Book Reading Homocystein

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)


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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/

Book Reading Homocystein

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