Pencegahan Penyakit Kardiovaskuler

7/21/2019 Pencegahan Penyakit Kardiovaskuler

1/59

PENCEGAHAN PENYAKIT

KARDIOVASKULER

Oleh:

Cindy Kesty, S.Ked

!"!#$$!$%

Pe'(i'(in):dr. Erwin Sukandi, Sp.PD-KKV

Tinjauan Pustaka

DEPARTEMEN ILMU PENYAKIT DALAM

FAKULTAS KEDOKTERAN UNIVERSITAS SRIWIJAYA

RSUP DR.MOHAMMAD HOESIN PALEMBANG

2014

$


2/59

*A* IPENDAHULUAN

+


3/59

CVDPK

Peny.

se-e(-/0s12le-

Peny. 0-te-i3e-i4e-

PR

P*

T-'(sis /en0

d0l0'

E'(li 30-2

5


4/59

Indnesi0st-1e, 3eny.Is1e'i1 60nt2n),di0(etes$st,

%th, &th

#7 30d0 ne)0-0(e-1e'(0n)

CVD$3enye(0(1e'0ti0nte-(0ny01 89HO,+$+

!


5/59

$&,5 6t -)'enin))0l

+5 6t -)010n

'enin))0l

+#

+5

"


6/59

;AKTOR RISIKO


7/59

A3li10siSt-0te)iPen=e)0h0n

P-i'e- >Se12nde-

P32l0si

G0y0 hid23 >

lin)12n)0n

Ke(i6010n >inte-/ensi1'2nit0s

*e-isi1 Tin))iAntili3id,

0ntihi3e-tensi,(e-henti 'e-11

&


8/59

Tin6020n P2st010

Re1'end0siKel0s ?

Tin)10t *21ti

De4inisi ?St-0ti4i10si

;01t- Risi1

A3li10siTind010n

Pen=e)0h0n

CVD

#


9/59

*A* II

REKO


10/59

REKO


11/59

TINGKAT *UKTI

TingkatBukti

Keterangan

A D0t0 did030t10n d0-i RCT '2lti3el0t02 'et00n0lisis

* D0t0 did030t10n d0-i RCT t2n))0l0t02 nnBRCT (es0-

C Knsens2s 3ini d0-i 0hli d0n3eneliti0n 1e=il, 3eneliti0n

-et-s3e1ti4

$$


12/59

KUALITAS *UKTI

Keterbatasan Studi lokasi !ang n!ata, penelitian "asil !angtidak disamarkan, "ilang selamapemantauan, tidak ada analisis mengenaiterapi

Pene'20n y0n)tid01 1nsistensi V0-i0(ilit0s te-)0nt2n) 3e-(ed00n 30d0 30sien

*21ti y0n) tid01l0n)s2n)

Pe-(0ndin)0n head to head (e-si40t l0n)s2n)

Ketid01te30t0n 2'l0h 30sien y0n) sedi1it

*i0s 32(li10si Peneliti0n y0n) 'en2n62110n tid01 0d0 e4e1inte-/ensi tid01 di32(li10si 0t02 di32(li10si 30d0

62-n0l y0n) tid01 (e-inde1s

$+


13/59

*A* III

DE;INISI DANSTRATI;IKASI ;AKTOR RISIKO

$5


14/59

DE;INISI

Pen=e)0h0n CVD

Tind010n30d0

tin)10t32(li1 d0nindi/id2

E-0di10si,eli'in0si,

'ini'0lis0si

E4e1 d0-iCVD d0n

dis0(ilit0ste-10it

$!


15/59

SCORE

Ne)0-0 -isi1 tin))i d0n -end0h

Knse3: 0te-s1le-sis3-ses y0n) (e-1el0n62t0n

P-i-it0s 30d0 ! tin)10t: 30sien didi0)nsis CVD,indi/id2 0si't'0ti1 den)0n -isi1 tin))i, s den)0n1el20-)0 'ende-it0 CVD 3-e'0t2-, s y0n) d0t0n) 1e3-01ti1

$"


16/59

KARAKTERISTIK

Indi/id2 Seh0tTid01 'e-11

A1ti/it0s 'in. "') 5 'enit


17/59

$&


18/59

STRATI;IKASI ;AKTOR RISIKO

CVD te-dete1si 'el0l2i 3e'e-i1s00n in/0si4 > nnBin/0si4 D< ti3e $ > + den)0n F $ 4.-isi1 CV > 1e-2s010n -)0n t0-)et GGK 8L;G 5 'l'enit$,&5'+

SCORE F $7

Sangat tinggi

;01t- -isi1 t2n))0l 'enin)10t se3e-ti disli3ide'i0 40'ili0l d0n hi3e-tensi (e-0t D< ti3e $ > + t0n30 401t- -isi1 CVD 0t02 1e-2s010n -)0n t0-)et GGK 'de-0t 8L;G 5B"@ 'l'enit$,&5'+ SCORE F "7 d0n $7

Tinggi

SCORE F $ d0n "7

#oderat

SCORE $7

Renda"

$#


19/59

PENANDA RISIKO CVD

hsCRP

;i(-in.)enIn4l0'0si3l01

tid01 st0(il

H.'.sisteinL3PLA+T-'(ti1

-23t213l01

$@


20/59

TEKNIK PENCITRAAN UNTUK

DETEKSI DINI CVD

Sten.sis1.-.ne-


21/59

Coronary Angiography Calcium Scoring

(NICE, 2!"

+$


22/59

Ankle#$rachial Inde%

++


23/59

PENYAKIT TERKAIT CVD

CVDIn4l2en0

GGK

OSA

Dis42n)sie-e1til

Peny01it02ti'2n

Pe-idntitis

Peny01it/0s12le-

+5


24/59

*A* IV

APLIKASI TINDAKANPENCEGAHAN CVD

+!


25/59

CVD

;.3e-il0B12

Ke(i0s00n


26/59

;AKTOR PERILAKU


27/59

KE*IASAAN


28/59

+#


29/59

NUTRISI

As0' le'01 6en2h $7 d0-i tt0l 10l-is2(stit2si den)0n 0s0' le'01 tid01

6en2h

As0' le'01 t-0ns tid01 6en2h di2s0h010n

sedi1it '2n)1intid01 'en)ns2'si'010n0n y0n) di3-ses

" ) )0-0' 3e- h0-i

5 J !" ) se-0t 3e- h0-i, d0-i 3-d21 (i6iB(i6i0n, (20h d0n s0y2-

+@


30/59

Cont&&&

+ ) (20h ? + ) s0y2- 3e- h0-i 8+B53-si

I10n 'ini'0l +h0-ii10n y0n)

(e-le'01

P-d21 y0n) 'en)0nd2n) 0l1hlse(0i1ny0 di(0t0si se(0ny01 + )el0sh0-i

8+ )h0-i 2nt21 3-i0 d0n $ )el0sh0-i 8$

)h0-i 2nt21 0nit0.

5


31/59

LATIHAN ;ISIK

L0tih0n 4isi1 di0'ete- 0-te-i 1-ne-,

'i1-si-12l0si, 42n)si endtel 3e-42si

'i10-di2'

L0tih0n 4isi1 /l2'e 3l0s'0, /is1sit0sd0-0h, 0)-e)0si t-'(sit, 01ti/it0s

t-'(liti1, -isi1 0-it'i0 -isi1 1l2si

1-ne-

Re1'end0si:

+,"B" 60''in))2 intensit0s 'de-0t, 0t02

$B+," 60''in))2l0tih0n y0n) intens.

5$


32/59

Cont&&

L0tih0n 4isi1 3e-ide F $ 'enit

(e-l0n)s2n) se30n60n) 'in))2

P0sien y0n) se(el2'ny0 tel0h 'ende-it0

in40-1 'i10-d 012t, 'en60l0ni CA*G, PCI,

0n)in0 3e1t-is st0(il, CH; st0(il

l0tih0n0e-(i1 den)0n intensit0s 'de-0t

se(0ny01 F 5 10li'in))2 d0n 5 'enit 3e-

sesi.

5+


33/59

;AKTOR PSIKOSOSIAL

Knselin) 3-i/0t)-23

Te-03i 3e-il012B1)niti4


34/59

*ERAT *ADAN

** 30d0 30sien y0n) o'ereight 8I


35/59

KLASI;IKASI I


36/59

KLASI;IKASI TEKANAN DARAH

8ESC, +$+

KategoriTekanan Dara"

Sistolik %mm1g(

Tekanan Dara"

Diastolik %mm1g(

+ptimal $+ d0n #

*ormal $+B$+@ d0n0t02 #B#!

*ormaltinggi

$5B$5@ d0n0t02 #"B#@

1ipertensi

grade $!B$"@ d0n0t02 @B@@

1ipertensi

grade '$%B$&@ d0n0t02 $B$@

1ipertensi

grade F $# d0n0t02 F $$

1ipertensi

sistolikF $! d0n @

5%


37/59

KLASI;IKASI TEKANAN DARAH

8NC VII

KategoriTekanan Dara"

Sistolik %mm1g(

Tekanan Dara"

Diastolik %mm1g(

*ormal $+ d0n0t02 #

Pre"ipertensi $+B$5@ d0n0t02 #B#@

1ipertensi

grade $!B$"@ d0n0t02 @B@@

1ipertensigrade '

F $% d0n0t02 F $

5&


38/59

TEKANAN DARAH

Penil0i0n )0y0 hid23 30d0 30sienhi3e-tensi

Hi3e-tensi )- $B+ d0n 30d0 30sien (e-isi1

CVD 'de-0t te-03i (0t d030t dit2nd0

(e(e-030 'in))2

Hi3e-tensi )- $ t0n30 401t- -isi1 l0in

(0t d030t dit2nd0 (e(e-030 (2l0n ?

3e-(0i1i )0y0 hid23

5#


39/59

Cont&&

Hi3e-tensi )- 5 d0n )- $B+ den)0n -isi1CVD tin))is0n)0t tin))i (0t di(e-i10n

se)e-0

St0tin di(e-i10n 30d0 3ende-it0

hi3e-tensi den)0n CVD 0t02 SCORE F "7 Anti3l0telet 3ende-it0 hi3e-tensi y0n)

3e-n0h 'en)0l0'i CVD3en2-2n0n 42n)si

)in60l-isi1 CVD tin))i

5@

ALGORIT


40/59

ALGORIT


41/59

ALGORIT


42/59

PE


43/59

DIA*ETES


44/59

Cont&&

St0tin 'en)2-0n)i -isi1 CVD 30d0

di0(etes. T0-)et 1leste-l LDL +,"

''lL 8$ ')dL, 1leste-l tt0l !,"

''lL, 1leste-l LDL $,# ''lL 8&')dL

Te-03i 0nti3l0telet den)0n 0s3i-in tid01

di-e1'end0si10n 30d0 3ende-it0 di0(etes

y0n) tid01 te-(21ti 'ende-it00te-s1le-sis

!!

HIPERLIPIDE


45/59

HIPERLIPIDE


46/59


47/59

O*AT ANTILIPID

+bat 2ara Ker;a

Inhi(it- 5Bhid-1siB5B'etil)l2t0-ilB= A-ed21t0se 8st0tin

drug o) choice, 1leste-lLDL

;i(-0t t-i)lise-id0, HDL

Se12est-0n 0s0' e'3ed28anion e%change resin

1leste-l tt0l d0n LDL, t-i)lise-id0

Ni0sin 80s0' ni1tin0t t-i)lise-id0, HDLInhi(it- 0(s-(si1leste-l sele1ti48eeti'i(

!&


48/59

ANTIPLATELET

;0se 012t d0-i ACS d0n hin))0 $+ (2l0n

sel0n62tny0 1'(in0si 0nti3l0telet den)0n

3en)h0'(0t P+Y$+ 8t-i10)-el- 0t02 3-0s2)-el

d0n 0s3i-in di-e1'end0si10n

Kl3id)-el 8% ') dsis loading, &" ') dsish0-i0n30d0 30sien y0n) tid01 d030t 'ene-i'0

t-i10)-el- 0t02 3-0s2)-el

P0d0 40se 1-ni1 8 $+ (2l0n setel0h in40-1

'i10-d, 0s3i-in di-e1'end0si10n 2nt213en=e)0h0n

!#


49/59

Cont&&

Se-0n)0n is1e'i1 t-0nsien nnB10-die'(li1

0t02 st-1e is1e'i1 di3i-id0'l ? 0s3i-in 0t02

1l3id)-el s060 di-e1'end0si10n

Intle-0nsi te-h0d03 di3i-id0'l 8s01it

1e30l01l3id)-el0s3i-in P0sien den)0n nnB10-die'(li, 1e60di0n

is1e'i1 se-e(-0l, 0nti10)2l0n tid01

di-e1'end0si10n

As3i-in 0t02 1l3id)-el tid01 di-e1'end0si10n30d0 indi/id2 t0n30 CVD 10-en0 tin))iny0 -isi1

3e-d0-0h0n

!@


50/59

*A* V

SI


51/59

SCORE y0n) di3010i leh ESC 2nt21

'enst-0ti4i10si 401t- -isi1 30d0 ne)0-0Bne)0-0 di

(en20 E-30

P0-0'ete- y0n) di)2n010n 0d0l0h

enis 1el0'in

Usi0

Ke(i0s00n 'e-11

Te10n0n d0-0h

Kleste-l tt0l

Indi/id2 di1el'3110n 'en60di -isi1:

S0n)0t tin))i 6i10 SCORE F $7 Tin))i 6i10 SCORE F "7 d0n $7


52/59

Pen0nd0 -isi1 CVD di1el'3110n 'en60di +

y0it2:

In4l0'0si 8hsCRP d0n 4i(-in)en T-'(ti1 8h'sistein d0n L3PLA+

Penye(0( CVD 0d0l0h 0te-s1le-sis 30d0

3e'(2l2h d0-0h y0n) (e-h2(2n)0n den)0n

3eny01it l0in se3e-ti:

In4l2en0, )0)0l )in60l 1-ni1, OSA, dis42n)si

e-e1til, 3eny01it 02ti'2n, 3e-idntitis se-t0

3eny01it /0s12le- setel0h -0di0si d0n

t-0ns3l0nt0si.

*e(e-030 te1ni1 3en=it-00n 30d0 CVD y0it2

EKG, e110-di)-04i st-es, s1inti)-04i

-0din21lid0, 3en=it-00n 0-te-i 10-tis, s1-

10lsi2' 1-ne-, A*I d0n


53/59

A3li10si tind010n 3en=e)0h0n CVD 'en=0123

(e(e-030 3in 3entin) y0it2:

;01t- 3e-il012, 1e(i0s00n 'e-11, n2t-isi,

l0tih0n 4isi1, 401t- 3si1ssi0l, (e-0t (0d0n,

te10n0n d0-0h, D


54/59

"!Thank


55/59

L0st-i

A3010h 3en=e)0h0n ini h0ny0 (e-l012 30d0 30sien 401t- -isi1

-end0hBtin))i 0t02 30d0 indi/id2 y0n) tel0h =/dM

Pen=e)0h0n 0)0- tid01 te-60di 1'3li10si, 'is0l st-1e

dih0-0310n tid01 le(ih 30-0h

Pene-030n d0n ed210si 2nt21 l0tih0n 4isi1, l0tih0n 4isi1 y0n)

dis0-0n10nM

0l0n s0nt0iintensit0s 'de-0t 8"'in))2

L0-i 0t02 (0d'intn$'in))2

Ste40ni Pen2-2n0n ** ide0l (e-030M *e-030 l0'0M

I


56/59

S2nd0-i

G2ideline d0-i l20-, 033li=0(le 0t02 tid01 2nt21 -0n)

Indnesi0M

NC)2ideline y0n) (i0s0 di)2n010n

"%


57/59

N0di0

O'e)0 5 d0n CVDM

CEYKA

Unt21 d1te- 2'2', 3e'e-i1s00n 030 y0n) (is0

dil01210nM

EKG

*e-d0s0-10n te-i, 30sien d0t0n) 2si0, ! t0h2n,

3e-11, disli3ide'i0ed210si (0)0i'0n0M

Psi1l)is d0n 1ein)in0n 30sien 2nt21 (e-henti

'e-11

L01210n 3ende10t0n 30d0 30sien

"&


58/59

Nis0

Pe'010i0n 0nti 3l0telet, 03010h se'20 -0n)

den)0n 401t- -isi1 3e-l2 di(e-i10nM

tid01

Pen=e)0h0n 030 y0n) (is0 dil01210n 30d0 30sien

den)0n PADM

Se4ti P-4il li3id y0n) 'enin)10t10n -isi1 0te-s1le-sisM

"#


59/59

Retn

Hi3e-tensi 3-i'e-, 13n di=2-i)0i 0d0ny0

0te-s1le-sisM

*0)0i'0n0 3en0t0l01s0n00nny0M

"@

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