ORIGINAL ARTICLE

Journal of Evolution of Medical and Dental Sciences/Volume1/Issue5/November-2012a!e-""2

A HOSPITAL BASED STUDY ON LIPID PROFILE IN SMOKERS AND NON
SMOKERS- A COMPARATIVE STUDY
#fro$ #fs%an& Man'us%ree Su!oor& I( #mruta S)ati& *evansidda++a , atil

1( #ssistant rofessor& De+artment of %-siolo!-& .onaseema Institute of Medical Sciences& #mala+uram(
2( #ssistant rofessor& De+artment of ,ioc%emistr-& .,NIMS& /ulbar!a(
0( #ssociate rofessor& De+artment of 1ommunit- Medicine& .,NIMS& /ulbar!a(
2( #ssociate rofessor& De+artment of %-siolo!-& M( * Medical 1olle!e& /ulbar!a(

CORRESPONDING AUTHOR
Dr( #fro$ #fs%an(
Sofi residence&
3( No 5-440-22"/#( Near Ne) 1%ildren ar5& Mecca 1olon-
*in! *oad& /ulbar!a-565102 7.arnata5a8
E-mail9 drafro$afs%an:!mail(com&
%9 0041 4014014222(

ABSTRACT: BACKGROUND: Smo5in! is one of t%e environmental factors )%ic% can alter
normal li+id +rofile( It is one of t%e ma'or ris5 factors in t%e !enesis of coronar- at%erosclerosis
and develo+ment of coronar- %eart disease( AIMS: ;o evaluate and com+are t%e li+id +rofile in
bot% !rou+s and to evaluate t%e e<istence of dose de+endent relations%i+ and durational
si!nificance bet)een smo5in! and li+id +rofile amon! smo5ers( SETTINGS AND DESIGN: =ut of
100 a++arentl- %ealt%- male sub'ects of a!e !rou+ 21-20-rs& 50 )ere smo5ers and 50 )ere non
smo5ers( #ll t%e sub'ects )ere non alco%olic& non >obese& normotensives and from same
socioeconomic status( Sub'ects )%o smo5e more t%an e?ual 10 ci!arettes for more t%an 2 -ears
)ere considered as smo5ers !rou+( METHODS AND MATERIAL: ;%e sub'ects )ere as5ed to
fast overni!%t and earl- mornin! blood sam+les collected and anal-$ed for li+id +rofile b-
a++ro+riate met%ods( STATISTICAL ANALYSIS USED: ;%e student@s un+aired AtB test )as used
for statistical anal-sis( -value of C 0(05 or value C0(01 )as considered statisticall- si!nificant(
RESULTS: In our stud- )e found serum ;1& ;/& DDD and VDDD )ere %i!%er in smo5ers as
com+ared to non smo5ers and t%e serum 3DD level )as si!nificantl- decreased in smo5ers
com+ared to non smo5ers s%o)in! !reater ris5 of t%ese +ersons to at%erosclerosis and
coronar- %eart disease(
1onclusions9 - Ee conclude our stud- )it% t%e observation t%at smo5in! causes alteration in
li+id +rofile( Increased amount and duration of smo5in! causes more d-sli+idaemia (;%is
alteration in serum li+id levels increases ris5 for coronar- arter- disease(
KEY WORDS: 1i!arette Smo5in!& 1oronar- 3eart Disease& D-sli+idaemia& Di+id +rofile and
;obacco(

INTRODUCTION: Smo5in! is !enerall- considered to be associated )it% increased ris5 of a
variet- of medical disorders( Diet and environmental factors influence t%e li+id +rofile( Smo5in!
is one of t%e environmental factors )%ic% can alter normal li+id +rofile and several studies
+rovide t%e evidence t%at tobacco is stron!l- associated )it% alterin! t%e normal status of t%e
li+id +rofile( ;obacco smo5in! is one of t%e lar!est sin!le +reventable causes of ill %ealt% in t%e
)orld(
1
eo+le smo5e for man- reasons li5e for relievin! stress& for en'o-ment& social
reinforcement etc( Fsuall- smo5in! starts )it% a curiosit- to 5no) %o) it feels at a tender a!e of
ORIGINAL ARTICLE

Journal of Evolution of Medical and Dental Sciences/Volume1/Issue5/November-2012a!e-""0

12-12 -ears( .essler
2
defined smo5in! as a Aediatric DiseaseB( ;%e +revalence of smo5in! %as
reac%ed its +ea5 amon! teena!ers(
;eena!ers are not a)are of %armful effects of smo5in!( Smo5in! +arents& attractive
smo5in! and tobacco c%e)in! advertisements& un%ealt%- bets on ma<imum smo5in! c%allen!es&
inade?uate le!islation to control smo5in! %ave made t%e teena!e smo5ers to become adult
c%ronic smo5ers( #ll t%ese factors %ave contributed tobacco smo5in! as a ma'or factor of
+reventable cardiovascular and res+irator- morbidit- and mortalit-( *elations%i+ of 1oronar-
3eart Disease 713D8 and smo5in! )as first develo+ed b- E%ite et al(
0
and Doll et al(
2
Incidence
of develo+in! 13D is directl- related to t%e number of ci!arettes smo5ed( Sudden deat% is 2-2
times more in %eav- smo5ers t%an in non smo5ers(
5
It %as been su!!ested t%at ci!arettes )%en
consumed more t%an 10 +er da- on re!ular constitute a ma'or ris5 factor for 13D(
"

;%is stud- )as carried out to assess t%e im+act of active tobacco smo5in! on li+id +rofile
and to com+are t%e effect of smo5in! in a++arentl- %ealt%- adult male smo5ers and non-
smo5ers(

AIMS:
1( ;o evaluate and com+are t%e li+id +rofile in bot% smo5ers and non-smo5ers(
2( ;o evaluate t%e e<istence of dose de+endent relations%i+ and durational si!nificance
bet)een smo5in! and li+id +rofile amon! smo5ers(

MATERIALS AND METHODS: ;%is stud- )as conducted in t%e De+artment of %-siolo!- and
,ioc%emistr-& M(*(M(1( and ,asaves%)ar teac%in! %os+ital /ulbar!a& after obtainin! t%e
+ermission of t%e Et%ical committee of our institution( ;%e +resent stud- includes a++arentl-
%ealt%- male sub'ects in t%e a!e !rou+ of 21>20 -ears of /ulbar!a cit-( #ll t%e sub'ects !ave t%e
informed consent( ;%e inclusion criteria of stud- sub'ects includes Non Smo5ers Gcontrol !rou+&
nH50I non alco%olic& non smo5ers& non-obese and Smo5ers !rou+ GnH50I& sub'ects )%o smo5e
more t%an 10 ci!arettes for more t%an 2 -ears and non-alco%olic sub'ects( ;%e e<clusion criteria
of our stud- includes sub'ects belo) 21-rs and above 20-rs of a!e& obese& +ersons )it% an!ina&
diabetics& alco%olics& sub'ects )it% renal failure& %e+atic failure and females e<cluded from t%e
stud- as female smo5ers are almost non-e<istent in our area( #ll sub'ects )ere of same
socioeconomic status( Detailed %istor-& name& a!e& se<& occu+ation& +ersonal %istor- and
+ersonal %abits of t%e sub'ects )ere ta5en( Smo5in! %istor- )as ta5en in detail( Jamil- %istor-
of %-+ertension& diabetes and obesit- )ere en?uired( ;%ese )ere noted in a +ersonal erforma
and +arameters concerned )it% t%e stud- )ere recorded( ;%e li+id +rofile +arameters include
serum ;otal 1%olesterol G;1I& ;ri!l-cerides G;/I& Do) Densit- Di+o+roteins GDDDI& 3i!% Densit-
Di+o+roteins G3DDI and Ver- Do) Densit- Di+o+roteins GVDDDI(
;%e sub'ects )ere as5ed to fast overni!%t and earl- mornin! blood sam+le from t%e
antecubital vein of eac% sub'ect G5 ml bloodI )as collected under all ase+tic +recautions(
Sam+les )ere +rocessed )it%in 1 %our for ?uantitative li+o+rotein c%olesterol measurements
usin! t%e vertical s+in ultracentrifu!ation tec%ni?ue( Serum )as obtained b- centrifu!ation for
2 min at 0000 r+m and )as t%en transferred into +ro+erl- labeled sterile vials and stored at -
20K1 till t%e +erformance of li+id +rofile( Serum ;1 )as measured b- 13=D-# met%od
L
&
serum ;/ b- /= -;*INDE* met%od
6
and 3DD-1 tests b- %os+%otun!stic #cid met%od
4

)%ereas DDD-1 and VDDD-1 )as determined b- calculation met%od(
10
#ll t%e tests )ere done on
E*,# 1%em-L semi autoanal-ser )it% in 1 %our after collection of sam+le in bioc%emistr-
laborator- at ,asaves%)ar ;eac%in! and /eneral 3os+ital(
ORIGINAL ARTICLE

Journal of Evolution of Medical and Dental Sciences/Volume1/Issue5/November-2012a!e-""2

;%e student@s un+aired AtB test )as used for statistical anal-sis( -value less t%an 0(05 or
value less t%an 0(01 )as considered statisticall- si!nificant(

RESULTS: In our stud- out of 50 smo5ers and 50 non smo5ers 22M )ere in t%e a!e !rou+ of
21to 00 -ears and 5"M )ere in t%e a!e !rou+ of 01 to 20 -ears( =ut of 50 smo5ers 20 72"M8
smo5ers )ere smo5in! 10 ci!arettes +er da- and 2L752M8 smo5in! more t%an 10 ci!arettes +er
da-( Ma'orit- i(e( 027"2M8 of smo5ers )ere smo5in! for more t%an 5 -ears duration and
1670"M8 smo5in! for less t%an 5-rs(
;able 1 de+icts t%e a!e )ise distribution of sub'ects in bot% smo5ers !rou+ and non
smo5ers !rou+ )it% mean a!e distribution of 24(15N 5(41 and 00(6 N 5(15 -ears( ;%is table
reveals t%at ma'orit- "6M of smo5ers )ere in t%e a!e !rou+ of 01-20 -ears(
;able 2 s%o)s t%e com+arison of li+id +rofile in bot% smo5ers !rou+ and non smo5ers
!rou+( # si!nificant 7C 0(0058 rise of li+id +rofile i(e( ;otal 1%olesterol& Serum ;ri!l-cerides&
Do) densit- li+o+roteins and Ver- lo) densit- li+o+roteins )as observed amon! smo5ers
!rou+ t%an t%eir control !rou+( =n t%e ot%er %and no si!nificant rise of li+id +rofile )as
observed amon! non smo5ers( 3DD )as decreased in smo5ers !rou+ com+ared to non smo5ersO
t%is decrease )as statisticall- si!nificant )it% + value C 0(005(
;able 0 indicates t%at t%e number of total ci!arettes smo5ed +er da- %as a si!nificant
im+act on li+id +rofile as mean ;otal c%olesterol& ;ri!l-cerides& DDD& VDDD )ere %i!%er in
smo5ers )%o smo5e more t%an 10 ci!arettes +er da- in com+arison to t%ose )%o smo5e 10
ci!arettes +er da- ( ;%is observed difference is statisticall- %i!%l- si!nificant )it% +C0(001 and
C0(005 res+ectivel- for DDD and ;otal c%olesterol( 3DD level )as lo)er in sub'ects )%o )ere
smo5in! more t%an 10 ci!arettes +er da-(
;%e ;able 2 reveals t%at duration of smo5in! in -ears %as an im+act on li+id +rofile as
;otal c%olesterol 7220m!/dl8& ;ri!l-cerides 7165m!/dl8& and DDD 71"1m!/dl8 )ere %i!% amon!
smo5ers )%o )ere smo5in! for more t%an 5 -ears in com+arison to smo5ers of less t%an 5
-ears of duration Eit% C 0(001& 0(01and 0(05 res+ectivel-(3DD level )as si!nificantl- lo)er
00(5N0 amon! smo5ers smo5in! for more t%an 5 -ears in contrast to t%ose smo5in! for less
t%an 5-ears of duration i(e( 3DD 04(LN 2 )it% C0(05(

DISCUSSION AND CONCLUSION: ;obacco smo5e contains man- constituentsO nicotine is one of
t%e main constituents( Nicotine and ot%er to<ic substances from tobacco smo5e are absorbed
t%rou!% t%e lun!s into t%e blood stream and are circulated t%rou!%out t%e bod-( ;%ese
substances narro) or dama!e t%e blood vessel )allsO %ence +la?ues form at a faster rate in
smo5ers(
11
;%ere is definite relations%i+ bet)een tobacco use and at%erosclerosis( ;%erefore
even modest ci!arette smo5in! durin! adolescence and earl- adult%ood adversel- alters t%e
serum li+id and li+o+rotein levels(
712& 10& 128

Ee conducted t%is stud- to assess t%e im+act of smo5in! on li+id +rofile( In our stud- all
sub'ects in bot% smo5ers and non smo5ers !rou+ )ere a++arentl- %ealt%- adult males )%o
)ere non-diabetic& non-alco%olic and normotensives( In our stud- Serum ;1& ;/& DDD and VDDD
)ere si!nificantl- %i!%er in smo5ers as com+ared to non-smo5ers and t%e serum 3DD level )as
si!nificantl- lo)er in smo5ers as com+ared to non-smo5ers(
=ur findin!s are in accordance )it% t%e findin!s of man- researc% )or5ers( ;%e c%an!e
in t%e serum li+o+rotein levels became more mar5ed )it% t%e number of ci!arettes smo5ed +er
da- and duration of smo5in! in -ears( ;%is findin! %as been substantiated b- N S Ne5i(
15

1ontrar- to t%e above findin!s Diricana M et al did not find si!nificant differences in serum ;1&
ORIGINAL ARTICLE

Journal of Evolution of Medical and Dental Sciences/Volume1/Issue5/November-2012a!e-""5

;/& DDD 3DD levels bet)een smo5ers and nonsmo5ers(
1"
Nes'e D# et al also found no si!nificant
difference bet)een smo5ers and non-smo5ers concernin! tri!l-cerides and total c%olesterol(
1L

D-sli+idemia is a )ell-establis%ed ris5 factor for t%e develo+ment of coronar- arter- disease(
=ur stud- demonstrated +resence of d-sli+idemia in c%ronic smo5ers(
Increased levels of ;ri!l-cerides& ;otal c%olesterol& DDD& VDDD and lo)er 3DD in
smo5ers +oints to coronar- arter- disease( 3DD is an anti-at%ero!enic substanceO its fall raises
cardiovascular disease( ;%e ra+id reduction of its ris5 after cessation of smo5in! im+lies t%at
tobacco en%ances t%rombosis and contributes in formation of at%erosclerotic +la?ue( ;%e %ealt%
benefits of smo5in! cessation occur faster for cardiovascular diseases com+ared to ot%er
conditions(
Ee conclude our stud- )it% t%e observation t%at smo5in! causes d-sli+idemia(
Increased amount and duration of smo5in! also en%ances t%is condition (;%is d-sli+idemic state
is an increased ris5 for coronar- arter- disease(
#s statistical anal-sis )ere de+endent on t%e accurac- of self re+orted smo5in! %abits
and a!e t%is could limit si!nificance of t%e result( ;%e result of our stud- cannot be !enerali$ed
at t%is sta!e to t%e entire +o+ulation because of small sam+le si$e and local !eo!ra+%ical
re+resentation(
;%e +olicies t%at +revent and reduce smo5in! )ill %ave immediate and lar!e benefits for
reducin! cardiovascular mortalit-(
16
1reatin! a)areness re!ardin! %ealt% conse?uences of
smo5in! in sc%ools and colle!es b- establis%ment of mandator- +ublic %ealt% education and
ot%er antismo5in! advice s%ould be made an im+ortant +art of +ublic %ealt% s-stem(

ACKNOWLEDGEMENT: ;%is researc% +a+er is made +ossible b- t%e su++ort from t%e
+artici+ants of our stud-( Ee dedicate our ac5no)led!ment of !ratitude to)ards
Dr( *as%mi( 1( / as s%e 5indl- read our +a+er and offered valuable detailed advices on !rammar&
or!ani$ation& and t%eme of t%e +a+er( Jinall-& )e sincerel- t%an5 almi!%t-& famil- and friends&
)%o +rovided financial su++ort and timel- advice(

REFERENCES:

1( 7E3=8 Eorld 3ealt% =r!ani$ation 714608( 1%ronicle 0L9 6"-40(
2( .essler D#& Natanblut SD& Eil5enfeld J& Dorraine 11& Ma-l SD& ,ernstein I,/ 7144L8(
Nicotine addiction9 a +ediatric disease( J( ediatr( 1009 516-522(
0( E%ite& (DO 1oronar- disease P coronar- t%rombosis in -out%( J(Med( Soc( J( 14059029 54"-
"05
2( Doll& *& P 3ill& #(,( Mortalit- in relation to smo5in!( ,r(Med( J( 14"29 ii9 044-220(
5( Stanler& J(Eent)ort% D( Is t%e relations%i+ bet)een serum c%olesterol P ris5 of +remature
deat% from coronar- %eart disease continuous P !radedQ J#M# 146"9 25"92620-26(
"( /arrison& *(J( .annel& E(,( 1i!arette smo5in! P 3DD c%olesterol( #t%erosclerosis9 14L49
00&1L(
L( *oesc%alu ,ernt E and /ruber E # 1lin ,ioc%em 14L2O 12722"8(
6( Mc /o)an& M (E etal(1lin(1%em& 1466 O249506(
4( ,urstein M( Sc%olnic 3*&Morfin *(J Di+id *es&14L0(
10( 1arl(#(,urtis& Ed)ard #s%)ood& 1ardiac function teit$ ;e<tboo5 of clinical ,ioc%emistr- and
molecular Dia!nosticO 2
t%
editionO Saunders +ublications9 1"14-1""0(
ORIGINAL ARTICLE

Journal of Evolution of Medical and Dental Sciences/Volume1/Issue5/November-2012a!e-"""

11( Mitc%ell , 714448( ;obacco use and cessation9 ;%e adverse %ealt% effects of tobacco and
;obacco-*elated roducts( rimar- 1are9 1lin( =ffice ract(& 2"9 2"0-246(
12( /luec5 1J& 3eiss /& Morrison J#& .%our- & Moore M 714618( #lco%ol inta5e& ci!arette
smo5in! and +lasma li+ids and li+o+roteins in 12-14 -ear c%ildren( 1irculation "29 26-5"(
10( Jreedman DS& Srinivasan S*& S%ear 1D& 3unter SM& 1roft J,& Eebber DS 7146"8( 1i!arette
smo5in! initiation and lon!itudinal c%an!es in serum li+ids and li+o+roteins in earl-
adult%ood9 ;%e ,o!alusa 3eart Stud-( #m( J( E+idemiol( 1229 20L-214(
12( 1rai! ER& aloma5i /E& Jo%nson #M& 3addo) JE714408( 1i!arette smo5in!-associated
c%an!es in blood li+id and li+o+rotein levels in t%e 6- to 14--ear-old a!e !rou+9 a meta-
anal-sis( ediatr( 659 155-156(
15( Ne5i NS( Di+id +rofile in c%ronic smo5ers-# clinical Stud-( JI#1MO 0951-2&720028
1"( Dirican M & Sarandol E & Flu5a-a E& ;o5ullu!il 3#( Effects of smo5in! on Serum li+id and
li+o+roteinconcentrations and lecit%in9 c%olesterolac-ltransferase activit-( J( Med( Invest(
2"91"4-1L2& 714448
1L( Nes'e D#& M'Ss =D( lasma 3DD c%olesterol and t%e subclasses 3DD2 ISSN 04L5-
"244 Vol(1/Issue-2/=ct-Dec(2010 )))(i'+bs(net ,ioc%emistr- , 110 and 3DD0 in smo5ers
and non-smo5ers (#rter-( O 10 7189L-16& 714658
16( E$$ati M& 3enle- SJ& ;%un MJ& Do+e$ #D& ( *ole of Smo5in! in /lobal and *e!ional
1ardiovascular Mortalit-( 1irculation(O 1129 264-24L& 720058(

Table-1: Age !"#$!b%#!&' &( "%b)e*#" "#%!e

#!e in -ears
Non-Smo5in! !rou+ Smo5in! !rou+
Number M Number M
21-00 26 5"(0 1" 02(0
01-20 22 22(0 02 "6(0
;otal 50 100(0 50 100(0
Mean T SD 24(12T5(41 00(60T5(15

Table +:- C&,-a$!"&' &( l!-! -$&(!le be#.ee' ",&/e$" a' '&' ",&/e$"
Di+id +rofile Smo5ers
nH50
Mean TSD7m!/dl8
Non > smo5ers
nH50
Mean TSD7m!/dl8
value
;otal c%olesterolG;1I 220T20(0 1"2T24(1 0(005
;ri!l-ceridesG;/I 162(2T21(1 104(1T25(2 0(005
DDD 122(0T02(2 101(2T20(2 0(005
VDDD 22(LT5(" 21(1T5(2 0(46
3DD 06(6T0(4 25(LT5(6 0(005
Re"%l#" a$e -$e"e'#e !' Mea' 0 SD1 P 2al%e &b#a!'e b3 "#%e'# # #e"#4
ORIGINAL ARTICLE

Journal of Evolution of Medical and Dental Sciences/Volume1/Issue5/November-2012a!e-""L

Table 5:- l!-! -$&(!le a,&'g ",&/e$" ba"e &' '%,be$ &( *!ga$e##e" ",&/e -e$ a3
Di+id +rofile 10 ci!arettes +er da-
nH20
Mean TSD7m!/dl8
U10 ci!arettes +er da-
nH2L
Mean TSD7m!/dl8
value
;otal c%olesterol 141T00 254T02 0(005
;ri!l-cerides 1"2T00 160T50 0(1
DDD 102T21 1""T22 0(001
VDDD 22T16 2"T1" 0(1L
3DD 06TL 05T2 0(1
Re"%l#" a$e -$e"e'#e !' Mea' 0 SD1 P 2al%e &b#a!'e b3 "#%e'# # #e"#4
Table 6:- l!-! -$&(!le a,&'g ",&/e$" ba"e &' %$a#!&' &( ",&/!'g4
Di+id +rofile Duration of smo5in!
C5-rs GnH 16 I
Mean TSD7m!/dl8
Duration of smo5in!
U5-rs GnH02 I
Mean TSD7m!/dl8
value
;otal c%olesterol 14LT22 220T51 C0(001
;ri!l-cerides 1"4T20 165T26 C0(01
DDD 112T2" 1"1T22 C0(05
VDDD 25T10 26T10 0(102
3DD 04(LT2 00(5T0 C0(05
Re"%l#" a$e -$e"e'#e !' Mea' 0 SD1 P 2al%e &b#a!'e b3 "#%e'# # #e"#4