140 J I M D C   2 0 1 7  140 

Op e n  Ac c e ss  
F u l l  L e n g t h  A r t i c l e  
 
 

Comparison of Mean Lipid Profile in Calcific Aortic Stenosis Cases 

and Controls  
Erum Afaq1, Syed Hafeezul-Hassan2, Muhammad Kashif Nisar3, Humera Afaq4, Kishwar Naheed5 

1 Assistant Professor Physiology, Liaquat National Hospital and Medical College, Karachi 
                                                                      2 Head/Professor Physiology, Liaquat National Hospital and Medical College, Karachi 

3 Associate Professor Biochemistry, Jinnah Medical & Dental College, Karachi 
4  Post Graduate Resident Medical Officer, Internal Medicine, Abbasi Shaheed Hospital, Karachi 

5Assistance professor, Anatomy, Liaquat National Hospital and Medical College, Karachi

A B S T R A C T  

Objective: This study was aimed to compare the mean lipid profile in calcific aortic stenosis patients and control group. 

Patients and Methods: Total 202 individuals, 101 cases and 101 controls visiting National Institute of Cardiovascular 

Disease and various tertiary care hospitals of Karachi from January 2012 to December 2012 were included in this study. 

Calcific AS patients having the age of ≥60 years fulfilling the inclusion criteria were selected from echocardiography 

department and OPD from NICVD. Age and gender match controls were selected from OPD. Lipid profile was done in 

DDRRL, Ojha Campus. Lipid profile estimates were carried out on HITACHI 902 analyzer using photometry technique. 

Results: Nonparametric Mann-Whitney test showed increase level of Triglyceride in calcific AS patients. 

Conclusion: Calcific AS patients showed altered lipid profile as compare to control group so dyslipidemia may be 

involved in its pathogenesis. 

Keywords: Calcific aortic stenosis, Cholesterol, Dyslipidemias, High density lipoprotein, Low density, lipoprotein, 

Triglyceride.

Author`s Contribution 
1
 Conceived the topic of research, 

designed the study, data collection, 
Literature review and manuscript writing 
2 

Discussion, Critical review, 
3
 Data 

analysis, 
4 

Critical Review,
 5 

Compiling 
results, 

Address of Correspondence 
Erum Afaq 
Email. doc_erum@yahoo.com 

Article info. 
Received: May 31, 2017 
Accepted: July 9, 2017 
 

Cite this article: Afaq E, Hassan H, Nisar MK, Afaq H, Naheed K. Comparison of Mean 

Lipid Profile in Calcific Aortic Stenosis Cases and Controls.JIMDC. 2017; 6(3):140-143 
Funding Source: Nil 
Conflict of Interest: Nil 

I n t r o d u c t i o n  
Severe calcific aortic stenosis (AS) is one of the most 

commonly encountered valvular pathologies requiring 

surgery in developed countries.1 It is postulated that an 

early lesion in AS is characterized by subendothelial 

thickening on the aortic side of the leaflet because of 

accumulation of cellular lipid infiltration and extracellular 

mineralization, accompanied by a proliferation of smooth 

muscle cells and lipid-laden foam cells resembling 

atherosclerotic plaques.2 There are similarities between 

risk factors for coronary atherosclerosis and the 

development of AS, which suggests that the 

atherosclerotic process involving aortic valve leaflets 

eventually brings about or accelerates the thickening of 

the leaflet structure, leading to significant AS.3-5 In 

patients with familial hypercholesterolemia, high 

cholesterol concentrations are associated with the 

development of AS.6,7 Many cardiovascular studies have 

proved that  there is a link between atherosclerotic risk 

O R I G I N A L  A R T I C L E  



 

                           141 J I M D C   2 0 1 7  141 

factors and the factors associated with the prevalence 

and  progression of calcific AS.8 That includes elevated 

LDL cholesterol, lipoprotein (a), hypertension, male 

gender and smoking.9  This information can leads the way 

as lipid lowering drugs may be the treatment of choice for 

prevention and delay the progression of calcific AS.10,11  

In Pakistan no such data is available. We designed this 

retrospective case-control study to evaluate the 

relationship between altered lipid profilein 

echocardiographically diagnosed patients with calcific AS, 

who referred to echocardiography department and OPD 

for further evaluation and to compare the mean values of 

lipid profile in calcific AS patients and controls. 

    P a t i e n t s  a n d  M e t h o d s  

This study was conducted in National Institute of 
Cardiovascular Disease (NICVD) and DDRRL, Ojha 
Campus DIMC, Dow University of Health Sciences 
(DUHS). Study was approved by ethical review committee 
of NICVD and DUHS. Patients were selected from 
echocardiography department and OPD from NICVD. A 
detailed history was taken and Elderly patients (age≥60 
years) having calcific AS were included in the study. For 
controls, age and gender matched persons without calcific 
AS were inducted. Patients having severe aortic 
regurgitation, history of endocarditis, rheumatoid arthritis, 
rheumatic fever or rheumatic heart disease and 
echocardiographic evidence of rheumatic valvular 
stenosis, chronic renal failure, familial 
hypercholesterolemia (total cholesterol >300 mg/dL in 
adults), cancer, prosthetic valves or patient taking lipid 
lowering drugs were excluded from the study. The 
patients were documented brased on their written consent 
on a detailed prescribed performa. Study was completed 
in 2 years after approval from Board of Advanced 
Scientific Research (BASR) and Funding Committee of 
Dow University of Health Science. Sample size was 
calculated with the help of open Epi 
(http://www.openepi.com/SampleSize/SSMean.htm) by 
taking mean total cholesterol in AS patients as 211±43 
mg/dl, mean total cholesterol in patients without aortic 
stenosis as 193±48 mg/dl,12 power of 80% and 
confidence interval of 95%. The calculated sample size 
was 202 patients, 101 in each case and control groups. 
Non-probability purposive sampling technique was used. 

Fasting blood samples were collected from both the case 
and control groups for lipid profiling. Lipid profile 
estimates were carried out on HITACHI 902 analyzer 
using photometry technique in DDRRL, Ojha Campus. 

Data was entered in Microsoft Excel and analyzed using 
SPSS version 21. Descriptive analysis was done 
according to the type of variable. Numeric data was 
analyzed by calculating mean and standard deviation 
(SD). Frequencies and percentages were calculated for 
categoric variables. As the data was nonparametric, 
median and range were taken. The nonparametric Mann-
Whitney test was used to compare the two groups. P-
value less than 0.05 was considered to be statistically 
significant. 

R e s u l t s  

A total of 202 individuals were recruited in our study. Total 

101 elderly people as calcific AS cases and 101 age and 

gender matched controls. The age and gender distribution 

among two groups is presented in table I. The mean age 

and standard deviation for the cases was 67.09±5.04 and 

the mean age and standard deviation for controls was 

66.72±3.68. There were 63 (62.4%) males and 38 

(37.6%) females in the case group and 67 (66.3%) male 

and 34 (33.7%) females were included in control group.  

Histogram and Shapiro-Wilk test were applied to check 

the normality. As the variables are violating the 

assumption of normality therefore nonparametric Mann-

Whitney test was used to compare both cases and 

controls. Triglyceride level showed significant difference 

between both the groups as mentioned in table 2. 

Table 1: Demographic profile in cases and controls 

Variables Cases 
 

Controls 
 

Age (years) Mean 67.09 66.72 

SD 5.04 3.68 

Gender Males   n (%) 63 (62.4) 67 (66.3) 

Female n 
(%) 

38 (37.6) 34 (33.7) 

 

Table 2: Descriptive statistics of lipid profile in both groups 

Lipid profile 
(mg/dl) 

Cases Controls p-Value 

Median 
(Range) 

Median 
(Range) 

Triglyceride 114 (421) 140 (356) <0.001 

Total Cholesterol 160 (177) 152 (218) 0.739 

HDL 39 (40) 40 (34.8) 0.524 

LDL 93 (119) 88 (118) 0.087 

D i s c u s s i o n  

Multiple studies have shown many similarities in the 

histopathologic features of atherosclerosis and calcific 

AS.3,13,14 There is also an overlap in the risk factors of 



 

                           142 J I M D C   2 0 1 7  142 

calcific AS and atherosclerosis, among them one is 

dyslipidemia. 8,15,16 In this study fasting lipid profile was 

done among calcific AS cases and controls. There was a 

difference in the mean triglyceride level in cases and 

controls with significant p-value <0.05. These findings are 

in contrast to Peltier et al 2003, who showed a higher 

level of triglyceride in AS cases.12 In our study, the cause 

of triglyceridemia may be due to the presence of coronary 

artery disease in controls.17  

Mean total cholesterol showed the insignificant difference 

in both groups. This finding is consistent with the findings 

of a study conducted by Ortlepp 2006 and in contrast to 

the study conducted by Peltier et al who found that there 

is hypercholesteremia in patients of calcific AS. 18 Models 

of atherosclerotic disease in rabbits and rats have also 

been used to determine the effects of 

hypercholesterolemia on the aortic valve morphology and 

function.19 Insignificant values in our study may be due to 

presence of comorbidities in both groups. 

HDL-cholesterol showed insignificant p-value but HDL- 

cholesterol was decreased in both the groups. The case-

control study conducted by Park et al. 2013, showed that 

decrease in HDL-cholesterol was associated with the AS 

and its progression.20 Novaro et al. 2003, showed an 

insignificant association of HDL-cholesterol with cases 

and controls. However, in his work patients had a normal 

level of HDL-cholesterol.21 In our study, insignificant p-

value for HDL-cholesterol might be due to the fact that 

both groups included female participants above sixty 

years of age and in females, HDL- Cholesterol decreases 

as age increases. 

Regarding mean LDL-cholesterol, our study showed non-

significant p-value. The study was consistent with the 

results of Novaro et al. 2003, who showed insignificant p-

value of LDL cholesterol between cases and controls. 21 

However, Moura et al 2007 showed higher level of LDL 

cholesterol in calcific AS patients. 22 In humans, a strong 

influence has been observed of the LDL cholesterol levels 

on the progression of AS, as quantified by electron beam 

tomography using a volumetric score.23 

C o n c l u s i o n  

Calcific AS is a multifactorial disease. The present study 

concluded that calcific AS patients have altered lipid 

profile as compared to control group so dyslipidemia may 

be involved in its pathogenesis. However, in some 

patients, the presence of coronary artery disease may 

have produced symptoms, predominantly angina, which 

incited investigation and hence resulted in bias towards 

finding an association between aortic stenosis and altered 

lipid profile. 

A c k n o w l e d g m e n t  

Authors acknowledged Muhammad Irfan and Hira Fatima 

Waseem bio-statisticians in the Department of Statistics, 

Liaquat National Hospital and Medical College, for their 

guidance in statistical analysis of the data. 

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