Glossary 1.

LDL (low density lipoprotein) cholesterol: a complex of lipids and proteins; with amount of lipids are greater than proteins, that transports cholesterol in the blood. 2. HDL (high density lipoprotein) cholesterol: a lipoprotein that transports cholesterol in the blood; composed of a high proportion of protein and relatively little cholesterol. 3. Triglycerides: a naturally occuring ester of three fatty acids and glycerol that is the chief constituent of fats and oils. 4. VCAM-1 (vascular cell adhesion molecule 1): a protein that in humans is encoded by the VCAM gene; functions as a cell adhesion molecule. 5. ICAM-1 (intercellular cell adhesion molecule -1): a transmembrane protein possesing an aminoterminus extracellular domain, a single transmembrane domain, and a carboxy-terminus cytoplasmic domain. 6. Dyslipidemia: an abnormal amount of lipid; an elevation of lipids in the blood, often die to diet and lifestyle. 7. Leukocyte: cells of the immune system involved in defending the body against both infectious disease and foreign materials. 8. Estradiol: predominant sex hormones present in female. 9. Atherosclerotic: a condition in which the artery wall thickens as the result of a build-up of fatty materials such as cholesterol. 10. Bilirubin: yellow breakdown product of normal heme catabolism. 11. Albumin: any protein that is water soluble, which is moderately soluble in concentrated salt solutions, and experiences heat coagulation. 12. SGOT (serum glutamic oxaloacetic transaminase): an enzyme that facilitates the conversion of aspartate and alphaketoglutarate to oxaloacetate and glutamate. 13. SGPT (serum glutamic pyruvic transaminase): an enzyme that catalyzes the transfer of amino acid groups from L-alanine to 2-ketoglutarate or reverse. 14. Osteoporosis: a disease characterized by decrease in bone mass and density.

15. Alzheimers disease: a degenerative disease of the brain, associated with the development of abnormal tissues and protein deposits in the cerebral cortex. 16. ROS (reactive oxygen species): molecules and ions of oxygens that have an unpaired electron. 17. Endothelial dysfunction: an imbalance between vasodilating and vasoconstricting substances produced by the endothelium. 18. Hysterectomy: surgical removal of the uterus, can be total or partial. 19. Oophorectomy: surgical removal of an ovary or ovaries. 20. Hypertension: a chronic medical condition in which the sytemic arterial blood pressure is elevated.

Questions: 1. What are traditional risk factors for cardiovascular disease? 2. Who were the subjects of the study? 3. What are the main causes of mortality in postmenopausal women? 4. Where was the study conducted? 5. What was the study design? 6. How were the subjects selected? 7. What were the exclusion criteria? 8. What is hip circumference? 9. How was systolic and diastolic pressure based on? 10. How to determined LDL cholesterol and estradiol? Answers: 1. The traditional risk factors for cardiovascular disease are body fat concentration, age, duration of menopause, body mass index, and estradiol concentration. 2. The subjects were postmenopausal women between 47 60 years of age. 3. The main causes of mortalitiy in postmenopausal women are cardiovascular and cerebrovascular disease. 4. The study was conducted in the area of Mampang Prapatan subdistrict health center. 5. The study was a cross-sectional design. 6. The subjects were selected by multistage cluster random sampling. 7. The exclusion criteria were women with chronic or terminal diseases and mastectomy. 8. Hip circumference is the largest circumference between the gluteal muscle dorsally and the pubic symphysis ventrally. 9. Systolic pressure was based on the first Korotkoff sound, whilst diastolic pressure was basen on the fifth Korotkoff sound. 10. LDL cholesterol and estradiol is determined by using reagents from Roche Diagnostics.

Background In premenopausal women cardiovascular disease (CVD) is rarely encountered, but after menopause the prevalence of cardiovascular disease increases drastically. Risk factors in cardiovascular disease can be divided to modifiable factors and unmodifiable factors. Modifiable factors include smoking, obesity, high blood pressure, and others lifestyle, whilst unmodifiable factors are sex and age. CVD in postmenopausal women is associated with endothelial dysfunction, in which there is a defect in the vascular mechanism that protects the vascular endothelium against physical and chemical stimuli, such as inflammation, procoagulation and vasoconstriction. One of the markers of endothelial dysfunction is the vascular cell adhesion molecule-1 (VCAM-1), which plays a role in the development of endothelial dysfunction, along with other adhesion molecules. The aim of this study was to determine the relationship of risk factors affecting the expression of VCAM-1 in postmenopausal women. Problem statement 1. LDL cholesterol is the most influencing factor in VCAM-1 expression. 2. HDL cholesterol doesnt play role in VCAM-1 expression. Discussion Among five factors analyzed in the present study duration of menopause, body mass index, estradiol concentration, HDL cholesterol, and LDL cholesterol only LDL cholesterol had the greatest influence on VCAM-1 expression. Among five subtypes that LDL cholesterol has, subtypes 4 and 5 are the most atherogenic, because they can easily enter the endothelial lining of blood vessel, especially the coronary artery. The role of LDL cholesterol in the atherosclerotic process lies among others in the formation of foam cells. Foam cells are formed from oxydized LDL cholesterol which is phagocytosed by macrophage. VCAM-1, which is both an inflammatory markers and an adhesion molecule, is used in this study as a marker for the prevention of CVD according to The American Heart Association. So when endothelium is injured by the formation of foam cells which are formed from oxydized LDL cholesterol and macrophage, the VCAM-1 value will decrease, thus indicating that blood vessels are injured. HDL cholesterol is essential for lipid transport from the peripheral circulation to the liver, thus decreasing peripheral accumulation of lipids. HDL and LDL cholesterols

function synergistically in maintaining cholesterol balance. Reduction of HDL cholesterol is an atherogenic risk factor, whereas an increase in HDL cholesterol concentration acts as a protective factor. Multiple regression analysis indicates that HDL cholesterol is not an influencing factor in VCAM-1 expression. Those analysis differs from the results of a cross-sectional study by Demerath et al. In the study by Demerath et al, HDL cholesterol stands alone as an independent factor for concentration of adhesion molecules in smokers. In the present study all subjects were between 47 and 60 years old and did not include any smokers, whereas in Demeraths study, the subjects were in the age range of 18 and 62 years old, and were differentiated into smokers and nonsmokers. Conclusion In conclusion, LDL cholesterol concentration decreased VCAM-1 expression in postmenopausal women.