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8/13/2019 Book Reading Homocystein
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Book Reading
Dr.Braghmandaru Adhi Bhaskara
Hubungan hiperhomocysteinemiadenganpenyakit kardiovaskular dan
sindroma metabolik
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Homocystein
Homocystein adalah asam amino yang secaraalami 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 menjadicystathionin dengan bantuan vit.B12 sebagai
kofaktor
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Metabolisme homocystein
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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 tersebutbersifat causal
homocystein dapat meningkat hingga 30% padapasien dengan aterosklerosis
Peningkatan diatas 12% berhubungan denganpeningkatan risiko AMI hingga 3x lipat
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Faktor Risiko
Peran homocystein dalam penyakitkardiovaskular masih belum jelas dipahami
Kadar homosistein yang tinggi diperkirakan dapatmenyebabkan kerusakan endotel pada dinding
vaskular
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Hyperhomocysteinemia
Belum ada kesepakatan mengenai nilai normalkadar homosistein
Beberapa penelitian menggunakan nilai diatas15umol/L sebagai hiperhomosisteinemia
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Sindroma metabolik sindroma metabolik memiliki ciri khas obesitas
sentral, resistensi insulin, hiperlipidemia, danhipertensi.
Sindroma metabolikterjadi karena obesitas,kurangnya aktivitas fisik dan faktor genetik
Resistensi insulin merupakan penyebab utama
sindroma metabolik
sindroma metabolik meningkatkan risiko terkenaDM tipe 2 dan penyakit kardiovaskular
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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
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Food sources of MethionineFood g/100g
Egg, white, dried, powder, glucose
reduced3.204
Sesame seedsflour (low fat) 1.656
Egg, whole, dried 1.477
Cheese, Parmesan, shredded 1.114
Brazil nuts 1.008
Soy protein concentrate 0.814Chicken, broilers or fryers, roasted 0.801
Fish, tuna, light, canned in water, drained
solids0.755
Beef, cured, dried 0.749
Bacon 0.593
Beef, ground, 95% lean meat / 5% fat,
raw0.565
Pork, ground, 96% lean / 4% fat, raw 0.564
Wheat germ 0.456
Oat 0.312
http://en.wikipedia.org/wiki/Egg_(food)http://en.wikipedia.org/wiki/Sesame_seedhttp://en.wikipedia.org/wiki/Egg_(food)http://en.wikipedia.org/wiki/Cheesehttp://en.wikipedia.org/wiki/Brazil_nuthttp://en.wikipedia.org/wiki/Soy_proteinhttp://en.wikipedia.org/wiki/Chicken_(food)http://en.wikipedia.org/wiki/Fish_(food)http://en.wikipedia.org/wiki/Beefhttp://en.wikipedia.org/wiki/Baconhttp://en.wikipedia.org/wiki/Beefhttp://en.wikipedia.org/wiki/Porkhttp://en.wikipedia.org/wiki/Wheat_germhttp://en.wikipedia.org/wiki/Oathttp://en.wikipedia.org/wiki/Oathttp://en.wikipedia.org/wiki/Wheat_germhttp://en.wikipedia.org/wiki/Porkhttp://en.wikipedia.org/wiki/Beefhttp://en.wikipedia.org/wiki/Baconhttp://en.wikipedia.org/wiki/Beefhttp://en.wikipedia.org/wiki/Fish_(food)http://en.wikipedia.org/wiki/Chicken_(food)http://en.wikipedia.org/wiki/Soy_proteinhttp://en.wikipedia.org/wiki/Brazil_nuthttp://en.wikipedia.org/wiki/Cheesehttp://en.wikipedia.org/wiki/Egg_(food)http://en.wikipedia.org/wiki/Sesame_seedhttp://en.wikipedia.org/wiki/Egg_(food)8/13/2019 Book Reading Homocystein
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Penanganan metabolic sindrom
Dengan mengubah penyebab dasar yaituobesitas, kurangnya aktivitas fisk, dan resistensi
insulin
Penurunan berat badan dan peningkatan aktivitas
fisik akan menurunkan resistensi insulin
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Metode lain adalah dengan mengobati faktir risikosindroma metabolik yaitu atherogenic
dyslipidemia, hipertensi, keadaan protrombotic,
dan resistensi insulin.
H t i d di l
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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) wouldreduce 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
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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;93:216220
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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
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in men with other CVD risk factors: the Kuopio
Ischaemic Heart Disease Risk Factor (KIHD)
Study
High serum tHcy may increase the risk of CVDmortality 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 deathsis 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 concentrationsshould also be considered in addition to
treatments for the other risk factors in the high-
risk populationsJ . K. VIRTANEN, Journal of Internal
Medicine 2005; 257: 255262
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with BMI and Insulin Resistance, amongst
Obese, Overweight and Non Obese Infertile
Women
amongst all the infertile women homocysteinelevels 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. Butno association was found between homocysteine
levels with age of subjects, S. TSH, and S.LH and
FSH.
Hence, we can conclude that a positivecorrelation was observed between increasing
homocysteine levels with BMI, insulin resistance,
testosterone levels and S. LH/FSH ratio.Sachan Rekha*, Patel ML ,International Journal
of Scientific and Research Publications, Volume2, Issue 5, May 2012
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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 fullyexplain cardiovascular risk. Therefore, there has
been a focus on newly identified risk factors such
as increased plasma homocysteine (Hcy),
Creactive protein (CRP), B-type natriureticpeptide level, and metabolic syndrome (MetS)
(3, 4).J Korean Med Sci. 2012
May;27(5):500-5.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3342540/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3342540/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3342540/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3342540/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3342540/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3342540/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3342540/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3342540/