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On Aug 2018




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Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
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Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2011 | Month : December | Volume : 5 | Issue : 8 | Page : 1544 - 1547 Full Version

Study of Lipid Profile and C Reactive Protein in Pre- and Post-menopausal Women


Published: December 1, 2011 | DOI: https://doi.org/10.7860/JCDR/2011/.1785
Shilpa S. Shende, M.V. Bimanpalli, I.C. Apte, Vishakha V. Mahajan, Harshal P. Narkhede

1. Assistant professor, Department of Biochemistry, Indira Gandhi Government Medical College Nagpur, India. 2. Assosiate professor, Department of Biochemistry, Indira Gandhi Government Medical College Nagpur, India. 3. Professor and Head of Department, Department of Biochemistry,Indira Gandhi Government Medical College Nagpur, India. 4. Assistant professor, Department of Biochemistry Indira Gandhi Government Medical College Nagpur, India. 5. Assistant professor, Department of Biochemistry Indira Gandhi Government Medical College Nagpur, Indi

Correspondence Address :
Shilpa Shende
Assistant professor, Department of Biochemistry,
Indira Gandhi Government Medical College Nagpur, India
Phone: 9372128381
E-maildr.shilpashende@yahoo.com

Abstract

Background and Objectives: Menopause is the transition period in women’s life when her normal ovarian function of ovulation ceases.There is less estrogen and progesterone secretion. Since cardiovascular disease (CVD) is the leading cause of death among post-menopausal women, the present study was undertaken to evaluate lipid profile status and C reactive protein (CRP) level in post-menopausal women and compare with premenopausal women.

Materials and Methods: 100 cases (post-menopausal women) were included in the study and 100 regularly menstruating women in the reproductive age group were taken as control. In both the study groups we have measured lipid profile which includes (Serum total cholesterol(TC), TG, HDL-C, LDL-C, VLDL-C), C-reactive protein(CRP) and Body mass index(BMI) as cardiovascular risk factors. Statistical analysis was done by students ‘t’-test.

Results: The results of this study shows significant increased level of serum total cholesterol, TG, LDL-C and VLDL-C in postmenopausal women compared to pre-menopausal women (p<0.001). While serum HDL-C level is significantly lower in cases compared to control(p<0.001). Present study also show elevated mean LDL-C to HDL-C ratio (4.8 + 0.73) in post-menopausal women compared to control(p<0.001). There was also increased level of CRP and BMI in cases compared to control(p<0.001).

Conclusion: The results of our study provide information that cardiovascular risk factors are elevated in post-menopausal women compared to pre-menopausal women so these women are at an increased risk of developing cardiovascular disease.

Keywords

Postmenopausal women, CRP, lipid profile, BMI, Cardiovascular disease (CVD)

Introduction
The incidence of cardiovascular disease is much lower in younger women than in men. This has led to popular misconception that cardiovascular disease is a disease of men and relatively rare in women. This however is not the case, with advancing age rate for women tend to approach those of men. One possible factor may be the different hormonal make up of the two sexes. Menopause is the end of menstruation and it is part of women’s natural aging process. It is characterized by decrease level of estrogen and large number of hormonal changes (1).

It has been proposed that estrogen may be responsible for the protective effects seen amongst younger (pre-menopausal) women. Estrogen exerts cardioprotective action by maintaining high level of high density lipoprotein cholesterol(HDL-C) and lowering the low density lipoprotein cholesterol( LDL-C) and triglycerides(TG) (1), (2), (3), (4). Loss of this protection after menopause may therefore be responsible for increased risk of developing cardiovascular disease in post-menopausal women (5), (6), (7), (8).

C-reactive protein an acute phase reactant synthesized in the liver is also a factor in the development of atherosclerotic plaque. Although CRP was initially believed to be only a marker of vascular inflammation, recent research indicates that it also plays an active role in atherogenesis (9). Thus addition of CRP to traditional lipid screening improves the ability to predict cardiovascular risk.

In view of the above findings the aim of our study was to study the level of lipid profile, CRP and BMI in post-menopausal women and compare them with pre-menopausal women.

Material and Methods

Study population and Design
The present study was carried out in the Department of Biochemistry, Indira Gandhi Government Medical College and Hospital, Nagpur. The study protocol was approved by the institutional ethical committee. An informed written consent was obtained from all the study subjects who were enrolled in the study.

In order to estimate whether post-menopausal women have an increased risk of developing cardiovascular disease a total number of 100 cases (post-menopausal women) attending the Gynaecology out patient department(OPD) were included in the study. Also 100 regular menstruating women in the reproductive age group were included in the study as a control. Women with heart disease,diabetes melitus (DM), any neoplasia, arthritis or any other inflammatory disease and women taking hormonal replacement therapy were excluded from the study.

The majority of patients have similar diets and lifestyle with regard to their daily exercise. Body weight and height were recorded. The BMI was calculated as the weight (Kg) divided by height meter squared (m2).

Laboratory Assays
All blood samples were drawn in the morning after 12 – 14 hrs of fasting. Sample was allowed to clot for 30 minutes and then centrifuged. The separated serum was analysed for the following biochemical parameters.

• Serum total cholesterol by enzymatic method,Serum triglycerides (TG) by enzymatic method • Serum HDL cholesterol by phosphotungstate precipitation followed by enzymatic method. • Serum LDL Cholesterol and VLDL Cholesterol by Friedwald formula (10). • Serum C- reactive protein by Turbilatex method.(Kit-MERCK laboratory). Principle: Latex particles coated with specific human anti-CRP are agglutinated when mixed with samples containing CRP. The agglutination causes an absorbance change dependent upon the CRP contents of the patient sample that can be quantified by comparison from a calibrator of known CRP concentration.

All the parameters were analyzed on semiautomatic analyzer (Transasia Erba Chem-5Plus)

STATISTICAL ANALYSIS
All statistical analyses were performed by using Graph Pad Prism Software. The data was expressed as Mean + SD. Statistical analysis was carried by using students ‘t’-test and P<0.05 was considered as statistically significant. Pearsons correlation coefficient (r) was used to assess correlation between measured parameters.

Results

We observed significant increase in serum total cholesterol(TC), triglycerides(TG), LDL-cholesterol and VLDL-cholesterol level in post-menopausal women compared to pre-menopausal women (p<0.001). HDL-cholesterol level was significantly decreased in post-menopausal women as compared to pre-menopausal women (p<0.001).Also in our study LDL-C to HDL-C ratio was significantly increased in cases compared to control (p<0.001). C reactive protein was significantly increased in post-menopausal women compared to pre-menopausal women (p<0.001).Body mass index (BMI) was also significantly increased in post-menopausal women compared to pre-menopausal women (p<0.001). We observed significant positive correlation between C reactive protein and BMI (r=0.6, p<0.001) in post-menopausal women. Significant positive correlation was also observed between triglycerides (TG) (r=0.3, p<0.001)and LDLcholesterol (r=0.5,p<0.001) with C reactive protein.

Discussion

The major cause of death among post-menopausal women is cardiovascular disease which accounts for nearly 53% of all deaths in women over 50 years of age. When we consider the overall lipid profile as a marker for evaluation of cardiovascular risk, in the present study serum total cholesterol (TC), triglycerides (TG), LDL Cholesterol and VLDL Cholesterol level shows a significant rise (P<0.001) in post-menopausal women compared to pre-menopausal women while serum HDL Cholesterol level is significantly lower in post-menopausal women compared to control (Table/Fig 1), which is in accordance with previous studies by Maturana etal(2008) (11) and Alfonso Cano etal (2003) (12).

Increased serum triglyceride levels indicated in our results may be due to estrogen related decrease in activity of lipoprotein lipase (LPL) after the loss of ovarian function as stated by Stevenson et al (1993) (13) and Wild et al (1995) (4).

According to Arca et al (1994) (14) decrease in estrogen secretion with the cessation of ovarian function probably contribute to higherLDL Cholesterol level in post-menopausal women. Estrogen increases hepatic synthesis of LDL Cholesterol receptor for Apo-β 100 resulting in increase LDL Cholesterol uptake and therefore decreases circulating LDL levels. Thus its deficiency results in rise in LDL Cholesterol in post-menopausal women (4).

HDL Cholesterol is a standard risk profile for coronary heart disease (CHD). Estrogen increases HDL Cholesterol level by inhibiting hepatic lipase, the enzyme that destroys HDL Cholesterol. Present study also shows elevated mean LDL-C to HDL-C ratio in cases compared to control (Table/Fig 1) suggestive of increased cardiovascular risk in post-menopausal women. The Framingham study (15) reported that persons with LDL-C: HDL-C ratio greater than 5 are at high risk of developing CHD and person with LDL-C: HDL-C ratio between 2 and 5 are at intermediate risk of developing CHD. In comparison with Framingham study, our study shows LDL to HDL ratio 4.8+0.73 in post-menopausal women which suggest an intermediate risk of developing CHD in these women.

Body mass index was strongly associated with death due to CHD with the risk of CHD over 3 times higher among women with a body mass index of 29 or higher (16). The finding of increased BMI in post-menopausal women was well supported by Wasir etal(2007)(6) and Tchernof etal (2002) (9).

From various studies it was found that C-reactive protein is a strong independent risk factor for cardiovascular disease among apparently healthy middle aged women (17),(18),(19). Present study shows increased level of CRP in cases compared to control (Table/Fig 1) which point towards increased cardiovascular risk in postmenopausal women compared to control.

There was also positive coefficient of correlation between BMI and CRP levels (Table/Fig 2). There are several mechanisms which may link adiposity with elevated CRP levels. It has been suggested that plasma CRP levels reflect the amount and activity of proinflammatory cytokines such as TNF- α, IL-1 and IL-6 which are implicated in the process of atherosclerotic plaque formation and acute coronary syndrome. In this regard, IL-6, which isinduced by both TNF- α and IL-1,has been proposed to play a central role in the relationship between CRP and cardiovascular disease. The contribution of adipose tissue in IL-6 secretion has been proposed to be the link between plasma CRP and adiposity,as CRP synthesis in the liver is largely under the control of IL-6 (9), (20). Thus adiposity is a significant predictor of plasma CRP in post-menopausal women.

We observed significant positive correlation between parameters of lipid profile such as TG, LDL with CRP level (Table/Fig 3) and (Table/Fig 4). This suggests that unfavourable lipid profile may facilitate the formation of foam cells in arterial wall increasing the inflammatory activity. Our results are in agreement with the findings of Tchernof etal (2002) (9).

In conclusion results of our study provide information that cardiovascular risk factors like lipids and lipoprotein conc, CRP andBMI are elevated in post-menopausal women compared to premenopausal women so these women are at an increased risk of developing cardiovascular disease. Considerable weightage should be given to prevent increase in the level of these parameters during midlife to reduce the later risk of developing coronary heart disease in these women.

References

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Adashi EY. The climacteric ovary as a functional gonadotropin driven androgen- producing gland. Fertile Sterile.1994;62(1):20-7.
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Barret CE, Bush TL. Estrogen and Coronary heart disease in women. JAMA.1991;265(14):1861-7.
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Groedstein F, Stampfer MJ, Manson JE, Colditz GA, Willet WC, Rosner B et al. Post-menopausal estrogen and progestin use and the risk of cardiovascular disease. N Engl J Med.1996 ;335(7): 453-61.
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Wild RA, Taylor EL, Knehans A. The gynecologist and the prevention of cardiovascular disease. AM J Obstet Gynaecol 1995;172:1-13.
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Bush TL: The epidemiology of cardiovascular disease in postmenopausal women. Prevalence medicine part (v) 1986; 263-71.
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Wasir JS, Misra A, Vikram NK, Pandey RM, Luthra K. C-reactive protein, obesity, and insulin resistance in post-menopausal women in urban slums of North India. Diabetes and metabolic syndrome: Clinical Research and Reviews. 2007;1(2):83-89.
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Maturana MA, Breda V, Lhullier F, Spritzer PM. Relationship between endogenous testosterone and cardiovascular risk in early postmenopausal women. Metabolism 2008;57(7):961-5.
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Edmunds E, Lip GY. Cardiovascular risk in women the cardiologist perspective. QJM 2000;93(3):135-45.
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Tchernof A, Nolan A, Sites CK, Ades PA, Poehlman ET. Weight Loss Reduces C-Reactive Protein Levels in Obese Post-menopausal Women. Circulation. 2002;105(5):564-9.
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Friedwald WT, Levy RL, Fredrickson DS. Estimation of the concentration of low density lipoprotein cholesterol in plasma without use of the preparative ultracentrifuge. Clin chem. 1972;18(6): 499-502.
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Maturana MA, Breda V, Lhullier F, Spritzer PM. Relationship between endogenous testosterone and cardiovascular risk in early postmenopausal women. Metabolism 2008;57(7):961-5.
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Alfonso Cano C, Vez García MD, García Urruticoechea P, Tornel Osorio PL, Canteras Jordana M, Abellán Alemán J. Influence of estrogen replacement therapy on atherogenic profile in postmenopausal women. An Med Interna 2003;20(2):70-4.
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Stevenson JC, Crook D , Godsland IF. Influence of age and menopause on serum lipids and lipoproteins in healthy women. Atherosclerosis.1993;98(1): 83-90.
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Arca M, Vega GL , Grundy SM. Hypercholesterolamia in post menopausal women.Metabolic defects and response to low-dose lovastatin. J Am Med Assoc.1994;271(6):453-59.
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Gorden T, KannelWB, Castelli WP, Dawber TR. Lipoproteins, cardiovascular disease and death: The Framingham study. Arch Intern Med. 1981;141(9):1128-31.
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Manson JE, Willet WC, Stampfer MG, Colditz GA, Hunter DJ, Hankinson SE, et al. Body weight and mortality among women. N Engl J med. 1995;333(11):677-85.
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Rifai N, Buring JE, Lee IM, Manson JE, Ridker PM. IS C-Reactive protein specific for vascular disease in women. Ann intern med. 2002;136(7):529-33.
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Ridker PM, Hennekens CH, Buring JE, Rifai N. C-reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women. N Engl J Med. 2000;342(12):836-43.
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Ridker PM, Buring JE, Shih J, Matias M, Hennekens CH. Prospective study of C-reactive protein and the risk of future cardiovascular events among apparently healthy post-menopausal women. Circulation. 1998;98(8):731-3.
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Loskutoff DJ, Samad F. The adipocyte and haemostatic balance in obesity. Studies of PAI-1. Arterioscler Thromb Vasc Biol.1998; 1899(1):1-6.

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JCDR/2011/1785

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  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)
  • www.omnimedicalsearch.com