Hyperlipidemias: India

Tripathi YB. · Institute of Medical Sciences, Banaras Hindu University, Varanasi, India. · Recent Pat Inflamm Allergy Drug Discov. · Pubmed #19149746 No free full text.

Abstract: Since hyperlipidemia, inflammation and obesity are closely related to atherosclerosis, therefore management of these factors together would be beneficial for overall treatment approach for atherosclerosis. Although, Indian system of medicine, especially Ayurveda has several medicinal plants with proven beneficial claims towards these pathological conditions, but most of them lack enough experimental data. BHUx is a novel polyherbal formulation, consisting of 5 medicinal plants namely Termenalia arjuna, Strychnox nux vomica, Boswellia serrata, Commiphora mukul, and Semecarpus anacardium, which have history of clinical use as single or in other combinations, but these plant fractions were never tried collectively in this ratio as in BHUx, which has been found to be effective on all the etiological factors, together. In this paper, antioxidant, anti-inflammatory, hypo-lipidemic, anti-proliferative properties of BHUx have been studied on several experimental models based on chemical tests, cell culture, in vitro models, and in vivo experiments with normal and transgenic animals. A separate pre-clinical toxicity study has also been carried out to prove its safety margin in therapeutic doses. Further, clinical trail of BHUx is under way, before it comes to market for public use as functional food to maintain healthy heart. This article also review some patent related to the field.

Manna P, Sinha M, Sil PC. · Department of Chemistry, Bose Institute, 93/1, Acharya Prafulla Chandra Road, Kolkata 700009, West Bengal, India. · Arch Toxicol. · Pubmed #18197399 No free full text.

Abstract: Arsenic, one of the most harmful metalloids, is ubiquitous in the environment. The present study has been carried out to investigate the protective role of a triterpenoid saponin, arjunolic acid (AA) against arsenic-induced cardiac oxidative damage. In the study, NaAsO2 was chosen as the source of arsenic. The free radical scavenging activity and the effect of AA on the intracellular antioxidant power were determined from its 2,2-diphenyl-1-picryl hydrazyl radical scavenging ability and ferric reducing/antioxidant power assay, respectively. Oral administration of NaAsO2 at a dose of 10 mg/kg body weight for 2 days caused significant accumulation of arsenic in cardiac tissues of the experimental mice in association with the reduction in cardiac antioxidant enzymes activities, namely superoxide dismutase, catalase, glutathione-S-transferase, glutathione reductase and glutathione peroxidase. Arsenic intoxication also decreased the cardiac glutathione (GSH) and total thiol contents and increased the levels of oxidized glutathione (GSSG), lipid peroxidation end products and protein carbonyl content. Treatment with AA at a dose of 20 mg/kg body weight for 4 days prior to NaAsO2 intoxication protected the cardiac tissue from arsenic-induced oxidative impairment. In addition to oxidative stress, arsenic administration increased total cholesterol level as well as the reduced high-density lipoprotein cholesterol level in the sera of the experimental mice. AA pretreatment, however, could prevent this hyperlipidemia. Histological studies on the ultrastructural changes in cardiac tissue supported the protective activity of AA also. Combining all, results suggest that AA could protect cardiac tissues against arsenic-induced oxidative stress probably due to its antioxidant property.

Jain KS, Kathiravan MK, Somani RS, Shishoo CJ. · Sinhgad College of Pharmacy, S. No. 44/1, Vadgaon(Bk.), Sinhgad Road, Pune 411 041, India. · Bioorg Med Chem. · Pubmed #17521912 No free full text.

Abstract: Coronary arterial diseases are responsible for more deaths than all other associated causes combined. Elevated serum cholesterol levels leading to atherosclerosis can cause coronary heart disease (CHD). Reduction in serum cholesterol levels reduces the risk for CHD, substantially. Medicinal chemists all around the world have been designing, synthesizing, and evaluating a variety of new bioactive molecules for lowering lipid levels. This review summarizes the disorders associated with elevation of lipids in blood and the current strategies to control them. The emphasis has been laid in particular on the new potential biological targets and the possible treatments as well as the current ongoing research status in the field of lipid lowering agents.

Singh B. · Department of Chemistry, Himachal Pradesh University, Shimla 171005, India. · Int J Pharm. · Pubmed #17329047 No free full text.

Abstract: There is no doubt that fibers, in particular viscous dietary fibers, have positive effects on human health, both in the prevention and in treatment of chronic diseases. Dietary fibers from psyllium have been used extensively both as pharmacological supplements, food ingredients, in processed food to aid weight control, to regulation of glucose control for diabetic patients and reducing serum lipid levels in hyperlipidemics. Keeping in view, the pharmacological importance of psyllium polysaccharide and its gel-forming nature, this article discusses the therapeutic value of psyllium for the treatment of constipation, diarrhea, irritable bowel syndrome, inflammatory bowel disease-ulcerative colitis, colon cancer, diabetes and hypercholesterolemia and exploitation of psyllium for developing drug delivery systems.

Tiwari A, Bansal V, Chugh A, Mookhtiar K. · Ranbaxy Research Laboratories, Metabolic & Urology Group, New Drug Discovery Research, Gurgaon-122001, Haryana, India. · Expert Opin Drug Saf. · Pubmed #16907655 No free full text.

Abstract: Hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors represent the most successful class of drugs for the treatment of hypercholesterolaemia and dyslipidaemia implicated in the pathogenesis of coronary heart disease and atherosclerosis. However, the popular profile of statins in terms of efficacy has been maligned by its adverse events. The myotoxicity, ranging from mild myopathy to serious rhabdomyolysis, associated with HMG-CoA reductase inhibitors, during treatment of hypercholesterolaemia is of paramount importance. Rhabdomyolysis is a rare but idiosyncratic muscle wasting disorder of different etiologies. Statin-associated rhabdomyolysis causes skeletal muscle injury by self-perpetuating events leading to fatal irreversible renal damage through a series of biochemical reactions. Preferential distribution and action of statins in liver could be the key to minimise myotoxicity concerns. Hepato-specific distribution of statins is governed by various factors such as physicochemical properties, pharmacokinetic properties and selective transporter-mediated uptake in liver rather in extrahepatic cells. The interactions of statins with concomitant drugs of different classes merit attention for their safety profile. Although pharmacokinetic as well as pharmacodynamic interactions have been implicated in pathophysiology of statin-induced muscle wasting, the underlying mechanism is not clearly understood. Besides, pharmacokinetic and phramcodynamic factors, statin-associated myotoxcity may also implicate pharmacogenomic factors. The pharmacogenomics characterised by CYP polymorphism and other genetic factors is responsible for inter-individual variations to efficacy and tolerability of statins. The pathophysiological mechanisms may include statin-induced differences in cholesterol:phospholipid ratio, isoprenoid levels, small GTP binding proteins and apoptosis. However, the present understanding of pathophysiological mechanisms, does not offer a reliable approach to address the same at preclinical level. Although statin-associated myotoxicity affects compliance, quality of life of patient and discontinuation rate, yet the low incidence of myotoxicty including rhabdomyolysis and less severity of commonly occurring myopathy and myalgia do not raise doubts about the clinical efficacy and tolerability of statins. Medical management of myotoxicity seems to be pivotal for the proper compliance of patients with statin treatment. The appropriate and judicious use of drugs would substantially reduce the likelihood of developing clinically important myopathy.

Tiwari A. · Metabolic and Urology Group, New Drug Discovery Research, Ranbaxy Research Laboratories, Gurgaon-122001, Haryana, India. · Drug Discov Today. · Pubmed #16635810 No free full text.

Abstract: Statins are an established therapeutic modality for the treatment of hypercholesterolemia. Although they generally exhibit a good efficacy and tolerability profile, their reputation has been tarnished as a result of reports of myotoxicity and, more recently, observations of proteinuria. The increased incidence of proteinuria with rosuvastatin was of particular concern, and raised questions about the renoprotective actions of statins. Different hypotheses have been put forward to explain the mechanisms of statin-induced proteinuria. The multifarious effects of statins, independent of their effects on cholesterol-lowering, form the basis of such hypotheses. However, rosuvastatin-associated proteinuria is transient and reversible and even at the highest dose did not affect renal function after prolonged treatment. It would appear that clinically relevant proteinuria is not associated solely with rosuvastatin and might represent a minor class effect of statins with a fairly low incidence. However, definitive proof of this assertion will need to be provided by rigorous testing.

Brahmkshatriya PS, Jani MH, Chhabria MT. · Department of Pharmaceutical Chemistry, L.M. College of Pharmacy, Navrangpura, Ahmedabad - 380009, Gujarat, India. · J Enzyme Inhib Med Chem. · Pubmed #16570499 No free full text.

Abstract: Atherosclerosis is one of the most frequent causes of cardiac arrest. The major cause of this disease is high concentrations of lipid in the blood. Medicinal agents so far have been quite successful in the management of hyperlipidemia. Among the several widely used drugs, (fibrates, statins and niacin) statins are the most frequently prescribed in many forms of hyperlipidemia. Recently, statins have been found to produce serious toxicities, which are rare but can be potentially harmful and are noise concern for the immediate need to develop some new chemical entities in this category. This review is primarily concerned with recent developments in atherosclerotic drug discovery including novel inhibitors of cholesterol biosynthesis, cholesterol absorption inhibitors and antioxidants. The review also focuses on possible future targets including gene therapy.

Das K, Kar P. · Department of Medicine, Maulana Azad Medical College and Associated LN Hospital, New Delhi - 2. · J Assoc Physicians India. · Pubmed #15926603 No free full text.

Abstract: Non-alcoholic steatohepatitis (NASH) represents only a part of a wide spectrum of non-alcoholic fatty liver disease (NAFLD) and its prevalence is only 2 - 3% in the general population. Obesity, diabetes, hyperlipidemia and female sex are important risk factors for NASH. Two hit theory describes very well the pathogenesis of NASH wherein hepatic steatosis, the first hit is followed up by the second hit, one of which may be reactive oxygen species. Mitochondria is the main source of reactive oxygen species which may trigger steatohepatitis by lipid peroxidation, cytokine induction or induction of fas-ligand. Insulin resistance syndrome is the only metabolic syndrome that has been consistently associated with NASH. The diagnosis rests on the hallmark histological features and rigorous exclusion of significant alcohol consumption. Most patients are asymptomatic, have mild-to-moderate elevations of serum aminotransferase levels, clinical hepatomegaly and features of fatty liver on imaging. Liver biopsy is essential for positive diagnosis and prognostication of NASH. Histologically, fat deposition is typically macrovesicular and inflammation of steatohepatitis is predominantly lobular. Neutrophilic cells in lobular inflammatory infilterate are a distinguishing feature of steatohepatitis and differentiate it from other chronic hepatitis. The pattern of collagen deposition is perivenular & peri-sinusoidal spaces in zone 3. NASH is a progressive disease in more than one in four and has spontaneous regression in less than one in six. Therapy options include weight reduction in obese, good control in diabetics and exercise. Ursodeoxycholic acid has membrane stabilizing, cytoprotective and immunological effect and normalizes raised transaminases. Liver transplantation has been done in NASH but transplanted liver shows re-development in more than two thirds. Many more therapies are in the pipeline and show promise for the future.

Misra A, Wasir JS, Vikram NK. · Department of Medicine, All India Institute of Medical Sciences, New Delhi 110029. · Indian J Med Res. · Pubmed #15713972 links to  free full text

This publication has no abstract.

Misra A, Luthra K, Vikram NK. · Dept. of Medicine, All India Institute of Medical Sciences, New Delhi-110 029, India. · J Assoc Physicians India. · Pubmed #15656049 No free full text.

Abstract: Data suggest that lipid fractions other than total cholesterol, i.e. serum triglycerides (TG) and high-density lipoprotein (HDL) cholesterol are important for the pathogenesis of atherosclerosis. A combination of hypertriglyceridemia, low levels of HDL-cholesterol and high levels of small dense low-density lipoprotein, termed as "atherogenic dyslipidemia', is particularly seen in Asian Indians. Although precise reason for such dyslipidemia is unknown, genetic predisposition and characteristic body composition (excess truncal subcutaneous fat and intraabdominal fat) may be important contributors. A common interface between such body composition and dyslipidemia in Asian Indians is high tendency to develop insulin resistance, more than the other ethnic groups. The general guidelines for the management of dyslipidemia in Asian Indians should be according to National Cholesterol Education Program, Adult Treatment Panel III. However, optimal management requires consideration of ethnic-specific dietary, lifestyle and management factors to formulate individual treatment guidelines.

Ravi GR, Pradeepa R, Mohan V. · MV Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai. · Indian Heart J. · Pubmed #15129785 No free full text.

This publication has no abstract.

Misra A, Kumar S, Kishore Vikram N, Kumar A. · Department of Medicine, All India Institute of Medical Sciences, New Delhi, India. · Am J Cardiovasc Drugs. · Pubmed #14728067 No free full text.

Abstract: Dyslipidemia is a major factor responsible for coronary heart disease and its reduction decreases coronary risk in patients with diabetes mellitus. However, the association of dyslipidemia with microvascular complications and the effect of intervention with lipid-lowering therapy in diabetes have been less investigated. We present the systematic review of association and intervention studies pertaining to dyslipidemia and microvascular disease in diabetes and also review possible mechanisms. Dyslipidemia may cause or exacerbate diabetic retinopathy and nephropathy by alterations in the coagulation-fibrinolytic system, changes in membrane permeability, damage to endothelial cells and increased atherosclerosis. Hyperlipidemia is associated with faster decline in glomerular filtration rate and progression of albuminuria and nephropathy. Recent evidence also suggests a role of lipoprotein(a) in progression of retinopathy and nephropathy in patients with diabetes mellitus. Lipid-lowering therapy, using single agents or a combination of drugs may significantly benefit diabetic retinopathy and diabetic nephropathy. In particular, hydroxymethyl glutaryl coenzyme A reductase inhibitors may be effective in preventing or retarding the progression of microvascular complications because of their powerful lipid-lowering effects and other additional mechanisms. However, most of the data are based on short-term studies, and need to be ascertained in long-term studies. Until more specific guidelines are available, aggressive management of diabetic dyslipidemia, according to currently accepted guidelines, should be continued for the prevention of macrovascular disease which would also benefit microvascular complications.

Ashavaid TF, Todur SP, Nair KG. · Research Laboratories, PD Hinduja Hospital and Medical Research Centre, Veer Savarkar Marg, Mahim, Mumbai 400 016. · J Assoc Physicians India. · Pubmed #14651139 No free full text.

Abstract: Apolipoprotein E is a constituent of various lipoproteins and plays an important role in the transport of cholesterol and other lipids among cells of various tissues. The gene is polymorphic with three alleles (epsilon2, epsilon3, and epsilon4) coding for isoforms E2, E3, and E4 and having different binding affinities for the apo E receptors. While the epsilon2 allele is associated with elevated triglyceride levels, epsilon4 allele is associated with increased cholesterol levels. Though several studies support the role of apo E polymorphism in CHD either directly or indirectly via its influence on lipid and lipoprotein levels, there are some studies, which show no association. With the increasing incidence of CHD among Indians, it becomes imperative to identify genetic markers that may predispose individuals to coronary events. It would be of importance to determine if apo E gene will become a usefuladjunct to assess cardiovascular risk profile when performing genetic studies in families.

Mukherjee PK. · Department of Pharmaceutical Technology, Natural Product Studies Laboratory, Jadavpur University, Kolkata 700032, India. · Adv Food Nutr Res. · Pubmed #14639785 No free full text.

This publication has no abstract.

Arvind K, Pradeepa R, Deepa R, Mohan V. · Madras Diabetes Research Foundation & M. V. Diabetes Specialities Centre, Chennai, India. · Indian J Med Res. · Pubmed #12710546 No free full text.

Abstract: Over 20 million people are affected by diabetes in India. These numbers are expected to increase to 57 million by 2025. Diabetic patients are at increased risk of atherosclerosis and its clinical sequelae, particularly coronary artery disease (CAD). CAD remains the most important cause of mortality among diabetic patients. The pathophysiological process of atherosclerosis in diabetic subjects is accelerated by several factors such as hyperglycaemia, insulin resistance, abnormal lipid profile, oxidative modification of lipoproteins, increased blood pressure, altered rate of fibrinolysis, etc. These changes in diabetics render the dormant atherosclerotic plaque vulnerable precipitating an early clinical event. Thus CAD in diabetic subjects carries a worse prognosis than in non-diabetic subjects. This review focuses on the potential role of various risk factors contributing to atherosclerosis in diabetic patients.

Chugh A, Ray A, Gupta JB. · New Drug Discovery Research, Department of Pharmacology, Ranbaxy Laboratories Ltd., Plot 20, Sector-18, Udyog Vihar Industrial Area, Gurgaon-122 001, Haryana, India. · Prog Lipid Res. · Pubmed #12467639 No free full text.

Abstract: Therapeutic success of statins has distinctly established inhibition of de novo hepatic cholesterol synthesis as an effective approach to lower plasma LDL-cholesterol, the major risk factor for atherosclerosis and coronary heart disease. Statins inhibit HMG CoA reductase, a rate limiting enzyme which catalyses conversion of HMG CoA to mevalonic acid. However, in this process statins also inhibit the synthesis of several non-sterols e.g. dolichols and ubiquinone, which are implicated in side effects observed with statins. This prompted many major pharmaceutical companies in 1990s to target selective cholesterol synthesis beyond farnesyl pyrophosphate. The enzymes squalene synthetase, squalene epoxidase and oxidosqualene cyclase were identified as potential targets. Though inhibitors of these enzymes have been developed, till date no compound has been reported to have entered clinical trials. We evaluated the literature to understand merits and demerits of pursuing squalene epoxidase as a target for hypocholesterolemic drug development. Squalene epoxidase catalyses the conversion of squalene to 2,3-oxidosqualene. Although it has been extensively exploited for antifungal drug development, it has received little attention as a target for hypocholesterolemic drug design. This enzyme though recognized in the early 1970s was cloned 25 years later. This enzyme is an attractive step for pharmacotherapeutic intervention as it is the secondary rate limiting enzyme and blocking cholesterol synthesis at this step may result in accumulation of only squalene which is known to be stable and non toxic. Synthesis of several potent, orally bioavailable inhibitors of squalene epoxidase has been reported from Yamonuchi, Pierre Fabre and Banyu pharmaceuticals. Preclinical studies with these inhibitors have clearly demonstrated the potential of squalene epoxidase inhibitors as hypocholesterolemic agents. Hypochloesterolemic therapy is intended for prolonged duration and safety is an important determinant in clinical success. Lack of clinical trials, despite demonstrated preclinical efficacy by oral route, prompted us to evaluate safety concerns with squalene epoxidase inhibitors. In dogs, NB-598, a potent competitive squalene epoxidase inhibitor has been reported to exhibit signs of dermatitis like toxicity which has been attributed by some reviewers to accumulation of squalene in skin cells. Tellurium, a non-competitive inhibitor of squalene epoxidase has been associated with neuropathy in weanling rats. On the other hand, increased plasma levels of squalene in animals and humans (such as occurring subsequent to dietary olive oil or squalene administration) are safe and associated with beneficial effect such as chemoprevention and hypocholesterolemic activity. In our view, high circulating levels of squalene epoxidase inhibitor may be responsible for dermatitis and neuropathy. Competitive inhibition and pharmacokinetic profile minimizing circulating plasma levels (e.g. by hepatic sequestration and high first pass metabolism) could be important determinants in circumventing safety concerns of squalene epoxidase inhibitors. Recently, cholesterol-lowering effect of green tea has been attributed to potent squalene epoxidase inhibition, which can be consumed in much higher doses without toxicological effect. These facts strengthen optimism for developing clinically safe squalene epoxidase inhibitors. Put in perspective squalene epoxidase appears to be undervalued target which merits attention for development of better hypocholesterolemic drugs.

Rai J, Singh J. · Department of Pharmacology, Government Medical College, Amritsar, India. · J Assoc Physicians India. · Pubmed #12164414 No free full text.

This publication has no abstract.

Ray SK, Rege NN. · Department Pharmacology, Seth G. S. Medical College and K. E. M. Hospital, Parel, Mumbai-400 012, India. · J Postgrad Med. · Pubmed #11298482 links to  free full text

This publication has no abstract.

Mohan LR, Mohan V. · Madras Diabetes Research Foundation & M.V. Diabetes Specialties Centre, Gopalapuram, Chennai, India. · J Assoc Physicians India. · Pubmed #11235599 No free full text.

This publication has no abstract.

Shantaram V. · Department of Medicine, Nizam's Institute of Medical Sciences, Hyderabad, India. · Clin Exp Hypertens. · Pubmed #10052643 No free full text.

Abstract: Prevalence of atherosclerotic vascular disease is markedly increased among individuals with diabetes-mellitus and hypertension. Its major clinical manifestations are consequences of atherosclerosis of coronary arteries, cerebral arteries and large arteries of lower extremities. Thus, atherosclerotic vascular disease is the major cause of mortality and significant morbidity in diabetes and hypertension. Dyslipidemia, hyperinsulinemia, and central obesity seem to be associated with increased risk of atherosclerosis, along with the development of hypertension and diabetes (NIDDM). Insulin resistance is the fundamental factor in this situation which has strong genetic predisposition. Accelerated atherosclerosis in diabetes due to mechanism unique to diabetes like non-enzymatic glycation of proteins, oxidative modification of lipoproteins, formation of lipoproteins immune complexes, lipoproteins aggregation, disturbances of cell replication and growth factors and propensity to thrombosis are clearly established. Therapeutic implication for the prevention of atherosclerosis in diabetes and hypertension clearly emphasizes the need to achieve tight control of hyperglycemia, hypertension, and hyperlipidemia in addition to avoiding cigarette smoking and developing obesity.

Save V, Patil N, Moulik N, Rajadhyaksha G. · Department of Biochemistry, Lokamanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, India; 2, Pragati CHS, Manjrekar Road, Dadar, Mumbai-400028, India. · J Cardiovasc Pharmacol Ther. · Pubmed #17220473 No free full text.

Abstract: Hyperlipidemia is commonly observed in patients with type 2 diabetes and is an independent risk factor for cardiovascular disease. The authors tested the effect of atorvastatin (10 mg/d) on 110 hyperlipidemic type 2 diabetes patients with low-density lipoprotein cholesterol (LDL-C) levels exceeding 130 mg/d. The primary efficacy end point was the percentage change in LDL-C and high-density lipoprotein cholesterol (HDL-C), and secondary efficacy included the percentage change in apolipoproteins at weeks 6, 12, and 24. The tertiary goal was percentage change in free radical scavenger enzymes and oxidative stress. LDL-C was reduced by 25%, 39.3%, and 49.2%. A similar trend was observed in total cholesterol, triglyceride, non-HDL-C, and apolipoprotein (apo) B-100. HDL-C was raised by 3.2%, 6%, and 8.2%. A similar trend was seen in apo A-1. Copper zinc-superoxide dismutase and glutathione were raised significantly (P < .001); however, changes in glutathione-S-transferase and glutathione peroxidase activities were nonsignificant. Malondialdehyde was decreased significantly (P < .001). Atorvastatin improves the lipoprotein profile and oxidative status in patients with type 2 diabetes.

Jayaram S, Jain MM, Naikawadi AA, Gawde A, Desai A. · Glenmark Pharmaceuticals Ltd, Mumbai 400026. · J Indian Med Assoc. · Pubmed #15195867 No free full text.

Abstract: To compare the efficacy, safety and tolerability of rosuvastatin 10mg with atorvastatin 10 mg in adult Indian patients with hypercholesterolaemia, a prospective, open-label, comparative, phase III study was conducted. A total of 45 patients of either sex, between 18 and 80 years of age with hypercholesterolaemia, having LDL cholesterol (LDL-C) of 160 and < 250 mg/dl and triglyceride < 400 mg/dl, were included in this trial. After a dietary run-in period of 2 weeks, patients received either rosuvastatin 10 mg once daily or atorvastatin 10 mg once daily, for 6 weeks. The fall in the mean LDL-C levels after 6 weeks of treatment in rosuvastatin group (40.1%) was significantly more as compared to the fall in atorvastatin group (29.8%). Other secondary lipid parameters like total cholesterol (TC), HDL cholesterol (HDL-C), triglycerides, apo-B, apo-AI, and TC/HDL-C ratio also showed more beneficial changes from the baseline in rosuvastatin group than in atorvastatin group. Rosuvastatin 10 mg shows significantly better efficacy than atorvastatin 10 mg in reducing LDL-C levels and produces greater improvements in other elements of the lipid profile.

Gupta A, Gupta V, Thapar S, Bhansali A. · Department of Ophthalmology, Postgraduate Institute of Education and Research, Chandigarh, India. · Am J Ophthalmol. · Pubmed #15059707 No free full text.

Abstract: PURPOSE: To determine the efficacy of the lipid-lowering drug atorvastatin in reducing retinal hard exudates and subfoveal lipid migration after focal/grid laser photocoagulation in clinically significant macular edema in patients with diabetes with elevated serum lipids. DESIGN: Randomized case trial. METHODS: Thirty patients with type 2 diabetes with clinically significant macular edema, dyslipidemia, and hard exudates of grade 4 and above were assessed in an institutional setting. All patients were subjected to strict metabolic control within 4 to 6 weeks of enrollment. In addition, 15 patients in group A received atorvastatin, a 3-hydroxy-3-methylglutaryl coenzyme A inhibitor; 15 members of group B did not receive any lipid-lowering therapy. All received laser photocoagulation after a metabolic control period and were followed up for a minimum of 18 weeks. The outcome measures were reduction in hard exudates, subfoveal lipid migration, status of macular edema, and visual acuity. RESULTS: The study included 21 men and nine women with noninsulin-dependent diabetes mellitus who could achieve good metabolic control within 4 to 6 weeks of inclusion in the study. All patients had elevated serum lipids at baseline. Ten (66.6%) of 15 patients in treatment group A and two (13.3%) of 15 patients in control group B showed reduction in hard exudates (P =.007). None of the patients in group A and five (33.3%) of 15 in group B showed subfoveal lipid migration after laser photocoagulation (P =.04). Regression of macular edema was seen in nine eyes in group A and five in group B (P =.27). None of the eyes in group A and three eyes in group B showed worsening of visual acuity (P =.22). CONCLUSION: Oral atorvastatin therapy in patients with type 2 diabetes with dyslipidemia reduces the severity of hard exudates and subfoveal lipid migration in clinically significant macular edema and could be an important adjunct in the management of clinically significant macular edema.

Samuels R, Mani UV, Iyer UM, Nayak US. · Department of Foods and Nutrition, M S University of Baroda, Vadodara, Gujarat, India. · J Med Food. · Pubmed #12487756 No free full text.

Abstract: In nephrotic syndrome, large amounts of plasma proteins are lost in urine, causing a decrease in the plasma oncotic pressure. This leads to enhanced hepatic synthesis of albumin and other proteins, including lipoproteins, causing a secondary hyperlipidemia. Essential fatty acids such as gamma-linolenic acid (GLA) can prevent accumulation of cholesterol in the body, and spirulina has an appreciable amount of GLA. In this study 23 patients (age 2 to 13 years) with nephrotic syndrome received either medication (group I) or medication plus 1 g/day Spirulina (group II). Height, weight, and serum levels of fasting blood sugar, triglycerides, total cholesterol (TC), and low- and high-density cholesterol fractions (LDL-C and HDL-C, respectively) were measured before and after the 2-month study period. Mean height and weight were normal compared with healthy, age-matched Indian children. Lipoprotein cholesterol levels were significantly increased at baseline. TC significantly decreased by 116.33 mg/dl, LDL-C by 94.14 mg/dl, and triglycerides by 67.72 mg/dl in group II; in control group I, these values fell by 69.87, 61.13, and 22.62 mg/dl, respectively. The LDL-C:HDL-C ratio also decreased significantly, by 1.66 in group II and 1.13 in group I. TC:HDL-C decreased by 1.96 in group II and 1.19 in group I. HDL-C:LDL-C also improved significantly in both the groups. It can be concluded that spray-dried Spirulina capsules, rich in antioxidants, GLA, amino acids, and fatty acids, helped reduce the increased levels of lipids in patients with hyperlipidemic nephrotic syndrome.

Khamar MB, Bhatt N, Patel K. · BJ Medical College, Ahmedabad, New Delhi, India. · J Indian Med Assoc. · Pubmed #12452518 No free full text.

Abstract: Topical use of timolol eye drops in the management of glaucoma is associated with various systemic side effects including alteration of lipid profile with increase in cardiovascular risk factors. Change over to timolol gel altered results in normalisation of altered lipid profile with decrease in cardiovascular risk factors. The decrease seen is attributable to lack of systemic absorption of timolol gel.