Allopathy, plants and medicinal herbs Текст научной статьи по специальности «Клиническая медицина»

ЭКСПЕРИМЕНТТ1К ЖЭНЕ КЛИНИКАЛЬЩ ЗЕРТТЕУЛЕР

УДК 615.015.32 МРНТИ 76.35.49

ALLOPATHY, PLANTS AND MEDICINAL HERBS

NAJAM UL HASAN1, ADNAN SHAFIQUE2, SHAH MURAD3*, KHALID NIAZ4, HINA ASLAM5, HAMID MAHMOOD6

'Clinical Psychology, IIUI, Islamabad-Pakistan 2MCC Pharmacy, Islamabad-Pakistan 'Pharmacology at Akbar Niazi Teaching Hospital, Islamabad-Pakistan 4IMDC-Islamabad. 5IMDC/ANTH, Islamabad-Pakistan 6SZAMU, Islamabad-Pakistan

Allopathy, plants and medicinal herbs

Najam Ul Hasan1, Adnan Shafique2, Shah Murad'*, Khalid Niaz4, Hina Aslam5, Hamid Mahmood6 'Clinical Psychology, IIUI, Islamabad-Pakistan 2MCC Pharmacy, Islamabad-Pakistan

'Pharmacology at Akbar Niazi Teaching Hospital, Islamabad-Pakistan 4IMDC-Islamabad. 5IMDC/ANTH, Islamabad-Pakistan 6SZAMU, Islamabad-Pakistan

Intro: Atherosclerosis is complication of dyslipidemia causing coronary artery disease leading to mortality due to Myocardial Infarction. There are various drugs which reduces plasma lipids but with potential side effects. Herbal medication like Green Cardamom has potential to lower bad cholesterol, i.e. LDL-cholesterol and raise good cholesterol, i.e. HDL-cholesterol. Research Design: Single blind placebo-controlled study. Place of research study: Jinnah Hospital Lahore. Research Design/type: It was single blind placebo-controlled study. Duration of research work: From July to November 2017. Aim and Objectives: In this work we compared hypolipidemic effects of Niacin with Cardamom. Inclusion Criteria: Male and female patients, age range from 18 to 17 years, suffering from primary or secondary hyperlipidemia. Exclusion Criteria: Alcoholics, cigarette smokers and patients taking regular medicine for their any physical or mental disease, with severe vital organ disease were excluded from the study. Sample size and selection/division of patients: Seventy five hyperlipidemic patients were selected for research work. They were divided in three groups. Group-I was on placebo, group-II was given 1.5 grams Niacin, and group-III was advised to use powdered Cardamom thrice daily for the period of two months. Methodology: Their base line lipid profile was determined by Freidewald Method. Total-cholesterol, LDL-cholesterol and HDL-cholesterol were main parameters we required for further calculation of change in these parameters. All patients were advised to visit clinic fortnightly for their follow up.. Parameters studied: Their lipid profile was measured at start of research and then on day-60. Statistical Analysis: Data were expressed as the mean ± Standard Diviation and "t" test was applied to determine statistical significance as the difference. A probability value of <0.05 was considered as non-significant and P<0.001 was considered as highly significant change in the results when pre and post-treatment values were compared. Results: After two months therapy group-II patients reduced total cholesterol 30.8 mg/dl and LDL cholesterol 12.1 mg/dl and increased HDL cholesterol 5.6 mg/dl. In group-III Cardamom decreased total cholesterol 7.2 mg/dl and LDL cholesterol 8.8 mg/dl. HDL cholesterol in this group increased 4.9 mg/dl. When results were compiled and analyzed biostatistically, these changes were significant. Conclusion: We conclude from the research work that Niacin has more effects on total cholesterol but effects of both drugs on LDL cholesterol reduction was almost same. Keywords: LDL-cholesterol, HDL-cholesterol, Niacin, Cardamom hyperlipidemic patients.

Аллопатия жэне дэрШк шептер

Najam Ul Hasan', Adnan Shafique2, Shah Murad'*, Khalid Niaz4, Hina Aslam5, Hamid Mahmood6 'МИУИ, Исламабад, Пэюстан 2MCC Pharmacy, Исламабад, Пэюстан

'Фармакология Акбар-Ницианской больницы, Исламабад, Пэюстан 4ИМДК, Исламабад, Пэюстан 5ИМДК / АНТ, Исламабад, Пэюстан 6СЗАМУ, Исламабад, Пэюстан

Атеро склероз - б^л миокард инфарктшщ салдарынан коронарлы артерия ауруынан eлiмге дейн экелетш дислипимедияньщ аскынуы. Плазма липидтершщ курамын азайтатын, бiрак потенциалды жанама эсерлерi болатын эртYрлi препараттар бар. Green Cardamom секшда шеп дэршердщ нашар холестериндi темендететш потенциалы бар, ягни LDL-холестеришнщ жэне жа;сы холестериннщ, демек, HDL-холестериншщ есуг Зерттеу дизайны: со;ыр плацебо-бакыланбалы зерттеу. Зерттеу журпзу орны: Джинна Лахор госпиталг Зерттеу жумысыныц ^зактыгы: 2017 жылгы шшде мен ;араша аралыгы. Ма;саты мен мшдеттерг б^л жумыста бiз кардамонды ниациннщ гиполипидемиялы; эсерлерш салыстырдык;. ^осылу критерийлерг бiрiншiлiк жэне еюншшж гиперлипидемиямен ауыратын 17-18 жастагы ерлер мен эйелдер. ^осылмайтын критерийлерг маскунемдер, шылым шегетшдер жэне соматикалы; жэне психикалык; аурулардан теракты дэрi кабылдайтын, eмiрлiк мацызы бар агзаларыныц ауыр дерт бар адамдар зерттеуге ;атыск;ан жо;. 1ржтеу / пациенттердi белу: зерттеу жумысына

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Батыс ^азацстан медицина журналы 58 (2) 2018

гиперлипидемиясы бар 75 пациент iрiктелiп алынды. Олар уш тоща бeлiндi. I топ плацебо алып отырды, II тоща 1,5 г ниацин берщщ, ал III тоща екi ай бойына кунбе-кун кунше уш мезгш унта; кардамон ;абылдау усынылды. Методолгиясы: базалы; желiнiц липидтi пiшiнi Фрейдевальд эдiсiмен аны;талды. öзгерiстi эрi ;арай есептеу ушн кажетп негiзгi пaрaметрлерi жалпы холестерин, ЛПИП холестеринi жэне ЛПБП холестеринi болды. Барлы; пациенттерге эр екi апта сайын клиникага барып кезектi тексершуден eтiп туру усынылды. Зерттелген параметрлер: липидтi пшш зерттеудщ басында, содан кейiн 60-шы кунi аныщталды. Статистикалы; сараптау: мэлiметтер орта ± стандартты ауыт;у ретiнде усынылды, ал «t» критериш айырмашылы; ушiн статистикалы; мэндiлiктi аньщтау ушн ;олданылды. Р <0,05 ьщтималдыльщ мэнi мардымсыз саналды, ал P<0,001 емдеуге дейiнгi жэне кейiнгi мэндерш салыстыру барысындагы нэтижелерiнiц айтарлыщтай eзгерiсi болып саналды. Hэтижелерi: екi ай ем алганнан кейн II топ пациенттершде 30,8 мг/дл жалпы холестерин жэне JülHii 12,1 мг/дл холестеринi тeмендедi жэне ЛПБП 5,6 мг/дл холестерин eстi. III топта кардамон холестериндi 7,2 мг/дл жэне ЛПЫП холестеринi 8,8 мг/дл eстi. ЛПЭП холестеринi 4,9 мг/дл дейн ewi. Hэтижелер биостатистикалы; курастырылып сарапталганнан кейн бул eзгерiстер едэуiр бащала тустг Тужырым. Биациннщ холестериннщ жалпы децгейне ыкцалы мол, бiрa; ЛПИП холестеринi децгейiнiц тeмендеуiне екi аппараттыц да эсерi бiрдейге жуы; болды.

Негiзгi свздер: LDL-холестерин, HDL-холестерин, ниацин, кардамон, гиперлипидемиямен ауыратын науцастар.

Аллопатия и лекарственные травы

Najam Ul Hasani, Adnan Shafique2, Shah Murad3*, Khalid Niaz4, Hina Aslam5, Hamid Mahmood6 1МИУИ, Исламабад, Пакистан 2MCC Pharmacy, Исламабад, Пакистан

зфармакология Акбар-Бицианской больницы, Исламабад, Пакистан

4ИМДК-Исламабад

5ИМДК / AHT, Исламабад, Пакистан

6СЗАМУ, Исламабад, Пакистан

Атеросклероз - это осложнение дислипидемии, приводящее к заболеванию коронарных артерий, вплоть до смертности вследствие инфаркта миокарда. Существуют различные препараты, которые уменьшают содержание липидов плазмы, но с потенциальными побочными эффектами. Лекарства растительного происхождения, такие как Green Cardamom, имеют потенциал для снижения плохого холестерина, то есть LDL-холестерина и повышения хорошего холестерина, то есть HDL-холестерина. Дизайн исследования: слепое плацебо-контролируемое исследование. Место проведения исследования: Госпиталь Джинна Лахор. Продолжительность исследовательской работы: с июля по ноябрь 2017. Цель и задачи: в этой работе мы сравнивали гиполипидемические эффекты ниацина с кардамоном. Критерии включения: мужчины и женщины в возрасте 17-18 лет, страдающие от первичной или вторичной гиперлипидемии. Критерии исключения: алкоголики, курильщики и пациенты, принимающие регулярные лекарства от соматических или психических заболеваний с тяжелой болезнью жизненно важных органов, были исключены из исследования. Bыборкa / деление пациентов: 75 пациентов с гиперлипидемией были отобраны для исследовательской работы. Они были разделены на три группы. Группа I получала плацебо, группе II давали 1,5 г ниацина, а группе III было рекомендовано ежедневно принимать порошкообразный кардамон три раза в день в течение двух месяцев. Методология: липидный профиль базовой линии определяли методом Фрейдевальда. Общий холестерин, холестерин ЛИШИ и холестерин ШШП были основными параметрами, необходимыми для дальнейшего расчета изменений. Bсем пациентам было рекомендовано посещать клинику каждые две недели для последующего наблюдения. Изученные параметры: липидный профиль был определен в начале исследования, а затем на 60-й день. Статистический анализ: данные были представлены как среднее ± стандартное отклонение, а критерий «t» применялся для определения статистической значимости для различия. Значение вероятности Р <0,05 считалось несущественным, а P <0,001 считалось очень значительным изменением результатов при сравнении значений до и после лечения. Результаты: после двух месяцев терапии у пациентов группы II снизились общий холестерин 30,8 мг / дл и холестерин ЛИШИ 12,1 мг / дл и увеличился холестерин •ЩЕП 5,6 мг / дл. B группе III кардамон снижал общий холестерин 7,2 мг / дл и холестерин ЛИШИ 8,8 мг / дл. Холестерин ШШП в этой группе увеличился до 4,9 мг / дл. Когда результаты были скомпилированы и проанализированы биостатистически, эти изменения были значительными. Заключение. ^анин оказывает большее влияние на общий уровень холестерина, но эффекты обоих препаратов на снижение уровня холестерина ЛИШИ были почти одинаковыми.

Ключевые слова: LDL-холестерин, HDL-холестерин, ниацин, кардамон, пациенты с гиперлипидемией.

Introduction. Atherosclerosis is a specific type of arteriosclerosis, but the terms are sometimes used interchangeably1-3. Atherosclerosis refers to the buildup of fats, cholesterol and other substances in and on human artery walls (plaques), which can restrict blood flow4-6. These plaques can burst, triggering a blood clot. Although atherosclerosis is often considered a heart problem, it can

affect arteries anywhere in your body. Atherosclerosis may be preventable and is treatable7. Hypolipidemic drugs reduce low density lipoprotein cholesterol (LDL-c) in plasma and thus lower the chance of developing atherogenesis leading to increased risk of hypercholesterolemic patients to be victimized by coronary artery disease, and myocardial infarction8. Conventionally, drugs used in hyperlipidemia

Najam ul Hasan - Assistant Professor, Clinical Psychology, IIUI, Islamabad-Pakistan

Adnan Shafique - Senior Pharmacist, MCC Pharmacy, Islamabad-Pakistan, email: adnan.shafique6666@gmail.com, tel.: +923142243415

*Shah Murad - HOD, Pharmacology at Akbar Niazi Teaching Hospital, Islamabad-Pakistan Khalid Niaz - Associate Professor of Pharmacology at IMDC-Islamabad. Hina Aslam - AP Pharmacology at IMDC/ANTH, Islamabad-Pakistan Hamid Mahmood - Chairman Biochemistry, SZAMU, Islamabad-Pakistan.

ЭКСПЕРHМЕНТТIК ^OHE K^HHHKA^M^ 3EPTTEy^EP

are statins, nicotinic acid, bile acid binding resins and fibrates, but all have potential for low compliance due to wide range of pharmacological and adverse effects9. Vitamin B-3 (Niacin), if given in large doses inhibits lipolysis in adipose tissue which is main source of plasma free fatty acids. In liver due to lack of these free fatty acids, no triglycerides or lipoproteins carrying these lipid forms (VLDL) will be synthesized. Low density lipoproteins (LDL) are synthesized from VLDL. Thus no availability of very low density lipoproteins (VLDL) causes reduced synthesis of LDL in plasma. Niacin also decreases clearance of apoprotein A-1 in plasma, so high density lipoproteins (HDL) which are concerned with these apoproteins are also increased10,11. To get good compliance, many health personals and researchers have started to put their healing potential for developing alternatives drugs used in primary or secondary hyperlipidemia. Cardamom or in Urdu ILAICHI is one of the hypolipidemic herb, widely encouraged by cardiologists to be used for prevention of atherogenesis, and coronary artery disease12. Regular consumption of cardamom treats high cholesterol levels and reduces high blood pressure; thus, lowering the risk of cardiovascular diseases13. Cardamom, when added to tea, gives a pleasant aroma, which serves as an effective remedy for depression14.Cardamom acts as a natural health tonic, when taken at bedtime, diluted with milk and honey. Besides, it is effective in preventing memory loss15.

Patients & Method. It was single blind placebo-controlled study conducted in Jinnah Hospital Lahore from July to November 2017. Seventy five hyperlipidemic patients were selected and enrolled for the study. Written, already explained and approved consent was taken from all patients. Inclusion criteria were age limit from 18 to 70 years of both gender primary or secondary hyperlipidemic patients. Patients suffering from any vital organ severe disease or their impaired function were excluded from the study. Alcoholics, cigarette smokers and patients taking regular medicine for their any physical or mental disease were also excluded. Seventy five patients were divided in three groups, comprising 25 patients in each group. Group-I were on placebo therapy. They were provided

capsules containing grinded rice and mixed wheat. They were advised to take one capsule before meal, thrice daily for two months. Group-II patients were advised to take half tablet niacin 250 mg, thrice daily after each meal. They were advised to raise dose of niacin tablets gradually after two days, until they tolerate dose of niacin up to two tablets of 250 mg, thrice daily after each meal for the period of two months, counting their day-0 from maximum tolerated dose of the drug. This titration of dose of drug was necessary because niacin can cause flushing if taken in high doses at start. Group-III was advised to take one gram grinded green cardamom powder mixed in black tea, thrice daily after each meal for the period of two months. Their base line lipid profile was determined by Freidewald method15. Total-cholesterol, LDL-cholesterol and HDL-cholesterol were main parameters we required for further calculation of change in these parameters. All patients were advised to visit clinic fortnightly for their follow up. After two months therapy their lipid profile was measured again by same Freidewald method. Data were expressed as the mean ± Standard Deviation and "t" test was applied to determine statistical significance as the difference. A probability value of < 0.05 was considered as non-significant and P value < 0.001 was considered as highly significant change in the results when pre and post-treatment values were compared.

Results. After two months therapy with Niacin and Cardamom three patients withdrew to take niacin due to its unwanted effects like flushing and urticaria and one patient stopped to take cardamom due to its personal reasons. After completion of research, mean values were expressed in SD ±SEM and paired t-test was applied to analyze result's significance biostatistically. Following changes were observed in total, LDL, and HDL cholesterol with their statistical significance.

Discussion. Atherosclerosis is a slow, progressive disease that may begin as early as childhood. Although the exact cause is unknown, atherosclerosis may start with damage or injury to the inner layer of an artery. Early diagnosis and treatment can stop atherosclerosis from worsening and prevent a heart attack, stroke or another

Table: Pre and Post treatment values with SD±SEM and their statistical significance

GROUP Parameter At day-0 At day-60 Change % change p-value

G-I n=25 TC 228.2±1.99 226.4±1.23 1.8 0.8 >0.05

LDL-C 178.4±1.67 176.5±1.09 1.9 1.1 >0.05

HDL-C 40.7±1.90 40.9±2.98 0.2 0.5 >0.05

G-II n=22 TC 235.4±1.11 204.6±1.99 30.8 13.1 <0.001

LDL-C 181.1±2.87 169.0±2.22 12.1 6.7 <0.01

HDL-C 43.5±1.99 49.1±1.04 5.6 11.4 <0.01

G-III n=24 TC 239.0±2.32 231.8±1.33 7.2 3.0 <0.01

LDL-C 188.8±2.45 180.0±1.95 8.8 4.7 <0.01

HDL-C 39.6±1.11 44.5±1.55 4.9 11.0 <0.01

KEY: G stands for group, G-I is for placebo group, G-II is for Niacin group, G-III is for Cardamom group, n stands for sample size, pre and post treatment changes are measured in mg/dl, ± stands for standard error of mean, p-values >0.05 indicates nonsignificant changes, p-values <0.01 indicates significant changes, and p-values <0.001 indicates highly significant changes in mean values.

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EaTbic ^a3a^CTaH Meg^HHa «ypHa^bi 58 (2) 2018

medical emergency. In our results two months therapy with niacin decreased total and LDL cholesterol 13.1 and 6.7 % respectively. Statistically decrease in total cholesterol is highly significant while change in LDL-cholesterol is significant biostatistically. These results match with results of study conducted by Sithwath E et al16, Ruthway T et al17, Woluy P et al18, Ethrr C et al19, Kolharr T et al20, and polkrr W et al21 who observed about same changes in lipid profile of hyperlipidemic patients. Our results of change in HDL cholesterol also match with results of Janwarr C et al22 who observed 14% increase in HDL cholesterol of 55 hyperlipidemic patients. Mittal et al23 explained that hypolipidemic effects of Vitamin B-3 (Niacin) can be achieved in doses that can damage liver. Soga et al24 conducted research and proved that one gram of niacin per day lowered total cholesterol maximum up to 9.11 mg/ dl and LDL cholesterol up to 6.90%. These results are in contrast with our results. This difference in two results can be due to low dose of the drug used in their research work. Molakasm R et al25, Ulba R et al26, and Hulbr H et al27 has warned researchers that vulnerability of hepatic damage can not be avoidable in hypolipidemic doses of this vitamin B-3 (niacin). To avoid frequent adverse effects and economic cost of conventional hypolipidemic agents like niacin or fibrates or even statins, alternative hypolipidemic therapy by herbal medications are going to get popularity

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in different ethnic groups in developing countries. Green cardamom is used generally in many cocktail food preparations in India, Pakistan, Bangladesh and Srilanka28. Our research study proved significant changes in total and LDL cholesterol in 24 hyperlipidemic patients, i.e. 7.2 mg/dl reduction in total cholesterol and 8.8 mg/dl decrease in LDL cholesterol. Changes in both parameters are biostatistically significant. Almost same results were observed by Tulhaar F et al29 in LDL-cholesterol, but they proved lesser reduction in total cholesterol, i.e. only 1.9% decrease in total cholesterol in four hyperlipidemic patients when they used one gram of green cardamom for three months. This difference may be due to small sample size, though they used same amount of cardamom as we used in our study. Lofar T et al30 proved same increase in HDL cholesterol as we observed in our work. Galleano et al31 agree with Ejer F et al32, Urth S et al33 and Ropasu U et al34 who wrote that this smaller aromatic herb has many health benefits when consumed rightly. Generally, the herb has very less side effects but over intake of the same may lead to some serious health consequences. It is therefore extremely important to know the proper dosage of the herb to avoid any of the side effects.

Recieved: 14.02.2018.

Accepted for publication: 27.02.2018.

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from novel drugs. JZMU 2015;11(9):45-70.

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