Keywords: Cardio vascular diseases; Saturated fats; Body Mass Index; Lipoprotein (a); Homocysteine Coenzyme Q10
The risk factors of CVD include age, sex, hypertension, heredity and faulty dietary habits, smoking, obesity, diabetes, elevated serum LDL cholesterol and reduced HDL cholesterol levels. Emerging independent risk factors include elevated serum concentration of Lipoprotein (a), C-reactive proteins, Fibrinogen, ruminant lipoproteins and Homocysteine [4-6].
The cornerstone of CHD prevention is lifestyle modification. Dietary intervention studies support that restricting saturated fat and cholesterol and increasing the intake of essential fatty acids, especially n-3 fatty acids, reduces CHD risk. The available data indicate that there should be a recommendation to use animal,dairy and hydrogenated fats, tropical oils, egg yolks and sugars sparingly and to encourage the use of vegetables, fruit and whole grains for the prevention from CHD.
Hence the present study was undertaken for the purpose of assessment of Nutritional Status of twenty cardiovascular disease patients with established angiographic evidence in the city of Ajmer (Rajasthan, India) and to assess the impact of intervention with Coenzyme Q10 in these patients.
|
Height (Ft) |
Weight (kg) |
BMI (kg/m2) |
W/H ratio |
Mean |
5.57 |
66.2 |
23.69 |
0.93 |
S.D (n = 20) |
± .23 |
± 4.92 |
± 2.01 |
± 0.02 |
|
|
Sugar fasting (mg/dl) |
Sugar PP (mg/dl) |
Hcymmol/L |
Lp(a)(mg/dl) |
Cholesterol(mg/dl) |
TG(mg/dl) |
VLDL(mg/dl) |
HDL(mg/dl) |
LDL(mg/dl) |
Normal Values |
|
60 -110 |
< 145 |
5-15 |
0-30 |
<200 |
50 - 160 |
10-50 |
35-80 |
0-100 |
Pre Intervention (n = 20) |
Mean+ S.D. |
118.45+ 55.88 |
160.44 + 76.02 |
22.52**+ 10.13 |
30.0 + 28.27 |
170.1 + 50.83 |
132.55 + 60.91 |
26.51 + 12.18 |
41.6 + 7.6 |
73.85 + 23.48 |
Post Intervention (n = 20) |
Mean+ S.D. |
119.45 ns+ 54.33 |
165.01 ns+ 81.77 |
17.08 * + 6.21 |
31.05 ns + 27.65 |
185.95 ns + 48.15 |
139.5 ns+ 50.88 |
28.9ns + 11.24 |
41.85 ns + 8.55 |
74.5 ns + 21.16 |
|
|
Energy (Kcal) |
Protein (gm) |
Fat (gm) |
Fiber (gm) |
Sodium (mg) |
P/S Ratio |
W3 Fatty Acid |
Men (n = 15) |
RDA |
2320 |
60 |
25 |
25 |
2092 |
- |
- |
Mean Intake |
1771.7** |
56.3ns |
59.9** |
8** |
328** |
1.3 |
2.0 |
|
S.D. |
295.9 |
18.5 |
13.8 |
4.46 |
219.8 |
1.2 |
0.66 |
|
Women (n = 5) |
RDA |
1900 |
55 |
20 |
25 |
1902 |
- |
- |
Mean Intake |
1639.9ns |
46.2* |
106.6** |
5.6** |
244.38** |
1.2 |
1.9 |
|
S.D. |
348.8 |
8.74 |
56.7 |
0.78 |
137.34 |
0.77 |
0.54 |
Phase II: The selected subjects were given 100 mg soft gel capsules of Coenzyme Q10 to assess its impact on serum lipids, Lipoprotein and Homocysteine levels and on the blood sugar levels.
Phase III: The impact of intervention with CoQ10 on the biochemical parameters of the subjects was assessed in this phase.
The criteria kept for selection was:
1. Patients (men & women) suffering from coronary artery disease, cardiomyopathy, hypertension, mitral valve prolapse and coronary revascularisation with established angiographic evidence.
2. Pregnant and breastfeeding patients were not included in this study.
3. Women of childbearing potential but not using any form of effective method of contraception were included.
4. Patients who were willing to co-operate in the study.
5. Subjects residing in Ajmer city.
The dietary intake data was assessed by collecting retrospective intake data and summarizing prospective intake data with the goal to determine the nutrient content of the food and the appropriateness of the intake for a particular individual. Information related to the dietary intake and food patterns of the subjects was collected through this questionnaire by a 24hour recall method for three consecutive days (24 × 3 = 72 hours recall). General information of all the twenty subjects was collected. General information consisted of all the personal information of the subjects, i.e. information regarding socio-economic status, education, type of family, number of family members, occupation etc. Two types of information on food intake were collected first about the qualitative aspects of food consumed i.e. kind of food eaten and the second about the food consumed in quantitative terms i.e. how much of food was taken. The 24 hour recall method was clubbed together with the weighment method to collect the dietary information. The different food items consumed were converted into their raw equivalents, categorised into the respective food groups and the average daily intake of energy, proximate principles, important minerals including sodium and fibre were calculated from the value per 100 gm of edible portion given in the Food Composition Tables and compared to the RDA given by the ICMR for adults [31].
Intervention procedure: The intervention trial was conducted on these CVD patients with established angiographic evidence for a period of 60 days. The subjects were asked to take 100 mg of CoQ10 i.e. one soft gel capsule everyday along with water, at the time of lunch. The Intervention Trial was duly approved and cleared by the Institutional Ethics Committee (IEC) which was constituted and which functioned as per the Indian Council of Medical Research (ICMR) Guidelines (2008) [32]. The IEC reviewed and approved all the ethical aspects of the study with respect to the welfare and safety of the subjects and the scientific soundness of the research work. The approval of the IEC was also communicated to the subjects participating in this research study. An Informed Patient Consent Form was given to individual subjects along with a coloured pamphlet regarding detailed scientific information about coenzyme Q10. This form was duly signed by each and every subject and only after receiving their written consent, the intervention trial began.
Anthropometric data of all the twenty subjects were measured prior to the intervention trial. The parameters included Height, Weight, Body Mass Index (BMI) and Waist/Hip ratio. The mean height of the subjects was found to be 5.57 ± 0.23 ft.
A platform weighing balance was used to measure the weight of the subjects. The average weight of the subjects in the present study was 66.20 ± 4.92 kg. BMI of the subjects was found to be within the normal range i.e. 23.69 ± 2.01 (Normal Range - 20-25 kg/m2). Waist hip ratio is also associated with obesity and increased risk of CVD. All the subjects (n = 20) had Waist/Hip ratio higher than normal (0.93 ± 0.02) indicating one of their possible risk factors for suffering from CVD. Regional fat distribution, particularly in the abdomen and hip, is considered important in development of CHD [34] as was seen in the present study also.
Different biochemical estimations of all the subjects (n = 20) was done twice, i.e. prior to intervention and after intervention with coenzyme Q10. Fasting blood samples were drawn for all the biochemical tests. Mean values were calculated and were then compared with the normal values. The Lp (a) of the subjects was found to be towards the higher side (30 ± 28.27 mg/dl). Both blood sugar fasting and P.P. were found to be slightly greater than the normal values i.e. 118.45 ± 55.88 and 160.49 ± 76.00 mg/dl respectively. Researchers have shown both Diabetes and Lipoprotein A levels to be associated with increased risk of CVD [4-6] as was seen in the present study. An elevated plasma level of the amino acid homocystiene is a significant and independent risk factor in the development of CHD [35]. Mean Hcy levels prior to intervention was found to be much higher (22.25** ± 10.05) than the normal values. The link between high levels of serum Hcy and atherosclerosis disease was seen in these subjects.
Lipid profile of all the subjects was also assessed prior to intervention. As shown in Table 2, the serum TG and cholesterol levels prior to intervention were found to be within the normal range. There is a strong inverse relationship between HDL concentration and coronary events. Low levels of HDL-C (< 40 mg/dl) is an independent risk factor of CVD and raising HDL-C is a major treatment strategy for regressing atherosclerosis and enhancing CVD risk reduction [36]. HDL levels of the subjects prior to intervention was found to be 41.6 ± 7.60 mg/dl (p < 0.01) LDL and VLDL values were found to be lying in the normal range i.e. 73.85 ± 23.48 mg/dl and 26.51 ± 12.18 mg/dl respectively
To assess the impact of intervention with 100 mg of CoQ10 soft gel capsules in the selected subjects of CVD (n = 20) with established angiographic evidence, the entire blood biochemical profile was repeated on completion of the intervention trial i.e. after the 60 days period. Results revealed that the impact of CoQ10 at the 100 mg dose in lowering the fasting and PP blood sugar levels, cholesterol, TG, HDL, LDL, VLDL and Lp (a) was not significant when compared with the pre intervention values. However, Hcy which is a major emerging risk factor for CVD was found to be significantly lowered (p ≤ 0.05) following 60 days intervention trial. CoQ10 has been reported to have a beneficial effect in the prevention and treatment of various forms of CVD. [23].
Diet is a vital determinant of health and nutritional status of the people. Diets of all the 20 subjects were assessed and calculated. Energy, Protein, Fat, Fiber & Sodium content of the diet was calculated and compared to the RDA given by the ICMR [31]. The energy and protein intake of subjects was lower than the RDA in both men and women. The results of the present study revealed that the fibre intake in both men and women was very low when compared with the RDA. It was 8 ± 4.46 gm and 5.6 ± 0.78 in men and women respectively. Epidemiological studies have found high fibre diets to have beneficial effects in the prevention of CVD [37]. High fat intake bears direct correlation with BMI and lipid profile of the subjects. High dietary saturated fat has therefore been associated with increased risk of CVD. All the subjects were consuming a very high fat diet. When compared with the RDA, the values were found to be highly significant at p ≤ 0.01 level. The mean fat intake in men subjects was 59.9 ± 13.8 gm, whereas in women subjects the fat intake was even higher than men (106.6 ± 56.7 gm).Increased consumption of dietary fat leads to an increase in body weight, waist circumference and mean systolic and diastolic blood pressure which are also associated with high intakes of sodium. Long term sodium reduction and potassium substitution may lead to a reduced risk of CVD. Data also revealed a low intake of omega 3 fatty acids in the diets of the selected subjects and the Polyunsaturated to Saturated fatty acid ratio was also low indicating that the subjects were at a high risk of developing CVD [Table 3].
Hence it can be concluded that faulty dietary practices reflected their impact on the anthropometric and biochemical profile of the cardiac subjects all of whom were suffering from some or the other kind of cardiovascular disease with angiographic evidence. A high fibre and a high Folic acid diet which is low in saturated fats, salt and cholesterol is recommended for the prevention of CVD. It can also be said that Coenzyme Q10 is a promising antioxidant with diverse therapeutic properties and a great degree of safety. Its role in preventing cardiovascular diseases and in the correction of hyper homocysteinemia can prove to be a milestone in lowering the incidence of this global, frightening and often fatal epidemic of CVD.
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