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ORIGINAL ARTICLE
Year : 2010  |  Volume : 4  |  Issue : 1  |  Page : 10-13

Lipid abnormalities: A case study of Ahmadu Bello University Teaching Hospital, Zaria, Nigeria


Department of Chemical Pathology, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria

Date of Web Publication17-Dec-2010

Correspondence Address:
S A Akuyam
Department of Chemical Pathology, Ahmadu Bello University Teaching Hospital, Zaria
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0331-3131.73869

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   Abstract 

Background : Abnormal lipid levels, especially elevated total cholesterol (TC), low density lipoprotein cholesterol (LDL-C) and triglyceride (TG) and decreased high density lipoprotein cholesterol (HDL-C), contribute additional risk to patients with diabetes mellitus (DM) and coronary heart disease (CHD). Reports on the pattern of lipid profile abnormality in blacks are scanty and inconsistent. The aim of the present study has been to carry out a retrospective analysis of lipid profile investigation in Ahmadu Bello University Teaching Hospital (ABUTH), Zaria.
Materials and Methods : A total of 448 patients with different disease conditions, such as type II DM, CHD, renal disorders, liver diseases and other abnormalities, who were referred to the chemical pathology laboratory from various clinics and hospitals for lipid profile analysis were assessed. The subjects were made up of 312 (69.67%) males and 136 (30.33%) females. The mean age for the total (combined males and females) was 58 (ranged 45-72) years and the mean age values for males and females were 62 (ranged 51-73) and 53 (ranged 35-65) years respectively.
Results : The results show that abnormal lipid profile was found in 51 (11.38%) patients who were consisted of 33 (67.71%) males and 18 (35.29%) females. These also consisted of 35 (68.63%) patients with cardiovascular diseases (CVD), 5 (9.80%) patients with type II diabetes mellitus (DM) and 11 (21.57%) patients with other clinical conditions such as liver and renal diseases. Hypercholesterolemia and hypertriglyceridemia alone were observed in 8 and 15 patients respectively. Low density lipoprotein cholesterol (LDL-C) levels were elevated in 11 patients. Thirty six (36) patients had reduced levels of HDL-C only, with concomitant high levels of TC/HDL-C ratio. Combined hyperlipidemia was observed in only five patients. The results revealed that abnormal lipid profile pattern was higher in patients with CVD (68.60%) than in other cases.
Conclusion : The results of the present study demonstrate that low HDL-C levels seemed to be more prevalent in this population. This report could contribute to the ongoing work on lipid research in Nigeria and the world at large.

Keywords: Cardiovascular diseases, diabetes mellitus, lipid abnormalities, lipid profile


How to cite this article:
Akuyam S A, Anaja P O, Isah H S, Aliyu I S, Yusuf R. Lipid abnormalities: A case study of Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. Ann Nigerian Med 2010;4:10-3

How to cite this URL:
Akuyam S A, Anaja P O, Isah H S, Aliyu I S, Yusuf R. Lipid abnormalities: A case study of Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. Ann Nigerian Med [serial online] 2010 [cited 2019 Aug 24];4:10-3. Available from: http://www.anmjournal.com/text.asp?2010/4/1/10/73869


   Introduction Top


Lipid profile assay forms one of the special investigations in most clinical biochemistry laboratories worldwide. The assay is becoming of increased importance in many third world countries like ours because of increased cases of hypertension, diabetes mellitus (DM), renal diseases, and other disease conditions. Our laboratory has been engaged in providing services in this endeavour since 1991. Clinicians make request for lipid profile estimation to help them in the management of their patients.

Lipid profile assay has found useful application in the monitoring of patients with diabetes mellitus [1],[2],[3] and in the management of patients with Coronary artery disease (CAD), [4],[5] as well as malnutrition. [6],[7] It is used as a screening test in obese individuals, alcoholics and persons of high social status with the risk factors for cardiovascular diseases (CVDs). [4],[8]

The pattern of lipid profile results is well established in the developed or advanced countries. [9],[10] The situation is different in most of the third world countries, including Nigeria. [8],[11] Published data on the pattern of lipid abnormalities in Nigeria are scanty and not well understood. [11],[12],[13] The objective of the present study has been to determine the pattern of lipid profile abnormalities in northern Nigerian population. This report could contribute to the ongoing work on lipid research in Nigeria and the world at large.


   Materials and Methods Top


The study was carried out in the Department of Chemical Pathology of Ahmadu Bello University Teaching Hospital (ABUTH), Zaria, northern Nigeria between January, 2005 and December, 2006. This study involved 448 subjects who were referred to the chemical pathology laboratory from various clinics and hospitals for lipid profile analysis. The subjects were made up of 312 (69.67%) males and 136 (30.33%) females. The mean age for the total (combined males and females) was 58 (ranged 45 - 72) years and the mean age values for males and females were 62 (ranged 51 - 73) and 53 (ranged 35 - 65) years respectively.

A complete lipid profile was done on all subjects. The parameters measured were total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C) and triglyceride (TG). The method of Levin and Zak [14] was used for the estimation of TC and HDL-C. TG values were estimated by the method of Levy [15] and LDL-C by the Friedewald formula. [16] Atherogenic risk ratio (index) was determined by TC divided by HDL-C levels (TC/HDL-C). The data were partitioned according to the disease conditions and the percentage, mean, and standard deviation values were then calculated. The criteria employed in arriving at the various diagnoses are shown in [Table 1]. A P-value of equal to or less than 0.05 (P<0.05) was considered as statistically significant.


   Results Top


The results of the present investigation are presented in [Table 1] and [Table 2]. [Table 3] shows the distribution of normal and abnormal lipid profile. The results show that abnormal lipid profile was found in 51 (11.38%) patients. These consisted of 33 (64.71%) males and 18 (35.29%) females. The results reveal that abnormal lipid profile pattern was higher in patients with CVDs (68.60%) than in other cases as shown in [Table 2]. These results also show that serum lipid abnormalities are more prevalent in males than in females. Hypercholesterolemia and hypertriglyceridemia alone were observed in 8 and 15 patients respectively. LDL-C levels were elevated in 11 patients. Thirty-six patients had reduced levels of HDL-C only. Combined hyperlipidemia was observed in only five patients. These results demonstrate that low HDL-C levels with concomitant high TC/HDL-C seemed to be more prevalent in this population.
Table 1 :Biochemical interpretation of lipid profile results in Ahmadu Bello University Teaching Hospital, Zaria

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Table 2 :Abnormal lipid levels (mean ± SD) according to disease conditions

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Table 3 :Distribution of normal and abnormal lipid levels (mean ± SD)

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   Discussion Top


Abnormal lipid levels, especially elevated TC, LDL-C and TG and decreased HDL-C, contribute additional risk to patients with DM and CHD. [6],[11],[15] The most common indication for serum lipid analysis is to assess the risk of developing CHD. Detection of abnormal lipid levels involves committing an attempt to reduce cardiovascular risk by providing dietary counselling, prescribing drug therapy for certain genetic hyperlipidemia and assessing the patient's response by follow-up measurements. Reports on the pattern of lipid profile abnormalities in blacks are scanty and inconsistent. This has greatly affected lipid lowering intervention using drugs and even life style changes, as an attempt to provide a general picture of lipid pattern in sub-Sahara Nigerians.

Our observations clearly revealed that lipid abnormality is a problem that requires adequate investigation in our environment. Patients with CVD seemed to have the highest prevalence of hypercholesterolemia and hypertriglyceridemia followed by patients with type II DM. However, the highest mean level of cholesterol was recorded in patients with type II DM. This confirms previous reports on elevated level of cholesterol in this group of patients. [11],[12],[13] The need for lipid-lowering intervention in diabetic patients is suggested to minimize the risk of Ischemic heart disease (IHD) in these patients.

Our observations also revealed that the males have additional risk resulting from abnormal lipid patterns in this environment. This agrees well with the reports of Patterson et al.[9] and Rohfe et al.[17] for the Caucasians and blacks respectively. The findings of this study demonstrate that majority of hyperlipidemic patients in our environment have increased risk of developing CHD as low levels of HDL-C indicate high risk because HDL-C is said to be cardio-protective. [18],[19],[20],[21] This is also supported by the marked increase of TC/HDL-C ratio (atherogenic risk ratio or index) in our patients with type II DM and CVDs.

Our observations have shown that lipid profile assay as a tool in the management of these patients in our environment is useful and the practice should continue. Our findings also suggest that it is necessary to measure complete lipid profile as a minimum requirement to define the lipoprotein abnormality responsible for substantial hyperlipidemia and to detect certain genetic disorders of lipoprotein metabolism as well as in assessing the risk of CHD. We also suggest adequate follow-up of the patients and introduction of lipid-lowering strategies during intervention in those who may benefit from it.

 
   References Top

1.Anaja HP, Isah HS, Abdu-Aguye I. Lipid profile in diabetic Nigerians: a Zaria update. Int Diab Dig 1995;6:90-3.  Back to cited text no. 1
    
2.Ferreira SR, Iunes M, Franco LJ, Iochida LC, Hirai A, Vivolo MA. Disturbances of glucose and lipid metabolism in first and second generation Japanese-Brazilians. Japanese-Brazilian diabetes study group. Diabetes Res Clin Pract 1996;34:59-63.  Back to cited text no. 2
    
3.Poirier P, Catellier C, Tremblay A, Nadeau A. Role of body fat loss in the exercise-induced improvement of the plasma lipid profile in non-insulin dependent diabetes mellitus. Metabolism 1996;45:1383-7.  Back to cited text no. 3
[PUBMED]    
4.Law MR, Waid NG, Thompson SG. By how and how quickly does reduction in serum cholesterol concentration lower risk of ischaemic heart disease? Br Med J 1994;308:367-73.  Back to cited text no. 4
    
5.Low PS, Saha N, Tay JS, Hong S. Ethnic variation of plasma apolipoprotein levels in relation to coronary risk level: a study in three ethnic groups of Singapore. Acta Paediatr 1996;65:1476-82.  Back to cited text no. 5
    
6.Ogunkeye OO, Ighogboja IS. Increase in total serum triglyceride and phospholipids in kwashiorkor. Ann Trop Pediatr 1992;12:463-6.  Back to cited text no. 6
    
7.Akuyam SA, Isah HS, Ogala WN. Serum lipid profile in malnourished Nigerian children in Zaria. Nig Postgrad Med J 2008;15:192-6.  Back to cited text no. 7
    
8.Das SC, Isichei UP. Beta lipoprotein cholesterol and triglycerides in a healthy Nigerian population. Nig Postgrad Med J 1997;4:88-92.  Back to cited text no. 8
    
9.Paterson JR, Pettigrew AR, Dominiczak MH, Small M. Screening for hyperlipidaemia in diabetes mellitus: relationship to glycemic control. Ann Clin Biochem 1991;28:354-8.  Back to cited text no. 9
[PUBMED]    
10.Lewis B, Chait A, Wootton ID, Oakley CM, Krikler DM, Sigurdsson G, et al. Frequency of risk factors for ischaemic heart disease in healthy British population with particular reference to serum lipoprotein levels. Lancet 1974;1:141-6.  Back to cited text no. 10
[PUBMED]  [FULLTEXT]  
11.Akanji AO, Agbedana EO, Ugbode C. Plasma lipid profile in relation to diabetic control in Nigerians. Afr J Med Sci 1989;18:229-34.  Back to cited text no. 11
    
12.Onyemelukwe GC, Stafford WL. Serum lipid in Nigerians: the effect on diabetes mellitus. Trop Geog Med 1981;33:323-8.  Back to cited text no. 12
    
13.Aduba O, Onwuamaeze I, Oli J, Udeozo K. Serum cholesterol and high density lipoprotein in Nigerian diabetics. East Afr Med J 1984;61:35-9.  Back to cited text no. 13
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14.Levine JB, Zak B. Automated determination of serum total cholesterol. Clin Chim Acta 1964;10:381-4.  Back to cited text no. 14
[PUBMED]    
15.Levy AL. Measurement of triglycerides by noname extraction and colorimetric, manual and automated methods. Ann Clin Lab Sci 1972;18:499.  Back to cited text no. 15
    
16.Friedwald WT, Levy RI, Fredricson DS. Estimation of the concentration of low density lipoprotein cholesterol in plasma without the use of preparative ultracentrifugation. Clin Chem 1972;18:499.  Back to cited text no. 16
    
17.Rohfe M, Mandelsohn D, Armstrong JR. Lipid levels in diabetic patients from Central Africa. Int Diabetes Dig 1993;4:154-7.  Back to cited text no. 17
    
18.Barry L. The appropriate use of diagnostic services: (vii) the investigation of hyperlipidaemia: why, how and for whom? Health Trends 1986;18:1-4.  Back to cited text no. 18
    
19.Kannel WB, Castelli WP, Gardon T. Cholesterol in the prediction of atherosclerotic disease: new perspective based on the Framingham study. Ann Intern Med 1978;90:85-91.  Back to cited text no. 19
    
20.Betteridge AL. High density lipoprotein and coronary heart disease. Br Med J 1989;298:974-5.  Back to cited text no. 20
    
21.Bold AM. Cholesterol and coronary heart disease: consensus, controversies and consequences. Lab Medica 1990. p. 17-20.  Back to cited text no. 21
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]


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