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SIMVASTATIN AND LIPID PROFILE

The Professional Medical Journal


www.theprofesional.com
ORIGINAL PROF-0-3974
DOI: 10.29309/TPMJ/2020.27.2.3974

ROLE OF SIMVASTATIN AND ALLIUM SATIVUM ON LIPID


PROFILE IN DIABETIC DYSLIPIDEMIC PATIENTS: A
COMPARATIVE STUDY.
1. MBBS, M. Phil, P.hD
Associate Professor Biochemistry,
United Medical & Dental College, Naveed Ali Siddiqui1, Fatima Bint Taj2, Imran Ishaque3, Ayesha Shahid4, Ayesha Ayaz5
Karachi, Pakistan.
2. Final year student, UMDC ABSTRACT…Objectives: To evaluate the changes in lipid profile in patients with diabetic
United Medical & Dental College, dyslipidemia using lipid lowering drug, simvastatin and herbal product allium sativum. Study
Karachi, Pakistan.
3. MBBS, M.Phil Design: Clinical trial. Setting: Surgeon Munawar Memorial Hospital, Karachi. Period: 1st January
Associate Professor Anatomy, 2017 to 30th April 2017. Material & Methods: The study was designed to assess the effects of
United Medical & Dental College, HMG Co-A reductase inhibitor (simvastatin) and allium sativum on lipid profile in patients with
Karachi, Pakistan.
diabetic dysplipidemia. The exclusion criteria included lactating/pregnant women’s, renal, liver
4. Final Year Student, UMDC
United Medical & Dental College, and established coronary artery disease. Results: Sixty patients with abnormal lipid profile
Karachi, Pakistan. were included in the study (age 30-60 years). Patients were divided into two groups (30 patients
5. Final Year Student, UMDC each). Group a was orally administered with product of simvastatin (20 mg)/day for 04 months
United Medical & Dental College,
Karachi, Pakistan and in group b, patients were orally administered with herbal product of allium sativum (300
mg)/day for 04 months. Conclusion: On the basis of this study it is observed that allium sativum
Correspondence Address: as well as simvastatin tablets both reduce total cholesterol, low density lipoprotein cholesterol
Dr. Naveed Ali Siddiqui
(LDL-C) and increase high density lipoprotein cholesterol (HDL-C).
Associate professor,
Department of biochemistry.
United Medical & Dental College, Keywords: Allium Sativum, Dyslipidemia, Lipid Profile, Simvastatin.
Karachi.
naveed_sddq@yahoo.com
Article Citation: Siddiqui NA, Taj FB, Ishaque I, Shahid A, Ayaz A. Role of simvastatin
Article received on: and allium sativum on lipid profile in diabetic dyslipidemic patients: A
25/07/2019 comparative study. Professional Med J 2020; 27(2):353-358.
Accepted for publication: DOI: 10.29309/TPMJ/2020.27.2.3974
15/10/2019

INTRODUCTION for development of cardiac ischemia and acute


CVD is the chief reason of disability among the coronary artery diseases are continuously rising
population and act as a factor to the growing in pakistan. Ratio of macro-vascular disease
expenditure of health related problems.1 it in pakistan is ascending as in western world.12
has been earlier proved that chronic increase Lipid decreasing drugs for the treatment of
level of diabetes is correlated with dysfunction, hyperlipidemia include statins (3-hydroxy-3-
impairment and finally failure of organs, especially methylglutaryl coenzyme a reductase inhibitors),
the heart, nerves, kidneys, blood vessels and fibrates, nicotinic acid, and bile acid binding
eyes. About half of the diabetic patients suffer sequestrants. The drugs used in diabetic
with these complications.2 Diabetes mellitus dyslipidemia contain simvastatin. These drugs
causes important changes such as dyslipidemia, contain 5 mg, 10 mg, 20 mg, and 40 mg of
and disturbance in the metabolism of lipids, simvastatin. Simvastatin have reported to be
carbohydrates, and proteins.3,4 it is reported especially effective in decreasing the level of
that by the year of 2015, cardiovascular artery low-density lipoprotein (LDL-C) cholesterol and,
disease will be responsible for 20 million to a lesser extent, that of triglycerides.13,14 The
deaths approximately, mainly from strokes and HMG-CoA reductase inhibitors are drug of choice
heart attacks.5 some of the contributing factors for decreasing LDL-C in diabetic dyslipidemic
commonly correlated with the evolution of patients.15,16 Allium sativum has been used for
atherosclerosis and cardiovascular diseases the past fewer years as both food and medicine
include elevated lipid profile, high blood pressure in human populations.17,18,19 Allium sativum used
and diabetes mellitus,6,7,8,9 tobacco use, obesity,10 as a cholesterol lowering agent, but efficacy
physical inactivity.11 Major common elements confusing results. Many of the clinical trials and
Professional Med J 2020;27(2):353-358. www.theprofesional.com 353
SIMVASTATIN AND LIPID PROFILE 2

studies showed no significant effects of allium RESULTS


sativum supplements on serum lipids profile. 20 In the present study 60 patients were investigated
for the lipid lowering activity of the international
MATERIAL AND METHODS product of simvastatin and herbal product of
Patient’s Selection: allium sativum with diabetic dyslipidemia. They
The population under study was representative of were divided into group I and II.
Pakistani population with diabetic dyslipidemia.
The study period consist of 4 months. Blood The individual of group i consist of 30 patients were
pressure, body weight and height of subjects were orally administered with product of simvastatin
assessed. The patient answered the questionnaire (20mg)/day for 4 months and group II consist of
on health complaints, smoking, social role, drug other 30 patients were orally administered with
usage, family history and dietary pattern. Patients herbal product of allium sativum (300mg)/day for
were asked to fill a consent form before starting 4 months. Figure 1 and 2 represents the variation
the experiment. The initial inclusion criteria of the of serum lipids including cholesterol, high density
patient were 1) age between old of either sex, 2) lipoprotein (HDL), triglyceride (TG) and low density
patients with diabetic dyslipidemia. The exclusion lipoprotein (LDL) in diabetic dyslipidemia before
criteria were 1) pregnancy or lactation, 2) and after 4 months of treatment with product of
patients with liver diseases, 3) patients with renal simvastatin and herbal product of allium sativum.
diseases. Detailed medical history and physical
examination of all patients were carried out. Patients who have been given simvastatin at a
dose of 20mg/day showed a reduction in total
Study design: cholesterol from baseline value of 232.53 to ±
Sixty patients were selected for the study. Serum 6.72 mg/dl to 189.76 to ± 5.46 mg/dl at month
lipid profile was done before and after the 04. This decreases was found to be statistically
treatment. Patients were orally administered with highly significant (p < 0.005) when compared
product of simvastatin (20 mg)/day and herbal from before and after treatment.
product of allium sativum (300 mg/day) for 04
months. After 04 months, blood samples were Patients who have been given simvastatin at a
collected again for the estimation of lipid profile. dose of 20mg/day showed a reduction in serum
triglyceride from baseline value of 207.26 to ±
Collection of Samples 10.22 mg/dl to 182.20 to ± 8.72 mg/dl at month
The blood sample was drawn using 5ml syringe 04. This decreases was found to be statistically
and centrifuged at 3000 rpm for 10 minutes. highly significant (p < 0.005) when compared
Serum was separated and collected in clean and from before and after treatment. Patients who
dry eppendorfs and was stored at -70 c till further have been given simvastatin at a dose of 20mg/
analysis. day showed an increase in serum high density
lipoprotein (HDL) from baseline value of 32.33 to
Biochemical Analysis ± 0.87 mg/dl to 34.76 to ± 0.92 mg/dl at month
The serum levels of total cholesterol, tg, and hdl 04. This increases was found to be statistically
were determined enzymatically on microlab using highly significant (p < 0.005) when compared
commercially available (randox laboratories from before and after treatment.
limited, UK) kits. LDL was calculated using
friedwald formula. Patients who have been given simvastatin at a
dose of 20mg/day showed a reduction in serum
Statistical Analysis low density lipoprotein (LDL) from baseline value
The data was analyzed statistically using spss of 183.93 to ± 7.14 mg/dl to 146.60 to ± 5.30
version-11. mg/dl at month 04. This decreases was found to
be statistically highly significant (p < 0.005) when
compared from before and after treatment.
Professional Med J 2020;27(2):353-358. www.theprofesional.com 354
SIMVASTATIN AND LIPID PROFILE 3

Patients who have been given allium sativum at


a dose of 300mg/day showed a reduction in total
cholesterol from baseline value of 225.86 to ± 4.22
mg/dl to 207.96 to ± 4.69 mg/dl at month 04. This
decreases was found to be statistically significant
(p < 0.05) when compared from before and after
treatment. Patients who have been given allium
sativum at a dose of 300mg/day showed baseline
value of serum triglyceride from 191.10 to ± 6.92
mg/dl to 194.30 to ± 7.20 mg/dl at month 04. This
was not significant when compared from before Figure-2: Effects of allium sativum on lipid profile in
and after treatment. diabetic dyslipidemic patients.
Values are mean ± s.e (n=30). *p < 0.05
Patients who have been given allium sativum significant difference by t-test as compared to
at a dose of 300mg/day showed an increase before treatment.
in serum high density lipoprotein (HDL) from
baseline value of 35.46 to ± 0.59 mg/dl to 38.00 DISCUSSION
to ± 0.57 mg/dl at month 04. This increases was Predisposing factors like smoking, diabetes
found to be statistically significant (p < 0.05) and hypertension are strongly linked with
when compared from before and after treatment. cardiovascular related disease among south
Patients who have been given allium sativum at a asia.21 In the urbanized life style and higher
dose of 300mg/day showed a reduction in serum socio-economic areas, higher incidence of CVD
low density lipoprotein (LDL) from baseline value has been reported as compared to lower socio-
of 158.30 to ± 3.22 mg/dl to 138.63 to ± 3.10 mg/ economic areas. Hyperlipidemia develops macro-
dl at month 04. This decreases was found to be vascular disease has a major public health issue
statistically significant (p < 0.05) when compared in Pakistan. In low-income countries who estimate
from before and after treatment. that the number of mortality due to CVD is rising.

Approximately eighty percent of the casualties


caused by macro-vascular disease and 86% of
the global burden of cardiovascular artery disease
are in the Pakistan.12 Diabetic dyslipidemia is one
of the major cause of ischemic heart disease.22
Diabetes mellitus is a chronic metabolic disorder
affecting around 200 million people worldwide
and is responsible for 32 million deaths in a year
and by year 2030 its prevalence will be increased
to 4.4%. Aside from this, greater than 60% of the
population with diabetes will arise from asia. It
has been reported that chronic hyperglycemia of
diabetes is linked with dysfunction, damage, and
Figure-1: Effects of simvastatin on serum lipid profile eventually failure of organs.
in diabetic dyslipidemic patients.
Values are mean ± s.e (n=30). **p < 0.005 About 50% of individuals with diabetes are
significant difference by t-test as compared to concerned with one or more of the above
before treatment. complications.2 HMG-CoA reductase inhibitors
commonly are effective in primary as well as
secondary prevention of coronary disease.
Therefore, these agents are used as the first
Professional Med J 2020;27(2):353-358. www.theprofesional.com 355
SIMVASTATIN AND LIPID PROFILE 4

choice for hypercholesterolemia in this subset were no significant effects on triglycerides. Long
of the population, especially simvastatin and term treatment with garlic is more effective in
atrovastatin. reducing serum total cholesterol levels and serum
triglycerides (TG) levels.27 In present study hdl-
Simvastatin is an inhibitor of HMG-CoA reductase cholesterol concentration significantly increase
in the cholesterol synthesis.23 As none of the in addition to decrease in serum total cholesterol
anti-hyperlipidemic agents are devoid of adverse and LDL cholesterol concentration observed
effects, harmful efficient and cost effective agent after 8 weeks treatment of allium sativum. Similar
for managing hyperlipidemia. Therefore the use anti-hyperlipidemic effects of garlic also reported
of plant based herbal medicines have increased previously.28 decreased in total cholesterol
considerably over centuries and are becoming a concentration observed with allium sativum is
popular alternative management option.24 Allium because of decrease in LDL - cholesterol which
sativum based herbal medicine has proved to is due to blockage of biosynthesis of hepatic
decrease many disorders.25 Allium sativum and cholesterol possibly via inhibition of hydroxyl
simvastatin are lipid lowering agents. Allium methylglutaryl coa (HMG-CoA) reductase by
sativum is used around the worldwide. Its allicin, an organo-sulfur constituent of garlic.29
beneficial effects on cardiovascular risk factors
are widely known but have not been evaluated yet CONCLUSION
especially in Pakistan. In present study effect of Present study was designed to compare the
simvastatin on different biochemical parameters anti-lipidemic effect of allium sativum, a herbal
along with their lipid lowering efficacy is compare product, with a standard lipid lowering drug,
with the effects of allium sativum in diabetic simvastatin. Allium sativum improves lipid profile in
dyslipidemic patients. diabetic dyslipidemic patients without producing
adverse effects as compare to simvastatin and its
In present study when diabetic dyslipidemic beneficial effects on cardiovascular risk factors
patients were treated with product of simvastatin, are widely known but have not been evaluated
their serum cholesterol, triglyceride and low yet specially in Pakistan.
density lipoprotein (LDL) were significantly Copyright© 15 Oct, 2019.
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AUTHORSHIP AND CONTRIBUTION DECLARATION


Sr. # Author(s) Full Name Contribution to the paper Author(s) Signature
1 Naveed Ali Siddiqui

2 Fatima Bint Taj


All authors participated
equally in bringing the idea,
3 Imran Ishaque
modifying it, data collection
and writing this article.
4 Ayesha Shahid

5 Ayesha Ayaz

Professional Med J 2020;27(2):353-358. www.theprofesional.com 358

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