Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Archana Dambal

"Journal of clinical and diagnostic research is a welcome change in publishing practices. It aims to reach out to the grass-root level researchers who do not lack in experience, clinical material and ideas, but lack in their knowledge in English language and statistics. The journal achieves it's aim by supporting in these exact domains.
It also gives due credit to all research designs like descriptive and qualitative studies while many journals ignore these important study designs. The rigorous review process does not allow any compromise in quality
It is indexed in many indexing agencies and the articles are available under creative commons licence free of cost
The frequency of publication supports many aspiring authors from India and other countries.
It's wide scope welcomes articles across various specialities in medicine. In an era when there is an unscientific insistence on speciality specific research by regulatory bodies in medical education, JCDR supports collaborative research across specialities. I wish the publisher all the best in his future endeavors."



Dr. Archana Dambal
Department of General Medicine,
Belgaum Institute of Medical Sciences,Belgaum, Karnataka,INDIA,
On 30 Nov 2018




Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



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.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

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

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

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)

How to cite this article :

Shilpa S. Shende, M.V. Bimanpalli, I.C. Apte, Vishakha V. Mahajan, Harshal P. Narkhede. STUDY OF LIPID PROFILE AND C REACTIVE PROTEIN IN PRE- AND POST-MENOPAUSAL WOMEN. Journal of Clinical and Diagnostic Research [serial online] 2011 December [cited: 2019 Sep 19 ]; 5:1544-1547. Available from
http://www.jcdr.net/back_issues.asp?issn=0973-709x&year=2011&month=December&volume=5&issue=8&page=1544-1547&id=1785

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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