Guggulipid show promise for metabolic syndrome: no reduction in LDL levels.
A recent randomized trial evaluating this ancient ayurvedic remedy as a cholesterol-lowering agent found no benefit in the study's primary outcome, which was a reduction in low-density lipoprotein (LDL) cholesterol levels.
But a secondary analysis of the study data has yielded some suggestion of "interesting biologic effects" on components of the metabolic syndrome, Dr. Philippe O. Szapary said at a symposium on alternative and complementary therapies sponsored by the Universities of Exeter and Plymouth.
In ayurvedic medicine, the concept of medoroga reflects an abnormal state of overindulgence, excessive consumption of animal fats and sweets, lack of movement, and daytime sleeping. This state could be considered analogous to the constellation of clinical findings--glycemic disorders, dyslipidemia, hypertension, endothelial dysfunction and inflammation, and hyperuricemia--that typically presage the development of atherosclerosis, Dr. Szapary said.
More than 20 previous studies had suggested beneficial effects for guggulipid. "So I thought maybe we were barking up the wrong tree, just looking at LDL cholesterol, and that other metabolic effects might be involved," he said.
The analysis included 85 hypercholesterolemic patients who completed the 8-week study (103 patients were initially randomized). They had been randomized to receive placebo, standard dose guggulipid (1,000 mg three times daily), or high-dose guggulipid (2,000 mg three times daily).
High-dose guggulipid reduced fasting glucose by 6 mg/dL and insulin by 1.9 mIU/L, changes that reflect "modest," but not statistically significant, improvements in insulin sensitivity in nondiabetic adults, he said.
Systolic blood pressure also decreased by a nonsignificant 4 mm Hg in the standard-dose guggulipid group.
One "dramatic" finding was that high dose guggulipid appeared to exert significant anti-inflammatory effects, reducing the median level of high-sensitivity C-reactive protein by 31%.
Other metabolic effects included small but significant changes in serum urate and a trend toward reduction of oxidized LDL cholesterol levels after adjustment for age, sex, and baseline body mass index, Dr. Szapary said.
The study was small and of short duration, he cautioned. He plans to conduct in vitro studies of guggulipid's effects on peroxisome proliferator-activated (PPAR)-[alpha] and -[gamma] receptors. The goal will be to identify components that are responsible for the metabolic effects, and possibly to isolate novel PPAR ligans that could be tested in vivo, he said. The in vitro studies also will attempt to identify the components of guggulipid that may cause the hypersensitivity rash that was seen in six patients in the original study (JAMA 290:765-72, 2003).
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|Title Annotation:||Cardiovascular Medicine|
|Publication:||Internal Medicine News|
|Date:||Jan 15, 2004|
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