Daily consumption of caper fruit along with atorvastatin has synergistic effects in hyperlipidemic patients: Randomized clinical trial

  • Saeed Sardari 1. Department of Iranian Traditional Medicine, Faculty of Medicine, Shahed University, Tehran, Iran 2. Department of Persian Medicine, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
  • Faramarz Fallahi Department of Cardiology Mostafa Khomeini Hospital, Faculty of Medicine, Shahed University, Tehran, Iran
  • Fatemeh Emadi Department of Iranian Traditional Medicine, Faculty of Medicine, Shahed University, Tehran, Iran
  • Ali Davati Department of Iranian Traditional Medicine, Faculty of Medicine, Shahed University, Tehran, Iran
  • Narjes Khavasi Department of Persian Medicine, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
  • Mohammad Gholamifesharaki Department of Biostatistics, Faculty of Medical sciences, Tarbiat Modares University, Tehran, Iran
  • Seied Saeid Esmaeili Department of Iranian Traditional Medicine, Faculty of Medicine, Shahed University, Tehran, Iran
DOI: https://doi.org/10.31661/gmj.v8i0.1345
Keywords: Caper, Atorvastatin, Lipid Profile

Abstract

Background: Dyslipidemia leads to micro- and macro-vascular complications. Atorvastatin is the main therapeutic drug used for dyslipidemia, but it causes side effects such as new type 2 diabetes mellitus onset and elevation of liver enzymes. Herbs may be useful in reducing atorvastatin doses. Caper fruit, an herbal drug in Iranian traditional medicine, has hypolipidemic effects. Hence, the effect of atorvastatin therapy with and without daily caper fruit pickle (CFP) consumption was assessed on hyperlipidemia. Materials and Methods: In this single-blinded, randomized, controlled trial, 60 hyperlipidemic patients were allocated in two groups and treated with 10 mg atorvastatin plus 40-50 g CFP (A10+CFP) or atorvastatin alone (A10) for eight weeks. Biochemical parameters were measured at baseline, 4, and eight weeks of the intervention. One-way repeated measure ANOVA and mixed ANOVA were used to measure the effect of the two treatments and the interaction between the type of treatment and time on lipid profile. Results: Serum total cholesterol and low-density lipoprotein cholesterol (LDL-C) were significantly decreased in the A10+CFP group compared with the A10 group (P<0.001 and P<0.001, respectively) from baseline up to the week 8. At week 4, mean changes of LDL-C was significantly higher in the A10+CFP compared with the A10 (P=.01). Adjusting for the baseline variables, the mean difference of alanine aminotransferase (P<0.01) and triglyceride (P=.003) were significantly higher in the A10+CFP group at the end. Conclusion: This study reports that the intake of CFP along with atorvastatin daily may have synergistic effects which improve the lipid profile in hyperlipidemic patients. [GMJ.2019;8:e1345]

References

Roger VL, Go AS, Lloyd-Jones DM, Benjamin EJ, Berry JD, Borden WB, et al. Heart disease and stroke statistics--2012 update: a report from the American Heart Association. Circulation. 2012; 125(1): e2-e220.

PMid:22179539

Tiwari V, Khokhar M. Mechanism of action of anti-hypercholesterolemia drugs and their resistance. Eur J Pharmacol. 2014; 741: 156-70.

https://doi.org/10.1016/j.ejphar.2014.07.048

PMid:25151024

Casula M, Mozzanica F, Scotti L, Tragni E, Pirillo A, Corrao G, et al. Statin use and risk of new-onset diabetes: A meta-analysis of observational studies. Nutr Metab Cardiovasc Dis. 2017; 27(5): 396-406.

https://doi.org/10.1016/j.numecd.2017.03.001

PMid:28416099

Laakso M, Kuusisto J. Diabetes Secondary to Treatment with Statins. Curr Diab Rep.2017; 17(2):10.

https://doi.org/10.1007/s11892-017-0837-8

PMid:28155189

Nazem Jahan MA. Eksir -e- Aazam [Great Elixir]: (Diseases). Tehran: Sarir -e- Ardehal 2008. [In Persian].

Kalantari H, Foruozandeh H, Khodayar MJ, Siahpoosh A, Saki N, Kheradmand P. Antioxidant and hepatoprotective effects of Capparis spinosa L. ntfractions and Quercetin on tert-butyl hydroperoxide- induced acute liver damage in mice. J Tradit Complement Med. 2018; 8(1): 120-127.

https://doi.org/10.1016/j.jtcme.2017.04.010

PMid:29321999 PMCid:PMC5755993

Eddouks M, Lemhadri A, Michel J.B. Hypolipidemic activity of aqueous extract of Capparis spinosa L. in normal and diabetic rats. J Ethnopharmacol. 2005; 98(3): 345-50.

https://doi.org/10.1016/j.jep.2005.01.053

PMid:15814271

Goodman E, Daniels SR, Morrison JA, Huang B, Dolan LM. Contrasting prevalence of and demographic disparities in the World Health Organization and National Cholesterol Education Program Adult Treatment Panel III definitions of metabolic syndrome among adolescents. J Pediatr. 2004; 145(4):445-51.

https://doi.org/10.1016/j.jpeds.2004.04.059

PMid:15480365

Mousavi SN, Faghihi A, Motaghinejad M, Shiasi M, Imanparast F, Amiri HL, et al. Zinc and Selenium Co-supplementation Reduces Some Lipid Peroxidation and Angiogenesis Markers in a Rat Model of NAFLD-Fed High Fat Diet. Biol Trace Elem Res. 2018; 181(2): 288-295.

https://doi.org/10.1007/s12011-017-1059-2

PMid:28577233

Lorvand Amiri H, Agah S, Tolouei Azar J, Hosseini S, Shidfar F, Mousavi SN. Effect of daily calcitriol supplementation with and without calcium on disease regression in non-alcoholic fatty liver patients following an energy-restricted diet: Randomized, controlled, Single-blind trial. Clin Nutr. 2017; 36(6):1490-1497.

https://doi.org/10.1016/j.clnu.2016.09.020

PMid:27720403

Khavasi N, Khadem E, Ayati MH, Torbati MA, Fazljou SMB. Daily Consumption of the Capparis spinosa Reduces Some Atherogenic Indices in Patients with Non-alcoholic Fatty Liver Disease: A Randomized, Single-blind, Clinical Trial. Iran Red Cres Med J. 2018(In Press).

https://doi.org/10.5812/ircmj.63446

Jellinger PS, Handelsman Y, Rosenblit PD, Bloomgarden ZT, Fonseca VA, Garber AJ, et al. American association of clinical endocrinologists and american colledge of endocrinology guidelines for management of dyslipidemia and prevention of cardiovascular disease. Endocr Pract. 2017; 23(Suppl 2): 1-87.

https://doi.org/10.4158/EP171764.APPGL

PMid:28437620

Emtiazy M, Keshavarz M, Khodadoost M, Kamalinejad M, Gooshahgir S. A, Shahrad Bajestani H, et al. Relation between Body Humors and Hypercholesterolemia: An Iranian Traditional Medicine Perspective Based on the Teaching of Avicenna. Iran Red Crescent Med J. 2012; 14(3): 133-8.

PMid:22737569 PMCid:PMC3372029

Kritchevsky D. Fiber, lipids, and atherosclerosis. Am J Clin Nutr. 1978; 31(10 Suppl): S65-s74.

https://doi.org/10.1093/ajcn/31.10.S65

PMid:101075

Miller YI, Chang MK, Binder CJ, Shaw PX, Witztum JL. Oxidized low density lipoprotein and innate immune receptors. Curr Opin Lipidol. 2003; 14(5): 437-45.

https://doi.org/10.1097/00041433-200310000-00004

PMid:14501582

El Azhary K, Tahiri Jouti N, El Khachibi M, Moutia M, Tabyaoui I, El Hou A, et al., Anti-inflammatory potential of Capparis spinosa L. in vivo in mice through inhibition of cell infiltration and cytokine gene expression. BMC Complement Altern Med. 2017; 17(1): 81.

https://doi.org/10.1186/s12906-017-1569-7

PMid:28143472 PMCid:PMC5282892

Moutia M, El Azhary K, Elouaddari A, Al Jahid A, Jamal Eddine J, Seghrouchni F, et al. Capparis Spinosa L. promotes anti-inflammatory response in vitro through the control of cytokine gene expression in human peripheral blood mononuclear cells. BMC Immunol. 2016; 17(1): 26.

https://doi.org/10.1186/s12865-016-0164-x

PMid:27483999 PMCid:PMC4969972

Dawid-Pac R. Medicinal plants used in treatment of inflammatory skin diseases. Postepy Dermatol Alergol. 2013; 30(3): 170-7.

https://doi.org/10.5114/pdia.2013.35620

PMid:24278070 PMCid:PMC3834722

Khavasi N, Somi MH, Khadem E, Faramarzi E, Ayati MH, Fazljou SMB, et al. Effect of Daily Caper Fruit Pickle Consumption on Disease Regression in Patients with Non-Alcoholic Fatty Liver Disease: a Single-Blinded Randomized Clinical Trial. Adv Pharm Bull. 2017; 7(4): 645-650.

https://doi.org/10.15171/apb.2017.077

PMid:29399555 PMCid:PMC5788220

Simões F.C, Marques RG, Diestel CF, Caetano CE, Dinis A, Horst NL, et al. Lipidic profile among rats submitted to total splenectomy isolated or combined with splenic autotransplant. Acta Cirúrgica Brasileira. 2007; 22: 46-51.

https://doi.org/10.1590/S0102-86502007000700010

PMid:17505655

Tarantino G, Scalera A, Finelli C. Liver-spleen axis: intersection between immunity, infections and metabolism. World journal of gastroenterology: World J Gasteroenetrol. 2013; 19(23): 3534.

https://doi.org/10.3748/wjg.v19.i23.3534

PMid:23801854 PMCid:PMC3691032

Polimeni L, Pastori D, Baratta F, Tozzi G, Novo M, Vicinanza R, et al. Spleen dimensions are inversely associated with lysosomal acid lipase activity in patients with non-alcoholic fatty liver disease. Intern Emerg Med 2017; 12(8): 1159-1165.

https://doi.org/10.1007/s11739-017-1746-1

PMid:28900817

Thompson PD, Panza G, Zaleski A, Taylor B. Statin-Associated Side Effects. J Am Coll Cardiol. 2016; 67(20): 2395-2410.

https://doi.org/10.1016/j.jacc.2016.02.071

PMid:27199064

Sahebkar A, Beccuti G, Simental-Mendía LE, Nobili V, Bo S. Nigella sativa (black seed) effects on plasma lipid concentrations in humans: A systematic review and meta-analysis of randomized placebo-controlled trials. Pharmacol Res. 2016; 106: 37-50.

https://doi.org/10.1016/j.phrs.2016.02.008

PMid:26875640

Guertin J.R, Rahme E, LeLorierJ. Use of Continuous Exposure Variables when Examining Dose-Dependent Pharmacological Effects - Application to the Association between Exposure to Higher Statin Doses and the Incidence of Diabetes. J Popul Ther Clin Pharmacol. 2017; 24(1): 5-15.

https://doi.org/10.22374/1710-6222.24.1.1

PMid:28186711

LaRosa JC, Grundy SM, Waters DD, Shear C, Barter P, Fruchart JC, et al. Intensive lipid lowering with atorvastatin in patients with stable coronary disease. N Engl J Med. 2005; 352(14): 1425-35.

https://doi.org/10.1056/NEJMoa050461

PMid:15755765

Pedersen TR, Faergeman O, Kastelein JJ, Olsson AG, Tikkanen MJ, Holme I, et al. High-dose atorvastatin vs usual-dose simvastatin for secondary prevention after myocardial infarction: the IDEAL study: a randomized controlled trial. JAMA. 2005; 294(19): 2437-45.

https://doi.org/10.1001/jama.294.19.2437

PMid:16287954

Cannon CP, Braunwald E, McCabe CH, Rader DJ, Rouleau JL, Belder R, et al. Intensive versus moderate lipid lowering with statins after acute coronary syndromes. N Engl J Med. 2004; 350(15):1495-504.

https://doi.org/10.1056/NEJMoa040583

PMid:15007110

Published
2019-05-27
How to Cite
Sardari, S., Fallahi, F., Emadi, F., Davati, A., Khavasi, N., Gholamifesharaki, M., & Esmaeili, S. S. (2019). Daily consumption of caper fruit along with atorvastatin has synergistic effects in hyperlipidemic patients: Randomized clinical trial. Galen Medical Journal, 8, e1345. https://doi.org/10.31661/gmj.v8i0.1345
Issue
Vol. 8 (2019): 2019
Section
Original Article

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