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Hubungan hiperhomocysteinemia denganpenyakit kardiovaskular dan sindroma metabolik

Book Reading Dr.Braghmandaru Adhi Bhaskara

Homocystein
Homocystein adalah asam amino yang secara

alami di produksi tubuh Metabolisme homocystein dalam tubuh dipengaruhi oleh asam folat, vit.B6 dan vit.B12 Homosistein dihasilkan dari metabolime metionin, dan dapat diubah kembali jadi metionin dengan bantuan asam folat dan B6 sebagai kofaktor Homocystein dapat pula diubah menjadi cystathionin dengan bantuan vit.B12 sebagai kofaktor

Metabolisme homocystein

Homocystein
Homocystein dapat menjadi faktor risiko dan

prognosis dalam penyakit kardiovaskular


Kadar homocystein dalam serum berhubungan erat

dengan kejadian IHD, DVT, stroke, dan emboli pulmo, walaupun belum diketahui apakah hubungan tersebut bersifat causal
homocystein dapat meningkat hingga 30% pada

pasien dengan aterosklerosis


Peningkatan diatas 12% berhubungan dengan

peningkatan risiko AMI hingga 3x lipat

Faktor Risiko
Peran homocystein dalam penyakit

kardiovaskular masih belum jelas dipahami


Kadar homosistein yang tinggi diperkirakan dapat

menyebabkan kerusakan endotel pada dinding vaskular

Hyperhomocysteinemia
Belum ada kesepakatan mengenai nilai normal

kadar homosistein
Beberapa penelitian menggunakan nilai diatas

15umol/L sebagai hiperhomosisteinemia

Sindroma metabolik
sindroma metabolik memiliki ciri khas obesitas

sentral, resistensi insulin, hiperlipidemia, dan hipertensi.


Sindroma metabolikterjadi karena obesitas,

kurangnya aktivitas fisik dan faktor genetik


Resistensi insulin merupakan penyebab utama

sindroma metabolik
sindroma metabolik meningkatkan risiko terkena

DM tipe 2 dan penyakit kardiovaskular

sindroma metabolik
Kriteria diagnosis: terdapat 3 atau lebih:
Obesitas abdominal : Lingkar pinggang >102cm

(pria) atau >88cm (wanita) Tekanan darah sistol 130mmHg atau diastol 80mmHg Hipertrigliseridemia: kadar TG 130mmol/L (150mg/dl) Kadar HDL rendah: serum HDL < 1.04mmol/L (40mg/dl) pada pria atau <1029mmol/L(50mg/dl) pada wanita Kadar gula puasa tinggi 6.1mmol/L (110mg/dl) atau menggunakan obat penurun kadar glukosa
Kriteria ATP III NCEP

Food sources of Methionine


Food
Egg, white, dried, powder, glucose reduced Sesame seeds flour (low fat) Egg, whole, dried Cheese, Parmesan, shredded Brazil nuts Soy protein concentrate

g/100g
3.204 1.656 1.477 1.114 1.008 0.814

Chicken, broilers or fryers, roasted


Fish, tuna, light, canned in water, drained solids Beef, cured, dried Bacon Beef, ground, 95% lean meat / 5% fat, raw Pork, ground, 96% lean / 4% fat, raw Wheat germ Oat

0.801
0.755 0.749 0.593 0.565 0.564 0.456 0.312

Penanganan metabolic sindrom


Dengan mengubah penyebab dasar yaitu

obesitas, kurangnya aktivitas fisk, dan resistensi insulin Penurunan berat badan dan peningkatan aktivitas fisik akan menurunkan resistensi insulin

Metode lain adalah dengan mengobati faktir risiko

sindroma metabolik yaitu atherogenic dyslipidemia, hipertensi, keadaan protrombotic, dan resistensi insulin.

Homocysteine and cardiovascular disease: evidence on causality from a meta analysis


strong evidence that the association between

homocysteine and cardiovascular disease is causal.


On this basis, lowering homocysteine

concentrations by 3umol/l from current levels (achievable by increasing folic acid intake) would reduce the risk of ischaemic heart disease by 16% (11% to 20%), deep vein thrombosis by 25% (8% to 38%), and stroke by 24% (15% to 33%).
David S Wald, Malcolm Law, Joan K Morris, BMJ 2002

sindroma metabolik patients but are not associated with an increased cardiovascular risk, in contrast to patients without the sindroma metabolik
sindroma metabolik patients have elevated

homocysteine levels, but these higher levels are not associated with an increased risk for new cardiovascular events. In contrast, elevated homocysteine levels confer increased risk in patients without the sindroma metabolik.

Gideon R Hajer, Yolanda van der Graaf, Heart 2007;93:216 220

The Association between Homocysteine Level and sindroma metabolik in Patients of Prior Myocardial Infarction
Elevated homocysteine levels were correlated to

the sindroma metabolik in patients with prior myocardial infarction. These data indicate that elevated plasma homocysteine levels are not a risk factor for cardiovascular events in sindroma metabolik patients in contrast to patients without the sindroma metabolik.

LUCIA AGOTON-COLDEA, TEODORA MOCAN, ROM. J. INTERN. MED., 2010, 48, 2, 151158

in men with other CVD risk factors: the Kuopio Ischaemic Heart Disease Risk Factor (KIHD) Study
High serum tHcy may increase the risk of CVD

mortality in middle-aged men from Eastern Finland, and it may especially increase the risk when present with other CVD risk factors, although in this study the number of CVD deaths is too low to draw any definite conclusions. If the results of this study can be confirmed in other prospective cohort studies, then treatment for increased homocysteine concentrations should also be considered in addition to treatments for the other risk factors in the highrisk populations J . K. VIRTANEN, Journal of Internal
Medicine 2005; 257: 255262

with BMI and Insulin Resistance, amongst Obese, Overweight and Non Obese Infertile Women
amongst all the infertile women homocysteine

levels were significantly correlated with BMI, insulin and fasting glucose and HOMA-IR. Positive correlation was also observed with sex steroid serum LH/FSH ratio and testosterone. But no association was found between homocysteine levels with age of subjects, S. TSH, and S.LH and FSH. Hence, we can conclude that a positive correlation was observed between increasing homocysteine levels with BMI, insulin resistance, Sachan Rekha*, Patel ML , International testosterone levels and S. LH/FSH ratio. Journal
of Scientific and Research Publications, Volume 2, Issue 5, May 2012

Use of Serum Homocysteine to Predict Cardiovascular Disease in Korean Men with or without Metabolic Syndrome
Traditional risk factors for cardiovascular disease

(CVD), such as diabetes mellitus, dyslipidemia, hypertension, smoking and low physical activity have been used to assess the risk of CVD (1, 2). However, these characteristics do not fully explain cardiovascular risk. Therefore, there has been a focus on newly identified risk factors such as increased plasma homocysteine (Hcy), Creactive protein (CRP), B-type natriuretic peptide level, and metabolic syndrome (MetS) (3, 4). J Korean Med Sci. 2012
May;27(5):500-5.