atherosclerotic disease 8 . In the Framingham Study, risk for CAD increases sharply as HDL levels fall progressively below 40 mg/dL 9-10 . In the Quebec Cardiovascular Study, for every 10% reduction in HDL, risk for CAD increased 13%. 2 Many clinicians believe that low HDL is associated with increased CAD risk because it is a marker for hypertriglyceridemia and elevated remnant particle concentrations. The Prospective Cardiovascular Münster Study, however, demonstrated that the increased risk associated with low HDL is independent of serum triglyceride levels 11 . There is considerable controversy about whether one HDL subfraction is more antiatherogenic than others. At the present time, the preponderance of evidence favors increasing total HDL mass, rather than any one subfraction of this lipoprotein. In the Framingham Study, risk for CAD increases sharply as HDL levels fall progressively below 40 mg/dL 12.

MATERIAL & METHOD
The study was conducted at Ghurki trust teaching hospital, Lahore Pakistan from January 2018 to August 2018. Ninty patients were selected for study. Consent was taken from all participants. Inclusion criteria was primary and secondary hyperlipidemic patients. Exclusion criteria was patients suffering from any kidney, liver and thyroid related disease. Name, age, gender, occupation, residential address, phone/contact number, previous medical history, disease in family history, drug history were recorded in specific Performa. Three groups I, II, and III were made (30 patients in each group). Group-I was allocated for placebo, to take placebo capsule once daily, after breakfast for six weeks. Group-II was advised to take 2 tea spoons of kalonji after breakfast for the period of six weeks. Group-III was on Niacin 2 grams in divided doses, after breakfast, lunch and dinner for 6 weeks. Their base line LDL-cholesterol and HDL-cholesterol level was estimated at the start of research work. Their serum was taken at follow up visits, fortnightly for lipid profile. Data were expressed as the mean±SD and 't' test was applied to determine statistical difference in results. A p-value > 0.05 was considered as nonsignificance and P-value < 0.001 was considered as highly significant change in the differences. Serum LDL-cholesterol was calculated by formula (LDL-Cholesterol=Total Cholesterol-(Triglycerides/5 +HDL-Cholesterol). Serum HDL-cholesterol was determined by using kit Cat. # 3022899 by Eli Tech Diagnostic, France

DATA INFERENCE & RESULTS
Numerical values and results of all parameters of participated patients were analyzed biostatistically.
In placebo group, LDL-cholesterol decreased from 189.15±3.90 mg/dl to 186.75±2.08 mg/dl, change in the parameter is 2.40 mg/dl. This difference in pretreatment and post treatment value is non-significant, ie; Pvalue > 0. 05 20 . In our research Niacin reduced LDL-Cholesterol from 212.65±1.19 mg/dl to 185.61±1.65 mg/dl in six weeks. This reduction in LDL-C was 27.04 mg/dl, which is highly significant change, when analyzed statistically. These results match with resultsn of research work conducted by Afilalo J et al 21 who proved almost same change in LDL-C in 32 hyperlipidemic patients who were cases of secondary hyperlipidemia and used Niacin 2 grams daily for two months. Their LDL-C reduction was 25.55 mg/dl. Their HDL-C increase was 6.65 mg/dl in 2 months. In our results HDL-C increase was 3.81 mg/dl in six weeks use of Niacin. Our results also match with results of research conducted by Whitney EJ et al 22 who proved 27.77 mg/dl reduction in LDL-C in 19 hyperlipidemic patients. Ginsberg HN et al 23 also support our results, as they proved 4.00 mg/dl increase in HDL-C when two grams of Niacin was used in 34 hyperlipidemic patients for six weeks. Our results do not match with results of research conducted by Boden WE et al 24 who proved that 2.5 grams Niacin decreased 10.99 mg/dl LDL-Cholesterol. HDL-C increase was only 1.11 mg/dl. These differences may be considered due to lack of physical exercise and no restriction of use of lipids in their diet. Taylor AJ et al 25 used Niacin 1.5 grams in 29 hyperlipidemic patients for 3 weeks. Patients reduced their LDL-C from 189.88 ±1.11 mg/dl to 187.87±0.99 mg/dl. Difference in their results and our results is due to less sample size, lesser duration of exposure of patients to drug and small amount of drug given in their patients. Baigent C et al 26

19.
EL-Dakhakhany M. Some pharmacological properties of some constituents of nigella sativa seeds: The carbo-nyl fraction of essential oil. Proceedings of the 2nd International