Comparison of desired levels of HDL and LDL in Acute Coronary Syndrome
BY
DR. ARMUGHAN RIAZ,
M.B.,B.S, Dip Card
Comparison of desired levels of HDL and LDL in Acute Coronary Syndrome
BY
DR. ARMUGHAN RIAZ,
M.B.,B.S, Dip Card
Abstract
Introduction
Hypercholesterolemia is considered as major risk factor in ACS all over the world. A lot of research has been done concerning high LDL in ACS. It has been an impression that low HDL is an important CAD risk factor along with high LDL in South Asians Communities. This study was conducted to validate this impression by observing and comparing the desired levels of HDL and LDL in ACS patients.
Purpose of Study:
The scope for reduction in morbidity and mortality by early detection and treatment of hyperlipidemia has prompted us to conduct this study in our community in order to evaluate and compare levels of HDL and LDL in Acute coronary syndrome.
Material and Meathods:
The present clinical prospective Cohort study was carried out from dated 1st March,06 to 1st June 06 at Sialkot Medical Complex on 155 patients of ACS. Detailed History , physical examination and diagnostic tests were performed on every patient. Inclusion criteria was age between 25 and 75, both male and females and diagnostic criteria based on history , ECG findings and Cardiac Troponin T test results. Excluding criteria was Patient not giving consent, No specific ECG changes, Age < 25y and > 75y, End organ Damage, Congenital or valvular heart diseases, Cardiomyopathies
Results
We see that there are 67% of patients have HDL level below 40mg/dl and 33% of patients had HDL level above 40mg/dl. Moreover, we have noticed that there are about 35% of patients who had isolated low HDL below 40mg/dl, thus considered as a single risk factor for ACS.
There are 84% of patients who have LDL level below 150 and 16% of patients had LDL above 150mg/dl. Only 5% of patients have been seen that had isolated high LDL greater than 150mg/dl. Thus only in 5% of patients, LDL was the single risk factor for ACS
Discussion
We compared our study results with other related studies held in Pakistan and other South Asian Countries. Most of studies favor our hypothesis that HDL is also becoming one of most important emerging risk factor for ACS.
Conclusion:
Along with high LDL, Low HDL is also considered as a major risk factor for Acute Coronary Syndrome. 67% of patients of ACS have HDL below desired level. While 35% of Patients have Isolated Low HDL as the only risk factor . Only 5% of patients are seen in which isolated high LDL was considered as single risk factor. So in our conclusion, we will say decrease HDL level is probably more important as compared to high LDL in Asian patients of ACS, and it is often overlooked.Thus while controlling hyperlipidemia, not only LDL, but HDL should also be within normal limits.
Introduction
Cardiovascular disease (CVD) is a major cause of morbidity and a leading contributor to mortality worldwide.18 Although CVD mortality has declined in economically developed countries, the emergence of a CVD epidemic has been observed in developing countries during recent decades 19. The absolute burden of CVD mortality is high in economically developing countries, and much of this burden in developing countries occurs in Pakistan.18 Over the next 20 years, CVD morbidity and mortality in China is projected to increase both in absolute number and as a proportion of total disease burden.20 The epidemic of CVD in economically developing countries has resulted, in large part, from the economic growth and associated sociodemographic change that has occurred over recent decades. During this period, the burden of illness from infectious disease has fallen, but changes in lifestyle and diet have led to an increase in life expectancy and a greatly increased burden of CVD and other chronic diseases.19,21,22.High blood cholesterol is one of the most important modifiable risk factors for CVD in western 23,24 as well as in Asian populations.
World Health Organization projected that, by 2020, at least 50% of all deaths due to CHD will occur in South Asian countries.15 There is compelling evidence that South Asians -- people who originate from India, Pakistan, Bangladesh and Sri Lanka – are at increased risk of CHD.16-17 Hypercholesterolemia is considered as major risk factor in ACS all over the world. Lot of work, studies and research has been done concerning high LDL in ACS. In our Community of South Asians, along with high LDL risk factor, low HDL is also getting more importance in patients of ACS. Assuming that HDL levels are at lower values in ACS and LDL values are high in ACS, we have conducted this study to observe and compare both high LDL and low HDL levels in ACS patients, and this study is hypothesized that in ACS , not only high LDL is a major risk factor but Low HDL is also considered as important risk factor in CHD patients. The Framingham Heart Study has been a strong proponent of the Concept that a low serum HDL-cholesterol level is a major risk factor for CHD . 1,2,3,4,5,6,7. Framingham reports advise that the inverse association between HDL-cholesterol levels and CHD risk at least equals the positive association between CHD risk and serum LDL-cholesterol levels. Data from Framingham were Influential in the NCEP decision to classify a low HDL level as a major risk factor for CHD.8,9.
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