European Journal of Cardiovascular Medicine

The American Heart Association describes hyperlipidaemia as an elevated amount of fats in the blood. Studies have shown that elevated levels of LDL-C are associated with the development of atherosclerosis, stroke and coronary heart diseases. Platelets have been shown to have a role in the thrombus formation due to atheromatous damage in hyperlipidaemic individuals.^[1] Automated cell counters have made the platelet count (PC) and the platelet indices routinely available in clinical laboratories at no additional cost.^[2] These include platelet count, plateletcrit(PCT),mean platelet volume(MPV), platelet distribution width(PDW), mean platelet concentration (MPC) and platelet large cell count and platelet large cell ratio (PLC-R).^[3]

Platelet parameters are easily available without any additional cost to clinicians, pathologists, patients and can be used to assess the risk associated with hyperlipidaemia, thereby assessing the risk of cardiovascular diseases. In the initial stages of atherosclerosis are accelerated by the production of mitogenic substances by platelets in response to arterial endothelial damage, such as platelets-derived growth factor (PDGF) and Tumor Growth Factor (TGF).Thus platelet activation and thrombotic events are known to be brought on by hypercholesterolemia and hyperlipidaemia in general This study aims to explore the relationship between lipid profiles and platelet parameters, particularly Platelet Count and Platelet Distribution Width (PDW) in hyperlipidaemic individual.

A cross-sectional analysis was conducted on 200 hyperlipidaemic patients in our hospital Srinivas institute of medical sciences and research center from December 2024 to May 2025.

Biochemical (Total Cholesterol, LDL, HDL, Triglycerides) and haematological (Platelet Count, PDW, P-LCR, PCT) parameters were taken from hospital records. Categorized by age and gender. Correlation analysis was employed to assess associations between lipid indices and platelet parameters.

Inclusion Criteria

All patients of both sexes above 20 years of age coming to our institution center for a routine health checkup with a deranged lipid profile.

Exclusion Criteria

Patients below 20 years, and patients who received a recent blood transfusion.

Statistical Analysis

The data was entered in an MS Excel spreadsheet and analysis was performed using Statistical Package for Social Sciences (SPSS) version 26.0. Statistical analysis was done using Pearson’s correlation test and data was expressed as mean ±SD for each parameter. A p-value of < 0.05 was considered to be significant.

The present study was intended to measure platelet parameters in hyperlipidaemic patients. The present study group consisted of 200 hyperlipidaemic patients. The cohort comprised 52% males and 48% females, with the majority aged between 41–60 years (42.5%). The mean Total Cholesterol, LDL, HDL, and Triglycerides were 231.8 ± 25.9 mg/dL, 151.4 ± 28.4 mg/dL, 39.7 ± 14.9 mg/dL, and 146.5 ± 45.6 mg/dL respectively. Platelet Count and PDW averaged 291.7 ± 224.4 x10³/µL and 14.3 ± 3.2 respectively. All parameters show a statistically significant positive correlation with platelet count (p < 0.05), aligning with literature reporting enhanced platelet activity in hyperlipidaemic states. PDW shows a strong positive correlation with both LDL-C (r = 0.841) and Total Cholesterol (r = 0.854), and a moderate inverse correlation with HDL-C.

The most frequently evaluated parameters are mean platelet volume (MPV), plateletcrit (PCT), platelet distribution index (PDW), and the presence of larger platelets (P-LCRs platelet larger cell ratio). The values of platelet indices (PI) were increased in patients suffering from type 2 diabetes mellitus, myocardial infarction or acute surgical conditions, such as appendicitis. The measurement of PIs does not require additional costs and can be performed during routine cell blood count without additional blood samples.^[4] Platelet hyperreactivity and dyslipidaemia contribute significantly to atherosclerosis.^[5]

In a prospective study conducted by Gautham D et al out of 223 cases studied Maximum number of patients was in 41-60 years of age (42.6%). The male-to-female ratio was 1: 1.1 with 47% males and 53% females. The mean total cholesterol, mean LDL-C and mean HDL-C of the study group were 230.4±26.7, 150.3±28.4, and 40.9±15.2 respectively. The mean platelet count and PDW were 288.9±230.5 and 14.1±3.3 respectively. There was a significant correlation between PDW with total cholesterol and LDL-C in a study group with a p-value of <.001.^[1]

In study conducted by Rashi Khemka et al out of 100 patients mean MPV (9.79 ±1.01), PDW (13.18 ± 2.44) and P-LCR (24.85 ± 7.14) of cases were significantly higher than the controls (mean MPV = 9.22 ± 0.91, mean PDW= 11.64 ± 1.75, mean P-LCR= 20.70 ± 7.07; p-value < 0.05). Also, hyperlipidaemic patients having an associated disease had significantly higher PVI than the patients having hyperlipidaemia in isolation.^[6]

In a cross-sectional study study done by Mahmoud Mohamed Abd El-Rahman El-Marabea et al out on 50 patients aged ≥ 18 years old, both sexes, diagnosed with hyperlipidemia (Group 1) and 30 healthy individuals as control (Group 2).PCT was positively correlated with TG, LDL-C, VLDL-C, ADP, cholesterol, BMI, MPV, PDW, and P-LCR.^[7]

In a prospective case control study conducted by Ahmed E. Al-Sharabi et al in 100 acute ischemic stroke patients and 100 controls from Mansoura University Hospitals. Laboratory investigations included complete blood count, platelet indices, and lipid profiles. The study involved a population of 63 % males and 37 % females. The mean of MPV and platelet lymphocyte ratio (PLR) were significantly higher in cases than in controls. However, the PDW was significantly lower in cases than in controls. The lipid profile showed significant differences in MPV, PLR, and LDL levels.^[8]

In a study conducted by Anurag singh et al total of 100 individuals were included in this study, with 68 cases of hyperlipidaemia and 32 controls having normal lipid profiles. Platelet volume indices (PVI) such as platelet count (PC), mean platelet volume (MPV), platelet distribution width (PDW), platelet large cell ratio (P-LCR),plateletcrit (PCT), and platelet function (platelet aggregation with adenosine diphosphate, ADP) were compared between hyperlipidaemia patients and age sex-matched controls with normal lipid profiles. The cases had a statistically significant higher mean MPV (10.55 ± 1.81), PDW (14.93 ± 2.82), and PLCR (30.97 ± 11.74) compared to mean MPV (9.35 ± 1.85), PDW (13.10 ± 2.60), and P-LCR (25.13 ± 12.23) of controls (p-value < 0.05). No significant difference was observed between the study group and control group with respect to mean PC and PCT (p-value > 0.05). In this study, there was a statistically significant increase noted in platelet aggregation percentage in hyperlipidaemic patients than in the control group (42.03 ± 25.28 vs 31.25 ± 15.11) (p-value < 0.05).^[9]

In a study conducted by R Ravindran et al^[10] effect of hypercholesterolemia on the cholesterol content of platelets, on platelet responsiveness and other platelet indices using platelets from 5 groups of age-matched subjects. All the patient groups showed increased platelet aggregation (p < 0.05) and low platelet crit compared with controls (p < 0.05). In addition, platelet cholesterol was increased in patients with coronary disease, hyperlipidemia and diabetes mellitus (p < 0.05) but not in patients with hypertension (p > 0.05); PDW was high only in CAD (p < 0.05). A higher PDW indicated a prothrombotic tendency in CAD patients.

In a study conducted C Tseng et al^[11] by the mean values for MPV (9.94±0.71), PDW (10.99±1.48) and P-LCR (24.29±5.65) in the study group were significantly higher compared to those in the control group (MPV = 8.97 ± 0.42, PDW= 9.19 ±0.83, P-LCR= 16.39 ± 3.24; p＜ 0.05). MPV (r=0.285, p=0.008), PDW (r=0.396, p=0.001) and P-LCR (r=0.269, p=0.013) all showed significant positive correlations with LDL/HDL. Conclusions Adults with hyperlipidaemia had significantly higher MPV, PDW, and P-LCR values compared to normolipidemic adults. There was a significant correlation between the LDL/HDL ratio and (Platelet volume indices) PVIs. Platelets of adults with hyperlipidaemia may become more aggregable and reactive owing to increased PVIs. The increased risk of atherosclerosis in adults with hyperlipidaemia may be a result of high PVIs.

The findings underscore a significant association between dyslipidemia and altered platelet parameters, suggesting enhanced platelet activity in hyperlipidaemic individuals. This reinforces the potential role of lipid-induced platelet activation in atherothrombosis and warrants further investigation into antiplatelet strategies for cardiovascular risk reduction in this population.

CONFLICT OF INTEREST

NIL

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