13800383 Atherosclerosis

7/26/2019 13800383 Atherosclerosis

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ATEROSKLEROSIS

(ATHEROSCLEROSIS)

OLEH

NECEL

PUBLICATION OF NECEL

Biokimia “atherosklerosis ! "e#el $%%& '

BAB I

PENAHULUAN

'' Latar Belaka"*

Arteri a+alah ,em-.l.h +arah /a"* mem-a0a oksi*e" +a" ".trisi +ari

1a"t."* ke a"**ota t.-.h /a"* lai" Ciri2#iri arteri /a"* sehat /ait. 3leksi-el4 k.at

+a" elastis La,isa" ,erm.kaa" +alam"/a li#i" sehi"**a +arah +a,at me"*alir

ta",a -atasa" Teta,i4 s.at. 0akt.4 terlal. -a"/ak teka"a" ,a+a arteri +a,at

me"/e-a-ka" +i"+i"* ,em-.l.h +arah me"1a+i te-al +a" kak.4 akhir"/a aka"

mem-atasi +arah /a"* me"*alir ke or*a" +a" 1ari"*a" Proses i"i +ise-.t

arterios#lerosis ata. ,e"*erasa" ,em-.l.h arteri'

Aterosklerosis a+alah -e"t.k .m.m +ari ateriosklerosis 5eski,." ke+.a

istilah terse-.t +alam a,likasi"/a +a,at sali"* me"**a"tika" Aterosklerosis

mer.,aka" ,e"*erasa" ,em-.l.h +arah arteri /a"* +ise-a-ka" kare"a

,e".m,.kka" sim,a"a" lemak (,lak) +a" s.-sta"si lai""/a'

Be-era,a ,e"elitia" me"**am-arka" ,er-e+aa" a"tara “ateriosklerosis“4

“atheros#lerosis“4a"+ arteriolosklerosis“alam ko"teks i"i4 atherosklerosis

+i*."aka" ketika me"*a#. ,a+a arteri .tama /a"* le-ih -esar4 +a"

arteriolosklerosis +i*."aka" ketika me"*a#. ,a+a arteriol4 se+a"*ka"

arteriosklerosis mer.,aka" i"+.k +ari ke+.a termi"olo*i +i atas $

Arterios#lerosis (,e"*erasa" arteri .tama) +iaki-atka" +ari s.at.

sim,a"a" /a"* ti+ak m.+ah r.sak +a" kola*e" /a"* kak. +i +alam +i"+i"*

,em-.l.h +arah +i sekitar ateroma Hal i"i me"i"*katka" kekak.a" +a"

me".r."ka" elastisitas +i"+i"* arteri Arteriolosklerosis (,e"*erasa" arteri ke#il4

arteriol)a+alah hasil +ari ,e"/im,a"a" kola*e"4 ,e"e-ala" +i"+i"* otot

,e"/im,a"a" ,rotei" (“h/ali"e“)6

Aterosklerosis a+alah ,e"/akit /a"* sa"*at ,ro*resi3 /a"* me"/e-a-ka"

me"*eras"/a ,em-.l.h arteri kare"a s.m-ata" oleh kolesterol teroksi+asi

Atherosklerosis i"i ti+ak 1ara"* s.+ah m.lai ter1a+i se1ak .sia masih sa"*at m.+a

Proses me"*eras"/a ,em-.l.h +arah mer.,aka" s.at. ,roses /a"* -er1ala"

,erlaha"2laha" "am." ,asti7

+a"

Biokimia “atherosklerosis ! "e#el $%%& $



i,erkiraka" -ah0a atheros#lerosis -era0al se-a*ai atheroma4 /ait.

t.mor 1i"ak ("o"ka"ker) sel2sel otot ,olos +i +alam +i"+i"* ,em-.l.h +arah Sel2

sel i"i -ermi*rasi +ari la,isa" otot ,a+a ,em-.l.h +arah ke ,osisi te,at +i -a0ah

la,isa" e"+othel4 sel2sel terse-.t ter.s mem-elah +iri +a" mem-esar Kem.+ia"4

kolesterol +a" lemak /a"* me".m,.k +i sel2sel otot ,olos a-"ormal i"i

mem-e"t.k ,lak7

Plak ter-e"t.k +ari sim,a"a" s.-sta"si lemak4 kolesterol sisa meta-olisme

sel4 kalsi.m +a" 3i-ri" S.-sta"si2s.-sta"si i"i +a,at -erkem-a"* ,a+a arteri

se+a"* ata. aorta Ker.saka" +i"+i"* ,em-.l.h /a"* ,arah aki-at terke"a ,lak

i"i me"1a+i keras +a" kehila"*a" elastisitas"/a Kea+aa" se,erti i"i +ise-.t

“,e"*erasa" arteri“8

Atherosklerosis -.ka"lah ,e"/akit /a"* -ar. +ike"al Pem-.l.h +arah

m.mmi 5esir4 le-ih +ari 68%% tah." /a"* lal.4 ter"/ata telah me"*i+a, ,e"/akit

i"i Oto,si ,ertama /a"* +ilak.ka" ,a+a tah." '&6'me"."1.kka" a+a"/a ta"+a2

ta"+a ,e"*a,.ra" ,a+a ,em-.l.h koro"er seora"* 0a"ita m.mmi 0a"ita -er.sia

8% tah." Oto,si ,a+a $%% ser+a+. /a"* mati m.+a +alam ,era"* Korea

me"."1.kka" 8% ,erse" ser+a+. it. me"."1.kka" ta"+a2ta"+a ,e"*a,.ra" ,a+a

,em-.l.h koro"er"/a 0ala.,." mereka ti+ak mem,."/ai kel.ha" sama sekali

i Amerika Serikat4 79 ,erse" +ari a"ak m.+a /a"* mati kare"a ke#elakaa" lal.

li"tas ter"/ata s.+ah me"*i+a, ,e"*a,.ra" koro"er /a"* "/ata4 teta,i teta, ta",a

*e1ala /a"* "/ata8

:.mlah ,e"+erita atherosklerosis +i era *lo-alisasi +a" i"+.strialisasi

#e"+er."* me"i"*kat Pa+a +eka+e terakhir i"i ,e"/akit 1a"t."* +a" ,em-.l.h

+arah /a"* +i+asari oleh atherosklerosis -erkem-a"* me"1a+i ,em-.".h .tama +i

I"+o"esia9 ari ,e"elitia" me"."1.kka"4 ,e"/e-a- kematia" +ari ,e"+.+.k

+."ia /a"* +iteliti a+alah 1a"t."* (7$4& ,erse")4 stroke ($84& ,erse")4 ,e"/akit

,ar. +a" asma ('$48 ,erse")4 ka"ker (847 ,erse")4 +a" ,e"/akit lai" (k.ra"* +ari

em,at ,erse");Salah sat. ,e"/e-a- 3e"ome"a i"i a+alah ,ola hi+., mas/arakat

/a"* ti+ak sehat <

St.+i /a"* +ilak.ka" oleh Or*a"isasi Kesehata" ."ia (=HO),a+a tah."

'&;9 me"/im,.lka" -ah0a ,ro*resi ,e"*a,.ra" koro"er -ertam-ah se-esar 6

,erse" ,er tah." se1ak .sia seseora"* mele0ai $% tah." Ke"/ataa" i"i

Biokimia “atherosklerosis ! "e#el $%%& 6



mem-.ktika" -ah0a ,ro*resi>itas ,e"*a,.ra" ,em-.l.h koro"er ses."**.h"/a

mema"* me"**.lir +iam2+iam +a" se"a"tiasa mem-a0a -aha/a late" Che#k .,

me"1a+i ,e"ti"*4 ter.tama -a*i seseora"* /a"* s.+ah mele0ati .sia 7% tah."

e"*a" +emikia"4 ,ro*resi>itas ,e"/akit i"i +a,at +i #e*ah se+i"i m."*ki"&

i "e*ara2"e*ara Barat aterosklerosis mer.,aka" se-a*ia" -esar -e"t.k

+ari ,e"/akit 1a"t."* Le-ih +ari ' '?$ +ari sem.a ,e"+erita /a"* me"i"**al

mer.,aka" hasil la"*s."* ma.,." ti+ak la"*s."* +ari aterosklerosis&

'$ 5asalah

' A,a /a"* +imaks.+ +e"*a" aterosklerosis@

$ Ba*aima"a meka"isme ter-e"t.k"/a aterosklerosis@

6 A,a ,e"/e-a- aterosklerosis@

7 A,a *e1ala +a" ta"+a +ari aterosklerosis@

8 Sia,a /a"* memiliki 3a#tor resiko terha+a, aterosklerosis@

9 Ba*aima"a #ara me"+ia*"osis aterosklerosis@

; Ba*aima"a ,erlak.a" (treatme"t) terha+a, aterosklerosis@

< Ba*aima"a #ara me"#e*ah aterosklerosis@

'' T.1.a"

' 5e"1elaska" ,e"*ertia" aterosklerosis

$ 5emahami meka"isme ter-e"t.k"/a aterosklerosis

6 5e"*etah.i ,e"/e-a- aterosklerosis

7 5e"1elaska" *e1ala +a" ta"+a +ari aterosklerosis

8 5e"*etah.i 3aktor resiko terha+a, aterosklerosis

9 5e"1elaska" #ara me"+ia*"osis aterosklerosis

; 5e"1elaska" #ara ,erlak.a" terha+a, aterosklerosis

< 5e"*etah.i #ara me"#e*ah +a" me"*hi"+ari aterosklerosis

'$ 5a"3aat

' 5e"am-ah khaa"ah ilm. ,e"*etah.a" ke+oktera" kh.s.s"/a te"ta"*

aterosklerosis




$ 5em-erika" i"3ormasi ke,a+a mahasis0a ke+oktera" me"*e"ai

atherosklerosis




BAB II

PE5BAHASAN

$' Pe"*ertia"

Atherosklerosis -erasal +ari kata athero /a"* +alam -ahasa ."a"i

(athera) s.at. -e"t.k *a-."* /a"* me"."1.ka" +e*e"erasi lemak ata. h.-."*a"

+e"*a" atheroma Se+a"*ka" sklerosis +alam -ahasa ."a"i -erarti i"+.rasi +a"

,e"*erasa" se,erti ,e"*erasa" se-a*ia" ,era+a"*a"4 ,em-e"t.ka" 1ari"*a" ikat

me"i"*kat ata. ,e"/akit at i"tersisial'%

Atherosklerosis a+alah s.at. ,e"/akit /a"* me"/era"* ,em-.l.h +arah

-esar ma.,." ke#il +a" +ita"+ai oleh kelai"a" 3."*si e"+otelial4 ra+a"* >ask.ler4

+a" ,em-e"t.ka" li,i+4 kolesterol4 at ka,.r4 -ekas l.ka >ask.ler +i +alam

+i"+i"* ,em-.l.h i"tima Pem-e"t.ka" i"i me/e-a-ka" ,lak4 ,e"*.-aha" -e"t.k

>ask.ler4 o-str.ksi l.mi"al ak.t +a" kro"is4 kelai"a" alira" +arah4 ,e"*.ra"*a"

s.,lai oksi*e" ,a+a or*a" ata. -a*ia" t.-.h terte"t. ''

Plak ter-e"t.k +ari lemak4 kolesterol4 kalsi.m4 +a" s.-ta"si lai" /a"* +i

tem.ka" +alam +arah Ketika it. t.m-.h4 mem-e"t.k ,lak +i -a*ia" +alam arteri4

+a" ,a+a saat"/a +a,at mem-atasi alira" +arah A+a +.a 1e"is ,lakD$

Sta-il +a" keras

Ti+ak sta-il +a" lem-.t

Plak /a"* keras me"/e-a-ka" ,e"*erasa" +a" ,e"e-ala" +i"+i"*

,em-.l.h +arah Plak /a"* lem-.t le-ih mem."*ki"ka" ."t.k ,e#ah +a"

terle,as +ari +i"+i"* ,em-.l.h +arah +a" mas.k alira" +a Hal i"i +a,at

me"/e-a-ka" ,e"**.m,ala" +arah /a"* +a,at se#ara ,arsial ata. total mem-lok

alira" +arah +i +alam arteri Ketika hal i"i ter1a+i4 or*a" /a"* +is.,lai oleh arteri

/a"* ter-lok aka" kek.ra"*a" ".trisi +a" oksi*e" Akli-at"/a sel or*a" terse-.t

aka" mati ata. me"+erita ker.saka" /a"* ,arah$






The ill.stratio" sho0s a "ormal arter/ 0ith "ormal -loo+ 3lo0 (Fi*.re A) a"+ a" arter/ #o"tai"i"*

,la.e -.il+., (Fi*.re B)

Aterosklerosis a+alah ,e"/akit /a"* sa"*at ,ro*resi3 /a"* +a,at +im.lai

,a+a masa ka"ak2ka"ak Aterosklerosis +a,at mem,e"*ar.hi arteri +i otak4 hati4

*i"1al4 le"*a" +a" kaki Kare"a ter1a+i ,em-e"t.ka" ,lak4 hal i"i +a,at

me"/e-a-ka" ,e"/akit /a"* seri.s +a" kom,likasi Se,erti D $

Pe"/akit arteri #oro"aria

o A"*i"a

o Sera"*a" :a"t."*

o 5ati me"+a+ak

Pe"/akit Cere-ro ask.ler

o Stroke

o Tra"sie"t is#hemi# atta#k (TIA) ata. “mi"i stroke

Biokimia “atherosklerosis ! "e#el $%%& ;



Pe"/akit arteri ,eri3er$

$$ 5eka"isme Aterosklerosis

Athero*e"esis a+alah ,roses ,em-e"t.ka" +ari ,lak2,lak atheroma Hal

terse-.t +ita"+ai +e"*a" remo+eli"* +ari arteri /a"* -ersamaa" +e"*a" ak.m.lasi

sel (ter.tama le.kosit se,erti mo"osit /a"* mer.,aka" t.r."a" makro,ha*e) +a"

+imo+i3ikasi oleh li,o,rotei" Sela"1.t"/a ra+a"* mema#. ke arah ,em-e"t.ka"

,lak artheroma +i +alam arteri i"tima4 s.at. +aerah ,a+a +i"+i"* sel /a"* terletak

a"tara e"+otheli.m4 me+ia +a" a+>e"titia Ba*ia" .tama +ari lesi i"i ter+iri atas

kele-iha" lemak4 sel4 kola*e" +a" elasti"6

Ter+a,at -er-a*ai hi,otesis te"ta"* ke1a+ia" aterosklerosis4 a"tara lai" The

res,o"se2to2i"1.r/4 5o"o#lo"al4 Clo"al Se"es#e"se4 li,i+s a"+ Co""e#ti>e Tiss.e

Akhir2akhir i"i4 telah +ia1.ka" ,era" mo"osit se-a*ai a0al lesi aterosklerosis

Pe"**a-."*a" teori i"3iltrasi lemak +a" ker.saka" e"+otel ,ali"* -a"/ak +ia".t'$

Plak atherosklerosis ter+iri +ari *a-."*a" lemak i"trasel.llar +a"

ekstrasel4 sel otot ,olos4 1ari"*a" ikat4 +a" *likosami"o*lika" eteksi ,ali"* a0al

me"*e"ai lesi ,a+a atherosklerosis a+alah la,isa" lemak ( Ter+iri +alam lemak

+im.ati sel -.sa4 /a"* ma"a makro,ha*e -ermi*rasi se-a*ai mo"o#/tes +ari

sirk.lasi ke+alam la,isa" s.-e"+othelial +ari i"tima )4 /a"* kem.+ia" lam-at la."

me"1a+i 3i-ro.s ,la.e ( ter+iri +ari sel otot ,olos i"tima /a"* +i kelili"*i

1ari"*a" ikat lemak i"trasel.llar +" ekstrasel.llar )'7

Pem-.l.h atherosklerosis me"*alami ,e"*.ra"*a" teka"a" sistolik +a"

ke#e,ata" ,e"/e-ara" *elom-a"* se#ara ti+ak "ormal Atherosklerosis ,em-.l.h

arteri ,a+a ,e"+erita hi,erte"si 1.*a me"*alami ,e"*.ra"*a" elastisitas4 /a"*

ma"a ,e"*.ra"*a" aka" -erla"1.t ketika atherosklerosis -erla"*s."*'7

.a hi,otesis /a"* telah +i a1.ka" ."t.k me"1elaska" meka"isme

,ato*e"esis +ari atherosklerosis D hi,otesis lemak +a" hi,otesis ker.saka"

e"+othelial kro"ik ke+.a"/a kem."*ki"a" memiliki keterkaita"'7

Hi,otesis Lemak

alil /a"* me"/ataka" ,e"i"*kata" "ilai +alam LL ,lasma mer.,aka"

hasil me"em-.s"/a LL +alam +i"+i"* arteri sehi"**a memi#. ,e"am-aha"

lemak +i +alam sel otot ,olos +a" makro,ha*e ( sel -.sa ) LL 1.*a

mem,er-esar sel otot se-a*ai res,o" terha+a, Gro0th Fa#tor LL +i mo+i3ikasi

Biokimia “atherosklerosis ! "e#el $%%& <



+a" +i oksi+asi +i +alam li"*k."*a" +a" me"*aki-atka" le-ih athero*e"ik

Partikel kolesterol LL le-ih re"ta" ."t.k +i mo+i3ikasi +a" +i oksi+asi LL

+imo+i3ikasi ata. +ioksi+asi me"*alami kemotaksis me".1. mo"osit4 se-a*ai

,ema#. mi*rasi mo"osit ke+alam i"tima4 ,em."#.la" a0al ,a+a la,isa" lemak

+a" sela"1.t"/a me"*alami tra"s3ormasi +a" mem,ertaha"ka""/a +i -a*ia"

s.-i"tima se-a*ai makro,ha*e Rese,tor s#a>e"*er +i atas ,erm.kaa"

makro,ha*e mem3asilitasi mas.k"/a LL teroksi+asi ke+alam sem.a sel +a"

me"tra"s3er ke +alam lemak /a"* +i m.ati makro,ha*e +a" sel -.sa LL

teroksi+asi melal.i ,roses sitotoksik me".1. ke sel e"+othelial +a" -erta"**."*

1a0a- terha+a, +is3."*si ,a+a e"+othel'7

Be"t.k atherosklerosis telah +i ,ela1ari kera /a"* +i-eri maka" +iet ka/a

kolesterol alam 0akt. ' sam,ai $ mi"**. aka" mem,e"*ar.hi

hi,erkolesterolemia4 mo"osit me"1a+i terkait +e"*a" ,erm.kaa" +ari e"+hoteli.m

arteri melal.i i"+.ksi +ari rese,tor /a"* s,esi3ik4 lal. -er,i"+ah tem,at ke +alam

s.-e"+otheli.m4 +a" ter1a+i ,e"am-aha" lemak (kare"a"/a +ise-.t sel -.sa)

Proli3erasi +ari sel otot ,olos 1.*a me"/e-a-ka" ,e"am-aha" 1.mlah lemak

Ketika la,isa" lemak +a" 3i-ro.s ,la.e mem-esar +a" mem-e"*kak?me"o"1ol ke

+alam l.me"4 s.-e"+otheli.m me"1a+i tereks,os ke +arah ,a+a lokasi e"+othel

/a"* terl.ka4 sehi"**a ter+a,at k.m,.la" ,latelets +a" -e"t.ka" +i"+i"*

trom-.s Pele,asa" *ro0th 3a#tor +ari /a"* +ik.m,.lka" ,latelet +a,at

me"i"*katka" ,roli3erasi otot ,olos +i +alam la,isa" i"tima'7 Alter"ati3 lai"4

s.at. ,e#aha" atheroma 1.*a +a,at me".m,ahka" ka"+."*a" lemak"/a +a"

me"#et.ska" ,em-e"t.ka" s.at. *.m,ala" +arah (throm-.s) Throm-.s +a,at

me"am-ah ,e"/em,ita" ata. -ahka" me"*ham-at arteri4 ata. m."*ki" le,as +a"

me"*a,."* ke arah m.ara /a"* aka" me"/e-a-ka" s.m-ata" (em-olism)'6

Hi,otesis e"+hoteli.m kro"is l.ka

alil /a"* me"/ataka" -ah0a ,a+a kea+aa" "ormal4 e"+oteli.m me"*hala"*i

,e"etrasi molek.l2molek.l -esar se,erti li,o,rotei" +e"*a" +e"sitas re"+ah +a"

sa"*at re"+ah (LL4 LL) ke +alam i"tima4 se+a"*ka" li,o,rotei" +e"*a"

+e"sitas /a"* le-ih ti"**i +e"*a" molek.l /a"* le-ih ke#il +a,at -er*erak -e-as

ke +alam +a" kel.ar i"tima Sel2sel e"+oteli.m 1.*a me"*hasilka" ,rostasikli"

Biokimia “atherosklerosis ! "e#el $%%& &

(PGI$) +a" oksi+a "itrit /a"* +a,at me"#e*ah ,e".m,.ka" ,latelet'74'8

Pe"i"**ia" ,ermea-ilitas e"+oteli.m mer.,aka" kelai"a" ,ertama aki-at

ter1a+i"/a 1e1as arteri /a"* mer.,aka" s.at. res,o"s "o"2s,esi3ik /a"*

+ise-a-ka" oleh >ir.s4 toksi"4 kom,leks im."4 ,ro+.k2,ro+.k /a"* +ile,aska"

oleh sel2sel +arah ,.tih ata. ,latelet2,latelet /a"* terakti>asi4 +a" stress 3isik /a"*

ti+ak laim Hal i"i 1.*a +a,at +ise-a-ka" oleh a+a"/a ,e"i"**ia" ko"se"trasi

li,o,rotei" +alam +arah Bila li,o,rotei" memas.ki i"tima aki-at ,e"i"**ia"

,ermea-ilitas ka,iler4 maka se"/a0a ,rotei" .tama +ari LL +a" LL

(a,oli,o,rotei" B) -erikata" +e"*a" *likosoami"o*lika"4 ter.tama +ermata"

s.l3at sehi"**a li,o,rotei" me".m,.k +i +alam i"tima Kem.+ia"4 LL terse-.t

+i.-ah oleh sel2sel sekitar"/a (teroksi+asi) +a" +ita"*ka, oleh rese,tor /a"* a+a

,a+a makro3a* (s#a>e"*er #ells) Sela"1.t"/a4 ter1a+i ,er.-aha"2,er.-aha" kimia

+ari LL +a" me"*hasilka" mo"o#/te #hemota#ti# 3a#tor /a"* mer.,aka"

sitotoksik terha+a, sel2sel e"+oteli.m 5o"osit tertarik +a" melekat ke

e"+oteli.m4 kem.+ia" melak.ka" ,e"etrasi ke s.- e"+oteli.m me"1a+i makro3a*

/a"* -erisi +ro,let2+ro,let li,i+ +a" me"/e-a-ka" ,erm.kaa" e"+oteli.m

me"1a+i ti+ak rata Sela"1.t"/a4 ter1a+i ,e"i"**ia" ,ermea-ilitas e"+otel terha+a,

li,i+ Lim3osit T 1.*a terli-at (kemotaksis mo"osit +a" ,e"etrasi i"tima 1.*a

mer.,aka" a0al +ari a-"ormalitas) Ker.saka" e"+otel 1.*a mera"*sa"* ,latelet2

,latelet ."t.k -ert.m,.k4 +e*ra".lasi4 +a" me"*hasilka" a+e"osi" +i3os3at serta

trom-oksa" A$ A+e"osi" +i3os3at +a" trom-oksa" A$ sela"1.t"/a me"/e-a-ka"

,e".m,.ka" ,latelet Platelet2,latelet4 sel e"+oteli.m4 makro3a*4 +a" lim3osit T

me"*hasilka" #/toki"es like #olo"/ stim.lati"* 3a#tors4 i"s.li" like *ro0th 3a#tor2

'4 TGF24 i"terle.ki"2'4 a"+ t.mor "ekrosis 3a#tor2 Sem.a i"i -eker1a

me"*hasilka" s.at. 3aktor /a"* +iketah.i se-a*ai ,latelet +eri>e+ *ro0th 3a#tor

(PGF) /a"* me"/e-a-ka" sel2sel otot ,olos ter,isah4 mas.k ke +alam i"tima

+a" me"*am-il li,o,rotei" ."t.k mem-e"t.k sel -.sa4 me"*hasilka" elasti" +a"

kola*e"4 kem.+ia" mem-e"t.k ,lak 3i-rosa '8

Biokimia “atherosklerosis ! "e#el $%%& '%





Pe"/e-a- Aterosklerosis

Pa+a atherosklerosis4 +i"+i"* arteri me"1a+i keras +a" te-al4 ka+a"*2

ka+a"* me"*a#a. sirk.lasi alira" +arah Ko"+isi i"i mer.,aka" aki-at +ari ,roses

,e".aa" alami +ari atherosklerosis '

Para ilm.a" -el.m me"*etah.i se#ara ,asti -a*aima"a meka"isme

aterosklerosis ter1a+i ata.,." ,e"/e-a-"/a Pe"/akit i"i -erkem-a"* -ertaha,

+a" kom,lek Ba"/ak ilm.0a" -er,ikir hal i"i +im.lai +e"*a" ker.saka" ,a+a

la,isa" /a"* ,ali"* +alam +ari arteri /a"* +ise-.t e"+hoteli.m Pe"/e-a- +ari

ker.saka" e"+hotli.m meli,.tiD'

Pe"i"*kata" ka+ar kolesterol

Teka"a" +arh ti"**i

ir.s

Reaksi aler*i

Baha"2-aha" irita"4 se,erti "ikoti" ata. +r.*s ata. terlal. -a"/ak

homo#/stei"

(s.at. asam ami"o /a"* ter+a,at ,a+a +arah)

Pe"/akit terte"t.4 se,erti +ia-etes

Ta"+a +a" Ge1ala

Ta"+a +a" *e1ala atherosklerosis -iasa"/a -erkem-a"* se#ara -erti"*kat

Pertama4 *e1ala m."#.l setelah a+a"/a .,a/a /a"* k.at 4 ketika arteri ti+ak +a,at

me"/.,lai #.k., okssi*e" +a" ".trisi ke,a+a otot '

ASPEK KLINIS

Ge1ala2*e1ala +ari aterosklerosis .m.m"/a -er>ariasi Pe"+erita

aterosklerosis ri"*a" +a,at me"*alami *e1ala i"3ark m/o#ar+ +a" ,asie" /a"*

me"+erita aterosklerosis ti"*kat la"1.t +a,at ti+ak me"*alami *e1ala2*e1ala /a"*

-erarti :a+i ti+ak a+a ,er-e+aa" *e1ala2*e1ala kli"is a"tara aterosklerosis /a"*

ri"*a" ata.,." /a"* telah ,arah Aterosklerosis +a,at me"1a+i kro"ik +e"*a"

me"."1.kka" ta"+a2ta"+a ker.saka" /a"* me"i"*kat se-a"+i"* +e"*a" .m.r

(,e"/akit +e*e"erati3) +a" lama"/a me"+erita aterosklerosis 5eski,."

mer.,aka" se-.ah ,e"/akit sistemik /a"* me"**lo-al teta,i aterosklerosis +a,at

Biokimia “atherosklerosis ! "e#el $%%& ''

,.la ha"/a me"/era"* salah sat. or*a" t.-.h +ima"a hal i"i -er>ariasi ."t.k

masi"*2masi"* ,e"+erita Berik.t i"i +isa1ika" -e-era,a e3ek kli"is kelai"a" /a"*

ter1a+i aki-at aterosklerosis D''

A+a"/a ,e"/em,ita" +iameter ,em-.l.h +arah aki-at ,e".m,.ka"

1ari"*a" 3i-ro.s (,la.e) /a"* maki" lama maki" -esar Pe"/em,ita" +a,at

me"#a,ai hi"**a "ilai 8%2;%J +ari +iameter ,em-.l.h a0al Hal i"i -eraki-at

ter*a"**."/a sirk.lasi +arah ke,a+a or*a" /a"* mem-.t.hka" sehi"**a

ke-.t.ha" oksi*e" +a" ".trisi sel ter*a"**. Co"toh ,e"/akit /a"* -erh.-."*a"

+e"*a" masalah i"i a+alah a"*i"a ,e#toris4 mese"terik a"*i"a4 +a" lai"

se-a*ai"/a''

Pla.e /a"* telah ter-e"t.k +a,at ,e#ah +a" me"*alir me"*ik.ti

,em-.l.h +arah me"1a+i trom-.s +a" em-oli Trom-.s i"i +a,at

me"/.m-at arteri2arteri ,e"ti"* t.-.h /a"* ,e"ti"* :ika me"/.m-at

arteri koro"er maka +a,at me"*aki-atka" otot 1a"t."* me"*alami iskemia

(kek.ra"*a" ".trisi) +a" sela"1.t"/a +a,at memi#. ter1a+i"/a i"3ark

m/o#ar+ +a" stroke Em-oli i"i +a,at 1.*a ter1a+i se#ara ta",a se"*a1a

,a+a ,eristi0a ,em-e+aha" aorta4 a"*io*ra34 +a" tera,i trom-olitik ,a+a

,asie" aterosklerosis

A"*i"a ,e#toris +it."1.kka" +e"*a" ,erasaa" ti+ak "/ama" ,a+a +aerah

retroster"al +a" me"/e-ar ke +aerah le"*a" ka"a" /a"* ka+a"*2ka+a"*

+isalah artika" se-a*ai *e1ala +/s,"ea A"*i"a ,e#toris tim-.l setelah

melak.ka" ker1a -erat +a" +io-ati +e"*a" -eristirahat ata. tera,i "itrat

:ika a"*i"a ,e#toris -erla"1.t +a" ter1a+i -er.la"*2.la"* +a,at -erla"1.t

ke,a+a i"3ark m/o#ar+ (sera"*a" 1a"t."*)

Stroke mer.,aka" kela"1.ta" +ari a+a"/a s.m-ata" ,a+a ,em-.l.h +arah

otak Aki-at"/a sel2sel otak me"*alami iskemia +a" ma"*alami *a"**.a"

+alam hal 3."*si"/a

Pe"/akit >ask.ler ,eri3er meli,.ti ,erasaa" ,e*al4 im,ote"si4 l.ka /a"*

tak k."1."* sem-.h +a" i"3eksi ,a+a +aerah ekstremitas Perasaa" ,e*al

i"i me"i"*kat setelah -erolahra*a +a" sem-.h ketika -eristirahat Perasaa"

i"i +a,at +iik.ti +e"*a" k.lit ke,.#ata" ata. kesem.ta"

Biokimia “atherosklerosis ! "e#el $%%& '$



Iskemia ,a+a or*a"2or*a" >is#eral -eraki-at ,a+a ker.saka" s.s."a" +a"

3."*si +ari or*a" /a"* terke"a

5ese"terik a"*i"a +ita"+ai +e"*a" sakit ,a+a e,i*astri.m ata.

,eri.m-ilikal setelah maka" +a" +ia"alo*ka" +e"*a" he"atemesis4 +iare4

+e3isie"si ".trisi4 ata. -erk.ra"*"/a -erat -a+a"

A"e.risme ,a+a aorta a-+omi"alis +ima"a aorta a-+omi"alis me"*alami

ker.saka" sehi"**a mem-esar me"im-.lka" se-.ah -e"1ola" ,a+a

+i"+i"* l.ar aorta a-+omi"alis

Em-oli arteri seri"* tim-.l -ersamaa" +e"*a" "ekrosis ,a+a 1ari21ari4

,e"+araha" sal.ra" ,e"#er"aa"4 i"3ark m/o#ar+4 iskemia ,a+a reti"a4

i"3ark sere-ral4 +a" *a*al *i"1al

ASPEK FISIK

Ta"+a2ta"+a 3isik +ari aterosklerosis meli,.ti a+a"/a ,e"im-."a" lemak4

,ele-ara" +a" kak."/a arteri m.sk.lar /a"* -esar4 +a" iskemia ata. i"3ark +ari

-e-era,a or*a" terta"t. Berik.t i"i +isa1ika" ta"+a 3isik +ari aterosklerosis D ''

Hi,erli,i+emia

Hi,erli,i+emia a+alah a+alah me"i"*kat"/a ka+ar lemak +i +alam +arah

Lemak i"i +a,at memi#. ter1a+i"/a ,e"im-."a" ,la.e ,a+a +i"+i"*

,em-.l.h +arah

Pe"/akit ,a+a arteri koro"er

ita"+ai +e"*a" a+a"/a -."/i 1a"t."* keem,at /a"* semaki" 1elas4 takikar+i4

hi,ote"si4 ata. hi,erte"si

Pe"/akit sere-ro>ask.ler

ita"+ai +e"*a" ti+ak tera-a"/a +e"/.t "a+i ,a+a arteri karotis +a"

kem."+.ra" +ari 3."*si otak

Pe"/akit >ask.ler ,eri3er

ita"+ai +e"*a" ,e".r."a" +e"/.t "a+i ,eri3er4 s.m-ata" ,a+a erteri ,eri3er4

sia"osis ,eri3er4 *a"*re"e4 ata. l.ka /a"* s.kar sem-.h

A"e.risme ,a+a aorta a-+omi"alis

ita"+ai +e"*a" tim-.l"/a -e"1ola" ,a+a arteri a-+omi"alis ata. kola,s"/a

sistem sirk.lasi

Biokimia “atherosklerosis ! "e#el $%%& '6



Em-oli ,a+a arteri

ita"+ai +e"*a" *a"*re"e4 sia"osis4 m."#.l"/a “,e+al ,.lses /a"* +ikaitka"

a+a"/a ,e"/akit mokro>ask.lar +a" em-oli kolesterol

$8 Faktor Resiko

5eski,." ilm.0a" ti+ak me"*etah.i se#ara ,asti ,e"/e-a- ter1a+i"/a

atherosklerosis4 "am." mereka me"*etah.i -ah0a ,a+a ko"+isi2ko"+isi terte"t.

+a,at me"i"*katka" resiko ter1a+i"/a atherosklerosis

Be-era,a 3aktor resiko +ari ,e"/akit aterosklerosis4 /ait. se-a*ai -erik.t D

' Faktor risiko -iolo*is /a"* tak +a,at +i.-ah4 /ait.D .sia4 1e"is kelami"4

ras4 +a" ri0a/at kel.ar*a Risiko aterosklerosis koro"er me"i"*kat +e"*a"

-ertam-ah"/a .sia ,e"/akit /a"* seri.s 1ara"* ter1a+i se-el.m .sia 7% tah."

Teta,i h.-."*a" a"tara .sia +a" tim-.l"/a ,e"/akit m."*ki" ha"/a

me"#ermi"ka" le-ih ,a"1a"*"/a lama ,a,ara" terha+a, 3aktor2 3aktor

atero*e"ik =a"ita a*ak"/a relati3 ke-al terha+a, ,e"/akit i"i sam,ai

me"o,a.se4 +a" kem.+ia" me"1a+i sama re"ta""/a se,erti ,ria +i+.*a oleh

a+a"/a e3ek ,erli"+."*a" estro*e" Ora"* Amerika2A3rika le-ih re"ta"

terha+a, aterosklerosis +ari,a+a ora"* k.lit ,.tih Ri0a/at kel.ar*a /a"*

,ositi3 terha+a, ,e"/akit 1a"t."* koro"er (sa.+ara ata. ora"* t.a /a"*

me"+erita ,e"/akit i"i se-el.m .sia 8% tah.") me"i"*katka" kem."*ki"a"

tim-.l"/a aterosklerosis ,remat.r Pe"ti"*"/a ,e"*ar.h *e"etik +a"

li"*k."*a" masih -el.m +iketah.i Kom,o"e" *e"etik +a,at +i+.*a ,a+a

-e-era,a -e"t.k aterosklerosis /a"* "/ata4 ata. /a"* #e,at ,erkem-a"*a""/a4

se,erti ,a+a *a"**.a" li,i+ 3amilial Teta,i4 ri0a/at kel.ar*a +a,at ,.la

me"#ermi"ka" kom,o"e" li"*k."*a" /a"* k.at4 se,erti misal"/a *a/a hi+.,

/a"* me"im-.lka" stres ata. o-esitas'9

$ Hi,erkolesterolemia

Pa+a kea+aa" hi,erkolesterolemi ter+a,at *a"**.a" homeostasis

,em-.l.h +arah /a"* +ise-a-ka" D';

a Pe".r."a" ,ro+.ksi NO aki-at *a"*.a" tra"s+.ksi si"/al ,rotei" G'2$




- Pe"i"*kata" ,ro+.ksi a"io" s.,eroksi+a melal.i ,rotei" ki"ase C /a"*

mer.sak NO

# Pe"i"*kata" reakti>itas E"+otheli"

+ Pe"i"*kata" a+hesi sel aki-at ,e"i"*kata" eks,resi NFKB melal.i

,e"i"*kata" ,ro+.ksi a"io" s.,eroksi+a

e Pe".r."a" e"+otheli.m +e,e"+e"t >aso+ilatatio"

3 Pe"i"*kata" a+hesi +ari mo"osit -ila +isertai +e"*a" +ia-etes mellit.s

$ Hi,ertri*liseri+emia

5asih mer.,aka" ,er+e-ata" a"tara ,ara ahli4 a,akah ko"se"trasi

tri*liseri+a ,lasma /a"* me"i"*kat a+alah 3aktor resiko ter1a+i"/a ,e"/akit

kar+io>ask.ler'<

6 ia-etes melit.s

Pa+a +ia-etes mellit.s ter1a+i ,e"i"*kata" akti>itas e"im al+osa

re+.ktase /a"* +i,erl.ka" ."t.k me"*.-ah *l.kosa /a"* ti"**i me"1a+i

sor-itol Pe"i"*kata" akti>itas al+osa re+.ktase me"/e-a-ka" ,e"i"*kata"

ko">ersi NAPH /a"* tere+.ksi me"1a+i -e"t.k teroksi+asi NAP

Pemakaia" NAPH aka" -eraki-at ,e".r."a" ,ro+.ksi NO +a" a"ti oksi+a"

Pe".r."a" a"ti oksi+a" aka" me"/e-a-ka" ra+ikal -e-as /a"* har.s"/a

+i+etoksi3ikasi oleh a"tioksi+a" -eri"teraksi +e"*a" NO me"1a+i ,eroksi"itrit

(NOO) /a"* +a,at mer.sak ,em-.l.h +arah Keti+akseim-a"*a" i"ilah /a"*

+ise-.t stres oksi+ati3 Ka+ar *l.kosa /a"* ti"**i 1.*a me"/e-a-ka"

ter1a+i"/a reaksi *likosilasi +e"*a" ,rotei" +a" molek.l lai" /a"*

me"*a"+."* *.*.s ami" sehi"**a me"*hasilka" a+>a"#e *l/#o#/latio" e"+

,ro+.#t (AGE) AGE aka" -erikata" +e"*a" rese,tor ,a+a e"+otel makro3a*

Ikata" +e"*a" e"+otel aka" me"i"*katka" eks,resi ICA54 >as#.lar a+hesio"

mole#.le '4 +a" E2selekti" /a"* mem.+ahka" ter1a+i a+hesi mo"osit 5o"osit

/a"* me"em,el terse-.t aka" -ermi*rasi ke s.-e"+otel +a" -erikata" +e"*a"

LL teroksi+asi4 sehi"**a mem-e"t.k 3oam #ell /a"* aka" -erkem-a"*

me"1a+i 3att/ streak'&4$%4$'4$$




Lo0 e"sit/ Li,o,rotei" (LL) teroksi+asi aka" me"*akti>asi sel

lim3osit T /a"* -eraki-at me".r.""/a +e"sitas +a" 3."*si otot ,olos4

sehi"**a si"tesa matriks me".r." :.*a aka" me"*akti>asi makro3a* ."t.k

me"*el.arka" e"im ,roteolitik se,erti matriks metallo,rotei"ase4 sehi"**a

me"/e-a-ka" ,e"i"*kata" +e*ra+asi matriks Pe"i"*kata" +e*ra+asi matriks

+a" ,e".r."a" si"tesis matriks terse-.t aka" mem.+ahka" r.,t.r ,lak$6

7 Hi,erte"si

Bila teka"a" +arah le-ih +ari '7%?&% mmH* Ber,e"*ar.h -.r.k ,a+a

,ria +a" 0a"ita +e"*a" kom,o"e" +iastol se-a*ai 3aktor ter,e"ti"* Pe"*ar.h

hi,erte"si ,a+a ,erkem-a"*a" aterosklerosis masih -el.m 1elas4 m."*ki" saatter1a+i ker.saka" ,a+a e"+otel mem."*ki"ka" mas.k"/a ,rotei"4 li,o,rotei"4

+a" sel lai" ke la,isa" i"tima Hi,erte"si me"am-ah teka"a" hi+ro+i"amik

i"tra arteri sehi"**a s.at. saat +a,at ter1a+i ro-eka" ,a+a ,la.e

aterosklerosis4 lal. -eraki-at trom-osis ak.t +a" o-str.ksi arteri'<

Pa+a kea+aa" hi,erte"si ter+a,at +is3."*si e"+otel aki-at D';4$74$84$94$;

a Pe"i"*kata" ka+ar a"io" s.,eroksi+a (O$2) /a"* aka" me"/e-a-ka" stress

oksi+ati3 +a" +a,at mer.sak NO

- Pe".r."a" -ioa>aila-ilitas ,rek.rsor si"tetis NO (L ar*i"i")

# Pe"i"*kata" a"*iote"si II me"/e-a-ka" ,e"i"*kata" ka+ar O$2 melal.i

,e"i"*kata" NAH?NAPH mem-ra" serta me"/e-a-ka" ,ert.m-.ha"

sel otot ,olos >ask.ler +e"*a" me"*i"+.ksi *ro0th 3a#tor se,erti PGF4

-FGF4 +a" TGT B'

+ Pe"i"*kata" e"+otheli"2' aki-at ,e"i"*kata" AII

8 Pe"/akit :a"t."* Koro"er

Pa+a m.la"/a +ise-a-ka" oleh ,e".m,.ka" lemak ,a+a +i"+i"* +alam

,em-.l.h +arah 1a"t."* (,em-.l.h koro"er)4 +a" hal i"i lama kelamaa"

+iik.ti oleh -er-a*ai ,roses se,erti ,e"im-."a" 1ari"ra"*a" ikat4 ,erka,.ra"4




,em-ek.a" +arah4 +ll4/a"* kesem.a"/a aka" mem,ersem,it ata. me"/.m-at

,em-.l.h +arah terse-.t Hal i"i aka" me"*aki-atka" otot 1a"t."* +i +aerah

terse-.t me"*alami kek.ra"*a" alira" +arah +a" +a,at me"im-.lka" -er-a*ai

aki-at /a"* #.k., seri.s4 +ari A"*i"a Pe#toris ("/eri +a+a) sam,ai I"3ark

:a"t."*4 /a"* +alam mas/arakat +i ke"al +e"*a" sera"*a" 1a"t."* /a"*

+a,at me"/e-a-ka" kematia" me"+a+ak

9 Hi,erhomosistei"emia

Pasie" ,e"/akit i"i -eresiko me"+a,at ,e"/akit okl.si >ask.ler

5eka"isme D mer.sak sel e"+otel +a" otot ,olos sehi"**a me"."1a"*

aterosklerosis Kelai"a" i"i :.*a mem-a"t. kelai"a" koa*.lasi ,latelet'<

; O-esitas

Pe"elitia" i##ar+ia P$% mem-.ktika" -ah0a 0a"ita +e"*a" o-esitas

+item.ka" a+a"/a +is3."*si e"+otel /a"* +ih.-."*ka" +e"*a" ,e"i"*kata"

lemak t.-.h4 kh.s.s"/a lemak >iseral Pa+a kea+aa" o-esitas ter1a+i

,e"i"*kata" me+iator ,roi"3lamasi4 se,erti TNF24 IL294 /a"* +a,at

me"i"*katka" eks,resi kemotaksis +a" molek.l a+hesi ,a+a e"+otel i

sam,i"* it. 1.*a +item.ka" ,e"i"*kata" >ask.lar a+hesio" mole#.le2'

(CA52')4 ICA52' +a" P2selekti" Pe"i"*kata" me+iator terse-.t

meme*a"* ,era" ,e"ti"* +alam ter1a+i"/a aterosklerosis Pe".r."a" -erat

-a+a" me"."1.kka" a+a"/a ,er-aika" e"+otel /a"* -ermak"a +a" -erkolerasi

+e"*a" ,e".r."a" sitoki" Peta"+a i"3lamasi +alam +arah se,erti CRP +a,at

+i,akai ."t.k me"+.*a kea+aa" kesehata"4 ter.tama ke1a+ia" /a"*

-erh.-."*a" +e"*a" ,e"/akit kar+io>ask.ler'<

Bel.m mer.,aka" 3aktor resiko /a"* s,esi3ik4 teta,i -iasa"/a o-esitas

+isertai oleh hi,erte"si4 54 hi,erkolesterolemi4 +a" hi,ertri*liseri+emi

5e"i"*kat"/a -erat -a+a" -erh.-."*a" +e"*a" me"i"*kat"/a LL +a"

me".r.""/a HL kolesterol4 sehi"**a ke"aika" -erat -a+a" seri"* +ikaitka"

+e"*a" m."#.l"/a 3aktor resiko'<

< 5erokok

Biokimia “atherosklerosis ! "e#el $%%& ';



5er.,aka" 3aktor resiko ."t.k ter1a+i"/a aterosklerosis +a" ,e"/akit

1a"t."* koro"er 5eka"isme ter1a+i"/a +is3."*si e"+otel ,a+a ,erokok

melal.i meka"isme ,e"i"*kata" i"teraksi trom-osit +e"*a" +i"+i"* ,em-.l.h

+arah4 ,e".r."a" eks,resi PGI$4 ,e"i"*kata" ka+ar kolesterol LL

teroksi+asi4 ,e".r."a" ko"se"trasi HL4 +a" ter1a+i"/a stres oksi+ati3 Selai"

it. merokok 1.*a me"/e-a-ka" ,e"i"*kata" a+hesi +a" a*re*asi trom-osit4

me"i"*katka" ka+ar 3i-ro*e"4 s,asme arteri4 +a" me".r."ka" ka,asitas

oksi*e" +arah$<

Ba"/ak merokok maka ker.saka" -ertam-ah -esar Kematia" kare"a

,e"/akit kar+io>ask.lar ,a+a ,erokok -erat ;% J le-ih ti"**i +ari,a+a "o"2

,erokok 5erokok -erh.-."*a" +e"*a" ,e"/akit sere-ro>ask.lar +a" i"si+e"s

le-ih ti"**i ,a+a ,e"/akit >ask.lar ,eri3er Bila merokok +ihe"tika" ,a+a

.m.r 98 tah."4 maka resiko aka" me".r." +rastis Faktor resiko ,erokok

,asi3 a+alah +.a kali li,at ,a+a istri +e"*a" s.ami ,erokok +ari,a+a istri

+e"*a" s.ami "o"2,erokok 5eka"isme ter1a+i kelai"a" kar+io>ask.lar ,a+a

,erokok aki-at >asoko"striksi4 a*re*asi ,latelet me"i"*kat4 +a" hi,oksemi

>ask.lar /a"* ti+ak ,erma"e"'<

& Kelak.a" +a" ke,ri-a+ia"

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ter1a+i"/a +is3."*si e"+otel4 "am." -el.m +i-.ktika" a"* se+a"* +ika1i

-a*aima"a reaksi ,asie" terha+a, stress4 -ah0a +e"*a" marah -erle-iha" aka"

me"i"*katka" teka"a" +arah +a" +e"/.t 1a"t."*'<

'% Akti3itas :asma"i

Akti3itas 1asma"i /a"* terat.r mem-eri ,ote"si ."t.k me"*.ra"*i

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me".r.""/a teka"a" +arah Ti+ak melak.ka" akti3itas 1asma"i a+alah 3aktor

resiko aterosklerosis4 "am." olahra*a -erle-iha" ti+ak ."t.k me"*atasi

,e"/akit i"i'<

'' Homosistei".ria

Biokimia “atherosklerosis ! "e#el $%%& '<



A+alah ,e"/akit /a"* 1ara"* +a" +it.r."ka" se#ara a.tosom resesi34

serta me"/e-a-ka" ,e".r."a" akti>itas e"im #/stathio"i"e B si"tetase

,e"i"*kata" ka+ar homosistei" ,e"+erita i"i mem,."/ai resiko aterosklerosis

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a.tooksi+asi homosistei"$<

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stress /a"* mele-ihi '8 +/"e?#m$ me"/e-a-ka" ,e".r."a" eks,resi

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3i-ri"olitik4 3aktor a"titrom-osit4 a"tioksi+a" Se+a"*ka" shear stress /a"*

re"+ah (%27 +/"e?#m$ ) +a,at me"i"*katka" eks,resi molek.l a+hesi4

>asoko"striktor4 ,rokoa*.la"4 ,rotrom-otik4 ,rooksi+a"4 s.-sta"si ,roli3erati3

/a"* aka" me"/e-a-ka" aterosklerosis$&

'6Pe".aa"

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oksi+ati3$$

'7Per.-aha" hormo"al

I"si+e" P:K me"i"*kat ,a+a 0a"ita setelah mele0ati +eka+e ke294

se+a"*ka" se-el.m +eka+e terse-.t i"si+e"s"/a se,ar.h ,a+a ,ria Be-era,a

,e"elitia" mem-.ktika" -ah0a hormo" estro*e" -ersi3at kar+io,rotekti3

terha+a, 0a"ita Pe"elitia" lai" me"."1.kka" -ah0a tera,i estro*e" +a,at

me"i"*katka" eks,resi NO +a" PGI$ ,a+a 0a"ita ,as#a me"o,a.se S.+ah

ter-.kti -ah0a estro*e" mem,."/ai si3at a"tioksi+a" Pa+a 0a"ita

,as#ame"o,a.se ter1a+i ,e".r."a" kolesterol HL4 ,e"i"*kata" kolesterol

LL4 ,e"i"*kata" 3i-ri"o*e" M ,e".r."a" a"titrom-i"$<

'8 I"3eksi

Biokimia “atherosklerosis ! "e#el $%%& '&





I"3eksi -er,era" ,a+a ,ato*e"esis aterosklerosis +a" i"3ark miokar+

I"3eksi /a"* ter1a+i ,a+a ,ato*e"esis P:K /ait. i"3eksi kro"ik her,es sim,le

>ir.s (HS2I)4 #hlam/+ia ,"e.mo"iae (C,") Hal it. +a,at +ilihat +e"*a"

a+a"/a ,e"i"*kata" C2rea#ti>e ,rotei" (CRP)6%4;

$9 S#ree"i"* +a" ia*"osis

okter a"+a m."*ki" me"em.ka" ta"+a2ta"+a +ari ,e"/em,ita"4

,erl.asa" ata. ,e"*erasa" arteri selama ,emeriksaaa" 3isik Termas.k +i

+alam"/aD'

Kelemaha" ata. keti+aka+aa"/a +e"/.t +i -a0ah +aerah ,e"/em,ita"

arteri

S.ara -isi"* +i sel.r.h arteri /a"* +a,at ter+e"*ar +e"*a"

me"**."aka" stetosko,

B.kti -ah0a l.ka ke#il me"1a+i sem-.h kem-ali +alam -a*ia" +ima"a

alira" +arah a"+a +i-atasi

Pe".r."a" teka"a" +arah ,a+a salah sat. etrimitas /a"* terke"a

,e"*ar.h

Ta"+a2ta"+a +ari a"e.r/sma +alam a-+ome" ata. +i -elaka"* l.t.t

a"+a

okter a"+a m."*ki" me"/ara"ka" sat. ata. le-ih +ari test2test -erik.t

."t.k me"*i+e"ti3ikasi ,e"/akit terse-.t ata. *e1ala2*e1ala"/a'

Test +arah S.at. test +arah +a,at me"*etah.i ,e"i"*kata" le>el

kolesterol4 homo#/stei"e ata. *.la +arah (*l.kosa)4 /a"* 1.*a mer.,aka"

3aktor resiko ."t.k ,e"/akit i"i

A"kle2Bra#hial I"+e (ABI) e"*a" me"**."aka" ma"set ."t.k

me"*.k.r teka" +arah +a" alat .ltraso."+ kh.s.s /a"* +i*."aka" ."t.

me"et.ka" "ilai +a" alira" +arah (o,,ler Ultraso."+) okter +a,at

me"*.k.r teka"a" +arah ,asie" ,a+a le"*a" +a" kaki ,asie"

Biokimia “atherosklerosis ! "e#el $%%& $%



me"."1.kka" ,e"/akit arteri ,eri3er4 /a"* ma"a -iasa"/a +ise-a-ka"

aterosklerosis'

Ele#tro#ar+io*ram (ECG)

Elektrokar+io*ram mer.,aka" alat .1i +ia*"osa /a"* ter+iri atas eleme"t2

eleme"t elektro+a /a"* +i tem,elka" +i k.lit ,asie" ."t.k me"*.k.r ha"tara"

elektrik (listrik) ata. im,.ls +ari 1a"t."* ECG 1.*a +a,at me"+eteksi

sera"*a" 1a"t."* le-ih +i"i ,a+a -e-era,a ,asie" Biasa"/a +okteraka"

melak.ka" ,emeriksaa" ECG se,a"1a"* +a" setelah trea+mill'

Gam-ar

Chest 2ra/s4 .ltraso."+4 #om,.terie+ tomo*ra,h/ (CT) s#a"a +a"

ma*"eti# reso"a"#e ima*i"* (5RI) mer.,aka" #ara /a"* ti+ak i">asi3 ."t.k

+okter memeriksa arteri ,asie"4 a,akah +i arteri ter+a,at s.m-ata" +a" -era,a

-a"/ak s.m-ata" /a"* me".t., arteri Sem.a test i"i ka+a"*2ka+a"* +a,at

me"."1.kka" ,e"*erasa" +a" ,e"/em,ita" serta arteri .tama /a"* le-ih

-esar4 sama -aik"/a se,erti ,a+a a"e.risma +a" sim,a"a" kalsi.m ,a+a

+i"+i"* arteri'

o,,ler Ultraso."+

Alat i"i +i*."aka" ."t.k me"*amati sel.r.h arteri +i +alam t.-.h +a"

me"e"t.ka" teka"a" +arah ,a+a a"*ka /a"* -er>ariasi ,a+a le"*a" +a" kaki

Pemeriksaa" i"i +a,at me"olo"* ."t.k me"e"t.ka" 1.mlah s.m-ata" +a"

ke#e,ata" alira" +arah ,a+a arteri'

5UGA ? ra+io".#li+e a"*io*ra,/

N.#lear s#a" ."t.k melihat -a*aima"a +i"+i"* 1a"t."* -er*erak +a"

-era,a -a"/ak +arah /a"* +i ,aksa kel.ar setia, ket.ka" 1a"t."*

(heart-eat)4 ketika ,asie" +alam kea+aa" istirahat 8

Thalli.m ? m/o#ar+ial ,er3.sio"s#a"

Pe"*amata" ".#lear /a"* +i-erika" ketika ,asie" +alam kea+aa" istirahat

ata. setelah latiha" /a"* +a,at me"*."*ka, +aerah +ari otot 1a"t."* /a"*

ti+ak #.k., me"+a,atka" s.,lai +arah8

Biokimia “atherosklerosis ! "e#el $%%& $'

$; Treatme"t ata. Perlak.a"

Pe"*o-ata" /a"* s,esi3ik +ite"t.ka" -er+asarka" 3isik a"+a D8

Usia4 kesehata" se#ara me"/el.r.h +a" ri0a/at kesehata"

Perl.asa" +ari ,e"/akit terse-.t

aerah /a"* me"*alami s.m-ata"

Ta"+a2ta"+a +a" *e1ala2*e1ala /a"* +ialami ,asie"

Ri0a/at kesehataha" +a" ,e"*o-ata"a" seseora"* terkait +e"*a"

se"si>itas"/a terha+a, tera,iM,rose+.r ,e"*o-ata" /a"* ,er"ah

+ialami

Arah /a"* +i hara,ka" ."t.k ,e"/akit i"i ke +e,a""/a

Pe"+a,at a"+a ata. ,iliha"

Pe"#e*aha" +a" ,e"*o-ata" +ari ,e"*e"+alia" atherosklerosis +ari 3aktor

resiko /a"* telah +iketah.i ."t.k ,e"/akit terse-.ti+alam"/a termas.k

,e"*o-ata" ."t.k hi,erte"si4 h/,erli,i+emia4 54 +a" ke-iasaa" merokok 8

Per.-aha" *a/a hi+., +a,at me"i"*katka" ker1a ,em-.l.h arteri okter

memiliki -e-era,a ti,e ,e"*o-ata" ."t.k mem,erlam-at ata. me"*atasi ,e"*ar.h

arteriosklerosis +a" atherosklerosis'

o O-at Pe".r."2kolesterol Se#ara a*resi>e +a,at me".r."ka" se1.mlah

lo02+e"sit/ li,o,rotei" (LL) kolestrol “1ahat /a"* +a,at

mem,erlam-at alira" +arah4 -erhe"ti ata. -ahka" se-alik"/a mem-e"t.k

,lak O-at i"i me"*a"+."* stati" +a" 3i-rate +a" +i-erika" +e"*a" +osis

terte"t.

o Pe"*o-ata" a"ti2,latelet As,iri" mer.,aka" salah sat. #o"toh +ari ti,e

o-at i"i +i*."aka" ."t.k me"*.ra"*i kem."*ki"a" ,e"**.m,ala"

ke,i"*a" +arah ,a+a atherosklerosis4 ter-e"t.k"/a -ek.a" +arah4 +a"

ter1a+i"/a s.m-ata" ,a+a ,em-.l.h +arah

o A"tikoa*.la" Se,erti He,ari" ata. =ar3ari" ( Koma+i" ) i*."aka"

."t.k me"*e"#erka" +arah +a" me"#e*ah ,em-ek.a" ."t.k ,em-e"t.ka"

arteri +a" alira" +arah /a"* me"*alami s.m-ata"

Biokimia “atherosklerosis ! "e#el $%%& $$



o aso+ilatasi Otot ,em-.l.h +arah aso+ilator se,erti Prosta*la"+i"4

+a,at me"#e*ah ,e"e-ala" otot ,a+a +i"+i"* arteri +a" me"*he"tika"

,e"/em,ita" arteri Ta,i e3ek +ari o-at i"i k.at +a" -iasa"/a ha"/a

+i*."aka" ketika o-at lai" ti+ak -eker1a

o Pe"*o-ata" lai""/a a,at +isara"ka" -e-era,a ,e"*o-ata" ."t.k

me"*o"trol 3aktor resiko4 se,erti +ia-etes4 teka"a" +arah ti"**i +a" le>el

homo#/stei"e /a"* ti"**i a,at 1.*a +isara"ka" o-at s,esi3ik ."t.k *e1ala

terte"t.4 se,erti #la.+i#asi /a"* i"termitte"t

:ika ter+a,at *e1ala /a"* ak.t4 s.m-ata" ak.t /a"* me"*a"#am kemam,.a" otot

+a" 1ari"*a" k.lit ."t.k -erko"traksi ata. salah sat. or*a" s.+ah ti+ak +a,at-er3."*si sem,.r"a4 m."*ki" +a,at +ilak.ka" ,e"*o-ata" sela"1.t"/a'

A"*io,last/ Pro#e+.r ,a+a ,e"*o-ata" i"i /ait. +e"*a" #ara memas.kka"

,i,a ( #atheter ) /a"* ,a"1a"* +a" ti,is ke +alam arteri /a"* ters.m-at ata.

terham-at Kem.+ia" ka0at +e"*a" -alo" /a"* kem,is +imas.kka" melal.i

#atheter ke area /a"* terham-at ta+i Balo" it. aka" me"*em-a"*4 me"eka"

,la.e ."t.k mela0a" +i"+i"* arteri L.-a"* ,i,a ( ste"t ) me"/a"**ah

arteri ."t.k mem-a"t. arteri teta, ter-.ka

Em-ole#tom/ Catheter +a,at 1.*a +i *."aka" ."t.k me"a"*ka, *.m,ala"

+arah Cara i"i +ise-.t Em-ole#tom/

E"+artere#tom/ Pa+a -e-era,a kas.s m."*ki" +i -.t.hka" o,erasi

,emi"+aha" ,lak +ari +i"+i"* arteri /a"* terham-at Pro#e+.r ,a+a

,e"*o-ata" i"i ahli -e+ah mem-.at i"#isi 4 kem.+ia" memi"+ahka" ,lak

+a" me".t., arteri

Pem-e+aha" ,em-.l.h +arah e"*a" #ara -/,ass +e"*a"

me"#a"*kokka" #a-a"* salah sat. ,em-.l.h +arah +ari -a*ia" t.-.h /a"*

lai" ata. ,i,a /a"* ter-.at +ari serat si"tetikCara i"i aka" me"*alirka"

+arah ke arteri /a"* ters.m-at ata. terham-at Proses i"i sa"*at seri"* +i

*."aka" ."t.k me"i"*katka" alira" +arah ke kaki4 ta,i #ara terse-.t 1.*a

+a,at +i*."aka" ."t.k me"*ham-at ,erl.asa" ata. ke-o#ora" ,a+a aorti#

a"e.r/sm

Biokimia “atherosklerosis ! "e#el $%%& $6





Throm-ol/ti# :ika arteri ters.m-at oleh a+a"/a *.m,ala" +arah4 -iasa"/a

+i-eri o-at ."t.k melar.tka" *.m,ala" ke +alam arteri sam,ai *.m,ala" it.

kem-ali "ormal

Pe"**."aa" A"*io*ra,h/ e"*a" #ara memas.kka" #atheter ke#il ke

+alam arteri +a" +i #el.,4 +a" kem.+ia" s.m-ata" terse-.t +i tolo"* +e"*a"

si"ar

$< Pe"#e*aha"

5e"*o"trol 3aktor resiko melal.i ,e"*.-aha" ,ola hi+., +a,at me"#e*ah

ata. mem,erlam-at kema1.a" +ari ,e"/akit i"i +ia"tara"/aD'

Ba"/aklah -er*erak Olah ra*a /a"* te,at +a,at me"*ko"+isika" otot

a"+a ."t.k me"**."aka" oksi*e" se#ara e3isie" Akti>itas 3isik 1.*a

+a,at me"i"*katka" sirk.lasi +a" ,erkem-a"*a" +ari ,em-.l.h +arah

kolateral ,em-.l.h +arah /a"* -ar. ter-e"t.k se#ara alami ("at.ral

-/,ass) +ia"tara o-str.ksi4 ."t.k s.,lai +arah a*ar +a,at me"#a,ai

+aerah2+aerah ,eri3er se,erti le"*a" +a" kaki

Berhe"ti 5erokok 5erokok mem-erika" ko"tri-.si +a" ker.saka" +ari

arteri Berhe"ti merokok a+alah hal /a"* ,ali"* ter,e"ti"* /a"* +a,at

me"*.ra"*i kema1.a" +ari s.m-ata" +a" me"*.ra"*i resiko terha+a,

kom,likasi

As.,a" maka"a" sehat ."t.k mem,ertaha"ka" -erat i+eal iet sehat

."t.k 1a"t."* +a,at me"olo"* me"*o"trol -erat -a+a"4 teka"a" +arah

+a" ti"*kat kolesterol4 /a"* ma"a kesem.a"/a mem-erika" ko"tri-.si

ter1a+i"/a atherosklerosis

5e"*.ra"*i stres +alam kehi+.,a" ata. -ela1ar -a*aima"a

me"*e"+alika""/a 5e"*.ra"*i ,e"/e-a- sters +i r.mah +a" +i tem,at

ker1a4 1ika m."*ki" Ata. -ela1ar teh"ik ."t.k me"*at.r stres4 se,erti

relaksasi otot +a" -er"a,as +alam




5e"1a*a ka+ar kolesterol4 teka"a" +arah +a" +ia-etes +i-a0ah ko"trol

Ko"s.ltasi +e"*a" +okter 1ika memerl.ka" -a"t.a" ."t.k me"1a*a ka+ar

kolesterol4 teka"a" +arah ata. +ia-etes ,a+a saat #he#k ., okter aka"

me".liska" rese, o-at -ar. ata. mem-erika" sara" treatme"t ."t.k

me"*atasi *e1ala +ari ,e"/akit terse-.t

Pera0ata" kaki 1.*a sa"*at ese"sial ."t.k mereka /a"* me"*alami

atherosklerosis ,a+a -a*ia" ,eri3er se,erti ,a+a kaki ata. ta"*a" G."aka" se,at.

+e"*a" .k.ra" /a"* te,at L.ka ata. *oresa" mem-.t.hka" ,erhatia" se*era

kare"a ,e".r."a" sirk.lasi /a"* -erarti -ah0a 1ari"*a" +isem-.hka" se#ara le-ih

,erlaha" :ika ti+ak me"+a,atka" ,erlak.a" ,e"*o-ata"4 -ahka" ,a+a l.ka ke#il

+i k.lit -a*ia" -a0ah +ari kaki +a,at memi#. i"3eksi'


BAB III

PENUTUP

6' Kesim,.la"

' Atherosklerosis a+alah s.at. ,e"/akit /a"* me"/era"* ,em-.l.h +arah

-esar ma.,." ke#il +a" +ita"+ai oleh kelai"a" 3."*si e"+otelial4 ra+a"*

>ask.ler4 +a" ,em-e"t.ka" li,i+4 kolesterol4 at ka,.r4 -ekas l.ka >ask.ler +i

+alam +i"+i"* ,em-.l.h i"tima

$ Pem-e"t.kka" ,la.e se#ara ,erlaha" +i +alam +i"+i"* ,em-.l.h arteri

me"/e-a-ka" ,e"/em,ita" +a" ,e"m*erasa" Pla.e ter-e"t.k +ari lemak4

kolesterol4 kalsi.m4 +a" s.-sta"si lai" /a"* +item.ka" +i +arah

6 Atheros#lerosis mer.,aka" ,e"/akit /a"* ,ro*resi3 +a" +a,at m.lai se1ak .sia

a"ak2a"ak Para ilm.a" ti+ak me"*etah.i se#ara ,asti ,e"/e-a- se#ara ,asti

+ari atheros#lerosis Atherosklerosis +a,at me"/era"* otak4 1a"t."*4 *i"1al4

le"*a" +a" kaki

7 Faktor resiko +a,at me"i"*katka" ,erkem-a"*a" atheros#lerosis Risk 3a#tors

i"#rease /o.r #ha"#e o3 +e>elo,i"* atheros#lerosis o.r #ha"#e o3 ha>i"*

atheros#lerosis i"#reases 0ith the ".m-er o3 risk 3a#tors /o. ha>e o. #a"

#o"trol some risk 3a#tors a"+ others /o. #a"Qt

8 Atheros#lerosis .s.all/ +oes "ot #a.se s/m,toms ."til it se>erel/ "arro0s or

totall/ -lo#ks a" arter/

9 Atheros#lerosis is o3te" +ia*"ose+ a3ter /o. +e>elo, s/m,toms or

#om,li#atio"s

; The *oal o3 treatme"t is to slo0 or e>e" re>erse atheros#lerosis

< o.r +o#tor 0ill re#omme"+ 0hi#h treatme"t is -est 3or /o. a3ter re>ie0i"*

/o.r s/m,toms4 /o.r risk 3a#tors4 a"+ the res.lts o3 /o.r ,h/si#al eam

& Treatme"t #a" i"#l.+e maki"* lo"*2lasti"* li3est/le #ha"*es4 taki"*

me+i#i"es4 a"+ ha>i"* s.r*er/

'% Pre>e"ti"* atheros#lerosis starts -/ k"o0i"* 0hi#h risk 3a#tors /o. ha>e a"+

-/ taki"* a#tio" to lo0er /o.r risk






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13800383 Atherosclerosis