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PREDICTION MODEL OF CORONARY HEART

DISEASE SUSPECT BASED ON PUBLIC HEALTH

CITRAKESUMASARI,
A.R.THAHA, YUSUF, T.SUNDORO, A.JAHARI,
A.ASPAR, B.BAHAR, V. HADJU

HASANUDDIN UNIVERSITY
CVD Luepker : CHD 69,8% ; stroke  21,476% ; PAD 8,699%

suspected CVD Risk Factor


CVD
CHD rank. 1 (Global Mortility 2020 & Available in
Disabiliti_adjusted Life years 2020 Riskesdas:
Age, sex, BP, BMI,
DM, Activities,
Prediction Smoking +
abdominal
• Framingham circumference &
Psychological
• Jakarta CV ? health
Framingham Score Jakarta CV Score
PREDICTION CVD
Score Value
Score
Risk Factor Men Female Risk factors
Value
Age
<35 -1 -9
Sex
Jakarta CV Score Female 0
35-39 0 -4
40-44 1 0 Men 1
45-49 2 3 sensitivity 77,9% Age
50-54 3 6
specificity 90,0% 25-34 -4
55-59 4 7 35-39 -3
60-64 5 8 Positive Prediction 92,2% 40-44 -2
65-69 6 8 Negative Prediction 72,8% 45-49 0
70-74 7 8
50-54 1
Cholesterol total (mg/dl)
55-59 2
<160 -3 -2
169-199 0 0 BASE ON LABORATORY 60-64 3
200-239 1 1 Blood Pressure
240-279 2 2 -More expensive Normal 0
≥280 hypertension 1 1
HDL Cholesterol (mg/dl)
3 3
-Difficult to do hypertension 2 2
≥60
50-59
-2
0
-3
0
-requires special skills hypertension 3
BMI (kg/m²)
3

45-49 0 1 13,79-25,99 0
35-44 1 2 26,00-29,99 1
<35 2 5 30,00-35,58 2
Systolic Blood Pressure
My research Question , it is possible smoking
<120 0 -3 no 0
120-129 0 0 to develop new model without lab
ex. Smoker 3
130-139 1 1 assesmen to predict CHD in smoker 4
140-159 2 2
community Diabetes Mellitus
≥160 3 3
Diabetes Mellitus No 0
no 0 0 yes 2
yes 2 4 Physical Activity
smoking none 2
no 0 0 low 1
yes 2 2 middle 0
high -3
Research Methods

• cross sectional studies by using data Indonesian Base


Research Design Health research (Riskesdas) in 2007

Population And • Household Population = 987.205


Samples • Samples = 162.962

• Diagnosis of Heart Disease & symptoms of chest pain.


Inclusion criteria • aged ≥ 25 years old ; not pregnant
RESULTS
Variables % OR 95%CI P Value
Sex
male 0.8 0.61 0,55-0,68 0,000*
female 1.3
Aged (years)
25-34 0.4 1 0,000*
35-39 0.8 1.83 1,51-2,21
40-44 1 2.29 1,,90-2,77
45-49 1.2 2.84 2,37-3,41
50-54 1.4 3.23 2,68-3,89
55-59 1.3 2.99 2,42-3,71
60-64+ 1.4 3.29 2,73-3,98
Education
risk 0.9 1.09 0,95-1,24 0.253
un risk 0.9
Jobs
risk 0.8% 0.730 0,62-0,86 0.000
un risk 1.1%
Economic status
Q5 1.1% 1.372 1,16-1.62 0.000
Q1 0.8%
Psychological health
risk 2.8 4.11 3,68-4,59 0,000*
unrisk 0.7
Variables % OR 95%CI P Value
Behavior
Fruits and vegetables
risk 0.9 1.01 0,38-2,72 0,801**
unrisk 0.9
Offal
risk 1.9 2.09 1,59-2,77 0,000*
unrisk 0.9
Fatty
risk 1.2 1.31 1,23-1,51 0,000*
unrisk 0.9
salty
risk 0.9 1.02 0,91-1,15 0.757
unrisk 0.9
sweet
risk 0.9 1.01 0,91-1,13 0.856
unrisk 0.9
Activity
risk 1.1 1.36 1,22-1,50 0,000*
unrisk 0.8
smoking
risk 0.9 1.34 1,09-1,66 0,007*
unrisk 0.7
Alcohol
risk 1.2 1.29 0,82-2,03 0.338
unrisk 0.9
Variable % OR 95%CI P Value
Abdominal Circumference
risk 1.7 2.09 1,83-2,39
0,000*
unrisk 0.8
BMI
risk 1.3 1.54 1,36-1,75
0,000*
unrisk 0.8
Blood Pressure
risk 1.4 1.91 1,72-2,12
0,000*
unrisk 0.8
Diabetes Mellitus
risk 11.4 14.89 12,11-18,30 0,000*
unrisk 0.9
Variable B S.E. OR 95%CI P value
Sex -.668 .126 .513 0,40-0,66 .000
Age .507 .084 1.660 1,41-1,95 .000
Education -.206 .105 .814 0,66-1,00 .050
Phiscial Health 1.195 .089 3.305 2,77-3,94 .000
Offal .827 .213 2.286 1,51-3,47 .000
Fatty -.156 .126 .855 0,67-1,09 .215
Physicla Activty .197 .078 1.218 1,04-1,42 .012
Number of cigarrete .206 .109 1.229 0,99-1,52 .058
Abdominal circumference .424 .152 1.528 1,13-2,06 .005
BMI .136 .125 1.146 0,89-1,46 .275
Blood Pressure .376 .085 1.456 1,23-1,72 .000
Diatebes Mellitus 2.566 .148 13.015 9,73-17,40 .000
Constant -5.885 .653 .003 .000
Variables B S.E. OR 95%CI P value
Sex -.662 .126 .516 0,40-0,66 .000
aged .505 .084 1.657 1,41-1,95 .000
education -.212 .105 .809 0,66-0,99 .043
Psychological health 1.190 .089 3.286 2,75-3,92 .000
offal .744 .203 2.104 1,41-3,13 .000
Activity .199 .078 1.221 1,05-1,42 .011
abdominal .505 .132 1.657 1,28-2,15 .000
circumference
Blood presure .381 .085 1.464 1,24-1,73 .000
DM 2.568 .148 13.043 9,76-17,44 .000
smoking .210 .109 1.233 0,99-1,53 .054
Constant -5.930 .641 .003 .000

Y=-5.930-0.662(sex)+0.505(aged)-0.505(education)+1.190(Psychological
health)+0.744(offal)+0199(activity)+0.505(abdominal
circumference)+0.381(BP)+2.568(DM)+0.210(smoking).
CHDSuspect Variables Prediktor
Total scores P Value
n % 1. aged
2. sex
0 96 0.7 0.000 3. Blood pressure
1
4. abdominal circumference
255 0.9
5. smoking
2 366 0.7

3 419 0.9

4 213 1.2 Explanation of cut of point :


• abdominal circumference male 83 cm ;
5 37 1.3 female 82 cm
• Sistolic = 129,5 mm/Hg ; diastolic = 87,5
Total 1386 0.9 mm/Hg
Suspek CHD
Total
Skor yes no P Velue OR
n % n % n %
4 213 1.3% 17232 98,8% 17445 100% 0.000 1,822

3 419 0,9% 46760 99,1% 47179 100% 0.000 1,321

2 366 0,7% 52674 99,3% 53040 100% 0.880 1,024

If it found 3 of 5 CHD variables, it


will called as CHD Suspect
Score
Risk Factors
values
Sex
Female 0 Score
Male 1 Risk factors
values
AGED
Sex
25-34 -4
Female 0

Jakarta CV scores
35-39 -3
Male 1

Riskesdas CHD skores


40-44 -2
45-49 0 AGED
50-54 1 <40 years old 0
55-59 2 ≥ 40 years old 1
60-64 3 Realibility test Blood Pressure*
Blood pressures*
Normal 0
Kappa value = 0,6 unrisk 0
risk 1
Hypertension Level-1 1
abdominal circumference*
Hypertension Level-2 2
unrisk 0
Hypertension Level-3 3
risk 1
BMI (kg/m²)
13,79-25,99 0 smoking
26,00-29,99 1 no 0
30,00-35,58 2 smoking 1
smoking Score (0-5)
no 0
ex smoking 3
smoking 4
Diabetes
no 0
yes 2
Aktivitas fisik
no ada 2
Ringan 1
Sedang 0
Berat -3
Sensitivitas Skor Riskesdas CHD pada 4 RS di Sulawesi Selatan

Skor Rasio LDL/HDL Di RSUP Dr. N % %


Rasio LDL/HDL Di RSUD K.H
Riskesdas Wahidin Sudirohusodo Se Skor
Hayyung Kepulauan Selayar Se
CHD Positif Negatif Riskesdas n %
Positif Negatif %
CHD
N % n % n % n %
Positif 35 9.3 14 8.6 49 58.3 76,1 Positif 23 65.7 12 34.3 35 100
Negatif 11 44 24 68.6 35 41.7 %
Negatif 6 35.3 11 64.7 17 100 79.3
Total 46 54.8 38 45.2 84 100,
0 Total 29 55.8 23 44.2 52 100

Skor Riskesdas Rasio LDL/HDL di RS N % % Rasio LDL/HDL di RSUD


Skor
CHD Pelamonia Makassar Se Kab. Pangkep %
Riskesdas N %
Positif Negative Positif Negatif Se
CHD
n % n % N % N %
Positif 42 53,8 36 46,2 78 76,5 72,4 Positif 22 40,7 32 59,3 54 77,1
Negatif 16 66,7 8 33,3 24 23,5 Negatif 5 31,2 11 68,8 16 22,9 81,4
Total 58 56,9 44 43,1 102 100 Total 27 38.6 43 61.4 70 100
CONCLUSION
• The New Model can be used to predict CHD
suspect if we have 3 of 5 variable
• This Model More simple than Jakarta CV
Score, we called Riskesdas CHD Score

RECOMMENDATION
- Need to Manage obesity, hypertension, and
smoking for prevent CHD
PREVALENSI PJK*) UMUR ≥ 15 TAHUN BERDASARKAN
WAWANCARA
MENURUT PROVINSI, 2013

Sumber Data : Riskesdas 201316


Proporsi Obesitas Sentral: 2007-2013
(Lingkar Perut: Lk>90 cm, Prp>80cm)
50,0

40,0
26,6
30,0

20,0

10,0
18,8
0,0

2007 2013
KECENDERUNGAN PREVALENSI DIABETES
MELLITUS MENURUT PROVINSI

L.18
Sumber Data : Riskesdas 2013
KECENDERUNGAN PREVALENSI HIPERTENSI
BERDASARKAN PENGUKURAN MENURUT PROVINSI

Sumber Data : Riskesdas 2013L.19


KECENDERUNGAN PREVALENSI STROKE PER
1000 MENURUT PROVINSI

L.20
Sumber Data : Riskesdas 2013
Proporsi Obesitas Sentral: 2007-2013
(Lingkar Perut: Lk>90 cm, Prp>80cm)
50,0

40,0
26,6
30,0

20,0

10,0
18,8
0,0

2007 2013
Body Mass Index (BMI) with Economy Status

Very Thin Thin Normal Overweight Obese33

30 28.4 28
27.1
24.8 24.1
21.6 21.7 21.7
20.6 2019.7
18.2 18.918.319.1 18.9
17.7
15.6 15.9 15.515.1
14.3
15 12.8

8.8

0%
Kuintil 1 Kuintil 2 Kuintil 3 Kuintil 4 Kuintil 5
Nutrients Intake Related Hiperhomosistein, Base on RDA

100% RDA
80% RDA
77% RDA

100%
40.6 36.4 22.4
90%
80%
70%
60%
50% 97.7 97.9 99
90
40% 78.1 78.2
70.9
30% 60.2 62.5

20%
10%
0%
PROTEIN VIT.B6 VIT.B12 AS.FOLAT

< ≥ < ≥
Protein
Intake ≥
80% B6, B12, Folat Intake Obesity
RDA < 80% RDA (1.4%)

Risk Faktor
Hyperhomocysteinemia
Intake Protein Intake B6B12FA
BMI ≥ 80% RDA BMI < 80% RDA
n % n %
Very thin 61 30.0 Very Thin 177 87.2

Thin 220 34.4 Thin 564 88.1 CHD


Normal 3011 34.7 Normal 7443 85.9
Overweight 1040 43.2 Overweight 2067 85.8
Obese 77 42.3 Obese 155 85.2
Aetiology of chronic non-communicable diseases

Preventing Chronic Diseases: a vital investment. Geneva, WHO 2005


PREVALENSI GAGAL GINJAL KRONIS > 15 TAHUN
BERDASARKAN DIAGNOSIS DOKTER
MENURUT PROVINSI, 2013

Sumber Data : Riskesdas 201327


SCREENING INDEPENDENT VARIABLES TO
ENTER MULTIVARIAT ANALYSIS
No. Variables P Value

RF unmodified social economic and Psychological health


1 sex 0,000*
2 aged 0,000*
3 education 0.235*
4 Psychological health 0,000*
RF behavior
5 Fruits and vegetables 0.979
6 Offal 0,000*
7 fatty 0,000*
8 salty 0.735
9 sweet 0.835
10 Activity 0,000*
11 smoking 0,008*
12 Alcohol 0.296
RF modified
13 abdominal circumference 0,000*
14 BMI 0,000*
15 Blood presure 0,000*
16 DM 0,000*
MENGAPA 1000 HPK PENTING?
Dampak jangka pendek Dampak jangka panjang
BB ibu Prahamil rendah

IBU Pendek Perkembangan Kognitif dan


otak Prestasi belajar

Gizi pada
1000 hari pertama
kehidupan Pertumbuhan (pendek)
Kekebalan
(janin dan massa tubuh
Kapasitas kerja
bayi 2 tahun) dan komposisi badan

Diabetes, Obesitas,
Metabolisme Penyakit jantung dan
glukosa, lipids, protein pembuluh darah,
Mati
Hormon/receptor/gen kanker, stroke,
dan disabilitas lansia

Sumber: Short and long term effects of early nutrition (James et al 2000) 29