Assessment of Atherogenic Risk indices and Dyslipidemia in Libyan Smokers

Assessment of Atherogenic Risk indices and Dyslipidemia in Libyan Smokers | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Assessment of Atherogenic Risk indices and Dyslipidemia in Libyan Smokers Hafsa Alemam, Ariej Mustafa, Afaf Shebani, Marwa Attayeb, Abdurrahman Akarem, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5270494/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background The atherogenic index of plasma (AIP) is a novel indicator for assessing the risk of atherogenicity and cardiometabolic health. The study was aimed to investigate the correlation between smoking behaviours and atherogenic indices among cigarettes smokers. Methods The study was conducted at the Libyan Biotechnology Research Centre in Tripoli, Libya. Two hundred Libyan male subjects were divided into two groups: a group of smokers and a group of non-smokers (as the control group). After an overnight 12-hour fast, five millilitres of fasting whole blood were collected for analysis. Plasma lipid profiles, including total cholesterol (TC), triglycerides (TGs), low-density lipoprotein (LDL), and high-density lipoprotein (HDL), were assessed, and levels of atherogenic index of plasma (AIP) were determined. Results The results of the study showed that the smokers' group had significantly elevated levels of total cholesterol (TC), triglycerides (TGs), and low-density lipoprotein (LDL) compared to the non-smokers. Interestingly, all smoker participants exhibited AIP levels greater than 0.1, indicating an increased risk of atherogenicity. In contrast, only 15% of the control group had AIP levels indicating intermediate risk, while the remaining 85% had low risk. Conclusion Based on these findings, the study concluded that there is a significant association between smoking and atherogenic indexes. It also suggested that AIP may serve as an alternative screening tool in situations where all other atherogenic parameters are normal. Atherogenic index of plasma cardiovascular disease high-density lipoprotein low-density lipoprotein triglycerides 1. Introduction Smoking tobacco is a significant global public health concern due to its association with various cardiovascular diseases, including coronary artery disease, acute coronary syndromes, myocardial infarction, peripheral vascular disease, congestive heart failure, and aortic aneurysms. These conditions primarily result from the initiation and progression of atherosclerosis, a condition characterized by the accumulation of plaques in the arteries [ 1 ]. When tobacco is smoked, it affects the central nervous system and stimulates the secretion of catecholamines, which are hormones involved in various physiological processes. In smokers, the elevated levels of catecholamines in the blood are associated with increased platelet aggregation and adhesion compared to non-smokers. Smoking also leads to lipolytic changes and the release of free fatty acids that are taken up by the liver, further contributing to cardiovascular risks [ 2 ]. Dyslipidemia, characterized by abnormal lipid profiles, is considered a major risk factor for cardiovascular diseases. Smoking has been proposed to cause dyslipidemia by increasing serum total and low-density lipoprotein (LDL) cholesterol levels, as well as triglycerides (TGs), and decreasing high-density lipoprotein (HDL) cholesterol. Smokers tend to exhibit dose-dependent elevations of TGLs and LDL cholesterol, along with decreased levels of HDL cholesterol and apolipoprotein A-I (apoA-I), compared to non-smokers. The ratios of total cholesterol (TC) to HDL and LDL to HDL have been found to be valuable predictors of future cardiovascular risks. Atherosclerosis, which involves cholesterol deposition and chronic inflammation, is triggered by lipid peroxidation and LDL oxidation [ 3 , 4 , 5 ]. Although it is well-established that smoking is detrimental to overall health, the impact of smoking on lipid profiles has yielded inconsistent findings, with some studies not finding a consistent association between smoking and adverse lipid profiles. Factors such as variations in study design, participant characteristics, and differing definitions of smoking exposure may contribute to these conflicting results [ 2 , 6 ]. Furthermore, high levels of LDL cholesterol can contribute to endothelial dysfunction and oxidative stress, which are additional risk factors for heart disease [ 7 ]. Limited studies have investigated dyslipidemia in high-risk groups such as smokers, and the results have been inconsistent. To assess the correlation between the atherogenic index of plasma (AIP) and dyslipidemia in Libyan smokers, this study aimed to investigate whether AIP could serve as a useful indicator of dyslipidemia in this specific group. The Castelli's risk index 1 and 2 (CAS-1 and CAS-2) and the atherogenic coefficient (AC) are mathematical ratios derived from the lipid profile that provide information beyond individual lipid parameters such as TC, HDL, LDL, and TGL and are used as indicators of atherogenic potential and the likelihood of developing atherosclerosis and cardiovascular disease [ 8 ]. Additionally, the TG/HDL ratio and AIP are used in various clinical settings to predict the risk of cardiovascular disease (CVD). The TG/HDL ratio is calculated by dividing TGL levels by HDL cholesterol levels and is considered a marker of insulin resistance and a useful predictor of CVD risk. Higher values of the TG/HDL ratio indicate an increased risk of atherosclerosis and cardiovascular events. The AIP is calculated as the logarithm base 10 of the ratio of molar concentrations of TG to HDL cholesterol and represents the balance between atherogenic and anti-atherogenic lipoproteins. A higher AIP value indicates a higher risk of cardiovascular disease, while values closer to zero indicate a lower risk [ 9 , 10 ]. 2. Materials and Methods The samples for this study were obtained at the Center for Preventive Medicine in Tripoli and analyzed at the Libyan Biotechnology Research Center Labs, both located in Tripoli, Libya. The study included 200 Libyan male participants who reside in Tripoli. These participants were divided into two groups: smokers and non-smokers, with the non-smokers (the control group). Information about the participants was collected using a questionnaire that was created by the researchers. The questionnaire was developed after an extensive review of the existing literature, focusing on sociodemographic characteristics of the participants and gathering information about smoking cessation. To assess cardiovascular risk factors, the researchers would have used internationally recognized guidelines. These guidelines provide standardized criteria for defining and evaluating various risk factors associated with cardiovascular diseases, such as hypertension, hyperlipidemia, obesity, diabetes, and smoking. The study was approved by the local ethics committee of the Biotechnology Research Centre, Tripoli, Libya (NBC:001. H. 24. 15). Written informed consent was obtained from all the participants. Inclusion criteria were males aged between 22 and 72 years, who were either non-smokers or active smokers of at least one year duration. Exclusion criteria: former smokers, those suffering from hereditary diseases, and those who take nutritional supplements and herbs. Furthermore, they were required to be either non-smokers or active smokers with a minimum smoking duration of one year. 2.1 Blood sample collection: After an overnight fasting period of 12 hours, blood samples were collected from all 200 participants. The blood was drawn into heparin tubes to prevent clotting. The blood samples were then subjected to centrifugation at 3000 rpm for 15 minutes. The plasma samples were carefully transferred into 1.5 ml Eppendorf tubes and stored at 5°C. It is mentioned that the storage duration did not exceed two days, as recommended by the manufacturer to maintain sample stability and integrity. To analyze the plasma lipid profiles, including (TC, TGs, LDL, and HDL), the researchers used DIALAB kits from DIALAB Produktion, Wiener Neudorf, Austria. The analysis was performed in triplicate for each sample to ensure accuracy and reliability according to the manufacturer's instructions [ 8 , 10 , 11 , 12 ]. Lipid indices were calculated using the following formulae: Atherogenic index of plasma (AIP) = Log (serum triglyceride/serum HDL-c), Castelli’s Risk Index (CRI-I) = Serum total cholesterol/serum HDL-c, CRI-II = Serum LDL cholesterol/serum HDL-c, atherogenic coefficient (AC) = (Serum total cholesterol – serum HDL-c)/ serum HDL-c [ 13 ]. 2.2 Statistical analysis: The data was analyzed using the IBM Armonk, New York, United States, statistical software for the social sciences (SPSS), version 26. To determine the means and standard deviations of the parameters measured, descriptive statistics were used. The means of the parameters for the smokers and non-smokers (control group) were compared using a t-test. The association between the parameters in smokers was determined using Pearson's correlation analysis. p values less than 0.05 were considered as statistical significance. 3. Results All 200 participants included in the study, both smokers and non-smokers, were residents of Tripoli city. The smokers had an average age of 42.28 years with a standard deviation of 9.99, while the non-smokers had an average age of 40.40 years with a standard deviation of 9.433. All non-smokers were in good health, whereas among the smokers, 25% had cardiovascular disease, 8% had hypertension, and 21% had diabetes, while the remaining participants had no reported illnesses. The mean ± S.D values of age and Body mass index (BMI) for smokers and non-smokers. The mean values of age of the smoker group were not significantly different from the non-smokers group. The associations between smoking and BMI were analyzed. The BMI mean values ± S.D in the smoker and non-smoker groups are equal to 23.00 kg/m2 (SD = 0.957) and 23.61 kg/m2 (SD = 0.534), respectively. Thus, the differences in average BMI value were very small and statistically insignificant (p = 0.00) by Student’s t-test as shown in Table 1 . Table 1 Smokers’ and non-smokers’ Anthropometric parameters Parameters Smokers (n = 100) Non-smokers (n = 100) t-test p-value Age (years) 42.28 ± 9.99 40.40 ± 9.433 1.368 0.173(NS) BMI (Kg/m2) 23.00 ± 0.957 23.61 ± 0.534 -5.522 0.00* BMI: Body mass index, *significant difference, NS: No significant difference Table 2 presents the average values, along with their standard deviations, of lipid profiles (mg/dl) for both smokers and non-smokers. In this study, we observed higher levels of total cholesterol (TC) (250.351 ± 48.627), triglycerides (TGs) (232.643 ± 33.03), and low-density lipoprotein (LDL) (141.733 ± 42.36) in the smoker group, which were significantly elevated (p = 0.000) compared to the non-smokers. Conversely, high-density lipoprotein (HDL) (45.351 ± 13.07) was significantly reduced (p = 0.000) in smokers compared to non-smokers. Table 2 Comparison of mean values of lipids in smokers and nonsmokers. Parameters (mg/dL) Smokers (n = 100) Non-smokers (n = 100) t-test p-value TC 250.351 ± 48.62 151.353 ± 10.477 19.915 0.000* TGs 232.643 ± 33.03 143.526 ± 8.489 11.593 0.000* LDL 141.733 ± 42.36 89.692 ± 14.209 11.646 0.000* HDL 45.351 ± 13.07 55.579 ± 5.985 -7.112 0.000* *Significant difference. n: Sample size, S.D: Standard Deviation, TC: Total cholesterol, TGs: Triglycerides, LDL: Lowdensity lipoprotein, HDL: Highdensity lipoprotein. Table 3 presents the average atherogenic indices of both smokers and non-smokers. The atherogenic indices, including AIP, CRI I, CRI II, and AC, were all found to be significantly higher in smokers compared to non-smokers. These indices provide valuable insights into predicting the heightened cardiovascular risk among smokers compared to non-smokers. Table 3 Comparison of mean values of atherogenic indices in smokers and non-smokers Parameters (mg/dL) Smokers (n = 100) Non-smokers (n = 100) t-test p-value AIP 0.350 ± 0.214 0.062 ± 0.048 13.088 0.000* CRI-I 5.999 ± 1.985 2.753 ± 0.355 16.093 0.000* CRI-II 3.388 ± 1.346 1.627 ± 0.279 12.810 0.000* AC 4.999 ± 1.985 1.753 ± 0.355 16.093 0.000* *Significant difference. n: Sample size, S.D: Standard Deviation, AIP: Atherogenic index of plasma, CRI: Castelli’s risk index, AC: Atherogenic coefficient. AIP levels below 0.1 indicate a low cardiovascular risk, while levels between 0.1 and 0.24 are associated with a medium risk, and values above 0.24 are considered to have a high risk of developing cardiovascular diseases. These atherogenic lipid ratios are helpful in assessing the risk of cardiovascular diseases among individuals who smoke cigarettes. A value of AC greater than 3.0 is considered a criterion for cardiovascular risk [ 14 ]. In this study, all smoker participants had AIP levels above 0.24, with an average of 0.350 (± 0.214). Only 15% of the control group had intermediate-risk AIP levels, while 85% had low-risk levels. The analysis revealed that 83% of the smoker group had CRI-I levels exceeding 3.5 (5.999 ± 1.985), whereas only 2% of the control group had higher CRI-I levels. It was also observed that 58% of smoker participants had CRI-II levels above 3 (3.388 ± 1.346), while all control participants had normal CRI-II levels (1.627 ± 0.279). In terms of AC levels, 80% of the smokers had values above 3 (4.999 ± 1.985), while all controls had normal AC levels. There was a significant association between smoking and the atherogenic indices (CRI-I, CRI-II, and AC) (P value = 0.00). Regarding AIP levels, our study found that all smoker participants were at a high risk of atherosclerosis, as they exhibited AIP levels above 0.24 (indicating increased risk), with an average of 0.350 (± 0.214). 4. Discussion Cigarette smoking is a major contributing factor to the development of cardiovascular disease (CVD). One way smoking affects cardiovascular health is by altering plasma lipoprotein levels [ 15 ]. Dyslipidemia, which refers to abnormal lipid levels in the blood, is a well-established risk factor for CVD and related conditions worldwide. This study aimed to investigate the atherogenic indices of plasma, specifically the Atherogenic Index of Plasma (AIP), in relation to smoking habits among Libyan cigarette smokers. AIP, calculated as (logTG)/HDL-C, is a strong predictor of CVD morbidity and its associated complications [ 16 ]. AIP can be used as an alternative screening test for assessing cardiovascular risk when other atherogenic parameters are within the normal range. By evaluating AIP, researchers can assess the atherogenic potential of plasma and identify individuals at higher risk of developing CVD due to smoking habits [ 17 ]. Abnormal lipid profiles have been shown to play a significant role in the progression of coronary artery disease (CAD). To evaluate the risk of CVD associated with dyslipidemia, various factors such as age, sex, and obesity were considered. Measures such as LDL-C to HDL-C ratios, triglyceride levels, and the HDL-C lipoprotein combined index (LCI) were used to assess the impact of dyslipidemia on CVD development. The study results revealed higher levels of total cholesterol, triglycerides, LDL-c, and lower levels of HDL-c in the smoker group compared to the non-smoker group. These findings are consistent with previous studies [ 18 – 20 ]. Smoking has been associated with oxidative stress, inflammation, and alterations in lipid metabolism, which can negatively affect HDL metabolism and functionality. Smoking also causes immediate constriction of coronary arteries and increases coronary vessel tone [ 21 ]. The study investigated plasma atherogenicity using AIP and the TC/HDL ratio. Both parameters were significantly higher among smokers compared to the control group, which aligns with previous reports [ 16 , 20 ]. Castelli risk indexes 1 and 2 are recognized as independent risk factors for CAD and have predictive value for cardiovascular events. The study found significant differences in AIP, CRI-I, CRI-II, and AC between smokers and non-smokers, consistent with previous studies [ 22 , 23 ]. All smoker participants in the study exhibited AIP levels indicating an increased risk, while only a small percentage of the control group had intermediate-risk levels. Additionally, most smokers had elevated CRI-I and AC levels, and a significant association was observed between smoking and atherogenic indexes (CRI-I, CRI-II, and AC). The study on the atherogenic index of plasma (AIP) in Libyan smokers presents several strengths but also has limitations. The difficulty in recruiting over 200 sample subjects may restrict the representation of the wider population, affecting the generalizability of the findings. Concentrating solely on male participants may overlook gender-specific differences in smoking habits and cardiovascular risk. Furthermore, future evaluations should consider other significant factors contributing to cardiovascular disease, such as hypertension and inflammation. Acknowledging these limitations will help guide future research to fill knowledge gaps concerning AIP and cardiovascular risk among Libyan smokers. 5. Conclusion The study findings reveal a strong link between smoking and elevated atherogenic indices, increasing the risk of cardiovascular disease. AIP and TC/HDL ratio proved to be sensitive markers for predicting atherogenic risk in smokers. Based on the information presented, we propose that these indices, including AIP, CRI, CRII, and AC, are valuable tools for identifying and assessing cardiovascular risk in smokers, especially when combined with traditional lipid profiles. Abbreviations AC Atherogenic Coefficient AIP Atherogenic Index of Plasma BMI Body mass index CAD Coronary artery disease CAS-1 Castelli's risk index 1 CAS-2 Castelli's risk index 2 CVD Cardiovascular disease HDL High-density lipoprotein (HDL) LDL Low-density lipoprotein SPSS statistical software for the social sciences TC Total Cholesterol TGs Triglycerides (TGs) Declarations Informed consent The study received approval from the local ethics committee of the Biotechnology Research Center in Tripoli, Libya on (15/04/2024), with the reference number: (NBC:001. H. 24. 15). All participants provided written informed consent. Consent for publication The manuscript has been authorized for publication by all the contributing authors. Conflicts of Interest The authors declare no conflict of interest. Funding The authors did not receive any funding for the submitted work. Author Contribution HA and FE made the design for the study. AS and AA collected the data of the patients. HA and MA did the laboratory analysis. AM did the statistical analysis. AM, AS and MA wrote the first draft. Revision, editing and supervision done by FE and AE. All authors have read and approved the final manuscript Acknowledgement The authors express their gratitude to the Preventive Medicine Center in Tripoli for their valuable assistance and cooperation in facilitating the collection of samples. Data Availability available upon request References - US (2014) Department of Health and Human Services.The Health Consequences of Smoking-50 Years of Progress: A Report of the Surgeon General. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, Atlanta - Gepner AD, Piper ME, Johnson HM, Fiore MC, Baker TB, Stein JH et al (2011) Effects of smoking and smoking cessation on lipids and lipoproteins: Outcomes from a randomized clinical trial. 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J Am Coll Cardiol 43:17317. https://doi:10.1016/j.jacc.2003.12.047 - Bendzala M, Sabaka P, Caprnda M et al (2017) Atherogenic index of plasma is positively associated with the risk of all-cause death in elderly women: A 10-year follow-up. Wien Klin Wochenschr 129(21–22):793–798. https://doi:10.1007/s00508-017-1264-1 - Niroumand S, Khajedaluee M, Khadem-Rezaiyan M et al (2015) Atherogenic Index of Plasma (AIP): A marker of cardiovascular disease. Med J Islam Repub Iran 29:240 - Ayu Agbecha, Ameh Emmanuel Ameh (2018) Atherogenic indices and smoking habits in cigarette smokers. Environ Disease 3(2):38. https://doi:10.4103/ed.ed_5_18 - Alharbi WD (2011) Influence of cigarette smoking on lipid profile in male university students. Pak J Pharmacol 28(2):45–49 - Venkatesan A, Hemalatha A, Bobby Z, Selvaraj N, Sathiyapriya V (2006) Effect of smoking on lipid profile and lipid peroxidation in normal subjects. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5270494","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":370709224,"identity":"a50f4b6a-7f63-4f76-8228-fad17020f583","order_by":0,"name":"Hafsa Alemam","email":"","orcid":"","institution":"Libyan Center for Biotechnology Research","correspondingAuthor":false,"prefix":"","firstName":"Hafsa","middleName":"","lastName":"Alemam","suffix":""},{"id":370709225,"identity":"698c5b5c-1f9d-47d8-98da-29dc8a232fef","order_by":1,"name":"Ariej Mustafa","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/UlEQVRIiWNgGAWjYFACxgYgYcHAIAGkeAxsIAwitEjAtKQRowUMYFoYDhPWwj/7cPOLDzUS0fyzu9Mk3hScT+yf3XzwAUONTTRO488ltlnOOCaRO+PO2W2ScwxuJ864cyzZgOFYWm4DLj1nGNuMedgkchtu5G6T5gFqabiRYybB2HAYpxZ5kJY//yRy50O0nEucT0iLwRnG5seMbRK5GyBaDiRuIKTFEGgLY2+fRO7GG7mbLecYJBtvvJGWbJCAxy9yZ9gff/jxzSZ33g2grjd/7GTn3Ug++OBDjQ1u7zMwsKFEhCNYZQJu5SDA/AGZZ49f8SgYBaNgFIxEAAA8PGIphJQt8gAAAABJRU5ErkJggg==","orcid":"","institution":"Libyan Center for Biotechnology Research","correspondingAuthor":true,"prefix":"","firstName":"Ariej","middleName":"","lastName":"Mustafa","suffix":""},{"id":370709226,"identity":"a88c2784-d179-4978-828f-2894b4644cdd","order_by":2,"name":"Afaf Shebani","email":"","orcid":"","institution":"Libyan Center for Biotechnology Research","correspondingAuthor":false,"prefix":"","firstName":"Afaf","middleName":"","lastName":"Shebani","suffix":""},{"id":370709227,"identity":"7b986df0-23cb-495e-9a17-e7a37f591bca","order_by":3,"name":"Marwa Attayeb","email":"","orcid":"","institution":"Libyan Center for Biotechnology Research","correspondingAuthor":false,"prefix":"","firstName":"Marwa","middleName":"","lastName":"Attayeb","suffix":""},{"id":370709228,"identity":"aff3526f-a929-484b-a1c7-aea0ad6ff148","order_by":4,"name":"Abdurrahman Akarem","email":"","orcid":"","institution":"Libyan Center for Biotechnology Research","correspondingAuthor":false,"prefix":"","firstName":"Abdurrahman","middleName":"","lastName":"Akarem","suffix":""},{"id":370709229,"identity":"c1fce886-db25-48d9-aa4b-e6fc852d6369","order_by":5,"name":"Adam Elzagheid","email":"","orcid":"","institution":"Libyan Center for Biotechnology Research","correspondingAuthor":false,"prefix":"","firstName":"Adam","middleName":"","lastName":"Elzagheid","suffix":""},{"id":370709230,"identity":"43f7705c-3670-43ed-9430-3a7fb8c4712c","order_by":6,"name":"Farag Eltaib","email":"","orcid":"","institution":"Libyan Center for Biotechnology Research","correspondingAuthor":false,"prefix":"","firstName":"Farag","middleName":"","lastName":"Eltaib","suffix":""}],"badges":[],"createdAt":"2024-10-15 17:08:22","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5270494/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5270494/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":98622280,"identity":"9eb4aff1-de1d-49a9-8e37-9097a6625484","added_by":"auto","created_at":"2025-12-19 16:50:48","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":560982,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5270494/v1/4f42d196-4b9d-48a8-aa4e-0369aa6d6101.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Assessment of Atherogenic Risk indices and Dyslipidemia in Libyan Smokers","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eSmoking tobacco is a significant global public health concern due to its association with various cardiovascular diseases, including coronary artery disease, acute coronary syndromes, myocardial infarction, peripheral vascular disease, congestive heart failure, and aortic aneurysms. These conditions primarily result from the initiation and progression of atherosclerosis, a condition characterized by the accumulation of plaques in the arteries [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. When tobacco is smoked, it affects the central nervous system and stimulates the secretion of catecholamines, which are hormones involved in various physiological processes. In smokers, the elevated levels of catecholamines in the blood are associated with increased platelet aggregation and adhesion compared to non-smokers. Smoking also leads to lipolytic changes and the release of free fatty acids that are taken up by the liver, further contributing to cardiovascular risks [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDyslipidemia, characterized by abnormal lipid profiles, is considered a major risk factor for cardiovascular diseases. Smoking has been proposed to cause dyslipidemia by increasing serum total and low-density lipoprotein (LDL) cholesterol levels, as well as triglycerides (TGs), and decreasing high-density lipoprotein (HDL) cholesterol. Smokers tend to exhibit dose-dependent elevations of TGLs and LDL cholesterol, along with decreased levels of HDL cholesterol and apolipoprotein A-I (apoA-I), compared to non-smokers. The ratios of total cholesterol (TC) to HDL and LDL to HDL have been found to be valuable predictors of future cardiovascular risks. Atherosclerosis, which involves cholesterol deposition and chronic inflammation, is triggered by lipid peroxidation and LDL oxidation [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlthough it is well-established that smoking is detrimental to overall health, the impact of smoking on lipid profiles has yielded inconsistent findings, with some studies not finding a consistent association between smoking and adverse lipid profiles. Factors such as variations in study design, participant characteristics, and differing definitions of smoking exposure may contribute to these conflicting results [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Furthermore, high levels of LDL cholesterol can contribute to endothelial dysfunction and oxidative stress, which are additional risk factors for heart disease [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Limited studies have investigated dyslipidemia in high-risk groups such as smokers, and the results have been inconsistent. To assess the correlation between the atherogenic index of plasma (AIP) and dyslipidemia in Libyan smokers, this study aimed to investigate whether AIP could serve as a useful indicator of dyslipidemia in this specific group.\u003c/p\u003e \u003cp\u003eThe Castelli's risk index 1 and 2 (CAS-1 and CAS-2) and the atherogenic coefficient (AC) are mathematical ratios derived from the lipid profile that provide information beyond individual lipid parameters such as TC, HDL, LDL, and TGL and are used as indicators of atherogenic potential and the likelihood of developing atherosclerosis and cardiovascular disease [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Additionally, the TG/HDL ratio and AIP are used in various clinical settings to predict the risk of cardiovascular disease (CVD). The TG/HDL ratio is calculated by dividing TGL levels by HDL cholesterol levels and is considered a marker of insulin resistance and a useful predictor of CVD risk. Higher values of the TG/HDL ratio indicate an increased risk of atherosclerosis and cardiovascular events. The AIP is calculated as the logarithm base 10 of the ratio of molar concentrations of TG to HDL cholesterol and represents the balance between atherogenic and anti-atherogenic lipoproteins. A higher AIP value indicates a higher risk of cardiovascular disease, while values closer to zero indicate a lower risk [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e"},{"header":"2. Materials and Methods","content":"\u003cp\u003e The samples for this study were obtained at the Center for Preventive Medicine in Tripoli and analyzed at the Libyan Biotechnology Research Center Labs, both located in Tripoli, Libya. The study included 200 Libyan male participants who reside in Tripoli. These participants were divided into two groups: smokers and non-smokers, with the non-smokers (the control group). Information about the participants was collected using a questionnaire that was created by the researchers. The questionnaire was developed after an extensive review of the existing literature, focusing on sociodemographic characteristics of the participants and gathering information about smoking cessation. To assess cardiovascular risk factors, the researchers would have used internationally recognized guidelines. These guidelines provide standardized criteria for defining and evaluating various risk factors associated with cardiovascular diseases, such as hypertension, hyperlipidemia, obesity, diabetes, and smoking. The study was approved by the local ethics committee of the Biotechnology Research Centre, Tripoli, Libya (NBC:001. H. 24. 15). Written informed consent was obtained from all the participants. Inclusion criteria were males aged between 22 and 72 years, who were either non-smokers or active smokers of at least one year duration. Exclusion criteria: former smokers, those suffering from hereditary diseases, and those who take nutritional supplements and herbs. Furthermore, they were required to be either non-smokers or active smokers with a minimum smoking duration of one year.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Blood sample collection:\u003c/h2\u003e \u003cp\u003eAfter an overnight fasting period of 12 hours, blood samples were collected from all 200 participants. The blood was drawn into heparin tubes to prevent clotting. The blood samples were then subjected to centrifugation at 3000 rpm for 15 minutes. The plasma samples were carefully transferred into 1.5 ml Eppendorf tubes and stored at 5\u0026deg;C. It is mentioned that the storage duration did not exceed two days, as recommended by the manufacturer to maintain sample stability and integrity. To analyze the plasma lipid profiles, including (TC, TGs, LDL, and HDL), the researchers used DIALAB kits from DIALAB Produktion, Wiener Neudorf, Austria. The analysis was performed in triplicate for each sample to ensure accuracy and reliability according to the manufacturer's instructions [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Lipid indices were calculated using the following formulae: Atherogenic index of plasma (AIP)\u0026thinsp;=\u0026thinsp;Log (serum triglyceride/serum HDL-c), Castelli\u0026rsquo;s Risk Index (CRI-I)\u0026thinsp;=\u0026thinsp;Serum total cholesterol/serum HDL-c, CRI-II\u0026thinsp;=\u0026thinsp;Serum LDL cholesterol/serum HDL-c, atherogenic coefficient (AC) = (Serum total cholesterol \u0026ndash; serum HDL-c)/ serum HDL-c [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Statistical analysis:\u003c/h2\u003e \u003cp\u003eThe data was analyzed using the IBM Armonk, New York, United States, statistical software for the social sciences (SPSS), version 26. To determine the means and standard deviations of the parameters measured, descriptive statistics were used. The means of the parameters for the smokers and non-smokers (control group) were compared using a t-test. The association between the parameters in smokers was determined using Pearson's correlation analysis. p values less than 0.05 were considered as statistical significance.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cp\u003eAll 200 participants included in the study, both smokers and non-smokers, were residents of Tripoli city. The smokers had an average age of 42.28 years with a standard deviation of 9.99, while the non-smokers had an average age of 40.40 years with a standard deviation of 9.433. All non-smokers were in good health, whereas among the smokers, 25% had cardiovascular disease, 8% had hypertension, and 21% had diabetes, while the remaining participants had no reported illnesses.\u003c/p\u003e \u003cp\u003eThe mean\u0026thinsp;\u0026plusmn;\u0026thinsp;S.D values of age and Body mass index (BMI) for smokers and non-smokers. The mean values of age of the smoker group were not significantly different from the non-smokers group. The associations between smoking and BMI were analyzed. The BMI mean values\u0026thinsp;\u0026plusmn;\u0026thinsp;S.D in the smoker and non-smoker groups are equal to 23.00 kg/m2 (SD\u0026thinsp;=\u0026thinsp;0.957) and 23.61 kg/m2 (SD\u0026thinsp;=\u0026thinsp;0.534), respectively. Thus, the differences in average BMI value were very small and statistically insignificant (p\u0026thinsp;=\u0026thinsp;0.00) by Student\u0026rsquo;s t-test as shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSmokers\u0026rsquo; and non-smokers\u0026rsquo; Anthropometric parameters\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameters\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSmokers\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;100)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNon-smokers\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;100)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003et-test\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e42.28\u0026thinsp;\u0026plusmn;\u0026thinsp;9.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e40.40\u0026thinsp;\u0026plusmn;\u0026thinsp;9.433\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.368\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.173(NS)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBMI (Kg/m2)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e23.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.957\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e23.61\u0026thinsp;\u0026plusmn;\u0026thinsp;0.534\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-5.522\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.00*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eBMI: Body mass index, *significant difference, NS: No significant difference\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e presents the average values, along with their standard deviations, of lipid profiles (mg/dl) for both smokers and non-smokers. In this study, we observed higher levels of total cholesterol (TC) (250.351\u0026thinsp;\u0026plusmn;\u0026thinsp;48.627), triglycerides (TGs) (232.643\u0026thinsp;\u0026plusmn;\u0026thinsp;33.03), and low-density lipoprotein (LDL) (141.733\u0026thinsp;\u0026plusmn;\u0026thinsp;42.36) in the smoker group, which were significantly elevated (p\u0026thinsp;=\u0026thinsp;0.000) compared to the non-smokers. Conversely, high-density lipoprotein (HDL) (45.351\u0026thinsp;\u0026plusmn;\u0026thinsp;13.07) was significantly reduced (p\u0026thinsp;=\u0026thinsp;0.000) in smokers compared to non-smokers.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of mean values of lipids in smokers and nonsmokers.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameters\u003c/p\u003e \u003cp\u003e(mg/dL)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSmokers\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;100)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNon-smokers\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;100)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003et-test\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTC\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e250.351\u0026thinsp;\u0026plusmn;\u0026thinsp;48.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e151.353\u0026thinsp;\u0026plusmn;\u0026thinsp;10.477\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e19.915\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTGs\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e232.643\u0026thinsp;\u0026plusmn;\u0026thinsp;33.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e143.526\u0026thinsp;\u0026plusmn;\u0026thinsp;8.489\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11.593\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLDL\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e141.733\u0026thinsp;\u0026plusmn;\u0026thinsp;42.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e89.692\u0026thinsp;\u0026plusmn;\u0026thinsp;14.209\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11.646\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHDL\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45.351\u0026thinsp;\u0026plusmn;\u0026thinsp;13.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e55.579\u0026thinsp;\u0026plusmn;\u0026thinsp;5.985\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-7.112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e*Significant difference. n: Sample size, S.D: Standard Deviation, TC: Total cholesterol, TGs: Triglycerides, LDL: Lowdensity lipoprotein, HDL: Highdensity lipoprotein.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e presents the average atherogenic indices of both smokers and non-smokers. The atherogenic indices, including AIP, CRI I, CRI II, and AC, were all found to be significantly higher in smokers compared to non-smokers. These indices provide valuable insights into predicting the heightened cardiovascular risk among smokers compared to non-smokers.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of mean values of atherogenic indices in smokers and non-smokers\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameters (mg/dL)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSmokers\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;100)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNon-smokers\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;100)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003et-test\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAIP\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.350\u0026thinsp;\u0026plusmn;\u0026thinsp;0.214\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.062\u0026thinsp;\u0026plusmn;\u0026thinsp;0.048\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13.088\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCRI-I\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.999\u0026thinsp;\u0026plusmn;\u0026thinsp;1.985\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.753\u0026thinsp;\u0026plusmn;\u0026thinsp;0.355\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16.093\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCRI-II\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.388\u0026thinsp;\u0026plusmn;\u0026thinsp;1.346\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.627\u0026thinsp;\u0026plusmn;\u0026thinsp;0.279\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12.810\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAC\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.999\u0026thinsp;\u0026plusmn;\u0026thinsp;1.985\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.753\u0026thinsp;\u0026plusmn;\u0026thinsp;0.355\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16.093\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e*Significant difference. n: Sample size, S.D: Standard Deviation, AIP: Atherogenic index of plasma, CRI: Castelli\u0026rsquo;s risk index, AC: Atherogenic coefficient.\u003c/p\u003e \u003cp\u003eAIP levels below 0.1 indicate a low cardiovascular risk, while levels between 0.1 and 0.24 are associated with a medium risk, and values above 0.24 are considered to have a high risk of developing cardiovascular diseases. These atherogenic lipid ratios are helpful in assessing the risk of cardiovascular diseases among individuals who smoke cigarettes. A value of AC greater than 3.0 is considered a criterion for cardiovascular risk [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn this study, all smoker participants had AIP levels above 0.24, with an average of 0.350 (\u0026plusmn;\u0026thinsp;0.214). Only 15% of the control group had intermediate-risk AIP levels, while 85% had low-risk levels. The analysis revealed that 83% of the smoker group had CRI-I levels exceeding 3.5 (5.999\u0026thinsp;\u0026plusmn;\u0026thinsp;1.985), whereas only 2% of the control group had higher CRI-I levels. It was also observed that 58% of smoker participants had CRI-II levels above 3 (3.388\u0026thinsp;\u0026plusmn;\u0026thinsp;1.346), while all control participants had normal CRI-II levels (1.627\u0026thinsp;\u0026plusmn;\u0026thinsp;0.279). In terms of AC levels, 80% of the smokers had values above 3 (4.999\u0026thinsp;\u0026plusmn;\u0026thinsp;1.985), while all controls had normal AC levels. There was a significant association between smoking and the atherogenic indices (CRI-I, CRI-II, and AC) (P value\u0026thinsp;=\u0026thinsp;0.00). Regarding AIP levels, our study found that all smoker participants were at a high risk of atherosclerosis, as they exhibited AIP levels above 0.24 (indicating increased risk), with an average of 0.350 (\u0026plusmn;\u0026thinsp;0.214).\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eCigarette smoking is a major contributing factor to the development of cardiovascular disease (CVD). One way smoking affects cardiovascular health is by altering plasma lipoprotein levels [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Dyslipidemia, which refers to abnormal lipid levels in the blood, is a well-established risk factor for CVD and related conditions worldwide. This study aimed to investigate the atherogenic indices of plasma, specifically the Atherogenic Index of Plasma (AIP), in relation to smoking habits among Libyan cigarette smokers. AIP, calculated as (logTG)/HDL-C, is a strong predictor of CVD morbidity and its associated complications [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. AIP can be used as an alternative screening test for assessing cardiovascular risk when other atherogenic parameters are within the normal range.\u003c/p\u003e \u003cp\u003eBy evaluating AIP, researchers can assess the atherogenic potential of plasma and identify individuals at higher risk of developing CVD due to smoking habits [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Abnormal lipid profiles have been shown to play a significant role in the progression of coronary artery disease (CAD). To evaluate the risk of CVD associated with dyslipidemia, various factors such as age, sex, and obesity were considered. Measures such as LDL-C to HDL-C ratios, triglyceride levels, and the HDL-C lipoprotein combined index (LCI) were used to assess the impact of dyslipidemia on CVD development. The study results revealed higher levels of total cholesterol, triglycerides, LDL-c, and lower levels of HDL-c in the smoker group compared to the non-smoker group. These findings are consistent with previous studies [\u003cspan additionalcitationids=\"CR19\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Smoking has been associated with oxidative stress, inflammation, and alterations in lipid metabolism, which can negatively affect HDL metabolism and functionality. Smoking also causes immediate constriction of coronary arteries and increases coronary vessel tone [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe study investigated plasma atherogenicity using AIP and the TC/HDL ratio. Both parameters were significantly higher among smokers compared to the control group, which aligns with previous reports [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Castelli risk indexes 1 and 2 are recognized as independent risk factors for CAD and have predictive value for cardiovascular events. The study found significant differences in AIP, CRI-I, CRI-II, and AC between smokers and non-smokers, consistent with previous studies [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. All smoker participants in the study exhibited AIP levels indicating an increased risk, while only a small percentage of the control group had intermediate-risk levels. Additionally, most smokers had elevated CRI-I and AC levels, and a significant association was observed between smoking and atherogenic indexes (CRI-I, CRI-II, and AC).\u003c/p\u003e \u003cp\u003eThe study on the atherogenic index of plasma (AIP) in Libyan smokers presents several strengths but also has limitations. The difficulty in recruiting over 200 sample subjects may restrict the representation of the wider population, affecting the generalizability of the findings. Concentrating solely on male participants may overlook gender-specific differences in smoking habits and cardiovascular risk. Furthermore, future evaluations should consider other significant factors contributing to cardiovascular disease, such as hypertension and inflammation. Acknowledging these limitations will help guide future research to fill knowledge gaps concerning AIP and cardiovascular risk among Libyan smokers.\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eThe study findings reveal a strong link between smoking and elevated atherogenic indices, increasing the risk of cardiovascular disease. AIP and TC/HDL ratio proved to be sensitive markers for predicting atherogenic risk in smokers. Based on the information presented, we propose that these indices, including AIP, CRI, CRII, and AC, are valuable tools for identifying and assessing cardiovascular risk in smokers, especially when combined with traditional lipid profiles.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eAC\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAtherogenic Coefficient\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eAIP\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAtherogenic Index of Plasma\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eBMI\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBody mass index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eCAD\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCoronary artery disease\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eCAS-1\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCastelli's risk index 1\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eCAS-2\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCastelli's risk index 2\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eCVD\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCardiovascular disease\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eHDL\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHigh-density lipoprotein (HDL)\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eLDL\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLow-density lipoprotein\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eSPSS\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003estatistical software for the social sciences\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eTC\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eTotal Cholesterol\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eTGs\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eTriglycerides (TGs)\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eInformed consent\u003c/h2\u003e \u003cp\u003e The study received approval from the local ethics committee of the Biotechnology Research Center in Tripoli, Libya on (15/04/2024), with the reference number: (NBC:001. H. 24. 15). All participants provided written informed consent.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003e The manuscript has been authorized for publication by all the contributing authors.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eConflicts of Interest\u003c/h2\u003e \u003cp\u003eThe authors declare no conflict of interest.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThe authors did not receive any funding for the submitted work.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eHA and FE made the design for the study. AS and AA collected the data of the patients. HA and MA did the laboratory analysis. AM did the statistical analysis. AM, AS and MA wrote the first draft. Revision, editing and supervision done by FE and AE. All authors have read and approved the final manuscript\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors express their gratitude to the Preventive Medicine Center in Tripoli for their valuable assistance and cooperation in facilitating the collection of samples.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eavailable upon request\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003e- US (2014) Department of Health and Human Services.The Health Consequences of Smoking-50 Years of Progress: A Report of the Surgeon General. 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Neurol Res 35(5):505\u0026ndash;511. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi:10.1371/journal.pone.0074634\u003c/span\u003e\u003cspan address=\"https://doi:10.1371/journal.pone.0074634\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Atherogenic index of plasma, cardiovascular disease, high-density lipoprotein, low-density lipoprotein, triglycerides","lastPublishedDoi":"10.21203/rs.3.rs-5270494/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5270494/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe atherogenic index of plasma (AIP) is a novel indicator for assessing the risk of atherogenicity and cardiometabolic health. The study was aimed to investigate the correlation between smoking behaviours and atherogenic indices among cigarettes smokers.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThe study was conducted at the Libyan Biotechnology Research Centre in Tripoli, Libya. Two hundred Libyan male subjects were divided into two groups: a group of smokers and a group of non-smokers (as the control group). After an overnight 12-hour fast, five millilitres of fasting whole blood were collected for analysis. Plasma lipid profiles, including total cholesterol (TC), triglycerides (TGs), low-density lipoprotein (LDL), and high-density lipoprotein (HDL), were assessed, and levels of atherogenic index of plasma (AIP) were determined.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe results of the study showed that the smokers' group had significantly elevated levels of total cholesterol (TC), triglycerides (TGs), and low-density lipoprotein (LDL) compared to the non-smokers. Interestingly, all smoker participants exhibited AIP levels greater than 0.1, indicating an increased risk of atherogenicity. In contrast, only 15% of the control group had AIP levels indicating intermediate risk, while the remaining 85% had low risk.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eBased on these findings, the study concluded that there is a significant association between smoking and atherogenic indexes. It also suggested that AIP may serve as an alternative screening tool in situations where all other atherogenic parameters are normal.\u003c/p\u003e","manuscriptTitle":"Assessment of Atherogenic Risk indices and Dyslipidemia in Libyan Smokers","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-05 15:10:41","doi":"10.21203/rs.3.rs-5270494/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7cf8a0b0-fb17-40bd-b67d-5b3af721f689","owner":[],"postedDate":"November 5th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-12-08T22:08:28+00:00","versionOfRecord":[],"versionCreatedAt":"2024-11-05 15:10:41","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5270494","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5270494","identity":"rs-5270494","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}