PENGARUH PROGRAM PERUBAHAN GAYA HIDUP ’IDE KONSULEN’ TERHADAP FAKTOR RISIKO DAN RISIKO KARDIOVASKULAR MAYOR PADA KELOMPOK PENDERITA DAN BUKAN PENDERITA PENYAKIT JANTUNG KORONER

Iqbal Mochtar, Prof. Dr. Sri Suparyati, SpA (K)., PhD.

2013 | Disertasi | S3 Kedokteran Umum

Penyakit kardiovaskular, khususnya PJK, merupakan penyakit yang memiliki tingkat morbiditas dan mortalitas yang tinggi, termasuk di Indonesia. Pada tahun 2001, proporsi kematian kardiovaskular di Indonesia berkisar 26,3% dan merupakan peringkat pertama penyebab kematian. Setiap individu memiliki kemungkinan mengalami PJK dan komplikasinya (major adverse cardiovascular events atau MACE), seperti angina tidak stabil, infark miokard dan kematian. Untuk mencegah timbul dan memberatnya PJK dan MACE dapat dilakukan penatalaksanaan-penatalaksanaan non-farmakologis (perubahan gaya hidup), farmakologis dan tindakan lain. Tujuan penelitian ini adalah mempelajari pengaruh program perubahan gaya hidup gabungan IDE KONSULEN (yaitu gabungan presentasi video, konseling, pembagian materi cetak/brosur dan follow-up lewat telepon selama 9 bulan) terhadap faktor risiko kardiovaskular dan risiko kardiovaskular mayor pada kelompok penderita dan bukan penderita PJK. Penelitian ini menggunakan metode acak terkontrol bersifat terbuka dengan rancangan pre- dan post-test control group design. Subjek penderita PJK diambil dari populasi penderita PJK yang berobat ke RSJ Harapan Kita, Jakarta, periode September- Oktober 2011. Subjek bukan penderita PJK diambil dari populasi bukan penderita PJK yang bertempat tinggal disekitar RSJ Harapan Kita, Jakarta. Pada awal penelitian telah direkrut sebanyak 200 subjek penderita PJK dan 200 subjek bukan penderita PJK. Dengan menggunakan metode random sederhana dengan nomor komputer, subjek penderita PJK dan bukan PJK masing-masing dialokasikan kedalam kelompok intervensi dan non-intervensi. Subjek yang berada pada kelompok intervensi diberi program perubahan gaya hidup yang terdiri atas presentasi video, konseling individual dengan dokter umum, pembagian materi cetak dan follow-up lewat telepon sebanyak 2 kali dalam periode 9 bulan. Subjek pada kelompok non-intervensi tidak diberi program perubahan gaya hidup. Luaran primer yang diukur adalah risiko kejadian kardiovaskular mayor, yang diestimasi dengan skor Framingham Heart Study atau FHS (bagi bukan penderita PJK) dan skor ACTION (bagi penderita PJK). Selain itu, diukur pula luaran sekunder berupa nilai rerata/median faktor-faktor risiko (tekanan darah, kolesterol, kadar gula, IMT) dari subjek penelitian sebelum dan sesudah program. Hasil penelitian menunjukkan bahwa pada kelompok bukan penderita PJK, program perubahan gaya hidup berhubungan dengan penurunan tekanan darah sistolik (treatment effect sebesar -9,03 mmHg), tekanan darah diastolik (treatment effect sebesar -6,00 mmHg), kolesterol total (treatment effect sebesar -13,60 mg/dl) dan IMT (treatment effect sebesar -0,34 kg/m2). Perbaikan faktor risiko ini disebabkan oleh perbaikan pola diet, yang ditandai oleh perbaikan nilai skor diet (treatment effect sebesar 7,00 poin). Perbaikan faktor-faktor risiko ini menyebabkan penurunan risiko kardiovaskular mayor yang ditandai oleh penurunan nilai skor FHS (treatment effect sebesar -2,15%). Pada kelompok penderita PJK, program perubahan gaya hidup berhubungan dengan penurunan nilai tekanan darah sistolik (treatment effect sebesar -7,00 mmHg), tekanan darah diastolik (treatment effect sebesar -0,78 mmHg) dan perubahan nilai QTc interval (treatment effect sebesar -0,088 detik). Perubahan faktor risiko ini dapat disebabkan oleh perbaikan skor diet (treatment effect sebesar 3,00 poin). Perbaikan faktor-faktor risiko ini tidak menyebabkan penurunan risiko kardiovaskular mayor, yang ditandai dengan tidak adanya perubahan nilai skor ACTION. Simpulan penelitian adalah bahwa program perubahan gaya hidup IDE KONSULEN memperbaiki faktor risiko kardiovaskular pada kelompok penderita dan bukan penderita PJK. Perbaikan faktor risiko yang dialami oleh kelompok bukan penderita PJK lebih besar daripada perbaikan pada kelompok penderita PJK dan hal ini menyebabkan terjadinya penurunan risiko kardiovaskular mayor pada kelompok bukan penderita PJK. Perbaikan yang terjadi pada kelompok penderita dan bukan penderita PJK diperantarai oleh perbaikan pola diet dan bukan oleh peningkatan aktivitas fisik atau perbaikan status merokok.

Cardiovascular disease, especially coronary artery disease, is related to high morbidity and mortality rates, including in Indonesia. In 2001, the proportion of cardiovascular deaths in Indonesia was 26.3% and it was the number one cause of death at that time. Every individual has chances of developing CAD and its complications (major adverse cardiovascular events or MACE), such as unstable angina, myocardial infarction and death. There are three different types of managements that can be entertained to prevent the occurrence and progression of CAD and MACE, namely nonpharmacological, pharmacological and other managements. The purpose of this research was to study the effect of a combined lifestyle modification program of IDE KONSULEN (combination of video presentation, counseling, distribution of printed materials or brochures and follow-up by phone for a 9 months period) on cardiovascular risk factors and risk of major cardiovascular events in the subjects with and without CAD. This research utilized an open randomized controlled method with pre-and posttest control group design. The CAD subjects were drawn from CAD patients who attended outpatient visit in Harapan Kita hospital, Jakarta, in the period of September- October 2011. The non-CAD subjects were drawn from the population without CAD who resided around Harapan Kita Hospital, Jakarta. At the beginning of the study, 200 CAD subjects and 200 non-CAD subjects had been recruited. Using simple random method with computer number, the subjects were allocated into intervention and non-intervention groups. The subjects in the intervention group were given a lifestyle modification program that consisted of video presentation, individual counseling with a general practitioner, distribution of printed materials (brochures) and telephone follow-up 2 times in a period of 9 months. The subjects in the non-intervention group were not given a lifestyle modification program. The primary outcomes measured were the risk of major cardiovascular events, which was estimated with the Framingham Heart Study score (for CAD subjects) and ACTION score (for non-CAD subjects). In addition, secondary outcomes were also measured, namely the mean/median values of risk factors (blood pressure, cholesterol, blood sugar, BMI) before and after the program. The results of this research indicated that in the non-CAD subjects, lifestyle modification program were associated with decreases in systolic blood pressure (treatment effect was -9.03 mmHg), diastolic blood pressure (treatment effect was -6.00 mmHg), total cholesterol (treatmet effect was -13.60 mg/dl) and BMI (treatment effect was -0.34 kg/m2). These risk factor improvements were due to improved dietary pattern, which was evidenced by an improved dietary score (treatment effect was 7.00 points).Improvements of these risk factors led to a reduced risk of major cardiovascular events evidenced by the reduction of FHS score (treatment effect was -2.15%). In the CAD subjects, lifestyle modification program was only associated with decreases in systolic blood pressure (treatment effect was -7.00 mm Hg), diastolic blood pressure (treatment effect was -0.78 mmHg) and change in QTc interval (treatment effect was -0.088 seconds). The changes in these risk factors might be caused by an improved dietary score (treatment effect was 3.00 points). Improvements of these risk factors, however, did not lead to a decrease in risk of major cardiovascular events. The conclusion of this research indicated that the lifestyle modification program of IDE KONSULEN led to improved cardiovascular risk factors in both CAD and non- CAD subjects. The magnitude of risk factor improvement in the non-CAD subjects was more noticeable than that in the CAD subjects, and this led to the improved risk of major cardiovascular events in the non-CAD subjects. Improvements of risk factors in both CAD and non-CAD subjects were mediated by improved dietary patterns and not by improvements in physical activity or smoking status.

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