A 2^k Factorial Design on The Effect of Different Cholesterol ‎Reducing Factors

Authors

  • Ukeme P. Akra

    Department of Statistics, Akwa Ibom State University, Ikot Akpaden
  • Anthony A. Isaac

    Department of Statistics, Akwa Ibom State University, Ikot Akpaden
  • Edet E. Bassey

    Department of Statistics, University of Calabar, Calabar
  • Andrew C. Etim

    Department of Statistics, Akwa Ibom State University, Ikot Akpaden
  • Usenobong B. Akpan

    Department of Physics, Akwa Ibom State University, Ikot Akpaden
  • Itoro T. Michael

    Department of Statistics, Akwa Ibom State University, Ikot Akpaden

Received date: May 14, 2025

Accepted date: June 5, 2025

Published date: June 10, 2025

DOI:

https://doi.org/10.14419/rd686p43

Keywords:

Cholesterol; Reduction; Factor; Level; Factorial Design

Abstract

This research focuses on the application of a 2K factorial design on the effect of different cholesterol-reducing factors. The purpose is to determine the effect of each factor and its interactions that ‎contribute to the reduction of cholesterol levels. A complete 24 factorial design with two replicates ‎was used for the experiment, where the factors are: Frequency (A), Duration (B), Dosage (C) and ‎Drug type (D) each at two levels. The levels are A (Once and Twice daily), B (4 and 8 weeks), C ‎‎(Low and High), and D (Statins and PCKS9 inhibitor). The analysis of variance technique was used ‎to test the significant effects, and a Pareto chart was plotted to show a particular factor that has a ‎higher reduction strength to reduce cholesterol level. Results revealed that all the main effects are ‎significant, two–factor interactions of six two–factor interactions are not significant, three–factor interactions are not significant, and four–factor interactions is significant at the 5% level of ‎significance. Hence, from the Pareto chart, it is confirmed that factor C outperformed than ‎other factors and their interactions in reducing cholesterol level‎.

 

References

  1. Joshi, P. H., & Jacobson, T. A. (2010). Therapeutic options to further lower C-reactive protein for patients on statin treatment. Curr Atheroscler Rep. 12:34-42 https://doi.org/10.1007/s11883-009-0075-x.
  2. Causevic-Ramosevac, A., & Semiz, S. (2013). Drug interactions with statins. Acta Pharm. 63:277-293https://doi.org/10.2478/acph-2013-0022.
  3. Hu, M., & Tomlinson, B. (2014). Evaluation of the pharmacokinetics and drug interactions of the two recently developed statins, rosuvastatin and pitavastatin. Expert Opin Drug Metab Toxicol. 10:51-65 https://doi.org/10.1517/17425255.2014.851667.
  4. Sirtori, C. R. (2014). The pharmacology of statins. Pharmacol Res.88:3-11 https://doi.org/10.1016/j.phrs.2014.03.002.
  5. Bellosta, S., & Corsini, A. (2018). Statin drug interactions and related adverse reactions: an update. Expert Opin Drug Saf. 17:25-37 https://doi.org/10.1080/14740338.2018.1394455.
  6. Awad, K., Serban, M.C., & Penson, P. (2017). Effects of morning vs evening statin administration on lipid profile: a systematic review and meta-analysis. J Clin Lipidol. 11:972-985 e979 https://doi.org/10.1080/14740338.2018.1394455.
  7. Krishnamurthy, A., Bradley, C., & Ascunce, R. (2022). SAMSON and the Nocebo Effect: management of Statin Intolerance. Curr Cardiol Rep. 24:1101-1108 https://doi.org/10.1007/s11886-022-01729-x.
  8. Echavarria Uceta, R., & Guzman, E. (2021). New and Emerging Lipid Modifying Drugs to Lower LDL Cholesterol. Drugs Context; 10:1-22 https://doi.org/10.7573/dic.2021-8-3.
  9. Rojas-Fernandez, C., Hudani, Z., & Bittner, V. (2015). Statins and cognitive side effects: what cardiologists need to know. Cardiol Clin. 33:245-256 https://doi.org/10.1016/j.ccl.2015.02.008.
  10. Rojas-Fernandez, C. H., Goldstein, L. B., & Levey, A. I. (2014). The National Lipid Association's Safety Task Force. An assessment by the Statin Cognitive Safety Task Force: 2014 update. J Clin Lipidol. 8:S5-16 https://doi.org/10.1016/j.jacl.2014.02.013.
  11. Richardson, K., Schoen, M., & French, B. (2013). Statins and cognitive function: a systematic review. Ann Intern Med. 159:688-697 https://doi.org/10.7326/0003-4819-159-10-201311190-00007.
  12. Newman, C. B., Preiss, D., & Tobert, J. A. (2019). Statin Safety and Associated Adverse Events: a Scientific Statement from the American Heart Association. Arterioscler Thromb Vasc Biol. 39:38-81 https://doi.org/10.1161/ATV.0000000000000073.
  13. Russo, M. W., Scobey, M., & Bonkovsky, H. L. (2009). Drug-induced liver injury associated with statins. Semin Liver Dis. 29:412-422 https://doi.org/10.1055/s-0029-1240010.
  14. Bays, H., Cohen, D. E., & Chalasani, N. (2014). The National Lipid Association's Statin Safety Task F. An assessment by the Statin Liver Safety Task Force: 2014 update. J Clin Lipidol. 8:47-57 https://doi.org/10.1016/j.jacl.2014.02.011.
  15. Stoekenbroek, R. M., Lambert, G., & Cariou, B. (2018). Inhibiting PCSK9—Biology beyond LDL Control. Nat Rev Endocrinol. 15:52-62 https://doi.org/10.1038/s41574-018-0110-5.
  16. Kosmas, C. E., & Dejesus, E. (2015). Proprotein Convertase Subtilisin/Kexin Type 9 Inhibitors: an Emerging Chapter in The Field of Clinical Lip-idology. Enliven Clin Cardiol Res. 2:E1.
  17. Leren, T. P. (2014). Sorting an LDL Receptor with Bound PCSK9 to Intracellular Degradation. Atherosclerosis. 237:76-81 https://doi.org/10.1016/j.atherosclerosis.2014.08.038.
  18. Schwartz, G. G., Steg, P. G., & Szarek, M. (2018). Alirocumab and Cardiovascular Outcomes after Acute Coronary Syndrome. N Engl J Med. 379:2097-2107 https://doi.org/10.1056/NEJMoa1801174.
  19. Sabatine, M. S., Giugliano, R. P., & Keech, A. C. (2017). Evolocumab and Clinical Outcomes in Patients with Cardiovascular Disease. N Engl J Med. 376:1713-1722 https://doi.org/10.1056/NEJMoa1615664.
  20. Nicholls, S. J., Kataoka, Y., & Nissen, S. E. (2022). Effect of evolocumab on coronary plaque phenotype and burden in statin-treated patients fol-lowing myocardial infarction. J Am Coll Cardiol Img. 1308-1321 https://doi.org/10.1016/j.jcmg.2022.03.002.
  21. Räber, L., Ueki, Y., & Otsuka, T. (2022). Effect of alirocumab added to high-intensity statin therapy on coronary atherosclerosis in patients with acute myocardial infarction: the pacman-ami randomized clinical trial. JAMA, 327:1771-1781 https://doi.org/10.1001/jama.2022.11836.
  22. Sun, J., Lepor, N. E., & Cantón, G. (2021). Serial Magnetic Resonance Imaging Detects a Rapid Reduction in Plaque Lipid Content Under PCSK9 Inhibition with Alirocumab. Int J Cardiovasc Imaging. 37:1415-1422 https://doi.org/10.1007/s10554-020-02115-w.
  23. Lepor, N. E., Sun, J., & Canton, G. (2021). Regression in Carotid Plaque Lipid Content and neovasculature with PCSK9 Inhibition: a Time Course Study. Atherosclerosis, 327:31-38 https://doi.org/10.1016/j.atherosclerosis.2021.05.008.
  24. Ray, K. K., Wright, R. S., & Kallend, D. (2020). Two phase 3 trials of inclisiran in patients with elevated LDL Cholesterol. N Engl J Med. 382:1507-1519 https://doi.org/10.1056/NEJMoa1912387.
  25. Akra, U. P., Etim, A. C., Chiukpai, A. I., Umondak, U. J., & Inyang, E. E. (2025). A Multi- Level Factor Factorial Design for Solving Uncertainty Criteria in Establishing a Retail Business in Nigeria. International Journal of Economic, Finance and Business Statistics, 3(1), 1-14. https://doi.org/10.59890/ijefbs.v3i1.239.
  26. Akra U. P., Bassey E. E., Etim A. C., Umondak U. J., Chiukpai A. I., & Akpan U. A. (2024). A Mixed-level Factorial Experiment to Elucidate the Impact of Inorganic Fertilizers on Crop Yield. Research Journal of Agricultural Economics and Development, 3(1), 61-73. https://doi.org/10.52589/RJAED-MLJYW3AX.
  27. Akra, U. P., & Edet, E. B. (2017). Confounding 2K Factorial Design to Obtain Optimal yields using Different Organic Manure. Journal of Scientific and Engineering Research, 4(11), 75-85.
  28. Wang, H., Lin, Y., & Zhang, M. (2023). A factorial trial evaluating statin and ezetimibe co-administration in hypercholesterolemia. Journal of Clini-cal Lipidology, 17(1), 15–22. https://doi.org/10.1016/j.jacl.2022.10.004.
  29. Kim, D. H., Seo, J., & Park, S. (2022). Factorial design trial of atorvastatin dose and niacin in cholesterol control. Atherosclerosis, 348, 40–47.
  30. Sharma, R., Mehta, V., & Kaur, G. (2022). Combined effect of plant sterols and dietary fiber on lipid profile: A factorial study. Nutrition & Me-tabolism, 19(1), 88.
  31. Lopez-Miranda, J., & Delgado-Lista, J. (2023). Olive oil polyphenols and fish oil synergy in lipid modulation: A factorial study. Nutrition Reviews, 81(4), 322–331. https://doi.org/10.1093/nutrit/nuad004.
  32. Ganesan, A., Krishnamurthy, S., & Nair, M. (2024). Diet and statin synergy in lowering LDL cholesterol: A factorial design analysis. Journal of Preventive Cardiology, 10(1), 12–20.
  33. Singh, P., Rao, R., & Patel, T. (2022). Interaction of exercise intensity and statin dose in hyperlipidemia management: A factorial study. Journal of Sports Medicine and Health Science, 11(2), 102–109.
  34. Li, Q., Zhao, X., & Feng, Y. (2023). APOE genotype-specific response to cholesterol-lowering interventions: A factorial RCT. Frontiers in Cardio-vascular Medicine, 10, 1134215.
  35. [Zhao, Y., Sun, J., & Liu, H. (2023). Plant compound and dietary fat interaction in cholesterol metabolism: A 3×3 factorial design in mice. Experi-mental and Molecular Medicine, 55(3), 471–480.
  36. Ahmed, F., Banu, S., & Islam, R. (2024). Public health strategies for cholesterol control: A factorial design trial in rural communities. BMJ Global Health, 9(1), e014773.
  37. Bays, H. E., Dujovne, C. A., Davidson, M. H., Shapiro, M. D., & McKenney, J. M. (2003). Comparison of once-daily extended-release nia-cin/lovastatin with single-agent extended-release niacin and statins in patients with dyslipidemia. The American Journal of Cardiology, 91(11), 1304–1310. https://doi.org/10.1016/S0002-9149(03)00007-9.
  38. McKenney, J. M., Davidson, M. H., Jacobson, T. A., & Guyton, J. R. (2006). A comparison of the efficacy and tolerability of rosuvastatin versus atorvastatin, simvastatin, and pravastatin across doses. The American Journal of Cardiology, 92(2), 152–160.
  39. Law, M. R., Wald, N. J., & Rudnicka, A. R. (2003). Quantifying effect of statins on LDL cholesterol, ischaemic heart disease, and stroke: system-atic review and meta-analysis. BMJ, 326(7404), 1423. https://doi.org/10.1136/bmj.326.7404.1423.
  40. Park, S. Y., Lee, H. S., & Kim, J. M. (2016). A 2⁴ factorial design analysis of dose, frequency, and combination in antihypertensive drug trials. Journal of Clinical Pharmacology, 56(7), 860–867. https://doi.org/10.1002/jcph.654.

Downloads

Received date: May 14, 2025

Accepted date: June 5, 2025

Published date: June 10, 2025