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Normal Artery

Atherosclerotic Artery. Normal Artery. NORMAL VALUES:. Total cholesterol < 200 mg / dL (for >19 y/o) Triglycerides < 150 mg / dL HDL-c 40 – 60 mg / dL LDL-c < 100 mg / dL. Allium sativum. antioxidant antimicrobial, antihypertensive antithrombotic antineoplastic

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Normal Artery

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  1. Atherosclerotic Artery Normal Artery

  2. NORMAL VALUES: Total cholesterol < 200 mg / dL (for >19 y/o)Triglycerides < 150 mg / dLHDL-c 40 – 60 mg / dLLDL-c < 100 mg / dL

  3. Allium sativum • antioxidant • antimicrobial, • antihypertensive • antithrombotic • antineoplastic • hypolipidemic effects

  4. Mechanism • HMG-CoA reductase inhibitor • Decreases hepatic cholesterol synthesis • Central nervous system • Affecting satiety

  5. “Does garlic supplementation have a lipid lowering effect in hyperlipidemic patients?”

  6. METHODOLOGY

  7. Criteria for Considering Studies

  8. Type of study • Randomized Controlled Trial - May or may not involve crossover period • May be unblinded, single-blinded or double-blinded • Published or Unpublished • English Articles

  9. Types of Participants • Adults (19 years old above) • With mild, moderate or severe hypercholesterolemia • No comorbid illnesses • No other pathological serum clinical chemistries • Not taking any other medications • Not taking any substantial amount of garlic in the diet

  10. Types of Interventions • Garlic Supplementation • Any form (tablet, capsule, aged garlic extract or oil for) versus placebo • May have minor ingredients that are not known to have an effect on the outcome • May or may not be taken with meals • Any dose • At least six weeks of intervention

  11. Types of Outcome Measures • Total Cholesterol • Low Density Lipoprotein Cholesterol (LDL-C) • High Density Lipoprotein Cholesterol (HDL-C) • Triglycerides

  12. Search Methods for Identification of Studies • Systematic online article search via PubMed • MESH terms “garlic AND dyslipidemias” • LIMITS: humans, RCTs, English, All adult 19+

  13. “Garlic” [MESH] AND “dyslipidemias” [MESH] (n=111) LIMITS: RCT, Humans, all adults > 19 y/o, English only 24RCTs Excluded studies (n=10) Studies that met the inclusion criteria (n=14) 3 Full-text RCTs cannot be retrieved 11 Full-text RCTs included

  14. Search Methods for Identification of Studies • Cross-referencing of all appraised articles • 2 articles included • Free text search via Yahoo and Google search engine • Various combinations of the search terms (cholesterol-lowering effects, garlic, allicin, alliumsativum, hyperlipidemia, and hypercholesterolemia) • 1 article included

  15. Search Methods for Identification of Studies • Hand searching • Medscapepharmacist • HighWirePress (a Division of the Stanford University Library) • RBD-SLMC • Dept. of Nutrition-SLMC • DOH-OPAC • UP-PGH College of Medicine OPAC • UPD-College of Science OPAC • UST-OPAC • Kansas University Libraries OPAC • SLCM-WHQM Medical Library OVID Program and Journal Collection

  16. Search Methods for Identification of Studies • Local study article search via Herdin online • Search terms “garlic AND dyslipidemia” and “garlic AND hypercholesterolemia” • Manufacturers of locally available garlic supplements • Cardiologists at St. Luke’s Medical Arts Building and Cathedral Heights Building Complex (CHBC) were also contacted through telephone and/or visits to their clinics

  17. Total Number of Included Studies FOURTEEN

  18. Methodological Quality • Assessed using the EBM approach

  19. Description of Studies • All double-blinded RCTs (n=14) • 4 studies with crossover • Population • Hyperlipidemic male and female adults • No other comorbidities • Not taking any garlic supplementation, any other medications • Substantial amount of garlic in their diet

  20. Description of Studies • All of the studies are homogenous at baseline • Thirteen randomized hyperlipidemic subjects with garlic versus placebo or no intervention • One articlerandomized hyperlipidemic subjects with garlic versus anethumgraveolens or placebo

  21. Description of Studies • Intervention • Garlic supplementation • Form • Capsule or tablet • Dose • Range: 400mg/day-7,200mg • Duration • Range 6 weeks-5 months

  22. Measurements of Treatment Effect • Mean change from baseline • Total Cholesterol, LDL-Cholesterol, HDL-Cholesterol and Triglycerides • Mean percent change • Total Cholesterol, LDL-Cholesterol, HDL-Cholesterol and Triglycerides

  23. Subgroup Analysis • Diet • No change in diet (n=7) • Diet Advice (n=2) • Strict Dietary Regimen (n=5) • Sex • All males (n=3) • Males and Females (n=11)

  24. Unit of Analysis Issues • Crossover Trials • The group used the lipid parameters given in the study prior to the crossover period • One study (Steiner, et al.) did not show the exact values , the group estimated the values through the given graphs

  25. Data Synthesis • Random Effects Model • Fixed Effects Model

  26. Results and Discussion

  27. RESULTS 14 INCLUDED STUDIES Age: 19-80 years Total cholesterol, LDL-C, HDL-C, Triglyceride 1 excluded from statistical analysis MEAN CHANGE (N = 592-625 ) MEAN PERCENT CHANGE (N = 183 ) SEX DIET SEX DIET MIXED (M& F) MALES only NO dietary change Dietary advice Diet regimen MIXED (M&F) MALES only NO dietary change Dietary advice Diet regimen

  28. Standard Deviation • Only 3 studies showed the SD for mean change and/or mean percent from baseline: • Isaacsohn et al. • Kojuri et al. • Superko et al. • 10/13: no SD cited • SD values were imputed

  29. Not included in the statistical analysis • Berthold et al. • No significant effect • Maderet al. and Vorberg and Schneider • Significantly decreased total cholesterol and triglyceride levels • Silady et al. • no significant differences bet. the 2 groups

  30. Total Cholesterol (TC) Fig.2 Comparison of Mean Change from Baseline of Total Cholesterol Levels

  31. Total Cholesterol (TC) Fig.3 Comparison of Mean Percent Change from Baseline of Total Cholesterol Levels

  32. LDL-C Fig.4 Comparison of Mean Change from Baseline of LDL-C Levels

  33. LDL-C Fig.5 Comparison of Mean Percent Change from Baseline of LDL-C Levels

  34. HDL-C Fig.6 Comparison of Mean Change from Baseline of HDL-C Levels

  35. HDL-C Fig.7 Comparison of Mean Percent Change from Baseline of HDL-C Levels

  36. Triglyceride (TG) Fig.8 Comparison of Mean Change from Baseline of Triglyceride Levels

  37. Triglyceride (TG) Fig.9 Comparison of Mean Percent Change from Baseline of Triglyceride Levels

  38. Summary of Results • Mean change from baseline of TC and LDL-C • Favored the garlic treatment group • Significantly decreased levels • Mean change from baseline of HDL-C and TG • Favoured the garlic treatment group, but • not significant • Mean percent of all lipid parameters • Not significant • small number of participants

  39. Subgroup analysis (Jacy girl’s part)

  40. Conclusion • Garlic treatment significantly reduces the total cholesterol and LDL-C levels among hyperlipidemic patients. • However, a larger number of participants may be needed to make the conclusion more robust. • There is no sufficient evidence that garlic affects the HDL-C and triglyceride levels.

  41. Implication for Practice • Recommend the use of garlic as a supplement to lower the lipid levels among hyperlipidemic patients. • However, this should not be used as the primary lipid-lowering medication. • Garlic supplementation markedly improves the serum lipid levels of hyperlipidemic men. • The hypolipidemiceffect is augmented by an approved dietary regimen.

  42. Implication for Research • Because the robustness of the results remains debatable, the inclusion of more studies involving a larger number of participants is recommended. • The population of our study only focused on hyperlipidemic patients. Normolipidemic patients may also be included in the future to determine the applicability of effects of garlic supplementation to these patients.

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