PENETAPAN PERKIRAAN KADAR LOW DENSITY LIPOPROTEIN (LDL), HIGH DENSITY LIPOPROTEIN (HDL) DAN RASIO LDL TERHADAP HDL PADA POPULASI DATA RISKESDAS TAHUN 2007

Background: Coronary Heart Disease (CHD) occurs due to narrowing of coronary arteries. The risk factor of CHD is dyslipidemia, These is abnormality of lipid metabolism showed by increased LDL or HDL cholesterol decreased in the plasma. The ratio of LDL to HDL is also an indicator to describe the risk of CHD. The risk increased progressively by increasing levels of serum LDL and will be protective in the high concentrate of HDL. The risk factors are age, sex, food habit, smoking, lack of activity, and obesity. Objective: To determine the approximate levels of LDL, HDL, and the ratio LDL to HDL, and factors related to levels of LDL, HDL, and the ratio LDL to HDL. Method: This was an analytical research with Cross-sectional design by reviewing analysis of secondary data of Riskesdas 2007 data. The population is all subjects which were tested of blood specimens. This was a total sampling and the total number of sample was 7.740 people. Statistical analysis were T-test, Anova and Regression to determine the most affected risk factor. Results: The mean of LDL, HDL, and the ratio LDL to HDL, in the population (125,59 ± 35,78 mg/dl, 43,32 ± 12,79 mg/dl, and 3,15 ± 1,41 mg/dl), in heart disease patients (125,45 ± 35,71 mg/dl, 43,29 ± 12,72 mg/dl, and 3,15 ± 1,41 mg/dl), in patients with heart disease ( 136,20 ± 38,62 mg/dl, 45.67 ± 17,37 mg/dl, and 3,29 ± 1,41 mg/dl). There were sex effect (

HUBUNGAN OBESITAS SENTRAL DENGAN PENYAKIT JANTUNG KORONER DI PUSKESMAS KOTA BOGOR

Background : Obesity is one of the problems associated with an increased risk of disease, one of which coronary heart disease. Coronary heart disease is the leading cause of death in both developed and in developing countries. Objective : This study aims to determine the relationship of central obesity with coronary heart disease in Bogor primary health centers Methods : The research method was observational study with cross sectional approach. The population in the study were all visitor centers are inspected aged 18 and over, according to the exclusion and inclusion criteria, totaling 200 people, 71 men and 129 women. The statistical package was used for analyzing the data. Results : The prevalence of central obesity by 65% or 130 people, 30 men with central obesity (42.3%) and 100 women with central obesity (77.5%). The prevalence of CHD patients as many as 36 people or 18%. CHD patients who have central obesity as many as 24 people (12%). The study on bivariate analysis with chi-square was found that central obesity is not a risk factor for coronary heart disease (RP 1.077, 95% CI 0.574 to 2.020, p 0.817) and this was not statistically significant. Independent variables are statistically significant are the variables of age (RP 2.097, 95% CI 1.127 to 3.900, p 0.025), older age (� 60 years) 2 times higher risk for CHD compared with age 18-59 years. Hypertension increases the risk of CHD 2.4 times (RP 2.381, 95% CI 1.099 to 5.161) than nonhypertensive patients. The results of multivariate analysis with logistic regression showed that none of the independent variables have significant relationships with CHD Stats. Age after consideration of central obesity and hypertension increase the risk of 2 times (RP 2.095, 95% CI 0.861 to 5.094, p 0.103) but not statistically significant. 2.4 times the risk of hypertension to be a CHD after taking into consideration the age and central obesity (RP 2.402, 95% CI 0.970 to 5.946, p 0.058), but not statistically significant. Central obesity as an important substance in this study is included in the multivariate calculations, the results remained not significant relationship with CHD exists Stats after considering age and hypertension (RP 1.102, 95% CI 0.505 to 2.408,p 0,808). Conclusions : There is no relationship between central obesity with incident CHD

HUBUNGAN KADAR SERUM MATRIX METALLOPROTEINASE-9 TERHADAP KEJADIAN GAGAL JANTUNG AKUT SEBAGAI KOMPLIKASI SINDROMA KORONER AKUT

Background: Acute heart failure (AHF) after acute coronary syndrome (ACS) is the biggest complication with a poor prognosis in a long term. The influence of MMP-9 as proteolytic enzyme that degrades extracellular matrix in remodeling left ventricle was recognized. However, according to researcher�s knowledge, evaluation of the MMP-9 as a predictor of AHF after ACS was never reported. Objective: To find out the serum level of MMP-9 in ACS with AHF higher than that without it, as well as to find out the level of MMP-9 with risk of AHF after ACS. Method: The study used a cross-sectional study. Samples were collected by using a consecutive sampling technique among patients with ACS treated in ICCU of Public Hospital Dr Sardjito Yogyakarta, since June 2008 to August 2010. Questionnaires were used to collect sample raw data. The level of MMP-9 was examined a time at admission in ICCU before trombolysis was done. The heart failure had Killip II- IV scores. Factors influencing the incidence was analyzed by using multivariate analysis technique. A significance level was at p< 0.05. The relative risk of acute heart failure at a certain level of MMP-9 (from cut-off value) was obtained after it was adjusted. Result: Among 122 subjects, 75 was without AHF and 47 with AHF. Median of the level of MMP-9 in the whole sample of ACS was 1248.55 ng/mL with a minimum of 170.50 ng/mL and maximum of 3058.40 ng/mL. Moreover, the level of MMP-9 in ACS with AHF (1700.81±740.43 ng/mL) was significantly higher than ACS without AHF (1189.55±654.60 ng/mL) with p value = 0.000. Independent risk factor after the multivariate analysis was done indicates the level of MMP-9 above 1444 ng/mL (RR= 4.2) and the location of anterior infarction (RR= 2.9). Conclusion: In patients with ACS treated in ICCU of RSUP Dr Sardjito, the level of MMP-9 with AHF was higher than that without it. If the level of MMP-9 above 1444 ng/mL, the possibility of AHF was 4.2 times

KEJADIAN KARDIOVASKULAR MAYOR PADA PENDERITA INFARK MIOKARD AKUT DENGAN ELEVASI SEGMEN ST (IMA-EST) YANG DILAKUKAN TERAPI TROMBOLITIK DIBANDING INTERVENSI KORONER PERKUTAN (IKP) PRIMER SELAMA PERAWATAN DI RUMAH SAKIT

Background: A study comparing thrombolytic therapy and primary percutaneous coronary intervention (PCI) in patients with STEMI has been reported in developed countries. There has not been many studies reporting the outcome of pirmary PCI in developing countries where this intervention had just recently performed. Objective: To observed the major cardiovascular events in patients with STEMI who recieved thrombolytic therapy compared with primary PCI during hospitalization. Methodology and Methods: we performed retrospective cohort study using medical record of STEMI patients with the onset <12 hours who recieved thrombolytic therapy and primary PCI at Dr. Sardjito Hospital at Yogyakarta starting January 1 st , 2008 until March 31 st , 2010. Clinical outcomes: primary clinical outcomes: major cardiovascular events are composit of cardiovascular death, reinfarction and stroke during hospitalization. Secondary clinical outcomes: post-infarction angina pectoris, heart failure, cardiogenic shock and side effects of bleeding. Results: from 78 patients who recieved thrombolytic therapy and 53 patients with primary PCI we found that major cardiovascular events during hospitalization was not significantly different,10.3% vs 9.4% (RR 1.0

PERBEDAAN KADAR SERUM MATRIX METALLOPROTEINASE-9 PADA PASIEN SINDROM KORONER AKUT DENGAN DAN TANPA HIPERGLIKEMIA

Background. Hyperglycemic condition increases the risk of mortality and severity in acute coronary syndrome patients. Matrix metalloproteinase-9 is an extracellular matrix destructive enzyme, which play a role in atherosclerotic plaque wrapping lyse and cause plaque rupture leading to acute coronary syndromes. In patients with acute coronary syndromes found elevated levels of MMP-9. Purpose. This study aimed to determine differences in serum levels of MMP-9 acute coronary syndrome patients with and without hyperglycemia. Methods. The study design was cross-sectional study. Sampling was carried out in a sequence of ACS patients who were treated in the ICCU Dr Sardjito Yogyakarta. Measurement of MMP-9 and blood glucose done once before thrombolysis of venous blood. Data presented in the form of a descriptive analysis of the characteristics of the study subjects such as average and standard deviation levels of MMP-9 and blood glucose. To analyze the differences in the levels of MMP-9 between patients with and without hyperglycemia SKA using Student�s T Test. Figures significance was p < 0.05. Results. There are 72 subjects, consisting of 34 ACS patients with hyperglycemia and 38 ACS patients with hyperglycemia. The mean blood glucose levels there were significant differences between the ACS groups with hyperglycemia and without hyperglycemia (204.4 ± 92.16 vs. 108.93 ± 19.1, p = 0.00). The mean levels of MMP-9 in ACS patients with hyperglycemia was significantly higher than patients ACS without hyperglycemia (1574 ± 573.61 ng / mL vs. 1370 ± 573.66 ng / mL, p = 0.025) Conclusion. Levels of MMP-9 in ACS patients with hyperglycemia significantly higher than ACS patients without hyperglycemia

HUBUNGAN KADAR SOLUBLE CD40 LIGAND DENGAN GAGAL JANTUNG AKUT PADA PASIEN INFARK MIOKARD AKUT

Background: Soluble CD40 ligand (sCD40L) is released by activated platelets and plays a crucial role in the progression and outcome of acute myocardial infarction (AMI). The study was conducted to determine the differences of sCD40L level in patients with AMI with or without cardiac events particularly of acute heart failure (AHF) Method: This study used cross-sectional method on patients with AMI admitted in ICCU Dr. Sardjito General Hospital. Consecutive sampling was conducted. The diagnosis of AHF based on Killip criteria. Determination of sCD40L level by ELISA method. Statistical methods for assessing differences of the level with Student T-test. Multivariate analysis was performed with stepwise forward logistic regression to assess whether this difference wass independent of other variables. Threshold value was determined by ROC curve. Results: The study involved 59 subjects with a mean age of 56 years. SCD40L levels were higher in AMI patients with AHF (9307 ± 1995 pg/ml), compared to AMI patients without AHF (7497 ± 2488 pg/ml, p = 0.005). On multivariate analysis, the variables sCD40L levels (p = 0.048) and creatinine (p = 0.006) were found statistically significantly different. ROC curve analysis of the sCD40L levels provide the highest AUC value was the threshold value of sCD40L 9000 pg/mL. The level of sCD40L � 9000 pg/mL was defined as the threshold value to indicate the increased incidence of AHF. At this threshold value, the odds ratio was of 4.125 with 95% CI 1.3 to 13.1. Conclusion: sCD40L levels were significantly higher in AMI patients with AHF than in those without AHF. The threshold value was 9000pg/mL with the odds ratio 4.125