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,RISIKO DAN
PENCEGAHAN CARDIOVASCULAR DISEASES
Dr. Idawati Trisno, M!s
FK UNDANA, "" F!# "$%&
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E'id!(io)o*i CVD
• CVD da)a( s!*a)a #!nt+na (!r+'aan'!n!#a# +ta(a !(atian di s!)+r+- d+nia, #aidi n!*ara (a+ (a+'+n n!*ara #!r!(#an*/0HO, "$%12
• 3+()a- tota) !(atian ai#at CVD '!r ta-+n 4 %5 +ta /s!itar "67 dari tota) !(atian2.
• 8$7 !(atian ai#at CVD t!radi di n!*ara#!r!(#an* /0HO, "$%$2
•K!(!n!s RI9 '!nait ant+n* (!nadi'!n!#a# +ta(a !(atian as+s rawat ina' darita-+n "$%":"$%;
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TOTAL prevalensi CVD= 56%
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HT ;8,"7Stro! %%,&7
Indon!sia<HT 1&,=7Stro!%1,;7
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S'!tr+( CVD
• > 6=7 CVD da'at diat!*orian s!s+ai ondisi'ato)o*is (aor an* (!ndasarina /?ra+nwa)d,!t a))< %6652
• 5=7 !(atian ai#at CVD dis!#a#an o)!- d+a
ondisi +ta(a 9 is@-!(i@ @oronar -!art dis!as!/P3K2 dan stro!.
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%. P)a ada)a- (at!ria) an* s!@ara'!r)a-an #!ra+(+)asi da)a( dindin*art!ri, an* (!('!rs!('it a)annaa)iran dara-.
". Mat!ri an* (!n+(#at ini dis!#+td!n*an PLA dan s!irin* wat+, aant!ra+(+)asi s!'anan* dindin* art!ri,
;. dan '!r)a-an (!('!r!ras dindin*'!(#+)+- art!ri.
1. K!adaan ini dis!#+t AT!"O#L!"O#$#
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%. Art!ri it+ 'i'a !si#!), a*ar dara- d't(!n*a)ir d*n )an@ar (aa dindin* art!ri
(!(!*an* '!ranan 'a)in* '!ntin*.". T' ia sel ini r&sak ai#at #!#!ra'a
a)asan /!+ran*an n+trisi2 responin'amasi akan m&n(&l.
;. R!s'on ina(asi menarik sel im&n +nt+ (!na*a dari s!ran*an inB!si danmemanggil )ahan kimia lainnya +nt+
(!('!r#aii !r+saan.1. S!)" i(+n#a-an i(ias!) )ain dari
dindin* art!ri 4 dinding mene)al diatasdindin*.
=. D!n*an si)+s '!r)+aan * #!r+)an*",
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K!tia ')a t!r#!nt+ da)a( art!ri oronaria
ant+n*, dis!#+t d!n*an '!nait ant+n*oron!r /coronary heart disease2.
Ada ti*a -a) (!n*a'a ')a (!r+'aan(asa)a- s!ri+s9
%. K!tia r+'t+r
". K!tia s!#+a- 'oton*anna )!'as dan
(!n+(#at '!(#+)+- dara- !@i);. K!tia #!nar:#!nar (!n+t+' s!#+a- art!ri
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P it 3 t
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P!nait 3ant+n*Koron!r
P3K ada)a- '!nait ant+n* ai#at'!r+#a-an o#str+tiB 'ada '!(#+)+- dara-oron!r an* (!n!#a#an B+n*si ant+n*t!r*an**+, an* dis!#a#an t!r+ta(a o)!-
'ros!s at!ros)!rosis.
?!nt+ P3K an* +(+( di!na) ait+ 9
%. An*ina '!toris
". InBar (io@ardi+( a+t /IMA2
;. P!nait 3ant+n* Is-!(ia
1. K!(atian (!ndada /sudden death2
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Tanda,tanda &m&mserangan -ant&ng .heart attack / 0
%. N!ri dada /chest pain2 #!r)an*s+n*(!n!ta' ± %$ (!nit
". Loasi sait t!rasa di#a*ian #!)aan*t+)an* dada iri
;. Rasa sait t!rasa (+)ai dari #a*ian#awa- )!n*an atas dan da'at
(!na)ar !atas, !#a-+ iri, !)!-!rata+ ra-an* #awa-.
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1am)aran Distri)&si P2
•L!#i- #ana 'ada (asaraat n!*ara#!r!(#an* di#andin*an n!*ara s!dan*#!r!(#an*
• L!#i- #ana dit!(+an di'!rotaandari'ada '!d!saan
• L!#i- #ana (!n*!nai *o)on*an(asaraat sosia) !ono(i (!n!*a-!atas di#andin*an sosia) !o)o(i r!nda-.
• L!#i- #ana (!n*!nai 'ria dari'ada
wanita, na(+n an* (ati #ana wanita.Insid!n P3K 'ada 'ria 4 =:5 )!#i- #anadi#andin*an 'ada wanita t!ta'i s!t!)a-(!no'a+s! '!r#!daan #!r+ran*.
• M!nin**i s!t!)a- +(+r 1$ ta-+n. Risiotin**i s+da- t!radi ia (!(as+i +(+r =$
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Coronar Art!r Dis!as!
• CAD ada)a- '!n!#a# +ta(a !(atianar!na CVD, (aniB!stasi )inis #isa a+t/a+t (io@ard inBar2 ata+ ronis /@-roni@sta#)! an*ina2
• 5," +ta oran* (!nin**a) ar!na CAD dis!)+r+- d+nia /%"7 dari tota) !(atian2 'dt-n "$$1.
•K!(atian ai#at CAD (!nin*at di n!*ara#!r!(#an*
• Fator an* t+r+t #!r'!n*ar+-9 +(+r,*!nd!r, stat+s sosia) !ono(i dan d!'r!si.
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C-roni@ Sta#)! An*ina
• Pr!a)!nsi di n!*ara (a+ 4 1:=7
• Insid!ns as+s #ar+ di n!*ara(a+ 4 1&%$$.$$$ '!nd+d+
• M!si s+da- di)a+an t!ra'i, %dari ; '!nd!rita (asi- t!r+s(!n*a)a(i s!ran*an an*ina
s!diitna s!a)i s!(in**+.
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Mo@ard InBar• Pr!a)!nsi MI di n!*ara (a+ 9 ;:17
• Insid!ns as+s #ar+ di n!*ara (a+9"$$%$$.$$$
• Fator an* (!('!n*ar+-i Br!+!nsi AMI
ada)a-9 Bator d!(o*ra /+(+r, *!nd!r2,Bator )iB!:st)! /'ro) )!(a, (!roo,t!anan dara-, dia#!t, o#!sitas, inta!sa+r#+a-, ons+(si a)o-o)2, dan Bator
'siososia)
• S!itar % dari = 'asi!n t!r+s (!n*a)a(i
s!ran*an an*ina da)a( %" #+)an s!t!)a-
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Fator RisioNon:Modia#)!
Fa(i) Histor G!nd!r
A*!
Modia#)!
H'!r)i'id!(ia, !)!at!d s!r+(@-o)!st!ro)
S(oin*
H'!rt!nsion
Dia#!t!s O#!sit
S!r+( (ar!rs s+@- as !)!at!dHo(o@st!in!
Poor Di!t, La@ oB E!r@is!
a or s o
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a or s o.modi4a)le/
%. Hi'!rt!nsi
: Hasi) st+di Fra(in*-a(9 TD %&$6= ((H*, risio t!r!na P3K ≥ =
TD %%$6$ ((H* DM HT risio t!r!na P3K "
dari'ada non DM HT )!#i- s!rin* dit!(+an%,& a)i 'ada
P3K di#andin*an tan'a HT". Ko)!st!ro)
: LDL /Low Density Lipoprotein2 #!rsiBatat-!ro*!ni. : HDL /Hi*- D!nsit Li'o'rot!in2 #!rsiBat
'rot!tiB t!r-ada' P3K.
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3aktor "isiko .(ontd/
;. Roo : M!roo adar HDL C-o)!st!ro). : R!sio P3K 5$7 > #+an '!roo.
: t!r*ant+n* 'ada9 +()a- roo an*di-isa', )a(a (!rooFra(in*-a( st+d 9
> ;$ #atan* -ari ;:= risio P3K
> 1$ #atan* -ari
&,= risio P3K
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3aktor "isiko .(ontd/
1. Dia#!t!s M!))it+s /DM2
: Risio P3K =$7 > di#andin*an d!n*an nonDM
: Fra(in*-a( st+di 9 'ria DM, risio P3K "
wanita DM, risio P3K ;
=. O#!sitas
&. Str!s
5. Po)a (aanan an* sa)a-8. Gaa -id+'
6. K+ran* o)a- ra*a
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Str!ss
• P!n!)itian S+'ar*o d /%68%:%68=2 diFK UI (!n+n+an oran* an* str!ss%%" )!#i- #!sar (!nda'atan risio
P3K.• Str!ss di sa('in* da'at (!naian
t!anan dara- +*a da'at(!nin*atan adar o)!st!ro) dara-
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Sumber: DIET, NUTRITION AND THE PREVENTION OF CHRONIC DISEASES, 2002
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Sumber: DIET, NUTRITION AND THE PREVENTION OF CHRONIC DISEASES, 2002
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Sumber: DIET, NUTRITION AND THE PREVENTION OF CHRONIC DISEASES, 2002
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K! S@r!!nin* M!as+r!s
• A'aa- anda (!roo
• ?!ra'a T!anan Dara-
• adar o)!st!ro) dara- dan 'ro) )!(a
• Kadar *+)a dara- '+asa
• ?od (ass ind! /?MI2:ratio oB -!i*-tto w!i*-t /*("2
• S'!@i@ (!as+r!s Bor tr+n@a) o#!sit
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P!C!1A7A
• P!n@!*a-an 'ri(!r )!#i- dit++an'ada (!r!a an* s!-at t!ta'i(!('+nai risio tin**i,
• P!n@!*a-an s!+nd!r dan t!rsi!r(!r+'aan s+at+ +'aa +nt+
(!n@!*a- (!(#+r+na '!naitan* s!@ara )inis t!)a- did!rita.
; ; $ % &
? ) o J
%J
" $ % =
A N .
;;
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P!n@!*a-an
%. Pen(egahan primer• Health education ( Bator risio dan tanda, *!a)a2• P!(!risaan t!anan dara- s!@ara r+tin• Srinin* Bator risio /@! +' r+tin2• Modiasi *aa -id+' an* #!raitan d!n*an Bator
risio
". Pen(egahan sek&nder• '!n*o#atan an* t!'at• Kontro) t!rat+r
;. Pen(egahan tersier• r!-a#i)itasi• Ba(i) s+''ort
i -
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Strat!*i P!n@!*a-anPri(!r• Hindari (!roo ata+ '!n**+naan t!(#aa+
d!n*an @ara a'a'+n
• P!rta-anan ?? an* s!-at
• Lati-an si a!ro#i ;$ (!nit tia' -ari
• ?atasi inta! )!(a, ons+(si )!(a ta !n+-dan -indari trans:Batt a@id
• Tin*atan ons+(si asa( )!(a o(!*a ; /dari(ina ian ata+ tana(an s!'!rti o)i! oi)2
• Di!t tin**i s!rta, #+a-, sa+ran dan a@an*"an• K+ran*i *ara( dan *+)a
• ?atasi '!n**+naan a)o-o).
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To#a@@o• Risio +ta(a an* da'at di@!*a-, saan*na
+()a- '!roo @!nd!r+n* (!n*a)a(i '!nin*atandi n!*ara" Asia. P!r)+ d++n*an '!(!rinta- +nt+(!n*!(#an*an 'ro*ra( @o((+nit -!a)t-!d+@ation t!rait (!roo dan #a-aana
•A'a#i)a #!r-!nti (!roo '!n+r+nan risio P3K aan#!r+ran* =$7 'ada a-ir ta-+n '!rta(a s!t!)a-#!r-!nti (!roo dan !(#a)i s!'!rti an* tida(!roo s!t!)a- #!r-!nti (!roo %$ ta-+n.
• Da)) P!to %65& (!nda'atan risio inBar aan
t+r+n =$7 da)a( wat+ = ta-+n s!t!)a- #!r-!nti(!roo.
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Atitas Fisi
• D!n*an atitas si t!rat+r da'at(!n+r+nan t!anan dara-, risiodia#!t!s, (!nin*atan HDL,
(!n*!)o)a str!s, (!nin*atan!s!-atan t+)an*, dan (!n*ontro) ??.
• ;$ (!nit s!tia' -ari (!)a+anatitas si (od!rat!
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K!nda)ian 'ro) )!(a dara-
• Di!t and !!r@is! ar! !
• Tota) @-o)!st!ro) *oa)9 "$$ (*dL
• LDL /#ad @-o)!st!ro)2 *oa)9 %$$
(*dL• Tri*)@!rid!s Goa)9 %=$ (*dL
• HDL /*ood @-o)!st!ro)2 *oa)9
• >1$ (*dL /'ria2 , >=$ (*dL/wanita2
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C!*a- o#!sitas
• O#!sitas ada)a- !)!#i-an +()a- )!(a t+#+->%67 'ada )ai:)ai dan > "%7 'ada'!r!('+an.
• U+ran an* (+n*in )!#i- s'!si ada)a-++ran )in*ar 'in**an* s!s+ai +(+r. /o#!sitass!ntra)2
• O#!sitas ada)a- Bator risio (aor +nt+
t!radina CAD, '!nin*atan ?P, adaro)!st!ro), DM dan #!r#a*ai (a@a( 'ro#)!(!s!-atan )ainna.
• Risio P3K aan !)as (!nin*at #i)a ?? (+)ai
(!)!#i-i "$7 dari ?? id!a).
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Srinin* T!anan Dara-
• Dir!o(!ndasian +nt+ (!)a+ansrinin* '!n*++ran TD #a*i oran*d!wasa s!tia' a)i (!)a+an +n+n*an! Bas!s.
• M!n*ontro) -i'!rt!nsi da'at (!n*+ran*irisio '!nait ant+n* s!#!sar "=7
• Strat!*i (!)i'+ti '!n*+ran*an ??
/!!r@is!, di!t r!nda- *ara(,'!(#atasan a)o-o)2
• Goa) ?P9 %"$ ssto)i@ and 8$ diasto)i@'r!ss+r!s
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Dia#!t!s
• O'ti(a) GDP %$$ (*dL
• Crit!ria Bor Dia*nosis oB Dia#!t!s
• GDP %"& (*dL or -i*-!r
• GDA "$$ (*dL or -i*-!r s('to(s• T++an '!n@!*a-an9 (!nd!t!si 'asi!n
d!n*an risio dia#!t!s ait+ 'asi!nd!n*an )!!) GDP %$$:%"= (*dL
• Indiid+ d!n*an risio dia#!t!s da'at(!n*+ran*i risio t!radina DM d!n*an(!r!n@anaan 'ro*ra( di!t dan !!r@is!.
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P!n@!*a-an t!rsi!r
• Non:'-ar(a@!+ti@a) )iB!st)!(odi@ation /!!r@is! t!rat+r dan'!n*at+ran di!t2
• P-ar(a@!+ti@a) int!r!ntion9'!n**+naan o#at"an +nt+(!n*ontro) '!nait dasarna
/as'irin, statin +nt+-i'!r)i'id!(ia, OAD, d))2, dan t!niint!nsiB /@oronar st!ntin* dan
@oronar #'ass *raBtin*2.
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K!si('+)an
• CVD da'at di@!*a- d!n*an strat!*i'+#)i@ -!a)t- dan int!r!nsi Batorrisio.
• A*ar strat!*i '!n@!*a-an da'at!B!tiB, di'!r)+an 'raondisi s##9
• K!'!(i('inan dan o(it(!n dari'!(!rinta- /r!*+)asi, strat!*i -!a)t-
'ro(otion dan -!a)t- !d+@ation, d))2
• A)iansi dan !(itraan d!n*an#!r#a*ai 'i-a
• Lin*+n*an an* (!nd++n* /@ar
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