ORIGINAL ARTICLE P J M H S VOL.4 NO.3 JUL – SEP 2010 255 Atherosclerosis May Be Prevented by Using Psyllium Husk SHAH MURAD, HASAN RAZA*, ARUNA BASHIR, AMAR LAL GHURBAKHSHANI**, MANZOOR AHMAD UNAR**, MOOSA KHAN ABSTRACT Research study was conducted to examine the effects of psyllium husk on lipid profile of primary hyperlipidemic patients. It was single blind placebo controlled research study, which was conducted in Jinnah Postgraduate Medical Centre, Karachi, Pakistan, from December 2008 to June 2009. Forty volunteer primary hyperlipidemic patients were included, in the research. Twenty patients were on placebo as control group, and twenty were on psyllium husk, 10 gram daily, in divided doses, TID, for the period of three months. Patients with hypothyroidism, alcoholism, renal and hepatic disease were excluded from the study, as these pathological conditions mask primary hyperlipidemia. Triglycerides and serum cholesterol were estimated by the enzymatic calorimetric method. Serum HDL-Cholesterol was determined by direct method, at day one and at last day of the treatment. LDL-Cholesterol was calculated by Friedwald formula (LDL= Tc- (TG/5 + HDL-C). Data were expressed as the mean ± SD and “t” test was applied to determine statistical significance of results. P value lesser than 0.05 was the limit of significance. When results compiled it was observed that two patients discontinued to take drug given, due to metallic test of psyllium husk. Psyllium decreased serum total cholesterol from 228.27±4.89 mg/dl to 199.22 ± 2.30 mg/dl, triglycerides from 169.27± 9.92 mg/dl to 164.5±8.56 mg/dl, LDL-Cholesterol from 159.72 ± 5.70 to 129.55± 2.81mg/dl, and increased serum HDL-Cholesterol from 34.61±1.85 to 36.77±1.96 mg/dl in three months of treatment. Results of all parameters were significant when paired „t‟ test was applied for result analysis. At end of the research work we concluded that psyllium is very effective agent to maintain lipid profile parameters at normal limits in hyperlipidemic patients. Key words: Primary hyperlipidemia, Coronary heart disease. Atherosclerosis. Psyllium husk. Cholesterol. Triglycerides. Lipoproteins. INTRODUCTION There are five types of primary hyperlipidemia, (a) Type I is known as hyperchylomicronemia (b) Type II- a is known as hypercholesterolemia (c) Type II-b is known as combined hyperlipidemia (d) Type III is known as remnant hyperlipidemia or broad-beta disease and (e) Type IV is called endogenous hyperlipidemia or familial hyper pre-beta lipoproteinemia. All five types of primary hyperlipidemia are due to genetic reasons 1 . Elevated lipids and lipid carrying lipoproteins can cause atherosclerosis, especially low density lipoprotein cholesterol (LDL-C) which cause oxidation and formation of foamy cells (atheromas) at the wall of blood vessels, leading to narrowing of vessels and atherosclerosis 2 . Elevation of LDL-Cholesterol is particularly associated with risk of coronary artery disease risk, but it is increasingly clear that moderately raised ---------------------------------------------------------------------- Department of Pharmacology, Biochemistry*, Lahore Medical & Dental College, Lahore **Department of Physiology, Chandka Medical College, Larkana ***BMSI, JPMC, Karachi Correspondence to Prof. Shah Murad, Head of Pharmacology Department LMDC Email: shahmurad65@gmail.com triglycerides or VLDL or remnants in the presence of low HDL-Cholesterol may also be atherogenic 3 . It is well defined that atherosclerosis, if not stoped at earlier steps may lead to development of myocardial infarction or heart attack 4 . Keys to prevention and treatment of hyperlipidemia are the elimination or modification of risk factors, if possible, in conjunction with treatment of the specific lipid disorder 5 . For treating primary hyperlipidemia, statins, nicotinic acid, bile acid binding resins, psyllium husk and fibrates are main drug groups used. For many years psyllium husk has been used as an agent for gastrointestinal disturbances but it has remarkable hypolipidemic effects too 6 . Psyllium husk binds bile acids in the intestine, thereby interrupting the enterohepatic circulation of bile acids and increasing the conversion of cholesterol into bile acids in the liver. Hepatic synthesis of cholesterol is also increased, which in turn increases the secretion of VLDL into the circulation, raises serum triglyceride concentrations, and limits the effect of the drug on LDL cholesterol concentrations. HDL-Cholesterol concentrations increase by about 0.5 mg/dl, when psyllium is added