The Importance of Managing HbA1c in Coronary Artery Disease: Keep It Low

Coronary Artery Disease (CAD) is the most prevalent cardiovascular disease, which remains the leading cause of death worldwide. In Indonesia, it accounts for approximately 1.5% of the entire population. Diabetes mellitus (DM) is taken into consideration as one of the most potent risk factors for cardiovascular diseases. HaemoglobinA1c (HbA1c) reflects a long-term glycemic control and is used as a valuable diabetes biomarker. High serum glucose levels, expressed as glycated hemoglobin levels in diabetics or non-diabetics, are related to varying degrees of systemic inflammation and promote the release of the proinflammatory cytokines. The association between higher glycated serum HbA1c levels and the severity of the coronary disease is well known. The predictive value of HbA1c for CAD severity, re-hospitalization, and the mortality of cardiovascular disease had been studied extensively since 2004. Numerous previous trials discovered that severity of CAD correlated with the elevation of HbA1c levels, suggesting it as a broad surrogate marker for CAD. Thus, HbA1c is currently considered as an independent risk factor for CAD. A higher level of HbA1c and the presence of factors associated with ongoing atherosclerosis and extensive CAD are concomitantly contributing to the higher major adverse cardiovascular events (MACEs) incidence and long-term mortality

PENELITIAN PSIKONEUROIMUNOLOGI: APAKAH STRESS MEMPENGARUHI IMUNITAS DAN MENYEBABKAN PENYAKIT ARTERI KORONER?

Tulisan ini bertujuan mempelajari pentingnya psikoneuroimunologi (PIN) dalam memahami peran stressorpsikologi akut dan kronis pada system kekebalan dan perkembangan penyakit arteri koroner (CAD).Pertama, PNI mengilustrasikan bagaimana stress psikologi merubah fungsi endotel dan merangsangkemotaksis. Kedua, stress psikologi akut merangsang leukositosis, meningkatkan sitotoksisitas sel NK danmengurangi respons proliferasi mitogen ketika stress psikologi kronik mungkin merangsang efek burukkesehatan. Ini akan menghasilkan perubahan dalam fungsi kardiovaskuler dan perkembangan CAD. Ketiga,stress psikologi akut dan kronis akan meningkatkan factor hemostasis dan protein fase akut, kemungkinanmerangsang pembentukan thrombus dan miokard infark. Bukti untuk pengaruh stress psikologi akut dankronis pada onset dan progres CAD adalah konsisten dan meyakinkan. Tulisan ini juga menyoroti daerahpenelitian potensial dan akibatnya dar

Dyslipidemia Aterogenic, antara fakta dan harapan yang akan datang

Disregulasi dari metabolisme lipoprotein merupakan inti dari perkembangan aterosklerosis. Suatu studi epidemi prospektif secara konsisten menunjukkan bahwa kenaikan dari Low Density Lipoprotein Cholesterol (LDL-C) dihubungkan dengan peningkatan risiko dari penyakit kardiovaskular, namun hal tersebut mungkin secara terpisah menyebabkan dislipidemia aterogenik, jika bergabung dengan hipertensi, obesitas sentral dan resistensi insulin, yang secara bersamaan dikenal sebagai sindroma metabolik. Dislipidemia aterogenik ditandai dengan tingginya trigliserid (TG) plasma, rendahnya High Density Lipoprotein Cholesterol (HDL-C) dan tingginya konsentrasi apolipoprotein (apo)-B yang berisi lipoprotein, khususnya peningkatan small dense LDL.Hipertrigliserid (HTG) adalah peningkatan kadar trigliserid (TG) puasa di atas normal (> 150 mg/dl). Pada 2010 di Amerika Serikat ada 74,6 juta penduduk mempunyai peningkatan kadar trigliserid, 36,4 juta diantara mereka memiliki kadar triglsierid yang tinggi (200-499 mg/dl), dengan meningkatnya prevalensi ini secara paralel juga terjadi peningkatan yang tajam terhadap kejadian obesitas.

Perkembangan Implikasi Biologi dan Klinis Proprotein Convertase Subtilisin-Kexin 9

Pada tahun 2003 Proprotein Convertase Subtilisin-Kexin 9 (PCSK9) berhasil diidentifikasi.1 PCSK9 berfungsi meningkatkan kadar LDL Cholesterol (LDL-C) melalui degradasi LDL Receptor (LDLR).2 Penemuan PCSK9 telah merevolusi serta merupakan perkembangan terpenting pada bidang riset kardiovaskular satu dekade terakhir, terutama dalam regulasi LDL-C. 1Pada tahun 2003 Proprotein Convertase Subtilisin-Kexin 9 (PCSK9) berhasil diidentifikasi.1 PCSK9 berfungsi meningkatkan kadar LDL Cholesterol (LDL-C) melalui degradasi LDL Receptor (LDLR).2 Penemuan PCSK9 telah merevolusi serta merupakan perkembangan terpenting pada bidang riset kardiovaskular satu dekade terakhir, terutama dalam regulasi LDL-C.

The Differences of Food Compositions in Adolescent Metabolic Syndrome in Malang

BACKGROUND: Obesity, especially obesity in adolescent, is a worldwide health problem needing much of our attention because it can continue to be obesity in adulthood. About 50% obese adolescents grew up to be obese adults. It was a concern since it is one of risk factor associated with cardiovascular events including hypertension, dyslipidemia, insulin resistance and stroke. Visceral obesity is correlated with diabetogenic, atherogenic, prothrombotic, pro-inflammation, and abnormal metabolism. The objective of this study was to assess the prevalence of obese adolescents in Malang and to identitfy the differences in food compositions between metabolic syndrome and non-metabolic adolescents.METHODS: Prevalence of obesity was determined by assessing BMI in 20 Senior and Junior High Schools. Metabolic syndrome was diagnosed using IDF criteria; waist circumference of >80cm and >90cm for female and male, respectively, and increased triglyceride and decreased HDL concentration levels. The food composition was assessed using food recalls, and then regression linier test was done to define the correlation between food intake and the components of metabolic syndrome.RESULTS: The prevalence of adolescent obesity in Malang had reached 3.32%, with the prevalence of obesity in male subjects higher than in female subjects, i.e. 54.1% compared to 45.9%. The boys had higher mean for height and weight than the girls did, however, the BMI was higher in girls rather than boys. The difference of fat in food composition was significantly higher for the metabolic groups (p=0.031), but the carbohydrate did not significantly differ between the two groups (p=0.407).CONCLUSIONS: The prevalence of adolescent obesity in Malang had reached 3.32%, with the prevalence of 54.1% in male and 45.9% in female. From the statistics test, fat intake showed a significant difference between metabolic syndrome and non-metabolic syndrome groups, but other food compositions didn’t.KEYWORDS: obesity, metabolic syndrome, adolescen

The accuracy of fibrinogen and hs-crp as a biomarker in acute coronary syndrome (ACS)

Background: acute coronary syndrome (ACS) refers to any group of clinical symptom compatible with acute myocardial infarction (AMI). AMI is a major cause of death and disability worldwide with the greates risk of death within the first hours of AMI onset. Thus, the identification of novel biomarkers that improve current strategies and/or accurately identify subjects who are at risk of developing acute and chronic manifestation of cardiovascuar disease are desperately needed. Obsjective: this study was aimed to determine the accuracy diagnostic value of Fibrinogen and High Sensitivity C-Reactive Protein as a biomarker for Acute Coronary Syndrome Subjects and methods: an observational study with cross sectional approach, was conducted from February to July 2011 involving 76 male and female patients aged 35 to 80 years old for cases all well as controls. The biomarker measured were level of Fibrinogen and Hs-CRP. We used Receiver Operating Curve to determine the cut off test. We calculated of sensitivity, specificity, likelihood ratio, negative predictive value, and postive predictive value for biomarkers in combination and single. Results : the mean age in both groups was 57.5 year old. Level of the Fibrinogen in cases (5.81.56) was significantly different than control (3.781.78). concentration Hs-CRP in cases (4.041.94) was significantly different than control (1.981.25). both these biomarkers can be used as a diagnostic tool for Acute Coronary Syndrome in combination or single. Conclusion : the combination of Fibrinogen and Hs-CRP has the better diagnostic value that when used single

Secretory Phospholipase A2 Tipe Ii (Spla Ii) pada Penyakit Kardiovaskuler

Reaksi inflamasi berperan dalam beberapa pathogenesis kondisi kardiovaskuler seperti atherosklerosis dan kerusakan iskemik pada infark miokard akut (IMA). Di antara mediator-mediator yang terlibat dalam inflamasi tersebut adalah enzim secretory phospholipase A2 tipe II (sPLA2-II). Meskipun beberapa sel memang memproduksi sPLA2-II, namun sintesis oleh sel-sel tertentu seperti hepatosit, adalah khas sebagai reaktan fase akut. Literatur terbaru menyatakan banyaknya peran dari sPLA2-II dalam penyakit kardiovaskuler. Dalam tulisan berikut, akan mendiskusikan peran sPLA2-II dalam berbagai model atherosklerosis atau IMA, baik in vitro maupun in vivo, termasuk perspektif terapeutik dari sPLA2-II inhibitor. Disimpulkan bahwa sPLA2-II merupakan mediator inflamasi yang penting dalam penyakit kardiovaskuler

The Association Between Cardiovascular Risk and Elevated Triglycerides

BACKGROUND: The association between elevated triglycerides and cardiovascular risk has been extensively studied. The elevated level of triglycerides occurs through abnormalities in hepatic very low-density lipoprotein (VLDL) production and intestinal chylomicron synthesis, dysfunctional lipoprotein lipase (LPL)-mediated lipolysis or impaired remnant clearance.CONTENT: Hypertriglyceridemia (HTG) commonly leads to a reduction in high-density lipoprotein (HDL) and increase in atherogenic small dense low-density lipoprotein (LDL) cholesterol, called the atherogenic dyslipidemia (AD). Triglycerides may also stimulate atherogenesis by mechanisms, such excessive release of free fatty acids, and production of pro-inflammatory cytokines, fibrinogen, coagulation factors and impairment of fibrinolysis. Genetic studies strongly support hypertriglyceridemia (HTG) and high concentration of triglyceride-rich lipoprotein (TRL) as causal risk factors for cardiovascular disease. Therefore, lipid management is crucial in reducing cardiovascular risk. Combination of lipid lowering drug therapy may be needed to achieve both LDL and non-HDL cholesterols treatment goal for cardiovascular disease prevention in patients with elevated triglyceride levels, particularly those with triglyceride ≥500 mg/dL.SUMMARY: LDL and non-HDL cholesterol can be a promising target therapy in HTG. Additional clinical outcomes data are needed to provide a more evidence-based rationale for clinical lipid management of hypertriglyceridemic patients

Secretory Phospholipase A2 Tipe II (SPLA II) In Cardiovascular Disease

Inflammatory reactions contribute to the pathogenesis of cardiovascular conditions such as atherosclerosis and ischemic damage in acute myocardial infarction (AMI). Among the mediators involved in inflammation are secretory phospholipase A2 group II (sPLA2-II) enzymes. Though some cells constitutively express Spla2-II, the synthesis by cells such as hepatocytes is typical for an acute-phase reactant. Recent literature suggest multiple roles for sPLA2-II in cardiovascular disease. In this review we discuss the role of sPLA2-II in included that sPLA2-II appears to be an inportant inflammatory mediator of cardiovascular disease

The Relationship Between Food Intake and Adolescent Metabolic Syndrome

Obesity as the component of metabolic syndrome and its associated disor-ders are a growing epidemic across the world. Several genetic, behavioral, and physiological factors play a role in etiology of obesity. Behavior factor such as high-carbohydrate and high-fat diet is important as this factor, but not the sedentary factor, is still having possibility to be altered. This study is performed to explain the influence of food intake to the components of metabolic syndrome. The method used is case-control analysis of population-based, epidemiological surveys using the metabolic syndrome definition of International Diabetes Federation. The results suggest that the total cholesterol and waist circumference components have higher pathway co-efficiency than other components. The compositions of food intake causing the metabolic syndrome are total calories followed by fat and carbohydrate, consecutively. From these results, reduction of total calorie and fat can be recommended as dietary modification that reduces the risk of developing metabolic syndrome