RAJIV GANDI UNIVERSITY OF HEALTH SCIENCES

KARNATAKA, BANGALORE

ANNEXURE-II

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

NAME OF THE CANDIDATE DR. JAGADISH NAYAK

1. AND ADDRESS POST-GRADUATE IN GENERAL
(IN BLOCK LETTERS) MEDICINE,
DEPARTMENT OF MEDICINE,
MYSORE MEDICAL COLLEGE AND
RESEARCH INSTITUTE,
MYSORE-570001
MYSORE MEDICAL COLLEGE AND
2. NAME OF THE INSTITUTION RESEARCH INSTITUTE
MYSORE
3. COURSE OF STUDY AND M.D (MEDICINE)
SUBJECT
4. DATE OF ADMISSION TO 14-06-2011
COURSE AND DATE OF
COMMENCEMENT OF COURSE 24-06-2011

5. TITLE OF TOPIC STUDY OF ASSOCIATION OF C-

REACTIVE PROTEIN AND LDL-HDL
CHOLESTEROL RATIO IN ACUTE
MYOCARDIAL INFARCTION

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6. BREIF RESUME OF THE INTENDED WORK

6.1 Need for the study –

Acute myocardial infarction triggers an inflammatory reaction which plays an important role in
myocardial injury . inflammatory markers such as c-reactive protein reflect the extent of
myocardial necrosis and correlate with cardiac outcomes following acute myocardial infarction .

Recent research has focused on the use of high-sensitivity C-reactive protein (hs-CRP), a marker
of inflammation, in the detection of patients at increased risk for cardiovascular disease. Several
prospective studies have demonstrated that hs-CRP is an independent predictor of future risk for
cardiovascular events among healthy individuals, as well as among patients with acute coronary
syndromes. In addition, because half of all cardiovascular events occur in persons with low to
average levels of low-density lipoprotein cholesterol, hs-CRP may aid in identifying patients at
high risk for a first cardiovascular event who might otherwise be missed by lipid screening alone.
Thus, hs-CRP is a potential adjunct for global risk assessment in the primary prevention of
cardiovascular disease

A more tenable option that has been proven to be an accurate predictor of cardiovascular risk is
the LDL-C/ HDL-C ratio which can be obtained from a standard lipid profile and is more
accurate than LDL-C or HDL-C alone.

The present study was conducted to study the association of serum CRP levels and
LDL:HDL ratio in the patients

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6.2 Review of Literature

1. case control study was conducted at National Institute for Cardiovascular Disease (NICVD).
In this study, CRP levels were significantly high and serum HDL levels significantly low in
patients as compared to controls. Serum LDL levels and the ratio of LDL and HDL were not
significantly different among the two groups.

2. The Honolulu Heart Program analyzed frozen serum samples to assess the relationship of hs-
CRP to the development of myocardial infarction in clinically healthy men over a follow-up
period of 20 years Overall, hs-CRP levels in this study were associated with coronary events that
occurred as many as 15 years later

3. Elevated hs-CRP has been shown to be a strong predictor of future cardiovascular risk in
patients with established CHD, with or without a previous myocardial infarction. In the
Scandinavian Simvastatin Survival Study, elevated hs-CRP levels predicted mortality in patients

4.In this study, higher CRP levels in patients were associated with lower HDL, as
compared to controls .Higher CRP levels were also found associated in patients with
high BMI and age group 46-60 years. This study did not show significantly higher levels
of LDL among patients within various groups. CRP appeared to be more strongly
associated with CAD as compared to serum HDL, LDL-cholesterol or their ratio in all
groups.with stable ischemic heart disease

5. Low HDL is shown to be associated with higher prevalence and incidence of CAD.
This study also had similar observations with majority of patients having LDL:HDL >3.
Low HDL in individuals in age group 46-60years, was also associated with greater
prevalence of AMI

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6.In PROCAM study it was found that a continous and graded relationship between the
LDL-C /HDL-C ratio and cvd mortality coronary deaths spiked when the LDL-HDL ratio
reached between 3.7 and 4.3.

7. The use of hs-CRP as an adjunct to lipid screening in primary prevention is

intended to improve global risk prediction in patients not clearly identified as being
at high risk by cholesterol levels alone

8. Using widely available high sensitivity assays CRP levels of <1 ,1-3, >3 mg/l
corresponds to low , moderate and high risk groups for cardiovascular events .

6.3 Objectives of Study.

To determine the association of high serum CRP levels and LDL:HDL in the
patients presenting with acute myocardial infarction.

7.MATERIALS AND METHODS

7.1 Source of Data

Patients with acute myocardial infarction who fulfill inclusion and exclusion criteria , getting

admitted to K R hospital mysore during the period of December 2011 to August 2013.

7.2 Method Of Collection of Data

Sample size: 100

Sampling Method:

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 Simple random sampling

7.3 Inclusion Criteria:

1. Age >40 years

2. Acute myocardial infarction evidenced by ECG, Elevated Troponin T ,2D

Echocardiography

7.4 Exclusion Criteria:

1.Patients below 40years of age

2 .Individuals with rheumatic disease,chronic liver diseases,renal disorders,cancer,sepsis and

patient critically ill with less than one month duration infectious diseases and surgical
procedure in 3 month duration.

3 .patient on statin therapy.

7.5 Method of study:

Data will be collected using a pretested proforma meeting the objectives of the study.
Detailed history and necessary investigations will be undertaken. The purpose of the study will
be explained to the patient and informed consent obtained.

The patients included were diagnosed as acute myocardial infarction on the basis of history,
clinical examination, ECG, and laboratory investigations. The controls were age, sex and socio-
economically matched persons not having any heart disease. The participants were excluded if
they had a past history of any heart disease, diabetes mellitus, any infection or inflammatory
disease.

The study included the quantitative estimation of serum C-Reactive Protein (CRP), Low-density
Lipoproteins (LDL), High-density Lipoproteins (HDL), Fasting Blood Sugar (FBS) as well as
Complete Blood Count (CBC) .
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The analysis of the Data will be done using appropriate statistical method .Ethical committee will be

taken

7.6 INVESTIGATIONS

1. ECG
2. TROP T,CK MB
3. CRP
4. LIPID PROFILE[LDL-C,HDL-C AND LDL-C/HDL-C RATIO]
5. BLOOD GLUCOSE LEVEL
6. COMPLETE BLOOD COUNT
7. 2D ECHOCARDIOGRAPHY

7.4 Has ethical clearance been obtained from your institution :

Yes [copy enclosed]

8. REFERNCES:

1. Sakkinen P, Abbott RD, Curb JD, Rodriguez BL, Yano K, Tracy RP. C-reactive protein and
myocardial infarction. J Clin Epidemiol. 2002;55:445-451

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2. Cesari M, Penninx BW, Newman AB, Kritchevsky SB, Nicklas BJ, SuttonTyrrell
K, et al. Inflammatory Markers and Onset of Cardiovascular Events: Results
from the Health ABC Study. Circulation 2003;108:2317-22.

3. Crea F, Monaco C, Lanza GA, Maggi E, Ginnetti F, Cianflone D, et al. Inflammatory

predictors of mortality in the Scandinavian Simvastatin Survival Study. Clin
Cardiol.2002;25:461-466

4.Pearson TA, Mensah GA, Hong Y, Smith SC Jr, for the Centers for Disease Control and
Prevention and the American Heart Association Workshop on Markers of Inflammation and
Cardiovascular Disease. CDC/AHA workshop on markers of inflammation and cardiovascular
disease: application to clinical and public health practice: overview. Circulation.2004; 110:e543-
544

5. Ridker PM. Clinical application of C-reactive protein for cardiovascular disease detection and
prevention [review]. Circulation.2003;107:363-369

6.bibi kulsoom , s nazral hasnain . department of biochemistry ,ziauddin medical

university and hospital Karachi. Association of serum c reactive protein and ldl/hdl ratio
in MI.

7. Cullen p . Schulte ,H.Assmann G ; The munster heart study (PROCAM) Total mortality in
middle aged men is increased at low total and ldl cholesterol concentrations in smokers but not
in non smokers circulation .96;2128-2136,1997.

8 Rader J. Daniel, Hobbs. H Helen. Disorders of lipoprotein metabolism. Harrison’s Principles of

Internal Medicine 18th edition. Pg no. 3157-3159.

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9.SIGNATUE OF THE CANDIATE: Dr. JAGADISH NAYAK

10. REMARKS OF THE GUIDE:

11.NAME AND DESIGNATION OF

11.1 Guide: Dr. MOHAMMED GHOUSE SHARIFF
MD
PROFESSOR
DEPARTMENT OF MEDICINE,
MYSORE MEDICAL COLLEGE
AND RESEARCH INSTITUTE,
MYSORE

11.2 SIGNATURE:

11.3 HEAD OF THE DEPARTMENT: Dr .H VASUDEVA NAIK

MD
PROFESSOR AND HEAD
DEPARTMENT OF MEDICINE
MYSORE MEDICAL COLLEGE
AND RESEARCH INSTITUTE

11.4 SIGNATURE:

12 12.1 REMARKS OF DEAN

AND DIRECTOR:

12.2 SIGNATURE:
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 ETHICAL COMMITTE CLEARENCE

1. TITLE OF DISSERTATION: STUDY OF ASSOCIATION OF CRP AND

LDL-C /HDL-C RATIO IN MYOCARDIAL
INFACTION PATIENTS

2.NAME OF THE CANDIDATE: DR. JAGADISH NAYAK

3.SUBJECT: MD GENERAL MEDICINE

4.NAME OF THE GUIDE: DR. MOHAMMED GHOUSE SHARIFF

MD
PROFESSOR
DEPT OF MEDICINE,
K R HOSPITAL
MMC&RI, MYSORE

5.APPROVED/NOT APPROVED: APPROVED

[If not approved ,suggestions]

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 MEMBERS OF ETHICAL CLEARANCE COMMITTEE

PROFESSOR AND HOD PROFESSOR AND HOD

DEPT OF MEDICINE DEPT OF SURGERY
MMC&RI,MYSORE MMC&RI, MYSORE

MEDICAL SUPERINTENDENT MEDICAL SUPERINTENDENT

K R HOSPITAL CHELUVAMBA HOSPITAL
MYSORE MYSORE

SUPERINTENDENT LAW EXPERT

PKTB HOSPITAL
MYSORE

DIRECTOR AND DEAN,

MMC&RI,
MYSORE

From,
Dr. JAGADISH NAYAK
Post-graduate in General Medicine
Department of General Medicine
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Mysore Medical College & Research Institute
Mysore.

To,
Registrar (Evaluation)
Rajiv Gandhi University of Health Sciences
Bangalore.

Through proper channel.

Respected Sir,

Subject: Submission of Synopsis titled “STUDY OF ASSOCIATION OF C-

REACTIVE PROTEIN AND LDL-HDL CHOLESTEROL RATIO IN
ACUTE MYOCARDIAL INFARCTION”

I am hereby submitting the above titled synopsis (4 copies) as mentioned above, so

kindly accept my application and do the needful.

Thanking you,
Yours faithfully,
(DR.JAGADISH NAYAK)

Forwarded to Dean and Director, MMC & RI, Mysore for further needful action.

Professor and Head,

Date: Department of Gen. Medicine
Place: MMC & RI, Mysore

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