Hyperlipidemia as a Risk Factor for Persons in Specific Professions
DOI: 10.5455/msm.2014.26.17-20
Received: 11 November 2013; Accepted: 27 January 2014 © AVICENA 2014
ORIGINAL PAPER
Published online: Published print:
20/02/2014 02/2014
Mater Sociomed. 2014 Feb; 26(1): 17-20
Hyperlipidemia as a Risk Factor for Persons in Specific Professions Merita Tiric Campara1, Sibila Sijaric-Voloder2, Miro Denislic3, Emir Tupkovic4, Jasminka Djelilovic Vranic1, Azra Alajbegovic1 Neurology Clinic, Clinical Center of Sarajevo University, Sarajevo, Bosnia and Herzegovina1 Institute for Health Care of Ministry of Interior Affairs Employee of the Canton Sarajevo, Sarajevo, Bosnia and Herzegovina2 Faculty of medicine Ljubljana, Ljubljana, Slovenia3 Department of Neurophysiology, Primary Health Care Center Tuzla, Tuzla, Bosnia and Herzegovina4 Corresponding author: Merita Tiric Campara, MD. Neurology Clinic, Clinical Center of Sarajevo University, 71000 Sarajevo, Bosnia and Herzegovina. E-mail: [email protected]
ABSTRACT Introduction: The increase in lipid levels associated with other risk factors for the occurrence of ischemic heart disease and stroke is one of the most important health problems in the world. Risk for development of changes is greater for people of specific occupations such as police officers. Material and methods: This prospective study included 300 police officers, 150 as experimental and 150 respondents as a control group. To both groups same methods have been applied: A detailed history, physical examination, complete laboratory evaluation, lipid electrophoresis targeted to hypercholesterolemia, ultrasound of the abdomen and Color Doppler of the neck vascular structures. The results obtained by statistical analysis of the data showed that there was a significant increase in levels of cholesterol and triglyceride levels in experimental compared to the control group. Ultrasound of the abdomen showed fatty infiltrated liver in 16% of respondents from the experimental and 2% of the respondents in the control group 2%. Color Doppler of the neck blood vessels in 14% of respondents from experimental group showed changes in blood vessels, which ranged from mild thickening of the intima of the vessel to a 50% decrease in circulation. For the control group, this percentage was 0.66%. Considering that this study involved young, active working population, hyperlipidemia becomes a bigger problem. Key words: ischemic heart disease, stroke, hyperlipidemia.
1. INTRODUCTION Previous studies have shown that elevated levels of lowdensity lipoprotein (LDL-cholesterol) are associated with the accelerated development of atherosclerosis and ischemic heart disease (IHD), while its reduction reduces the overall coronary vulnerability of patients with already diagnosed IHD, significantly reduces mortality and improves quality of life. However, studies have also shown that more than 40% of the IHD patients do not have elevated levels of LDL–cholesterol (1). All this raises many questions about the importance of other factors in the development of atherosclerosis. Until a few years ago, many researchers have argued that triglycerides are an independent risk factor of heart and blood vessels diseases, but they are only indirectly associated with an increased risk of developing these diseases. Recent studies shed more light on the importance of triglycerides in IHD development (2). In Copenhagen epidemiological study (3) was demonstrated the association of triglycerides with heart disease. This study showed that the incidence of IHD is highest (approximately 14%) in patients with triglyceride levels at 2.5 mmol/l. The association of triglycerides with the occurrence of the IHD also showed meta-analysis that by multivariate analysis Mater Sociomed. 2014 Feb; 26(1): 17-20 • ORIGINAL PAPER
examined nearly 60,000 persons. The results provided by these studies show that in the case of an increase in the level of triglycerides by 1 mmol/l also increases the risk of IHD in men by 15% and in women by 37%. In the case of coexisting reduced HDL cholesterol level, the risk increases (4). Other epidemiological studies (5,6), confirmed these results and led to the inevitable conclusion that the need to treat hypertriglyceridemia exist regardless of the level of LDL and HDL. Very important id moderate triglicaeridemia (2-5 mmol/l) for the development of atherosclerotic changes, while increasing levels of TG above 8 mmol/l represents danger for the development of pancreatitis.
2. GOAL The goal of this study was to determine how lipid component behaves after a certain time distance after effects of multifactorial war stress, in the postwar period among the workers of specific professions, such as members of the police department. One of the goals of this work is, if it proves the presence of hyperlipidemia in this group of working and young population, to emphasize the necessity for action in preventing hyperlipidemia by introducing among other things, mandatory periodic routine control of lipid levels, especially in high-risk populations.
17
Hyperlipidemia as a Risk Factor for Persons in Specific Professions
HDL level
SCL-90-R
Mean values of the responses of MeanSCL-90-R values of the responses of
3. MATERIAL AND METHODS sclerosis and subsequent morbidity from ischemic heart disease Figure 2. Mean triglyceride levels in the blood at experimental group for each By its nature, this is a prospective study, which processed and cerebrovascular insult. Associated with otherand riskcontrol factors, Figure 2. Mean triglyceride levels in the blood experimental and control group for each ageatgroup age group only healthy respondents by method of random sampling. In triglycerides increase the risk of these serious diseases, which this research are used descriptive methods. Due to the ethical in best case scenario lead to permanent disability (Figures principles every respondents in both experimental and control 1,2,3,4,5,6,7,8,9). group in which the hyperlipidemia is noticed was referred for 27,92 30 27,92 30 further treatment, but these results are beyond the purpose of 25 20,38 25 this study and are not taken into consideration. 20 20,38 13,18 15,61 20 15 The study included 300 employees of Ministry of Internal 13,18 15,61 Affairs of Federation of Bosnia and Herzegovina belonging to 15 10 the group of the working age population 39-56 years old. They 10 5 all stayed during the war in Bosnia and Herzegovina and were 0 e study Bosnia and1956-1960 he study included included 300 300 employees employees of of Ministry of Internal Affairs of Federation of Bosnia 5 and 1961-1965 1966-1970 1971-1973 military engaged. Due to the specifics of their work this is a Age groups erzegovina old. They They all erzegovina belonging belonging to to the the group group of the working age population 39-56 years old. all 0 Experimental Control physically population. Participants in the study yed during war Bosnia and and were military Due to to the the ayed during the theyoung, war in in Bosnia active and Herzegovina engaged. Due 1956-1960 1961-1965 1966-1970 1971-1973 Age groups were divided into two groups: respondents (who lived during ecifics the study study ecifics of of their their work work this this is is aa young, young, physically active population. Participants in the Experimental Control war in Sarajevo) and control (those who during the Figureand ere two groups: respondents (who group lived during and control ere divided divided into intothe two groups: respondents the war in Sarajevo) control 3. Mean total score on the SCL-90-R test for experimental and the control group for each age group. oup (those (those who whowar during theinwar war stayed oup during the stayed parts of the country). stayed other partsinofother the country). Figure 3. Mean total score on the SCL-90-R test for experimental and the ll were treated treated in inAll thewere sametreated manner: taken,history physical control examination, l were the same manner: a detailed history awas examination, in the same manner: detailed group for each age group. Figure 3. Mean total score omplete laboratory evaluation with the lipid evaluacomponent, targeted at mplete laboratory evaluation with special reference to laboratory targeted at on the SCL-90-R test for experimental and the control group for was taken, physical examination, complete each age group. ypercholesterolemia lipidspecial electrophoresis, andatColor Doppler percholesterolemia lipid electrophoresis, of the abdomen Doppler of of tion with reference toultrasound the lipid component, targeted eck vascular structures structures in case of dyslipidemia. analysis of the data obtained was ck vascular in case of dyslipidemia. Statistical obtained was hypercholesterolemia lipid electrophoresis, ultrasound of the 2 1,77 erformed using the the Student's Student's t-test, rformed using and ANOVA. 1,8 abdomen andt-test, ColorF-test Doppler of neck vascular structures in 1,6 1,47 case of dyslipidemia. Statistical analysis of the data obtained 1,34 1,2 1,4 1,26 1,05 1,08 1,21 . RESULTS RESULTSwas performed using the Student’s t-test, F-test and ANOVA. 1,18 1,02 1,2 1,07 1,05 1,04 1,04 1,03 1,01 2
1
0,98
0,98
0,92
0,85
1,77 0,75 0,7 atistical analysis analysis of the the data data obtained obtained showed significantly higher levels of cholesterol and 1,8 0,8 atistical of cholesterol and 4. RESULTS 0,56 0,6 glycerides in in experimental experimental compared compared the control group. 1,6 1,47 glycerides Statistical analysis ofto the data obtained showed significantly 0,4 1,34 1,2 ecent studies in in the the world world are are increasingly dealing with issues of triglycerides as an 1,4 cent studies triglycerides as an 1,26 1,05 1,08 1,21 0,2 higher levels of cholesterol and triglycerides in experimental 1,18 1,02 dependent risk risk factor factor for for atherosclerosis atherosclerosis and subsequent morbidity from ischemic heart 1,2 0 1,07 dependent ischemic heart 1,05 1,04 1,04 1,03 1,01 0,98 0,98 compared to the control group. 1 2 3 4 0,92 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 sease and and cerebrovascular cerebrovascular insult. insult. Associated with other risk factors, triglycerides 1 increase sease triglycerides increase 0,85 0,8 Experimental group 0,79 Recent studies in the world are increasingly dealing with 0,75 0,7 risk of of these these serious serious diseases, diseases, which which in best case scenario lead to permanent disability. 0,8 eerisk disability. 0,56 issues of triglycerides as an independent risk factor for athero- Figure 4. The individual levels of HDL in serum of 25 respondents from 0,6 0,79
HDL level
0,8
66
Cholesterol Cholesterolmean meanvalue value
55
Figure 4. The individual levels of HDL in serum of 25 respondents from experimental group experimental (baseline HDL in serum: mmol/l, ideal up 0,4 (baselinegroup HDL in serum: 1.06 to 1.94 mmol/l,1.06 idealtoup1.94 to 1.40 mmol/l)
5,67 5,67 5,24 5,24
5,09 4,86 5,09 4,86
4,81 4,81
4,69 4,69
5,04 5,04
to0,21.40 mmol/l) 0
4,43 4,43
44
2
7
33
3
4
5
6
7
8
9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25
5,12
6
6,04 4,76
6,02
5,8
Mentor:group Prof. Dr. Amir Pleho Experimental
4,9
5,92
6,06
5,98
5,66
5,6
5,95 6,345,82
5,15 4,98
LDL level
4,6 4,46 4,4 5 4,35 Figure 4. The individual levels of 4,42 HDL in serum of4,325 respondents from experimental group 4 (baseline HDL in serum: 1.06 to 1.94 mmol/l, ideal up to 1.40 mmol/l)
22 11 00
1
7,8 Dr. Sibila Sijarić – Voloder 9 Autor: 7,6 8 7,28
3 2 1
1956-1960 1956-1960
1961-1965 1961-1965
1966-1970 1966-1970
Experimental
Control
Age groups groups Age Experimental Control
1971-1973 1971-1973
0
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Autor: Dr. Sibila Sijarić – Voloder
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13
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xperimental group
17
19
21
23
25
Mentor: Prof. Dr. Amir Pleho
Figure 5. The individual display of LDL levels in the serum of 25 Figure 5. The individual display of LDL levels in the serum of 25 respondents from respondents from experimental LDL inup serum: to 4.30 group (baseline LDL in serum:group 2.00 to(baseline 4.30 mmol/l, ideal to 3.802.00 mmol/l) Figure 1. Mean blood cholesterol for experimental and the control group forexperimental igure 1. 1. Mean Mean blood blood cholesterol cholesterol for for experimental experimental and and the the control control group for each age group mmol/l, ideal up to 3.80 mmol/l) igure group for each age group each age group
Autor: Dr. Sibila Sijarić – Voloder
18
HDL level
Srednja Srednjavrijednost vrijednosttriglicerida triglicerida
Mean values for age subgroups of five years indicate that the 1,6 largest deviations are recorded for those born in period 19661,36 3 1,4 2,66 3 1,18 2,66 1,12 and triglyceride. Both groups with 1970 both for cholesterol 1,2 1,09 1,02 1,01 2,5 2,15 2,5 2,15 1,99 elevated1cholesterol underwent additional0,96lipid electrophore1,89 1,99 1,89 2 0,8 2 sis, which revealed elevated levels of LDL levels in 24 (16%) 0,6 1,5 respondents and decreased levels of HDL in 16 (10.6%) cases. 1,5 0,4 1 In the control group, elevated LDL was found in 7 (4.66%), and 0,2 1 0 HDL in 3 (2%) members of this group. decreased 0,5 0,5 1 2 3 4 5 6 7 Decreased HDL with increased triglyceride levels further increase 0 Control group 0 1956-1960 1961-1965 1966-1970 1971-1973 the risk of ischemic heart disease. If we consider that in this research the 1956-1960 1961-1965 1966-1970 1971-1973 Age groups respondents are relatively young working active male population, aged Age groups Experimental Control Figures 6. The individual display of HDL levels in serum for seven members of the control Experimental Control 39-56 years HDL of life, dealing specific which means that group (baseline in serum: 1.06with to 1.94 mmol / l,profession, ideal up to 1.40 mmol/l) Figure 2. Mean triglyceride levels in the blood at experimental and control they are under constant stress of work, the results of this study suggest group for each age group Autor: Dr. Sibila Sijarić – Voloder Mentor: Prof. Dr. Amir Pleho the need for serious and effective care for people with these changes. Mentor: Prof. Dr. Amir Pleho
ORIGINAL PAPER • Mater Sociomed. 2014 Feb; 26(1): 17-20
xperimental group
Figure 5. The individual display of LDL levels in the serum of 25 respondents from experimental group (baseline LDL in serum: 2.00 to 4.30 mmol/l, ideal up to 3.80 mmol/l)Hyperlipidemia as a Risk Factor for Persons in Specific Professions
1,6
1,36
1,4
1,18
HDL level
1,2
1,09
1,12
2
3
1
1,02
0,96
1,01
6
7
0,8 0,6 0,4 0,2 0
1
4
5
During data collection, the need for further testing of these persons arise, so are performed the ultrasound of the abdomen and Color Doppler of the neck blood vessels. In experimental group 21 (14% of respondents) have changes in the neck blood vessels, which ranged from mild thickening of the intima of the vessel to a decrease in circulation by 50%. Only one respondent in the control group (0.66%) have changes in the blood vessels. In the experimental group 24 cases (16%) had by ultrasound verified fatty liver, while this problem was present in 3 members of the control group (2%).
5. DISCUSSION Evidently, the increase in the incidence of hyperlipidemia Figures 6. The individual display of HDL levels in serum for seven members in a relatively young population of police officers and clinical Figures 6. Theofindividual display of HDLHDL levels serum fortoseven members of the the control group (baseline in in serum: 1.06 1.94 mmol / l, ideal up control group (baseline HDL in serum: 1.06 to 1.94 mmol / l, ideal up to 1.40 mmol/l) features that are specific to the older age groups are phenomto 1.40 mmol/l) ena that considering their consequences must be perceived as serious threat to health. Occurrence makes more serious also 5,58 6 found in a number of respondents changes in the blood vessels 5,25 5,17 4,98 5,58 6 with threatening of CVI and IHD. Using the control of two, 5 5,25 4,4 4,35 5,17 4,32 4,98 for blood vessels diseases most essential components, cholesterol 5,58 56 4,4 4,35 4,32 5,25 4 5,17 4,98 and triglycerides has been shown that the two components are 45 4,4 4,35 4,32 3 a significantly higher and more frequent disorders in persons 34 of the same profession that lived during the war in surrounded 2 23 Sarajevo, in contrast to the control group of persons who in the 1 same period lived in other cities of Bosnia and Herzegovina. 12 0 Sibila1Sijarić – Voloder Researches of LDH and lactate among students in the events Autor: Dr. Mentor: Prof. Dr. Amir Pleho 0 1 2 3 4 5 6 7 of the war (7) confirmed that the stressors of the war initiated 1 2 3 4 5 6 7 0 1 2 3 4 5 6 7 change which caused disturbances at the cellular level and Control group Control group completed by the destruction of its membrane. This further Control group 7. display The individual of LDL levels in the serum of seven gureFigure 7. The7.individual of LDL levels ininthe of membersofofthe the control TheFigure individual display ofdisplay LDL levels theserum serum of seven seven members control suggests that it has led to a series of changes in various places Figure 7.(baseline The individual display of LDL levels in4.30 thein serum seven members of the control members of theLDL control (baseline serum:of2.00 to 4.30 mmol/l, (baseline in group serum: 2.00 mmol/l, ideal to mmol/l) groupgroup LDL in serum: 2.00 totoLDL 4.30 mmol/l, ideal to 3.80 3.80 mmol/l) within the body including metabolic changes, changes of the group LDL in serum: 2.00 to 4.30 mmol/l, ideal to 3.80 mmol/l) ideal (baseline to 3.80 mmol/l) lipid components metabolism. Metabolic disturbances must be linked to the closeness of morphofunctional units of the neuro24 30 endocrine system. This assertion is supported by a modification 24 30 24 30 21 25 21 21 of diabetes mellitus during the war in Sarajevo (8). Studies of 25 25 20 these authors have sought understanding of neuroendocrine 20 20 No. of 15 components during stress. No. of 15 No. of 15 patients patients Similar results as in our study with elevated hyperlipidemia 1010 22 patients 11 10 5 were given by researchers from Croatia, Kadojic et al. (9) on a 5 2 1 group of 120 people who survived the war and showed a greater 5 00 11 22 33 44 risk of stroke in the war exposed group compared to the unex0 Typeof offindigs findigs 1 2 3 4 Type posed group. Solter et al. in a group of veterans with PTSD also found Type of group findigsrespondents who have Figure 8. Display of the number of experimental significantly higher values of cholesterol, triglycerides, LDL been found abnormal clinical findings; 1-IHD, 2-stroke, 3-fat infiltrated Figure Display of the number of experimental group respondents who have been found cholesterol and HDL, as well as atherosclerotic index compared Figure 8.8.Display of the number of experimental group respondents who have been found liver, 4 -changes in neck blood vessels abnormal clinicalfindings; findings;1-IHD, 1-IHD, 2-stroke, 2-stroke, 3-fat 3-fat infiltrated blood abnormal clinical infiltratedliver, liver,44-changes -changesininneck neck blood to the control group. This proves that patients with PTSD have vesselsgroup respondents who have been found igure 8. Display of the number of experimental vessels a higher risk of atherosclerosis (10). 5 normal clinical findings; 1-IHD, 2-stroke, 3-fat infiltrated4 liver, 4 -changes in neck blood 5 Maia DB et al. (11) in a survey conducted on 118 Brazilian 4 vessels police officers noticed that the values o f cholesterol, triglycerides 4 4 5 are higher, but not the LDL in a group of police officers exposed 4 3 to potentially traumatic stress as compared to the control group 3 No.4of patients No. of patients of policemen. S. Coughlin in 2011 published a study which re2 1 2 1 ported that people with PTSD, and the population of veterans 3 1 0 0 are at increased risk of hypertension, hyperlipidemia, obesity No. of patients 1 0 0 2 and cardiovascular diseases. Increased activity of sympatho0 1 0 1 2 3 4 adrenal axis may contribute to cardiovascular disease through Type of findings 1 2 3 4 1 0 the effects of catecholamines on the heart, blood vessels, and 0 Type of findings Figure 9. Display of the number of members of the control group respondents platelet function (12). 0 in which was found pathological clinical findings; 1-IHD, 2-stroke, 3-fat Recent research in the world for solving the problem of the 1 3 4 infiltrated 4 -changes in neck2blood vessels Autor: Dr. liver, Sibila Sijarić – Voloder Mentor: Prof. Dr. Amir Pleho origin and already formed atherosclerotic lesions involving inType of findings LDL level
LDL level
LDL level
Control group
Autor: Dr. Sibila Sijarić – Voloder
Mentor: Prof. Dr. Amir Pleho
Mater Sociomed. 2014 Feb; 26(1): 17-20 • ORIGINAL PAPER Autor: Dr. Sibila Sijarić – Voloder
Mentor: Prof. Dr. Amir Pleho
19
Hyperlipidemia as a Risk Factor for Persons in Specific Professions
terdisciplinary teams of experts in different fields. Thus, modern engineering and mathematical methods can simulate blood flow through a blood vessel and determine the locus minoris for resistance and blood vessels on the basis of changes in blood viscosity and characteristics of the wall of the blood vessel as a highly elastic solid body. This method can calculate the velocity of the creation of atheromatous deposits (13). Moving the pathological findings in biological mechanisms towards younger age groups indicate the need for serious scientific control of the health of all persons who are still in working age to prevent the acceleration of health damage. Finding the size of the damage and by moving the person from the stressful situation would preempt the emergence of early stroke and IHD.
6. CONCLUSION ■■ The war led to changes in lipid status of persons employed at risk professions, such as police officers. ■■ A significant increase in the level of cholesterol and triglycerides in the blood serum of the policemen who have spent the entire war in Sarajevo (experimental), compared to the police officers who spent the war in other areas of Bosnia and Herzegovina (control group) is noticed. ■■ Increased levels of cholesterol and triglyceride levels in experimental compared to the control group was found not only in general, but when the same age subgroups, of 5 years, are compared. ■■ Significantly higher levels of LDL and decreased HDL levels of respondents require urgent resolution of any hyperlipidemia. CONFLICT OF INTEREST: NONE DECLARED.
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5.
6.
7.
8.
9.
10.
11.
REFERENCES 1.
2.
3.
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Postiglione A. Napoli C. Hyperlipidemia and atherosclerosis cerebrovascular disease. Curr Opin Lipidol. 1995 Aug; 6(4): 236-242. Miller M. Is hypertrigliceridaemia an independent risk factor for coronary heart disease, The epidemiologic evidence. Eur Heart J. 1998; Suppl H:H18-H22. Jeppsen J, Hein HO, Suadicani P, Gyntelberg F. Triglyceride Concentracion and Ishemic Heart Disease. An Eight-year
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Follow-up in the Copenhagen Male Study, Circulation. 1998: 97: 1209-1236. Hokanson JF, Austin M.A. Plasma triglyceride level is a risk factor for cardiovascular of high-density lipoprotein cholesterol level: a meta-analysis of population based prospective studies. J Cardiovasv Risk. 1996; 3: 213-219. Yeh PS, Yang CM, Lin SH, Wang WM, Chen PS, Chao TH, Lin HJ, Lin KC, Chang CY, Cheng TJ, Li YH. Low levels of highdensity lipoprotein cholesterol in patients with atherosclerotic stroke: a prospective cohort study. Atherosclerosis. 2013 Jun; 228(2): 472-427. doi: 10.1016/j.atherosclerosis.2013.03.015. Austin MA, McKnight B, Edwards KL, Bradley CM, McNeely M.J, Psaty BM, Brunzell JD, Motulsky AG. Cardiovascular disease mortality in familiar forms of hypertriglyceridemia: a 20-year prospectie study, Circulation. 2000: 101: 2777-27782. Winterhalter-Jadrić M, Radovanović J, Jadrić R, Nakaš-Ićindić E, Radnić D, Mujić M. Blood Level of Lactate dehydrogenase, creatine kinase and lactate in patients following post traumatic stress syndrome, Congress:Stress of Life, 1997; Budapest, Abstract book: 24-25. Avdibegovic E, Delic A, Hadžibeganovic K, Selimbasic Z. Somatic Diseases in Patients with Posttraumatic Stress Disorder. Med Ar. 2010; 64(3):154-157. Kadojić D, Demarin V, Kadojić M, Mihaljević I, Barac B. Influence of prolonged stress on risk factors for cerebrovascular disease. Coll Antropol. 1999 Jun; 23(1): 213-219. Solter V, Thaller V, Karlović D, Crnković D. Elevated serum lipids in veterans with combat-related chronic posttraumatic stress disorder. Croat Med J. 2002 Dec; 43(6): 685-689. Maia DB, Marmar CR, Mendlowicz MV, Metzler T, Nóbrega A, Peres MC, Coutinho ES, Volchan E, Figueira I. Abnormal serum lipid profile in Brazilian police officers with post-traumatic stress disorder. J Affect Disord. 2008 Apr; 107(1-3): 259-263. . Coughlin SS. Post-traumatic Stress Disorder and Cardiovascular Disease. Open Cardiovasc Med J. 2011; 5: 164-170. doi: 10.2174/1874192401105010164. Džaferović E. Interakcija viskoplastičnog fluida i viskoplastičnog čvrstog tijela – numeričko modeliranje, Doktorska disertacija. Mašinski fakultet Univerziteta u Sarajevu, Sarajevo, 2002: 23-70.
ORIGINAL PAPER • Mater Sociomed. 2014 Feb; 26(1): 17-20
DOI: 10.5455/msm.2014.26.17-20
Received: 11 November 2013; Accepted: 27 January 2014 © AVICENA 2014
ORIGINAL PAPER
Published online: Published print:
20/02/2014 02/2014
Mater Sociomed. 2014 Feb; 26(1): 17-20
Hyperlipidemia as a Risk Factor for Persons in Specific Professions Merita Tiric Campara1, Sibila Sijaric-Voloder2, Miro Denislic3, Emir Tupkovic4, Jasminka Djelilovic Vranic1, Azra Alajbegovic1 Neurology Clinic, Clinical Center of Sarajevo University, Sarajevo, Bosnia and Herzegovina1 Institute for Health Care of Ministry of Interior Affairs Employee of the Canton Sarajevo, Sarajevo, Bosnia and Herzegovina2 Faculty of medicine Ljubljana, Ljubljana, Slovenia3 Department of Neurophysiology, Primary Health Care Center Tuzla, Tuzla, Bosnia and Herzegovina4 Corresponding author: Merita Tiric Campara, MD. Neurology Clinic, Clinical Center of Sarajevo University, 71000 Sarajevo, Bosnia and Herzegovina. E-mail: [email protected]
ABSTRACT Introduction: The increase in lipid levels associated with other risk factors for the occurrence of ischemic heart disease and stroke is one of the most important health problems in the world. Risk for development of changes is greater for people of specific occupations such as police officers. Material and methods: This prospective study included 300 police officers, 150 as experimental and 150 respondents as a control group. To both groups same methods have been applied: A detailed history, physical examination, complete laboratory evaluation, lipid electrophoresis targeted to hypercholesterolemia, ultrasound of the abdomen and Color Doppler of the neck vascular structures. The results obtained by statistical analysis of the data showed that there was a significant increase in levels of cholesterol and triglyceride levels in experimental compared to the control group. Ultrasound of the abdomen showed fatty infiltrated liver in 16% of respondents from the experimental and 2% of the respondents in the control group 2%. Color Doppler of the neck blood vessels in 14% of respondents from experimental group showed changes in blood vessels, which ranged from mild thickening of the intima of the vessel to a 50% decrease in circulation. For the control group, this percentage was 0.66%. Considering that this study involved young, active working population, hyperlipidemia becomes a bigger problem. Key words: ischemic heart disease, stroke, hyperlipidemia.
1. INTRODUCTION Previous studies have shown that elevated levels of lowdensity lipoprotein (LDL-cholesterol) are associated with the accelerated development of atherosclerosis and ischemic heart disease (IHD), while its reduction reduces the overall coronary vulnerability of patients with already diagnosed IHD, significantly reduces mortality and improves quality of life. However, studies have also shown that more than 40% of the IHD patients do not have elevated levels of LDL–cholesterol (1). All this raises many questions about the importance of other factors in the development of atherosclerosis. Until a few years ago, many researchers have argued that triglycerides are an independent risk factor of heart and blood vessels diseases, but they are only indirectly associated with an increased risk of developing these diseases. Recent studies shed more light on the importance of triglycerides in IHD development (2). In Copenhagen epidemiological study (3) was demonstrated the association of triglycerides with heart disease. This study showed that the incidence of IHD is highest (approximately 14%) in patients with triglyceride levels at 2.5 mmol/l. The association of triglycerides with the occurrence of the IHD also showed meta-analysis that by multivariate analysis Mater Sociomed. 2014 Feb; 26(1): 17-20 • ORIGINAL PAPER
examined nearly 60,000 persons. The results provided by these studies show that in the case of an increase in the level of triglycerides by 1 mmol/l also increases the risk of IHD in men by 15% and in women by 37%. In the case of coexisting reduced HDL cholesterol level, the risk increases (4). Other epidemiological studies (5,6), confirmed these results and led to the inevitable conclusion that the need to treat hypertriglyceridemia exist regardless of the level of LDL and HDL. Very important id moderate triglicaeridemia (2-5 mmol/l) for the development of atherosclerotic changes, while increasing levels of TG above 8 mmol/l represents danger for the development of pancreatitis.
2. GOAL The goal of this study was to determine how lipid component behaves after a certain time distance after effects of multifactorial war stress, in the postwar period among the workers of specific professions, such as members of the police department. One of the goals of this work is, if it proves the presence of hyperlipidemia in this group of working and young population, to emphasize the necessity for action in preventing hyperlipidemia by introducing among other things, mandatory periodic routine control of lipid levels, especially in high-risk populations.
17
Hyperlipidemia as a Risk Factor for Persons in Specific Professions
HDL level
SCL-90-R
Mean values of the responses of MeanSCL-90-R values of the responses of
3. MATERIAL AND METHODS sclerosis and subsequent morbidity from ischemic heart disease Figure 2. Mean triglyceride levels in the blood at experimental group for each By its nature, this is a prospective study, which processed and cerebrovascular insult. Associated with otherand riskcontrol factors, Figure 2. Mean triglyceride levels in the blood experimental and control group for each ageatgroup age group only healthy respondents by method of random sampling. In triglycerides increase the risk of these serious diseases, which this research are used descriptive methods. Due to the ethical in best case scenario lead to permanent disability (Figures principles every respondents in both experimental and control 1,2,3,4,5,6,7,8,9). group in which the hyperlipidemia is noticed was referred for 27,92 30 27,92 30 further treatment, but these results are beyond the purpose of 25 20,38 25 this study and are not taken into consideration. 20 20,38 13,18 15,61 20 15 The study included 300 employees of Ministry of Internal 13,18 15,61 Affairs of Federation of Bosnia and Herzegovina belonging to 15 10 the group of the working age population 39-56 years old. They 10 5 all stayed during the war in Bosnia and Herzegovina and were 0 e study Bosnia and1956-1960 he study included included 300 300 employees employees of of Ministry of Internal Affairs of Federation of Bosnia 5 and 1961-1965 1966-1970 1971-1973 military engaged. Due to the specifics of their work this is a Age groups erzegovina old. They They all erzegovina belonging belonging to to the the group group of the working age population 39-56 years old. all 0 Experimental Control physically population. Participants in the study yed during war Bosnia and and were military Due to to the the ayed during the theyoung, war in in Bosnia active and Herzegovina engaged. Due 1956-1960 1961-1965 1966-1970 1971-1973 Age groups were divided into two groups: respondents (who lived during ecifics the study study ecifics of of their their work work this this is is aa young, young, physically active population. Participants in the Experimental Control war in Sarajevo) and control (those who during the Figureand ere two groups: respondents (who group lived during and control ere divided divided into intothe two groups: respondents the war in Sarajevo) control 3. Mean total score on the SCL-90-R test for experimental and the control group for each age group. oup (those (those who whowar during theinwar war stayed oup during the stayed parts of the country). stayed other partsinofother the country). Figure 3. Mean total score on the SCL-90-R test for experimental and the ll were treated treated in inAll thewere sametreated manner: taken,history physical control examination, l were the same manner: a detailed history awas examination, in the same manner: detailed group for each age group. Figure 3. Mean total score omplete laboratory evaluation with the lipid evaluacomponent, targeted at mplete laboratory evaluation with special reference to laboratory targeted at on the SCL-90-R test for experimental and the control group for was taken, physical examination, complete each age group. ypercholesterolemia lipidspecial electrophoresis, andatColor Doppler percholesterolemia lipid electrophoresis, of the abdomen Doppler of of tion with reference toultrasound the lipid component, targeted eck vascular structures structures in case of dyslipidemia. analysis of the data obtained was ck vascular in case of dyslipidemia. Statistical obtained was hypercholesterolemia lipid electrophoresis, ultrasound of the 2 1,77 erformed using the the Student's Student's t-test, rformed using and ANOVA. 1,8 abdomen andt-test, ColorF-test Doppler of neck vascular structures in 1,6 1,47 case of dyslipidemia. Statistical analysis of the data obtained 1,34 1,2 1,4 1,26 1,05 1,08 1,21 . RESULTS RESULTSwas performed using the Student’s t-test, F-test and ANOVA. 1,18 1,02 1,2 1,07 1,05 1,04 1,04 1,03 1,01 2
1
0,98
0,98
0,92
0,85
1,77 0,75 0,7 atistical analysis analysis of the the data data obtained obtained showed significantly higher levels of cholesterol and 1,8 0,8 atistical of cholesterol and 4. RESULTS 0,56 0,6 glycerides in in experimental experimental compared compared the control group. 1,6 1,47 glycerides Statistical analysis ofto the data obtained showed significantly 0,4 1,34 1,2 ecent studies in in the the world world are are increasingly dealing with issues of triglycerides as an 1,4 cent studies triglycerides as an 1,26 1,05 1,08 1,21 0,2 higher levels of cholesterol and triglycerides in experimental 1,18 1,02 dependent risk risk factor factor for for atherosclerosis atherosclerosis and subsequent morbidity from ischemic heart 1,2 0 1,07 dependent ischemic heart 1,05 1,04 1,04 1,03 1,01 0,98 0,98 compared to the control group. 1 2 3 4 0,92 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 sease and and cerebrovascular cerebrovascular insult. insult. Associated with other risk factors, triglycerides 1 increase sease triglycerides increase 0,85 0,8 Experimental group 0,79 Recent studies in the world are increasingly dealing with 0,75 0,7 risk of of these these serious serious diseases, diseases, which which in best case scenario lead to permanent disability. 0,8 eerisk disability. 0,56 issues of triglycerides as an independent risk factor for athero- Figure 4. The individual levels of HDL in serum of 25 respondents from 0,6 0,79
HDL level
0,8
66
Cholesterol Cholesterolmean meanvalue value
55
Figure 4. The individual levels of HDL in serum of 25 respondents from experimental group experimental (baseline HDL in serum: mmol/l, ideal up 0,4 (baselinegroup HDL in serum: 1.06 to 1.94 mmol/l,1.06 idealtoup1.94 to 1.40 mmol/l)
5,67 5,67 5,24 5,24
5,09 4,86 5,09 4,86
4,81 4,81
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to0,21.40 mmol/l) 0
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Mentor:group Prof. Dr. Amir Pleho Experimental
4,9
5,92
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5,15 4,98
LDL level
4,6 4,46 4,4 5 4,35 Figure 4. The individual levels of 4,42 HDL in serum of4,325 respondents from experimental group 4 (baseline HDL in serum: 1.06 to 1.94 mmol/l, ideal up to 1.40 mmol/l)
22 11 00
1
7,8 Dr. Sibila Sijarić – Voloder 9 Autor: 7,6 8 7,28
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Autor: Dr. Sibila Sijarić – Voloder
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Mentor: Prof. Dr. Amir Pleho
Figure 5. The individual display of LDL levels in the serum of 25 Figure 5. The individual display of LDL levels in the serum of 25 respondents from respondents from experimental LDL inup serum: to 4.30 group (baseline LDL in serum:group 2.00 to(baseline 4.30 mmol/l, ideal to 3.802.00 mmol/l) Figure 1. Mean blood cholesterol for experimental and the control group forexperimental igure 1. 1. Mean Mean blood blood cholesterol cholesterol for for experimental experimental and and the the control control group for each age group mmol/l, ideal up to 3.80 mmol/l) igure group for each age group each age group
Autor: Dr. Sibila Sijarić – Voloder
18
HDL level
Srednja Srednjavrijednost vrijednosttriglicerida triglicerida
Mean values for age subgroups of five years indicate that the 1,6 largest deviations are recorded for those born in period 19661,36 3 1,4 2,66 3 1,18 2,66 1,12 and triglyceride. Both groups with 1970 both for cholesterol 1,2 1,09 1,02 1,01 2,5 2,15 2,5 2,15 1,99 elevated1cholesterol underwent additional0,96lipid electrophore1,89 1,99 1,89 2 0,8 2 sis, which revealed elevated levels of LDL levels in 24 (16%) 0,6 1,5 respondents and decreased levels of HDL in 16 (10.6%) cases. 1,5 0,4 1 In the control group, elevated LDL was found in 7 (4.66%), and 0,2 1 0 HDL in 3 (2%) members of this group. decreased 0,5 0,5 1 2 3 4 5 6 7 Decreased HDL with increased triglyceride levels further increase 0 Control group 0 1956-1960 1961-1965 1966-1970 1971-1973 the risk of ischemic heart disease. If we consider that in this research the 1956-1960 1961-1965 1966-1970 1971-1973 Age groups respondents are relatively young working active male population, aged Age groups Experimental Control Figures 6. The individual display of HDL levels in serum for seven members of the control Experimental Control 39-56 years HDL of life, dealing specific which means that group (baseline in serum: 1.06with to 1.94 mmol / l,profession, ideal up to 1.40 mmol/l) Figure 2. Mean triglyceride levels in the blood at experimental and control they are under constant stress of work, the results of this study suggest group for each age group Autor: Dr. Sibila Sijarić – Voloder Mentor: Prof. Dr. Amir Pleho the need for serious and effective care for people with these changes. Mentor: Prof. Dr. Amir Pleho
ORIGINAL PAPER • Mater Sociomed. 2014 Feb; 26(1): 17-20
xperimental group
Figure 5. The individual display of LDL levels in the serum of 25 respondents from experimental group (baseline LDL in serum: 2.00 to 4.30 mmol/l, ideal up to 3.80 mmol/l)Hyperlipidemia as a Risk Factor for Persons in Specific Professions
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During data collection, the need for further testing of these persons arise, so are performed the ultrasound of the abdomen and Color Doppler of the neck blood vessels. In experimental group 21 (14% of respondents) have changes in the neck blood vessels, which ranged from mild thickening of the intima of the vessel to a decrease in circulation by 50%. Only one respondent in the control group (0.66%) have changes in the blood vessels. In the experimental group 24 cases (16%) had by ultrasound verified fatty liver, while this problem was present in 3 members of the control group (2%).
5. DISCUSSION Evidently, the increase in the incidence of hyperlipidemia Figures 6. The individual display of HDL levels in serum for seven members in a relatively young population of police officers and clinical Figures 6. Theofindividual display of HDLHDL levels serum fortoseven members of the the control group (baseline in in serum: 1.06 1.94 mmol / l, ideal up control group (baseline HDL in serum: 1.06 to 1.94 mmol / l, ideal up to 1.40 mmol/l) features that are specific to the older age groups are phenomto 1.40 mmol/l) ena that considering their consequences must be perceived as serious threat to health. Occurrence makes more serious also 5,58 6 found in a number of respondents changes in the blood vessels 5,25 5,17 4,98 5,58 6 with threatening of CVI and IHD. Using the control of two, 5 5,25 4,4 4,35 5,17 4,32 4,98 for blood vessels diseases most essential components, cholesterol 5,58 56 4,4 4,35 4,32 5,25 4 5,17 4,98 and triglycerides has been shown that the two components are 45 4,4 4,35 4,32 3 a significantly higher and more frequent disorders in persons 34 of the same profession that lived during the war in surrounded 2 23 Sarajevo, in contrast to the control group of persons who in the 1 same period lived in other cities of Bosnia and Herzegovina. 12 0 Sibila1Sijarić – Voloder Researches of LDH and lactate among students in the events Autor: Dr. Mentor: Prof. Dr. Amir Pleho 0 1 2 3 4 5 6 7 of the war (7) confirmed that the stressors of the war initiated 1 2 3 4 5 6 7 0 1 2 3 4 5 6 7 change which caused disturbances at the cellular level and Control group Control group completed by the destruction of its membrane. This further Control group 7. display The individual of LDL levels in the serum of seven gureFigure 7. The7.individual of LDL levels ininthe of membersofofthe the control TheFigure individual display ofdisplay LDL levels theserum serum of seven seven members control suggests that it has led to a series of changes in various places Figure 7.(baseline The individual display of LDL levels in4.30 thein serum seven members of the control members of theLDL control (baseline serum:of2.00 to 4.30 mmol/l, (baseline in group serum: 2.00 mmol/l, ideal to mmol/l) groupgroup LDL in serum: 2.00 totoLDL 4.30 mmol/l, ideal to 3.80 3.80 mmol/l) within the body including metabolic changes, changes of the group LDL in serum: 2.00 to 4.30 mmol/l, ideal to 3.80 mmol/l) ideal (baseline to 3.80 mmol/l) lipid components metabolism. Metabolic disturbances must be linked to the closeness of morphofunctional units of the neuro24 30 endocrine system. This assertion is supported by a modification 24 30 24 30 21 25 21 21 of diabetes mellitus during the war in Sarajevo (8). Studies of 25 25 20 these authors have sought understanding of neuroendocrine 20 20 No. of 15 components during stress. No. of 15 No. of 15 patients patients Similar results as in our study with elevated hyperlipidemia 1010 22 patients 11 10 5 were given by researchers from Croatia, Kadojic et al. (9) on a 5 2 1 group of 120 people who survived the war and showed a greater 5 00 11 22 33 44 risk of stroke in the war exposed group compared to the unex0 Typeof offindigs findigs 1 2 3 4 Type posed group. Solter et al. in a group of veterans with PTSD also found Type of group findigsrespondents who have Figure 8. Display of the number of experimental significantly higher values of cholesterol, triglycerides, LDL been found abnormal clinical findings; 1-IHD, 2-stroke, 3-fat infiltrated Figure Display of the number of experimental group respondents who have been found cholesterol and HDL, as well as atherosclerotic index compared Figure 8.8.Display of the number of experimental group respondents who have been found liver, 4 -changes in neck blood vessels abnormal clinicalfindings; findings;1-IHD, 1-IHD, 2-stroke, 2-stroke, 3-fat 3-fat infiltrated blood abnormal clinical infiltratedliver, liver,44-changes -changesininneck neck blood to the control group. This proves that patients with PTSD have vesselsgroup respondents who have been found igure 8. Display of the number of experimental vessels a higher risk of atherosclerosis (10). 5 normal clinical findings; 1-IHD, 2-stroke, 3-fat infiltrated4 liver, 4 -changes in neck blood 5 Maia DB et al. (11) in a survey conducted on 118 Brazilian 4 vessels police officers noticed that the values o f cholesterol, triglycerides 4 4 5 are higher, but not the LDL in a group of police officers exposed 4 3 to potentially traumatic stress as compared to the control group 3 No.4of patients No. of patients of policemen. S. Coughlin in 2011 published a study which re2 1 2 1 ported that people with PTSD, and the population of veterans 3 1 0 0 are at increased risk of hypertension, hyperlipidemia, obesity No. of patients 1 0 0 2 and cardiovascular diseases. Increased activity of sympatho0 1 0 1 2 3 4 adrenal axis may contribute to cardiovascular disease through Type of findings 1 2 3 4 1 0 the effects of catecholamines on the heart, blood vessels, and 0 Type of findings Figure 9. Display of the number of members of the control group respondents platelet function (12). 0 in which was found pathological clinical findings; 1-IHD, 2-stroke, 3-fat Recent research in the world for solving the problem of the 1 3 4 infiltrated 4 -changes in neck2blood vessels Autor: Dr. liver, Sibila Sijarić – Voloder Mentor: Prof. Dr. Amir Pleho origin and already formed atherosclerotic lesions involving inType of findings LDL level
LDL level
LDL level
Control group
Autor: Dr. Sibila Sijarić – Voloder
Mentor: Prof. Dr. Amir Pleho
Mater Sociomed. 2014 Feb; 26(1): 17-20 • ORIGINAL PAPER Autor: Dr. Sibila Sijarić – Voloder
Mentor: Prof. Dr. Amir Pleho
19
Hyperlipidemia as a Risk Factor for Persons in Specific Professions
terdisciplinary teams of experts in different fields. Thus, modern engineering and mathematical methods can simulate blood flow through a blood vessel and determine the locus minoris for resistance and blood vessels on the basis of changes in blood viscosity and characteristics of the wall of the blood vessel as a highly elastic solid body. This method can calculate the velocity of the creation of atheromatous deposits (13). Moving the pathological findings in biological mechanisms towards younger age groups indicate the need for serious scientific control of the health of all persons who are still in working age to prevent the acceleration of health damage. Finding the size of the damage and by moving the person from the stressful situation would preempt the emergence of early stroke and IHD.
6. CONCLUSION ■■ The war led to changes in lipid status of persons employed at risk professions, such as police officers. ■■ A significant increase in the level of cholesterol and triglycerides in the blood serum of the policemen who have spent the entire war in Sarajevo (experimental), compared to the police officers who spent the war in other areas of Bosnia and Herzegovina (control group) is noticed. ■■ Increased levels of cholesterol and triglyceride levels in experimental compared to the control group was found not only in general, but when the same age subgroups, of 5 years, are compared. ■■ Significantly higher levels of LDL and decreased HDL levels of respondents require urgent resolution of any hyperlipidemia. CONFLICT OF INTEREST: NONE DECLARED.
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