Relevance of hypertension and lipid profile with coronary heart disease in Iraqi population

Prepared by the researche

• Dr. Salih M. AL-Khafaji¹, Professor/ Dept of Anatommy & Histology**University of Kufa/ College of Medicine
• Dr.Anwar M. AL-Janabi², Professor/ Dept of Biochemistry**University of Kufa/ College of Medicine

Democratic Arabic Center

Journal of Progressive Medical Sciences : First issue – May 2025

A Periodical International Journal published by the “Democratic Arab Center” Germany – Berlin

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Abstract

 Background: lipid abnormalities are  contribute to increase in risk of coronary heart disease (CHD), CHD represent one of the most important health problems and remain the major cause of morbidity and mortality in many countries all over the world.

Objective: The aim of this study is to evaluate the lipid profile parameters level among patients with CHD.

Methods:

A total of 100 patients (100 CHD; 50 males and 50 females ), in comparison with 100 of healthy individuals (50 male and 50 female). The patients were randomly selected in Najaf region. The lipid profile parameters were measured for each patients and healthy individuals using Spainreact kits with standard procedure.

Results:

The results revealed that CHD patients had higher level of TC and Tg, HDL-cholesterol was significantly lower in  CHD patients of both sexes when compared with normal individual, whereas LDL-cholesterol was significantly higher in CHD male and female patients. The atherogenic index was significantly increased in CHD male and female patients according to their age levels.

Conclusion: The present study indicate that lipid profile parameters level were elevated in  of patients with CHD with higher of atherogenic index Iraqi CHD patients population.

Introduction

      Dyslipidemia prevalence varies from population to population. Men and women with premature coronary disease, which occurs before 55 to 60 years of age, have the highest incidence. In such patients, the prevalence of dyslipidemia as high as 80 to 88 percent compared to approximately 40 to 48 percent in age-matched controls without coronary heart disease (CHD)[1].

Chronic metabolic diseases such as cardiovascular disease remains highly complex and multifactorial. In spite of the many risk factors that contribute to the aggravation of these diseases, raising cholesterol levels and their atherogenic potential have received great attention as potential risk factors [2].

 Coronary heart disease (CHD) or cardiovascular diseases are recognized to be one of the most important reasons of morbidity and mortality and imposes tremendously heavy socioeconomic burden worldwide.  There are varieties of risk factors in the literature which increases the incidence of CHD such as hyperlipidemia. By the year 2020, World Health Organization (WHO) is predicting more than 11.1 million deaths from CHD.  It is projected that the annual number of

deaths due to cardiovascular disease will increase from 17.5 million in 2012 to 25 million in 2030.  This increase is due to industrialization, urbanization and related lifestyle changes which is called epidemiologic transition. [3,4]

Coronary heart disease occurs when cholesterol accumulates on the artery walls, creating plaques. Reduced blood ow occurs when one or more of these arteries become partially or completely blocked. The four primary coronary arteries are located on the surface of the heart are: right, left main coronary artery, left circumflex artery and left anterior descending artery.[5]

The hypertriglyceridemia results both from increased substrate availability as free fatty acids and from decreased lipolysis of very-low-density lipoprotein (VLDL) triglyceride [3-5].

         Elevated concentrations of triglycerides rich lipoprotein specially very low density lipoprotein (VLDL), and decreased levels of high density lipoprotein (HDL), measured as HDL-cholesterol are the most characteristic lipoprotein abnormalities in CHD [6]. Most patients with CHD have total amount of LDL- cholesterol   occasionally high or it is the same as in healthy people [7].

         This investigation intiated with the aim of determining the serum levels of total cholesterol ( TC ), triglycerides ( Tg ), HDL- cholesterol, LDL-cholesterol, and VLDL- triglycerides as a primary risk factors in male and female patients with CHD those where randomly selected from Iraqi population in Najaf  region.

Material and Methods

     This case-control study included a total of 200 individuals 100 individuals (50 males and 50 females) were diagnosed with coronary heart disease, the medical examinations for patients were carried out by experienced physicians. Their ages between 45-73 years compared with age and sex matched 100 healthy control individuals (50 males and 50 females), their ages between 44-70 years. Between the period of 2022 to 2024. In this study the blood pressure, BMI and lipid profile parameters were evaluated for each participant.

Biochemical analysis:-

Subjects were fasting for 12 hours at the time of blood withdrawal. Blood specimens were taken by venpuncture using venous blood and either serum or plasma were used for analysis. Colorimetric method applied to evaluated total cholesterol (TC), triglycerides (Tg), HDL- cholesterol and LDL- cholesterol by using RANDOX kits (United Kingdom BT 29 4QY) according standard procedures, triglycerides devided by 5, VLDL- triglycerides was evaluated according to the formula of Friedwald et.al [8].

Statistical analysis

         Statistical analysis of the data was carried out using the STATGRAPHICS computer program package  the results are expressed as mean ±SD, and comparison of data were made by using ” student’s t-test and ANOVA test”.

Results

         In this study, a total of 100 subjects ( 50,50% males and 50,50% females ) were examined by clinicians and confirmed with CHD were collected from Al-Sadder city teaching hospital in Najaf Province and were compared with 100 sex and age matched control group . control group were generally healthy suffering no major diseases and were considered to represent perfectly normal subjects.

          Table (2) showed the biochemical data of lipid profile in  male and female groups. The highest levels of TC were observed in the CHD patients they were significantly higher than those of the normal subjects ( P<0.01) for CHD. The levels of Tg and VLDL-triglycerides in CHD of both sexes were significantly higher ( P<0.001and P<0.01, respectively ) than those of the normal subjects of  male and female groups.

         HDL-cholesterol was significantly decreased in both sexes  of patients when compared with normal individuals. Whereas LDL-cholesterol significantly elevated  CHD patients compared with normal individuals ( p<0.01 )

        Atherogenic index ( TC/ HDL-cholesterol ) of male and female groups distributed by age levels is presented in table ( 2 ). The atherogenic index of the CHD patients was significantly higher   ( P<0.001) than normal subjects among all the age levels, and higher in males than females.

Table (1): Demographic characteristics of CHD patients and control groups             

P<0.05 statistically significant

Discussion

              In developed countries like the United States, although there has been a very significant decrease in the incidence of vascular diseases like CHD cerebrovascular disease, and peripheral vascular diseases, yet CHD remains to be the major cause of death. The major risk factors are elevated LDL-C, reduced HDL-C, smoking, hypertension, insulin resistance with or without overt diabetes mellitus, age, and family history of premature CHD. Modifiable risk factors account for 85% of the elevated CHD risk, of which the most important is plasma cholesterol. TC levels of <160 mg/ dl is able to decrease CHD risk, even if other risk factors arepresent.[9]

The development of atherosclerotic vascular disease can be linked to hyperlipidemia; Cholesterol level is more commonly accepted than triglyceride level as an independent indicator of coronary heart disease; however, its significance in diabetes is not clear [9-12]

     Iraqi males have HDL-cholesterol levels of 52 mg/dl, a value which is agree with the values of 46-58 mg/dl in American males [13] ; 52-55 mg/dl in British, Italian and Swedish males [14];  46- 50 mg/dl in Dutch males [15]; 43-50 mg/dl in Ghainian males [16]; 48 mg/dl in Libyan males [12]. However HDL-cholesterol levels for male groups from Nigeria, Pakistan, Philippines by Surinam were reported to be in the range of 27-42 mg/dl [17,18] which are in line with the findings of conner et.al [19]. For Tarahomara Indians ( 27 mg/dl) and those of Robinson et.al [20]. For Maasai men ( 41 mg/dl ). The levels of Tg for Iraqi males ( 135 mg/dl ) are slightly lower than the levels of 148 mg/dl reported for Libyan males [21].

         In the present study, the levels of TC, Tg and  LDL-cholesterol were slightly lower in the normal females than in the normal males, while HDL-cholesterol levels were slightly higher in the female subjects. These differences were not significant in males and females, but the levels of TC, Tg and LDL-cholesterol in CHD patients were significantly higher.  In contrast, HDL-cholesterol levels were found to be significantly lower in CHD male and female patients. The result that HDL-cholesterol levels of male and female subjects are negatively related to the risk of CHD is in full agreement with the reported data in a number of population [22-24].  With increase in age, a slight incraese was seen in the atherogenic index in the normal males and females. In CHD patients, the atherogenic index was significantly higher than that of normal subjects in the male and female groups among all age levels. In the meantime,  the atherogenic index was increased more in the male patients rather than female patients with incraese age levels. This finding is considered to be in full agreement with other reports [12, 14].

Conclusion

The present study indicated that apart from TC, Tg and  LDL- cholesterol, VLDL-triglycerides levels were increased in  CHD patients when compared with the normal subjects, in the sametime HDL-cholesterol was decreased in CHD in Iraqi population when compared with other normal population.

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