Factors Affecting Lipid Profile Among Patients Attending OPD at KLES Dr. Prabhakar Kore Hospital & MRC, Belagavi-A one year Observational Cross Sectional Study

Abstract

Objective: To study the changes in lipid profile in an individual at different time interval and factors responsible for the changes. Methods:The present study was conducted in the Department of Medicine, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi on patients during the period of January 2017 to December 2017.Patients attending OPD at the Department of Medicine at KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi and having minimum 2 lipid profiles minimum 3 months apart were recruited sequentially by Convenient sampling method till the sample size of 200 subjects was reached. The selected patients were briefed about the nature of the study and a written informed consent was obtained (Annexure–I). Demographic data like gender and age were collected along with relevant history and recorded on predesigned and pretested proforma (Annexure-II). A thorough clinical examination was conducted and the findings were also recorded. All patient relevant data were noted. History of preexisting diseases like Diabetes Mellitus, Hypertension, Stroke, Ischemic Heart Disease, and previous admission to hospital and present symptomatology was listed and detailed physical examination was done. Details of medical interventions were recorded. The data was analysed using EPI info (version 7.2). The qualitative variables were expressed in terms of percentages. The quantative variables were both categorised and expressed in terms of percentages or in terms of mean and standard deviations. Difference between two proportions was analysed using chi square or fisher exact test. Difference between the two means was tested using student t test. All tables were graphically represented. All analysis was 2 tailed and the significance level was set at 0.05. RESULTS: The mean age of the study subjects was 51.24 ± 14.72 years. Most common age group was 50 to 60 years followed by 60 to 70 years and 40 to 50 years. In our study, 44.50% of them had past history of diabetes, 19% had hypertension, 5% had IHD, 9.50% had hypothyroidism and 25.50% had dyslipidemia. We found a significant difference between the proportions of hypothyroidism and dyslipidemia among the gender. The proportions of tobacco use, alcohol and smoking were significantly higher among the males when compared to females. Over all, the prevalence of tobacco use in our study was 23%, alcohol use was 32% and 19% of them were smokers. Majority of the study subjects were having low or sedentary physical activity levels in our study. In our study, 52.94% of the people having dyslipidemia used statins but the rest discontinued their statins (47.06%). About 30% of the subjects had lifestyle modification and 17.50% had knowledge about dyslipidemia. Among the diabetics, 27.66% had controlled their sugar levels in past 3 months and among the hypertensives, 42.11% had controlled their blood pressures in past 3 months. About 84.21% who had elevated TSH levels were started on treatment of hypothyroidism. About 27.50% underwent dietary changes. Between the 1st and 2nd lipid profile, the total cholesterol levels decreased significantly with lifestyle modification, knowledge about dyslipidemia, controlled sugars, controlled blood pressure and dietary changes. But, in case of discontinuation of statins, the total cholesterol level significantly increased. Use of statins did not affect the decrease in the total cholesterol levels. And treatment of hypothyroidism did not find any significant decrease in total cholesterol levels. The LDL levels significantly decreased in the patients with lifestyle modification, knowledge about dyslipidemia and dietary changes. Discontinuation of statins increased the levels significantly. But, use of statins, controlled sugars, controlled blood pressure and treatment of hypothyroidism did not yield any significant results. The HDL levels significantly increased with interventions like lifestyle modification, knowledge about dyslipidemia and use of statins and significantly decreased with discontinuation of statins. But there is no significant difference in the HDL levels from the 1st and 2nd lipid profile in case of controlled sugars, controlled blood pressures, treatment of hypothyroidism and dietary changes. The changes in triglyceride levels were significantly noted in controlled sugars and dietary changes. But in case of use of statins, discontinuation of statins, lifestyle modification, knowledge about dyslipidemia, treatment of hypothyroidism and controlled blood pressures, there was no significant difference. Upon detailed analysis, we found that there was significant decrease in the total cholesterol levels of 1st and 2nd reports who had received Rosuva 10mg, Atorva 40mg, Atorva 20mg and Rosuva 5mg but there was no significant difference in cases who had taken Atorva 10mg. When the LDL levels were assessed, there was significant decrease in LDL levels in patients who received Rosuva 10mg, Atorva 40mg, Atorva 10mg and Rosuva 5mg but there was no significant decrease in case of Atorva20mg. When the HDL levels and the drugs were assessed, there was significant increase the levels only in case of patients who used Atorva 20mg. Upon detailed analysis, the triglyceride levels were significantly decreased in the patients who used Rosuva 10mg, Atorva 40mg, Atorva 20mg, Rosuva 5mg and Atorva 10mg. CONCLUSION:  Subjects more than 40 years of age had raised LDL, triglyceride levels by 18.40 % and 12.44 % respectively and decreased HDL levels by 9.33 %as compared to those less than 40 years of age.  Males had raised LDL, triglyceride levels by 15.11 % and 12.44 % respectively and decreased HDL levels by 3.42 %as compared to females.  Diabetic individuals had raised LDL, triglyceride levels by 22.27 % and 33.52 % respectively and decreased HDL levels by 12.52 % as compared to the non diabetics.  Subjects who had sedentary lifestyle had raised LDL, triglyceride levels by 23.20 % and 27.79 % respectively and decreased HDL levels by 9.33 % as compared to the individuals who had moderate to vigorous physical activity.  Smokers had raised LDL, triglyceride levels by 27.81 % and 22.98 % respectively and decreased HDL levels by 9 % as compared to the non smokers.  Subjects who didn’t have knowledge about dyslipidemia had raised LDL, triglyceride levels by 18.17 % and 19.54 % respectively and decreased HDL levels by 9.46 % as compared to those who had knowledge about dyslipidemia.  Subjects who had less than 2 visits to doctor had raised LDL, triglyceride levels by 16.76 % and 23.27 % respectively and decreased HDL levels by 6.92 % as compared to those who had more than 2 visits.  Subjects with abnormal waist-hip ratio had raised LDL, triglyceride levels by 22.08 % and 27.33 % respectively and decreased HDL levels by 9% as compared to those who had a normal waist-hip ratio.  Our study revealed that use of statins have a favourable effect on the LDL levels (18% decrease), HDL levels (8.08 % increase) and triglycerides (22.42 % decrease). The change in triglycerides was mainly due to control of sugars.  Atorva 20 mg followed by Rosuva 10 mg were the statins used by most of the subjects in our study. However, the percent reduction of LDL levels by the statins used by the subjects in our study were almost same.  Discontinuation of statins (either because of statin intolerance or ignorance) increased the LDL levels (by 13%), triglyceride levels (by 19.72 %) and decreased the HDL levels (16.75 %). None of the subjects enrolled in our study were receiving Fibrates.  Diabetic patients with controlled blood sugar levels had decreased LDL levels by 9.25 %, increased HDL levels by 13.04 % and decreased Triglyceride levels by 25.04 %.  Lifestyle modification along with dietary modification had a favourable effect on LDL, HDL values. Particularly, moderate physical activity, cessation of smoking and tobacco use altered the values favourably. Dietary modification and lifestyle modification decreased the LDL levels by 23.88 % and 13.25 % respectively, increased the HDL levels by 8.08 % and 17.7 % respectively and decreased the triglyceride levels by 22.42% and 7.85 % respectively.