FOR LIVER: Herbs in Pakistani Population

Abstract

Coronary artery disease is a complex syndrome to get initiation from formation of atherosclerotic plaques in systemic circulation to cardiac arrhythmia causing morbidity/mortality. This study was conducted to compare hypolipidemic effects of Niacin and Indian date (Jujuba) in hyperlipidemic patients. Study was conducted from July 2019 to December 2019 at National Hospital Lahore- Pakistan. Sixty participants were enrolled of both gender male and female patients’ age range from 25 to 60 years. Consent was taken from all patients. They were divided in two groups. Group-I was advised to take 2 grams Niacin in divided doses for the period of two months. Group-II was advised to take 500 grams of fruit Jujube daily for the period of two months. All patients’ systolic and diastolic blood pressure was noted. Their baseline LDL and HDL cholesterol was determined by conventional method of measuring Lipid Profile. After two months therapy, their post treatment blood pressure and lipid profile was measured and mean values with ± SEM were analyzed biostatistically. Group-I which was on Niacin their blood pressure was reduced but it was non-significant change, LDL cholesterol decreased significantly and HDL cholesterol was increased significantly. In group-II patients LDL cholesterol was decreased significantly but HDL increase was not significant with p-value of >0.05. It was concluded from the research work that Niacin is potent in lowering LDL and increasing HDL cholesterol, while Jujube has significant effect as LDL cholesterol lowering potential, but it does not increase HDL cholesterol significantly. Jujubes and vitamin B-3 did not reduced blood pressure, when analyzed statistically.

Introduction

Hypolipidemic drugs decrease risk of atherosclerosis and its complications. Therefore, these drugs may be used in prevention of heart attack, peripheral vascular disease and ischemic stroke [1]. Commonly used medications for treatment of Hyperlipidemia include Statins, Fibric acids, Niacin, and Resins. All these medicines have potential for SEs and low compliance due to one reason or another [2]. Niacin when given in hypolipidemic doses i.e. more than 2 grams per day it causes partial inhibition of release of free fatty acids from adipose tissue, and increased lipoprotein lipase activity, which may increase the rate of chylomicron triglyceride removal from plasma. Niacin decreases the rate of hepatic synthesis of VLDL and LDL by synthesis if apoproteins which are integral part of LDL or VLDL structure [3]. Some herbs have been proved to reduce plasma lipids in human population. Jujubes or Ziziphus jujube have somewhat hypolipidemic as well as hypoglycemic effects [4]. Jujube fruit is known to contain considerable amount of phenolic compounds, including chlorogenic acid, gallic acid, protocatechuic acid and caffeic acid [5]. High polyphenolic content of Z Jujube suggests its potent capacity in clearing of oxidants. Many studies proved the hepatoprotective effect of methanolic extract of Zizyphus jujube fruits. Histopathological studies supported the biochemical findings. Study concludes a hepatoprotective activity probably due to its antioxidant effect [6]. Some studies evaluated the effect of Z Jujube fruit in controlling dyslipidemia in obese adolescents. A tripleblind randomized placebo-controlled trial of 86 obese adolescents aged 12--18 with dyslipidemia proved its hypolipidemic features. Results showed the fruits to be generally well tolerated, with potential favorable effects on blood pressure and serum lipid profile [7]. Hydro-alcoholic preparations from Indian dates have been proved to posses hypotensive and hypolipidemic effects in human population. Main problem with ingestion of Indian dates or Jujuba was its larger amount to take by human population to reduce blood pressure and hyperlipidemia. It is proved in various studies that if taken in high amount Indian dates are antioxidant and anti-inflammatory in characteristics. Their cardiotonic and hepatotonic effects are explained in various studies [8]. In ancient Chinese book on herbal medicine Huangdi Neijing (475-221 BC), jujube was described as one of the five most valuable fruits in China. In Shennong Bencao Jing (300 BC-200 AD), an earlier book recoding medicinal herbs, jujube was considered as one of the superior herbal medicines that prolonged our life-span by nourishing blood, improving quality of sleep, and regulating digestive system [9].

Subjects and Method

The research work was started after written approval of ETHICS COMMITTEE of National Hospital, Lahore. It was conducted from July 2019 to December 2019. Sixty hyperlipidemic patients were selected from National Hospital Lahore-Pakistan to compare hypolipidemic effects of Niacin (vitamin B-3) and commonly used fruit in winter season in Pakistan i.e. Indian date or Jujube (Bair in urdu). Both male and female patients suffering from primary or secondary hyperlipidemia were selected. The age limit for patients was 25 to 60 years. Exclusion criteria were alcoholics, cigarette smokers, habitual to enjoy sedentary life, with impaired liver or renal functions. Written and already explained consent was taken from all participants. Their systolic/diastolic BP was measured by using mercury sphygmomanometer. Baseline Lipid Profile was determined in Biochemistry lab of the Hospital. Patients were divided in two groups, 3o patients in each group. Group-I was on Tab. Niacin 2 grams daily in three divided doses. Group-II was on Jujube 500 grams daily in three divided times to eat. They were advised to take fruit and vitamin B-3 for two months. They were also advised not to take junk food and were also advised to do 35 minutes brisk walk daily in the morning or evening. Mean values ± SEM were taken for statistical analysis using SPSS version 10.0, 2015. Paired ‘t’ test was applied to get significance changes in parameters before and after treatment. P-value >0.05 was considered as non-significant change, p-value <0.01 was considered as significant and p-value <0.001 was considered as highly significant change in the parameter.

Results

With two months therapy by vitamin B-3 (Niacin) and Indian dates (Jujube or Jujuba), systolic/diastolic blood pressure was not changed when analyzed statistically but plasma total cholesterol, LDL-cholesterol and HDL-cholesterol were changed, which are shown in following (Table).

  


    
 

    
LDL-C

    
HDL-C

    
SYSTOIC BP

    
DIASTOILC BP

  

  


    
Before treatment

    
G1= 210.1 ±2.11


      G2= 198.8 ±2.17

    
37.9 ±1.91


      38.6 ±2.19

    
110.02 ±1.12


      113.98 ±2.86

    
86.87 ±2.01


      89.66 ±1.04

  

  


    
After treatment

    
G1= 180.9 ±2.22


      G2= 190.9 ±1.73

    
45.2 ±2.19


      41.9 ±2.97

    
108.55 ±2.87


      112.56 ±2.67

    
85.84 ±1.00


      87.52 ±2.22

  

  


    
Change in mg/dl

    
G1= 29.2


      G2= 7.9

    
7.3


      3.3

    
1.47


      1.42

    
1.03


      2.14

  

  


    
Change in %

    
G1= 13.9 %


      G2= 4.0 %

    
16.2 %


      7.9 %

    
1.33%


      1.24%

    
1.18%


      2.38%

  

  


    
p-value

    
G1=<0.001


      G2= >0.05

    
<0.001


      <0.01

    
>0.05


      >0.05

    
>0.05


      >0.05

  

  


    
KEY: G1 is group on Niacin, G2 is group on drug-2 ie    Jujube, ± stands for Standard Error    of Mean values , BP stands for blood    pressure, p-value >0.05 is    non-significant cnage, p-value <0.01 is used for significant change in    parameter, and p-value <0.001 is highly significant change in tested    parameter.

  

Table : Illustrating mean values with ± SEM and p-values in two groups of hyperlipidemic patients before and after treatment.