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ABSTRACT
Aim: to see which component of the triad lipid that has
more important role and frequently found in patients with
acute coronary syndrome, focusing on HDL cholesterol.
Methods: a lipid profile study has been conducted in
391 patients with acute coronary syndrome (ACS), who have
been hospitalized in ICCU of Cipto Mangunkusumo Hospital since January 1st, 2001 December 31st, 2005.
Results: there were 294 male patients (75.2%) and 97
female patients (24.8%), from 25-89 years age group, with
mean value 57.35 11.05. The mean value of total cholesterol level was 205.23 mg/dl 54.84. The LDL cholesterol
level was 136.16 mg/dl 47.29. The mean HDL cholesterol
level was 42.84 mg/dl 10.28, mean triglycerides level was
157.25 mg/dl 100.16. There were 82 patients (21%) with
high total cholesterol (> 240 mg/dl), 102 patients (26.1%)
with high and very high LDL cholesterol level (> 160 mg/dl),
152 (38.6%) patients with low HDL cholesterol level (< 40
mg/dl), consisted of 126 male patients or 42.9% of total male
patients, 26 female patients or 26.8% of total female patients.
The number of patients with high / very high triglycerides
level (> 200 mg/dl or 500 mg/dl) was 84 patients (21.5%).
The number of patients with optimal lipid level, total
cholesterol level < 200 mg/dl was 191 patients (48.8%); 82
patients (21%) had LDL cholesterol level < 100 mg/dl, 23
patients (5.9%) had HDL cholesterol level > 60 mg/dl, 226
patients (57.8%) had triglycerides level < 150 mg/dl. There
were 260 patients with atherogenic lipid profile (64%), 135
patients with borderline lipid profile (34.5%), and optimal
lipid profile was found only in 6 patients (1,5%). The mean
value of HDL cholesterol level in male patients was 41.75
mg/dl 9.9, while HDL cholesterol level in female patients
was 46.16 mg/dl 10.74. Principally, lipid profiles of all age
groups were evenly distributed. ACS patients with history of
family heart disease had a more atherogenic lipid profile
compared to lipid profile of patients with hypertension,
diabetes mellitus, and cigarette smoking.
196
and may stimulate macrophages migration into endothelium. It may also stimulate vascular endothelial to
promote thrombogenic mediator synthesis, for example:
Plasminogen Activator Inhibitor (PAI-1).10 NCEP /ATP
III regards < 150mg/dL as optimal level. 150 -189 mg/dl
as borderline level, 200 499 mg/dl as high level, and
> 500 mg/dl as very high level.1
In this study, we will see, which component of the
triad lipid that has more important role and frequently found
in patients with acute coronary syndrome, focusing on
HDL cholesterol.
METHODS
Mean (SD)
205.23 54.84
136.16 47.29
42.84 10.28
157.25 100.16
Number of Patient
Percentage
(%)
82
118
191
391
21.0
30.2
48.8
100.0
Number of Patient
Percentage
(%)
41
61
101
106
10.5
15.6
25.8
27.1
82
391
21.0
100.0
Number
of Patient
Percentage
(%)
23
216
152
391
5.9
55.5
38.6
100.0
Daulat Manurung
Sex
Number
of Patient
Percentage
(%)
Number
Percentage
(%)
126
26
152
42.9
26.8
38.6
191
82
23
226
48.8
21.0
5.9
57.8
Number of Patient
Percentage
(%)
< 150
150-199
200-499
> 500
Total
226
81
82
2
391
57.8
20.7
21.0
0.5
100.0
Number
Percentage
(%)
82
102
152
84
21
26.1
38.6
21.5
If it calculated based on two combination of atherogenic lipid, there were 68 patients (17.4 %), while if it
calculated based on single atherogenic lipid, there were
172 patients (44%). No lipid atherogenic was found in
141 patients (36 %). Moreover, if the three lipid types
were optimal, only six patients were found (1.5 %). There
were 141 patients 6 patients 135 patients with
borderline lipid profile (34.5 %). (Table 9)
Table 9. Combination of Lipid Triad in ACS patients
Lipid Combination
3 atherogenic lipid
2 atherogenic lipid
1 atherogenic lipid
Borderline lipid
Optimal lipid
10
68
172
135
6
2.6
17.4
44.0
34.5
1.5
32
8.2
21
5.4
15
3.8
68
17.4
Num
Total
Chol
SD
LDL
Chol
SD
HDL
Chol
SD
Trig
Chol
SD
20-29
30-39
40-49
50-59
60-69
70-79
>=80
2
17
71
129
111
51
10
0.5
4.3
18.2
33
28.4
13.
2.6
124.5
206.41
209.00
208.99
200.78
201.18
213.90
14.85
40.32
56.24
51.64
56.68
54.63
82.83
68.0
135.65
140.47
137.81
135.81
127.47
147.20
15.56
35.00
46.33
42.93
50.68
49.24
71.82
35.50
44.00
41.32
42.45
42.34
46.43
45.50
9.19
9.60
9.64
10.16
10.17
11.16
11.98
127
149.41
185.70
171.08
134.57
141.22
129.70
74.95
63.65
99.55
135.28
61.35
62.70
60.13
Table 12. Lipid Profile in ACS Patients with Hypertension (N = 229; 58.8%)
Total Cholesterol
LDL Cholesterol
HDL Cholesterol
Triglycerides
Mean SD
Median
Minimum
Maximum
209.76 58.51
138.47 50.43
42.99 9.52
161.72 86.59
204
132
42
140
50
34
12
33
553
461
84
744
Table 13. Lipid Profile in ACS Patients with Smoking Habit (N = 205; 52.4%)
Total Cholesterol
LDL Cholesterol HDL
Cholesterol
Triglycerides
Mean SD
Median
Minimum
Maximum
202.62 52.68
135.24 44.82
41.62 9.52
157.31 86.78
203
131
41
139
50
34
19
30
382
292
76
744
Table 14. Lipid Profile in ACS Patients with Diabetes (N = 132; 33.7%)
Total Cholesterol
LDL Cholesterol
HDL Cholesterol
Triglycerides
Mean SD
Median
Minimum
Maximum
206.09 62.0
138.47 50.43
42.99 9.52
161.72 86.59
200
132
42
140
87
34
12
33
553
461
84
744
Table 15. Lipid Profile in ACS Patients With History of Familial Heart Disease
Mean SD
Median
Minimum
Maximum
216.92 49.25
142.21 43.26
41.02 9.07
177.89 117.65
223
146
41
157
114
57
17
33
340
274
62
744
DISCUSSION
Daulat Manurung
Table 16. Comparison of Lipid Profile in Present Study and Other Studies
Total Cholesterol
LDL Cholesterol
HDL Cholesterol
Triglycerides
Mean (SD)
11
(Nissen et al )
Mean (SD)
12
(Nissen et al )
Mean (SD)
13
(Sarwono )
Mean (SD)
(Present Study)
204 (41.2)
130.4 (34.3)
43.1(11.1)
152.2 (81.7)
232 34.2
150 26.9
426 10.7
197.1 105.6
198 47.0
111.4 31.5
44.5 7.3
150.8 101
202.22 54.84
136.16 47.29
42.84 10.20
157.25 100.16
high triglycerides level is about 8.2%, high LDL cholesterol and high triglycerides level are about 5.4% and
combination of high LDL cholesterol level and low HDL
cholesterol level is about 3.8%. The most common
optimal lipid profile is triglycerides and total cholesterol
level, i.e. 57.8% and 48.8% respectively.
The most common non-lipid coronary risk factor is
hypertension (58.8%) and smoking (52.4%). The more
atherogenic lipid profile lipid is found in patients with
history of familial heart disease.
This study is a retrospective study, therefore it is not
known whether the patient already had any previous
therapy of hypolipidemic agents, and there is no record
about it. This obviously affects the cholesterol examination of hospitalized ACS patients. Other risk factors, such
as metabolic syndrome, are not recorded, but the major
coronary risk factors have been included in this study.
Since low HDL cholesterol is the largest component
of other atherogenic lipids, education about increasing
HDL cholesterol is important in order to provide primary
prevention by emphasizing the importance of total health
life changes
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ACKNOWLEDGEMENT
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REFERENCES
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