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Garlic Supplementation for Hyperlipidemia

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  1. Garlic Supplementation for Hyperlipidemia Soto, Tanggol, Teo, Torio, Torregrosa, Tuddao, Tumangday, Valenzuela, Valerio, Vidal, Villanueva, Ampil

  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. $ (-) (+)

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

  5. P = Hyperlipidemic Patients I = Garlic Supplementation C = Placebo O = Lipid Profile M = RCTs

  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Trial - May or may not involve crossover period • May be unblinded, single-blinded or double-blinded • Published or Unpublished • English Articles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 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 four 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 • Other Databases • Cochrane • Medscapepharmacist • HighWirePress (a Division of the Stanford University Library) • Herdin • 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 • Hand Searching • RBD-SLMC • Department of Nutrition-SLMC • 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. Methodological Quality • Assessed using the EBM approach

  18. Total Number of Included Studies FOURTEEN

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

  20. Description of Studies • Thirteen of the fourteen studies were homogenous at baseline, the remaining study adjusted using analysis of covariance • Thirteen randomized hyperlipidemic subjects with garlic versus placebo or no intervention, the remaining 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. Description of Studies

  23. 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

  24. 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)

  25. 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

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

  27. Results and Discussion

  28. RESULTS 14 INCLUDED STUDIES 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

  29. 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

  30. 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

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

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

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

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

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

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

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

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

  39. 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

  40. SUBGROUP ANALYSES

  41. sex Males Only Mixed (Males and Females)

  42. SEX: Males Only Total Cholesterol

  43. SEX: Males Only LDL-C Levels