The relationship between hypercholesterolemia as a risk factor for stroke and blood viscosity measured using Digital Microcapillary

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1 Joural of Physics: Coferece Series PAPER OPEN ACCESS The relatioship betwee hypercholesterolemia as a risk factor for stroke ad blood viscosity measured usig Digital Microcapillary To cite this article: D Destiaa ad I S Tima 2018 J. Phys.: Cof. Ser View the article olie for updates ad ehacemets. This cotet was dowloaded from IP address o 09/10/2018 at 02:33

2 The relatioship betwee hypercholesterolemia as a risk factor for stroke ad blood viscosity measured usig Digital Microcapillary D Destiaa ad I S Tima * Departmet of Cliical Pathology, Faculty of Medicie, Uiversitas Idoesia, Jakarta, 10430, Idoesia * ia_st_ui@yahoo.com Abstract Hypercholesterolemia is a risk factor for stroke, ad it is kow that patiets exhibit elevated blood viscosity after experiecig a stroke. This study examied the relatioship betwee hypercholesterolemia as a risk factor for stroke ad icreased blood viscosity. Blood viscosity was measured usig Digital Microcapillary. The data used i this cross-sectioal study were obtaied from the medical records of patiets at Pos Biaa Terpadu (Posbidu), ad data from healthy cotrols were obtaied from a previous study. The results illustrated that 51.3% ( = 98) ad 88.5% ( = 169) of patiets had hypercholesterolemia ad hyperviscosity, respectively. The results revealed a sigificat differece i blood viscosity betwee patiets with hypercholesterolemia ad healthy subjects, but this differece was ot oted betwee patiets with ormal cholesterol levels ad those with hypercholesterolemia. The study results support the lik betwee cholesterol levels ad blood viscosity ad cofirm the utility of Digital Microcapillary as a tool for screeig patiets who are at risk of stroke. 1. Itroductio Hypercholesterolemia is caused by a disruptio i the metabolic process of lipoproteis, thus resultig i icreased lipoprotei cocetratios i the blood [1]. I the Uited States, 98.9 millio people aged 20 years old have cholesterol levels that exceed 200 mg/dl, with 31.9 millio people exhibitig levels >240 mg/dl [2]. I Idoesia, the prevalece of abormal cholesterol levels amog people aged 15 years old reached 35.9% i 2013 [3]. High ad ucotrolled cholesterol levels represet a risk factor for stroke. Hypercholesterolemia teds to lead to early atherosclerosis ad is a high risk factor for cardiovascular disease; this iformatio is i lie with the fidig that stroke is the leadig cause of death i Idoesia [4-6]. Accordig to a previous study, blood viscosity levels are higher i patiets who experieced a ischemic stroke tha i healthy idividuals. High cholesterol levels ca alter blood viscosity, e.g., LDL-C ca cause erythrocyte aggregatio ad deformability, thus resultig i icreased blood viscosity ad decreased blood flow [7]. These chages lead to disturbaces i the perfusio of tissues, icludig the brai, thus potetially resultig i ischemic stroke [8]. To date, blood viscosity has bee measured i the laboratory by usig expesive istrumets, with results obtaied withi a few days. Digital Microcapillary was developed to easily measure blood viscosity. This tool ca be used i small health facilities to provide easy access to patiets. Moreover, results are obtaied istatly ad ca be read automatically [5]. Cotet from this work may be used uder the terms of the Creative Commos Attributio 3.0 licece. Ay further distributio of this work must maitai attributio to the author(s) ad the title of the work, joural citatio ad DOI. Published uder licece by Ltd 1

3 This study examied the relatioship betwee high cholesterol levels as a risk factor for stroke ad blood viscosity measured usig Digital Microcapillary. If the results reveal a relatioship, blood viscosity i patiets with hypercholesterolemia could be maaged usig this iformatio, thus prevetig the occurrece of stroke. 2. Methods The study protocol was approved by the Health Research Ethics Committee, Faculty of Medicie Uiversitas Idoesia-Cipto Magukusumo Hospital. The data used i this crosssectioal study were obtaied from the medical records of patiets who visited Itegrated Commuity Health Post (Posbidu) i Jauary ad March 2015 ad from a previous study coducted by Rasyid et al. [5] i The hypercholesterolemia group i this study cosisted of patiets who uderwet examiatios usig the Accutred Plus System ad with cofirmed cholesterol levels exceedig 200 mg/dl. Data were obtaied for a healthy cotrol group cosistig of subjects without factors liked to icreased blood viscosity such as diabetes, hyperuricemia, obesity, hypertesio, or smokig. Total cholesterol levels were measured usig a cholesterol meter, ad blood viscosity was measured usig Digital Microcapillary. The samplig techique used was cosecutive samplig, ad the miimum umber of samples was 85 subjects. The potetial relatioship betwee hypercholesterolemia ad blood viscosity was examied usig the chi-squared test ad Pearso s correlatio aalysis. The Kolmogorov Smirov ormality test was used as eeded to determie whether data were ormally distributed. SPSS software was used for data processig. 3. Results A total of 203 respodets were recruited amog patiets who visited Posbidu i Jauary ad March Amog the respodets, four were excluded because of aticoagulat use, ad data for eight respodets could ot be processed because they exceeded the liear capacity of the tool. Therefore, the total umber of respodets was 191. The majority of the respodets were female (150 subjects), ad their average age was 60 years old (Table 1). Table 1. Distributio of Study Subject Characteristics i Posbidu Characteristic Sex Male Female Age <45 years 45 years Frequecy 41 (21.5%) 150 (78.5%) 61 (31.9%) 130 (68.1%) * Mea ( xഥ ± 2 SD)** Media (Mi Max) Mea* Media** 50** (18 79) 41** (18 49) 55** (45 79) Table 2 shows the basic characteristics of the study subjects based o cliical variables. Most of the Posbidu respodets exhibited elevated cholesterol levels, with 98 of 191 subjects displayig hypercholesterolemia. Subjects with hypercholesterolemia were mostly female ad older tha 45 years old. Amog the 191 study subjects, 169 had elevated blood viscosity. Table 2. Cliical variables of the study subjects Characteristic Frequecy Mea* Media** Cholesterol Level (mg/dl) (203.6 ± 61.8)* 2

4 Table 2. Cotiue Characteristic Hypercholesterolemia Yes Male Female Age <45 years Age 45 years No Frequecy 98 (51.3%) 17 (17.3%) 81 (82.7%) 27 (27.6%) 71 (72.4%) 93 (48.7%) Mea* Media** 223 ( )** (227.1 ± 42.2)* 223 ( )** 182 ( )** Blood viscosity level 6.1 ( ) Hyperviscosity Yes Male Female Age <45 years Age 45 years No 169 (88.5%) 36 (21.3%) 133 (78.7%) 55 (32.5%) 114 (67.5%) 22 (11.5%) *Mea ( xഥ ± 2 SD) ** Media (Mi Max) 3.1. Differece i hyperviscosity betwee healthy subjects ad patiets with hypercholesterolemia Accordig to the chi-squared test results, the healthy subjects had ormal cholesterol levels ad had o risk factors for icreased blood viscosity (Table 3). By cotrast, 88 patiets with hypercholesterolemia had hyperviscosity. Table 3. Chi-squared test results for healthy subjects ad patiets with hypercholesterolemia Viscosity Normal High p value Cholesterol Normal 40 0 <0.001 High Total Relatioship betwee hypercholesterolemia ad hyperviscosity amog patiets at Posbidu The aalysis illustrated that the data for cholesterol levels were ormally distributed (p = 0.2), whereas the distributio of data for blood viscosity was abormal (p = 0.009). Accordig to Pearso s correlatio aalysis of cholesterol levels ad blood viscosity, the relatioship betwee cholesterol levels ad blood viscosity was isigificat (p = 0.103). Figure 1 presets the results of Pearso s correlatio aalysis. The chi-squared test further idicated that hypercholesterolemia was isigificatly associated with blood viscosity (p = 0.559, Table 4). Table 4. Chi-squared aalysis of the associatio betwee hypercholesterolemia ad hyperviscosity Viscosity Normal High p value Cholesterol Normal High Total

5 R : 0,118 p : 0,103 : 191 Figure 1. Correlatio betwee cholesterol ad blood viscosity 4. Discussio Accordig to NCEP, cholesterol levels exceedig 200 mg/dl ecessitate follow-up ad medical treatmet. Hypercholesterolemia is a risk factor for stroke because cholesterol ca form atherosclerotic plaques, which ca restrict blood flow, thus reducig blood vessel diameter ad leadig to reduced perfusio to tissues, icludig the brai [9]. Our study data shows that a large portio of patiets at Posbidu are at icreased risk of stroke. Idoesia has a abormally high prevalece of high cholesterol levels at 35.9%, with hypercholesterolemia beig more commo i females tha i males. These data are i accordace with the results of our study, i which hypercholesterolemia was more prevalet amog females tha amog males. Furthermore, the prevalece of hypercholesterolemia was higher at Posbidu tha i the rest of the coutry. This fidig could be attributed to the fact that most patiets at Posbidu are older tha 45 years old. I our study populatio, early three-fourths of patiets older tha 45 years old exhibited hypercholesterolemia. Therefore, this age may be liked to icreased risk of cardiovascular disease i patiets with hypercholesterolemia owig to the icreased prevalece of atherosclerosis. Accordig to a study by Rasyid et al. [5], blood viscosity ca affect blood flow, icludig slower blood flow to the brai, thereby icreasig the icidece of stroke. Cosequetly, most of the patiets at Posbidu had elevated risks of stroke. Give its ease of use, the Digital Microcapillary device ca be quickly employed to idetify subjects with hyperviscosity, thus permittig early treatmet to prevet stroke. The curret study foud a isigificat relatioship betwee cholesterol levels ad blood viscosity, which cotradicts the results of Machida et al. [10]. The researchers argued that LDL-C ca stimulate erythrocyte aggregatio, thus leadig to extremely slow blood flow i vessels ad icreasig blood viscosity. The differece betwee the curret study ad that by 4

6 Machida et al. [5] is the iclusio of a cotrol group of patiets without hypercholesterolemia. However, the cotrol patiets may have factors other tha hypercholesterolemia that lead to icreased blood viscosity, such as diabetes mellitus, hyperuricemia, obesity, hypertesio, ad smokig habits. These factors might explai why most patiets i the cotrol group exhibited hyperviscosity without hypercholesterolemia. This hypothesis is supported by the sigificat differece i the risk of hyperviscosity betwee patiets with hypercholesterolemia ad healthy cotrols without risk factors for hyperviscosity. 5. Coclusio A sigificat differece i the risk of blood viscosity was observed betwee healthy cotrols ad patiets with hypercholesterolemia. However, elevated cholesterol levels were ot liked to a icreased risk of hyperviscosity. This fidig may be due to the presece of other risk factors i patiets i the cotrol group, who have ormal cholesterol levels. Furthermore, the study cofirmed the utility of Digital Microcapillary as a tool for measurig blood viscosity i primary health facilities because of its simple examiatio procedure ad istat results. Refereces [1] Ferri F F 2016 Ferri s Cliical Advisor 2016: Hypercholesterolemia. (Philadelphia: Elsevier Sauders) p [2] America Heart Associatio & America Stroke Associatio. Statistical Fact Sheet 2014 Update: High Blood Cholesterol & Others Lipids; [3] Kemetria Kesehata Republik Idoesia. Riset kesehata dasar 2013 [Iteret]. [Diakses 2014 Juli 16]. Tersedia di: rkd2013/lapora_riskesdas2013.pdf [4] Nagy C D ad Kwiterovich P O 2011 Evaluatios ad Maagemet of Dyslipidemia i Childre ad Adolescets Prevetive Cardiology: Compaio to Brauwald s Heart Disease ed RS Blumethal, J M Foody, N D Wog (Philadelphia: Elsevier Sauders) p [5] Rasyid A 2014 Efektivitas mikrokapiler digital sebagai alat ukur ilai viskositas darah utuk prediksi progosis stroke iskemik akut [dissertatio]. Jakarta: Fakultas Kedoktera Uiversitas Idoesia. [6] Yudiarto F, Machfoed M, Darwi A, Karyaa M ad Siswato 2014 Idoesia stroke registry Neuology 82 S [7] Cho Y I ad Cho D J 2011 Hemorheology ad microvascular disorders Korea Circ. J [8] Wood J H ad Kee D B 1985 Hemorheology of the cerebral circulatio i stroke. Stroke [9] Weg W C, Huag W Y, Su F C, Chie Y Y, Wu C L, Lee T H ad Peg T I 2013 Cli. Neurol. Neurosurg [10] Machida T, Sumio H, Fukushima M, Kotajiima N, Amagai H ad Murakami M J. It. Med. Res