Kadar Kolesterol Yang Tinggi Di Dalam Darah Mempunyai Peran Penting Dalam Proses Aterosklerosis Yang...

7/23/2019 Kadar Kolesterol Yang Tinggi Di Dalam Darah Mempunyai Peran Penting Dalam Proses Aterosklerosis Yang Selanju

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Kadar kolesterol yang tinggi di dalam darah mempunyai peran penting dalam proses

aterosklerosis yang selanjutnya akan menyebabkan kelainan kardiovaskuler. Dari banyak

penelitian kohort menunjukkan bahwa makin tinggi kadar koleterol darah, makin tinggi angkakejadian kelainan kardiovaskuler. Begitu juga dengan makin rendah kadar kolesterol maka

makin rendah kejadian penyakit kardiovaskuler baik untuk pencegahan primer maupun

pencegahan sekunder. Setiap penurunan kadar kolesterol total 1 % menghasilkan penurunanrisiko mortalitas kardiovaskuler sebesar 1,5%. Begitu juga dengan besarnya kadar kolesterolLDL dan HDL. Penurunan KolesterolLow Density Lipoprotein (LDL) sebesar 1 mg/dl

menurunkan risiko kejadian kardiovaskuler sebesar 1% dan peningkatan kadar kolesterolHigh

Density Lipoprotein (HDL) menurunkan risiko kejadian kardiovaskuler sebesar 2-3%.

Di Indonesia, angka kejadian hiperkolesterolemia penelitian MONICA I (1988) sebesar 13.4 %

untuk wanita dan 11,4 % untuk pria. Pada MONICA II (1994) didapatkan meningkat menjadi16,2 % untuk wanita dan 14 % pria. Prevalensi hiperkolesterolemia masyarakat pedesaan,

mencapai 200-248 mg/dL atau mencapai 10,9 persen dari total populasi pada tahun 2004,.

Penderita pada generasi muda, yakni usia 25-34 tahun, mencapai 9,3 persen. Wanita menjadi

kelompok paling banyak menderita masalah ini, yakni 14,5 persen, atau hampir dua kali lipatkelompok laki-laki.

Hiperkolesterolemia adalah salah satu gangguan kadar lemak dalam darah (dislipidemia) yang

mana kadar kolesterol dalam darah lebih dari 240 mg/dl. (perkeni 2004). Hiperkolesterolemia

berhubungan erat dengan kadar kolesterol LDL di dalam darah. Dislipidemia adalah kelainan

metabolisme lipid yang ditandai peningkatan kolesterol total, kolesterol LDL, trigliserida di atasnilai normal serta penurunan kolesterol HDL.

Tabel 1. Klasifikasi dislipidemia menurut WHO

Fredrickson Klasifikasi dislipidemia Peningkatan lipoproteinI Kilomikron

IIa Hiperkolesterolemia LDL

IIb Dislipidemia kombinasi LDL + VLDL

III Dislipidemia remnant VLDL remnant +

kilomikron

IV Dislipidemia endogen VLDL

V Dislipidemia campuran VLDL + kilomikron

Keterangan LDL =Low Density Lipoprotein

VLDL = Very Low Density Lipoprotein(Trigliserida)

Penyebab Hiperkolesterolemia

Banyak faktor yang menyebabkan terjadinya hiperkolesterolemia. Bisa disebabkan oleh faktor

genetik seperti pada hiperkolesterolemia familial dan hiperkoleterolemia poligenik, juga bisa


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disebabkan faktor sekunder akibat dari penyakit lain seperti diabetes mellitus, sindroma nefrotik

serta faktor kebiasaan diet lemak jenuh (saturated fat), kegemukan dan kurang olahraga.

1.1 Hiperkolesterolemia Poligenik

Tipe ini merupakan hiperkolesterolemia yang paling sering ditemukan, merupakan interaksiantara kelainan genetik yang multipel, nutrisi dan faktor-faktor lingkungan lainnya serta

memiliki lebih dari satu dasar metabolik. Penyakit ini biasanya tidak disertai dengan xantoma.

1.2 Hiperkolesterolemia Familial

Penyakit yang diturunkan ini terjadi akibatkan oleh adanya defek gen pada reseptor LDL

permukaan membran sel tubuh. Ketidakadaan reseptor ini menyebabkan hati tidak bisa

mengabsorpsi LDL. Karena mengganggap LDL tidak ada, hati kemudian memproduksi VLDL

yang banyak ke dalam plasma. Pada pasien dengan Hiperkolesterolemia familial ditemukankadar kolesterol total mencapai 600 sampai 1000 mg/dl atau 4 sampai 6 kali dari orang normal.

Banyak pasien ini meninggal sebelum berumur 20 tahun akibat infark miokard.

1.3 Kebiasaan Diet lemak Jenuh, Kurang olahraga dan Kegemukan

Pada tubuh manusia, reseptor LDL menangkap LDL yang tidak teroksidasi dan disimpan di

dalam sel tubuh. Jika sudah berlebih, LDL tidak masuk ke dalam sel kemudian dimetabolime di

hepar untuk menjadi asam empedu dan diekskresikan keluar. Pada proses patologi, oksidan LDLditangkap oleh makrofag dan kemudian menjadi sel busa dan menumpuk di dalam tubuh, tidak

diekskresi dan apabila menumpuk didalam pembuluh darah menimbulkan plak aterome dan

lama-kelamaan menjadi aterosklerosis.

Penelitian pada binatang yang ditingkatkan kadar serumnya menunjukkan LDL memicuatrogenesis. Ada bentuk kelainan gen pada manusia yang menyebabkan peningkatan LDL secara

berat yang menimbulkan penyakit kardiovaskuler pada usia muda. LDL menimbulkanpenumpukan kolesterol pada dinding arteri. LDL juga menyebabkan rangsangan inflamasi dani

inflamasi pada lesi aterogenik. Peningkatan LDL berhubungan dengan semua tingkatan

aterogenik yaitu disfungsi endotel, pembentukan dan pertumbuhan plak, ketidakstabilan plak danthrombosis.Peningkatan LDL plasma menyebabkan retensi partikel LDL pada dinding arteri

meningkat, oksidasi LDL dan pengeluaran zat-zat mediator inflamasi . Terapi terhadap

peningkatan LDL menunjukkan fungsi endotel koroner menjadi normal


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Gambar 1. Proses terjadinya aterosklerosis.Dimulai dari cedera pada endotel pembuluh darah oleh karena faktor hipertensi, merokok, makan

makanan yang mengandung banyak lemak, oksidasi LDL, diabetes mellitus, zat vasoaktif dansitokin.

1.4 Akibat Penyakit Lain

Berikut ini dislipidemia yang disebabkan oleh penyakit lain :

Tabel 2. Penyebab Hiperkolesterolemia yang disebabkan oleh penyakit

Penyakit penyebab Kelainan lipid

Diabetes mellitus (DM) TG dan HDL

Gagal ginjal kronis TG

Sindrom nefrotik Kolesterol total

Hipotiroidisme Koleterol total

Penyalahgunaan alcohol TG

Kholestasis Kolesterol total

Kehamilan TG

Obat-obatan (kontrasepsi oral,diuretic, beta bloker,

kortikosteroid)

TG dan atau Kolesterol total ,

HDL

Keterangan : TG = Trigliserida, HDL = High Density Lipoprotein, = meningkat, = menurun
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4/5

Peningkatan prevalensi Diabetes seiring dengan peningkatan faktor risiko yaitu obesitas

(kegemukan), kurang aktivitas fisik, kurang konsumsi serat, tinggi lemak, merokok,

hiperkolesterol, hiperglikemia dan lain-lain. Prevalensi faktor risiko DM dari 2001-2004 yaitu :obesitas dari 12,7% menjadi 18,3%. Hiperglikemia dari 7,9% menjadi 11,3% dan hiperkolesterol

dari 6,5% menjadi 12,9%. Diabetes berpotensi menyebabkan hiperkolesterolemia dengan

meningkatkan kadar kolesterol LDL.

Sindrom nefrotik adalah sindroma klinis yang ditandai dengan adanya proteinuria,

hipoalbunemia, edema dan hiperkolesterolemia. Patogenesis terjadinya hiperkolesterolemiaadalah kebocoran pada membrane basalis glomerulus menyebabkan proteinuria sehingga terjadi

hipoalbiminemia. Hipoalbuminemia dikompensasi oleh hepar dengan memprodusksi kolesterol

sehingga terjadi hiperkolesterolemia. Terjadi hipoalbuminemia yang selanjutnya merangsang

hepar untuk memprodusksi kolesterol sehingga terjadi hiperkolesterolemi

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