Efficacy of Integrated Ayurveda Protocol in Dyslipidemia A randomized controlled clinical trial

Dyslipidemia is the imbalance of lipids such as cholesterol low-density lipoprotein cholesterol(LDL-C) triglycerides and high-density lipoprotein cholesterol(HDL-C) This condition can result from lifestyle factors tobacco exposure genetic and obesity can lead to cardiovascular disease with severe complications It is a prime reason for morbidity and mortality worldwide Abnormal cholesterol levels are estimated to cause 18% of the global CVDs (Cardiovascular diseases) and 56% of the global Ischemic Heart Diseases (IHD) For every 1% reduction in lipid level the risk of heart diseases reduces by 2.5% Dyslipidemia is an established risk factor for atherosclerotic diseaseAn estimated 17.9 million people died from CVDs in 2019 representing 32% of all global deaths Out of the 17 million premature deaths (under the age of 70) due to noncommunicable diseases(NCDs) in 2019  38% were caused by CVDs According to National Commission on Macroeconomics and Health (NCMH) a Government of India undertaking there is around 62 million patients with CVD in 2015 among which 23 million patients would be younger than 40 years of age In 2016 India reported 63% of  total deaths due to NCDs of which 27% were attributed to CVDs CVDs also account for 45% of deaths in the 40-69 year age group Despite considerable advances during the past 40 years there is increasing awareness among scientists epidemiologist and clinicians that current approaches to evaluate Coronary Heart Disease(CHD) risk in asymptomatic individual is sub optimal limiting HDL-C and LDL-C as therapeutic target Results of the Canadian cardiovascular  studies suggests that Total cholesterol to HDL ratio was better and cumulative marker for Dyslipidemia The total cholesterol/HDL ratio is a superior measure of risk for coronary heart disease compared with either total cholesterol or LDL cholesterol level Measurements of sdLDL size and LDL size have the potential to improve coronary disease risk assessment as well as decisions about LDL treatment intensity since they account for aspects of lipid atherogenicity that are incompletely reflected by values of LDL-C sdLDL size and non–HDL-C were more closely associated with the occurrence of future CAD than levels of LDL-C Whereas sdLDL size was related to CAD risk There is no direct reference of dyslipidemia in Ayurveda but the pathophysiology and presentation of dyslipidemia can be correlated to that of Medoroga Atisthoulya In comprehensive Ayurveda literature medoroga has been synonymously defined to Sthaulya Only Adhamalla while mentioning on sharangdhara samhita tried to differentiate between the two types of medo roga 1 Medo roga adiposity including its clinical features (Sthaulya) 2 Medo dosha lipid disorders where meda acts as an etiological factor in the genesis of other diseases The conventional drug therapy has limitation as lipid lowering drugs like statin and fibrates cause Myalgia increase blood glucose level Insulin Resistance headache dizziness digestive system problems when used for longer duration and in high doses So there is a need of alternate and safer therapies with fewer or no side effects Various studies on Ayurveda medications herbs shown results in  dyslipidemia Mostly drugs are Amala Tikta Kashaya and Katu in Rasa Laghu and Ruksha in Guna and Katu and Amala in Vipaka and thus pacifies the vitiated Kapha Dosha which is dominant in the pathogenesis of dyslipidemia It also depletes the excessively produced Rasa Mamsa Meda Vasa Sweda and Kleda which are all similar in attributes to Kapha Dosha Hence herbal formulations proved to have a better effect in dyslipidemia Diet has been recognized as playing a key role in the control of noncommunicable chronic diseases Specific foods and food components emerge as potential adjuvant strategies in the reduction of the risk of dyslipidemia Food components were revealed to act upon the different metabolic pathways that influence lipid disorders in humans They are believed to have the potential to ultimately become prominent in the future treatment and primary prevention of dyslipidemias and thereby in the control of CVDs The improvement in lipid profile with practice of  physical activity could be due to increased hepatic lipase and lipoprotein lipase This would increase the uptake of triglycerides by adipose tissue and affect the lipoprotein metabolism Vrikshamla (Garcinia indica Linn) has various pharmacological activities including antioxidant anti-obesity  anti-inflammatory hepatoprotective cardioprotective These characteristics are consistent with the previously reported activity of abundant phytochemical components such as garcinol HCA cyanidin-3-sambubioside and cyanidin-3-glucoside isolated from Vrikshamla (Garcinia indica Linn) These studies suggest the potential of Vrikshamla (Garcinia indica Linn) as a promising therapeutic agent for controlling and preventing various diseases However given that most of the trials have been conducted either in vitro or in vivo further study at the clinical level is needed to establish the efficacy and safety of Garcinia indica in humans So far no comparative clinical study has been published using  conventional antidyslipidemic protocol and  Integrated Ayurveda protocol involving small dense LDL as an assessment parameter