PENGGUNAAN STATIN DAN ANTIPLATELET SEBAGAI PENCEGAHAN SEKUNDER KOMPLIKASI KARDIOVASKULER PADA PASIEN DIABETES MELITUS TIPE 2
Abstract
Resistensi insulin pada pasien diabetes melitus (DM) tipe 2 dapat meningkatkan risiko terjadinya komplikasi kardiovaskuler yang selanjutnya dapat berkontribusi sebagai penyebab utama kematian. Resistensi insulin meningkatkan kerentanan pasien mengalami aterosklerosis dan menimbulkan gangguan pada fungsi platelet di pembuluh darah yang dapat berdampak pada peningkatan risiko komplikasi kardiovaskuler. Sebagai salah satu upaya untuk mencegah dan mengurangi risiko tersebut, Canadian Cardiovascular Society Guidelines tahun 2011 dan American Diabetes Association tahun 2019 merekomendasikan penggunaan golongan statin dan antiplatelet sebagai upaya pencegahan sekunder komplikasi kardiovaskuler pada pasien DM tipe 2. Penelitian ini bertujuan untuk mengetahui gambaran penggunaan statin dan antiplatelet sebagai pencegahan sekunder pada pasien DM tipe 2 dengan komplikasi kardiovaskuler. Penelitian ini bersifat observasional dengan desain cross sectional yang dilakukan pada 110 pasien di RSU Puri Raharja Denpasar Bali periode November 2019. Hasil penelitian menunjukkan bahwa dari 110 pasien yang memenuhi kriteria penggunaan statin, hanya 42 pasien (38,1%) yang menggunakan statin (simvastatin 20 mg; 95,2%). Selain itu, dari total 96 pasien yang memenuhi kriteria penggunaan antiplatelet, hanya 52 pasien (47,3%) yang menggunakan antiplatelet (aspirin 80 mg; 82,7%). Penelitian ini merefleksikan penggunaan statin yang masih rendah dalam upaya pencegahan sekunder komplikasi kardiovaskuler pada pasien DM tipe 2. Meskipun terdapat kecenderungan tingkat penggunaan antiplatelet aspirin yang lebih tinggi daripada statin dalam penelitian ini, pemberian aspirin selanjutnya masih perlu ditingkatkan lagi bersama-sama dengan peningkatan pemberian statin.References
Roglic G, Varghese C, Riley L, Harvey A, Krug E, Alwan A. Global report on diabetes. Roglic G, editor. Geneva, Switzerland: World Health Organization; 2016.
Williams R, Colagiuri S, Almutairi R, Montoya P, Basit A, Beran D. IDF Diabetes Atlas Ninth edition 2019. International Diabetes Federation. 2019.
Cho N, Kirigia J, Mbanya J, Ogurstova K, Guariguata L, Rathmann W. IDF Diabetes Atlas Eighth Edition 2017. IDF Diabetes Atlas, 8th edition. 2017.
Kazi AA, Blonde L. Classification of diabetes mellitus. Clin Lab Med. 2019;21(1):1–13.
Sulistyowati L. Kebijakan Pengendalian DM di Indonesia. Simp WDD. 2017;121–30.
Yang W, Cai X, Han X, Ji L. Clinical Characteristics of Young Type 2 Diabetes Patients with Atherosclerosis. Feng Y-M, editor. PLoS One [Internet]. 2016 Jul 8;11(7):1–8. Available from: doi:10.1371/journal.pone.0159055
Capodanno D, Angiolillo DJ. Aspirin for Primary Cardiovascular Risk Prevention and beyond in Diabetes Mellitus. Circulation. 2016;134(20):1579–94.
Gonna H, Ray KK. The importance of dyslipidaemia in the pathogenesis of cardiovascular disease in people with diabetes. Diabetes, Obes Metab. 2019;21(S1):6–16.
Goel S, Garg P, Malhotra V, Madan J, Mitra S, Grover S. Dyslipidemia in Type II Diabetes Mellitus - An assessment of the main lipoprotein abnormalities. Bangladesh J Med Sci. 2016;15(1):99–102.
Low Wang CC, Hess CN, Hiatt WR, Goldfine AB. Clinical update: Cardiovascular Disease in Diabetes Mellitus. Circulation. 2016;133(24):2459–502.
Bell A, Roussin A, Cartier R, Teal P, Théroux P, Turpie A, et al. The Use of Antiplatelet Therapy in the Outpatient Setting: Canadian Cardiovascular Society Guidelines Executive Summary. Can J Cardiol [Internet]. 2011;27(2):208–21. Available from: http://dx.doi.org/10.1016/j.cjca.2010.12.033
Riddle M, Bakris G, Blonde L, Boulton A. American Diabetes Association Standards of Medical Care In Diabetes-2019. J Clin Apllied Res Educ Diabetes Care [Internet]. 2019;42(1):54–67. Available from: http://repositorio.unan.edu.ni/2986/1/5624.pdf
Naeem F, McKay G, Fisher M. Cardiovascular outcomes trials with statins in diabetes. Br J Diabetes. 2018;18(1):101–5.
Jaiswal M, Schinske A, Pop-Busui R. Lipids and lipid management in diabetes. Best Pract Res Clin Endocrinol Metab [Internet]. 2014;28(3):325–38. Available from: http://dx.doi.org/10.1016/j.beem.2013.12.001
Zhang H, Plutzky J, Shubina M, Turchin A. Risk factors for lack of statin therapy in patients with diabetes and coronary artery disease. J Clin Lipidol. 2016;10(6):1406–13.
Ansa B, Hoffman Z, Lewis N, Savoy C, Hickson A, Stone R, et al. Aspirin Use among Adults with Cardiovascular Disease in the United States: Implications for an Intervention Approach. J Clin Med. 2019;8(2):264.
Kim J, Shim M, Lee S, Oh J. Aspirin for primary prevention of cardiovascular disease. J Lipid Atheroscler. 2019;8(2):162–72.
Pauff B, Jiroutek M, Holland M, Sutton B. Statin Prescribing Patterns: An Analysis of Data from Patients with Diabetes in the National Hospital Ambulatory Medical Care Survey Outpatient Department and National Ambulatory Medical Care Survey Databases, 2005-2010. Clin Ther [Internet]. 2015;37(6):1329–39. Available from: http://dx.doi.org/10.1016/j.clinthera.2015.03.020
Melaku T, Solomon Y, Chelkeba L. Statin Utilization Patterns among Type 2 Diabetes Mellitus Patients with High Cardiovascular Disease Risks in Ethiopia. J Pharm Care. 2018;6(3):44–51.
Lie PGCE, Irawati S, Presley B. Prevention of Cardiovascular Disease in Diabetes Mellitus Outpatient: Focusing on Antiplatelet, Statins and Irrational Antihypertensive Drug Use. Indones J Clin Pharm. 2016;5(3):169–83.
Chootong R, Jamulitrat S. Prevalence of Aspirin Prescriptions among Type 2 Diabetic Patients in Songklanagarind Hospital. Songklanagarind Med J. 2018;36(1):35–44.
Karaca A, Yakar B. Frequency of aspirin use in patients with type 2 diabetes: Is there any effect of concomitant diseases? Ann Med Res. 2019;26(12):2952–6.
Jaya I. Penerapan Statistik Untuk Penelitian Pendidikan. 1th ed. Jakarta, Indonesia: Prenadamedia Group (Divisi Kencana); 2019.
Maahs DM, Daniels SR, De Ferranti SD, Dichek HL, Flynn J, Goldstein BI, et al. Cardiovascular Disease Risk Factors in Youth with Diabetes Mellitus: A Scientific Statement from the American Heart Association. Circulation. 2014;130(17):1532–58.
McNeill JA, Cook JDM, Mahon M, Allwein DA, Rauschhuber M, Richardson CO, et al. A Family History Intervention Enhancing Cardiovascular Risk Assessment. AAOHN J. 2011;59(4):181–94.
Anagnostis P, Majeed A, Johnston DG, Godsland IF. Mechanisms in endocrinology: Cardiovascular risk in women with type 2 diabetes mellitus and prediabetes: Is it indeed higher than men? Eur J Endocrinol. 2014;171(6):R245–55.
Huebschmann AG, Huxley RR, Kohrt WM, Zeitler P, Regensteiner JG, Reusch JEB. Sex differences in the burden of type 2 diabetes and cardiovascular risk across the life course. Diabetologia [Internet]. 2019;62(10):1761–72. Available from: http://dx.doi.org/10.1007/s00125-019-4939-5
Kanamori M, Selim M, Takiddin A, Al-Homsi H, Al-Mahmoud K. Ethnic and gender differences in advanced glycation end products measured by skin auto-fluorescence. Dermatoendocrinol. 2013;5(2):325–30.
Chia CW, Egan JM, Ferrucci L. Age-related changes in glucose metabolism, hyperglycemia, and cardiovascular risk. Circ Res. 2018;123(7):886–904.
Lascar N, Brown J, Pattison H, Barnett AH, Bailey CJ, Bellary S. Type 2 diabetes in adolescents and young adults. Lancet Diabetes Endocrinol. 2018;6(1):69–80.
Moonesinghe R, Yang Q, Zhang Z, Khoury MJ. Prevalence and Cardiovascular Health Impact of Family History of Premature Heart Disease in the United States: Analysis of the National Health and Nutrition Examination Survey, 2007–2014. J Am Heart Assoc. 2019;8(14):1–11.
Domeikiene A, Vaivadaite J, Ivanauskiene R, Padaiga Z. ScienceDirect Direct cost of patients with type 2 diabetes mellitus healthcare and its complications in Lithuania. Mediciana. 2014;S4–6.
Chappidi M, Shivananjiah S, Thirthahalli C, Kunnavil R, Chappidi M, Med JC, et al. Complications of diabetes mellitus among patients attending the out- patient department of a tertiary care hospital. Int J Community Med Public Heal. 2018;5(1):341–8.
Fan W. Epidemiology in diabetes mellitus and cardiovascular disease. Cardiovasc Endocrinol. 2017;6(1):8–16.
Bertoluci MC, Rocha VZ. Cardiovascular risk assessment in patients with diabetes. Diabetol Metab Syndr. 2017;9(25):1–13.
Tancredi M, Rosengren A, Svensson AM, Kosiborod M, Pivodic A, Gudbjörnsdottir S, et al. Excess mortality among persons with type 2 diabetes. N Engl J Med. 2015;373(18):1720–32.
Khanam PA, Begum T, Chowdhury A, Habib SH. Coronary artery disease with type 2 diabetes and other risk factors: A tertiary care hospital in Bangladesh. Bangladesh Crit Care J. 2019;7(1):20–5.
Jelinek HF, Osman WM, Khandoker AH, Khalaf K, Lee S, Almahmeed W, et al. Clinical profiles, comorbidities and complications of type 2 diabetes mellitus in patients from United Arab Emirates. BMJ Open Diabetes Res Care. 2017;5(1):1–9.
Haas A V., McDonnell ME. Pathogenesis of Cardiovascular Disease in Diabetes. Endocrinol Metab Clin North Am [Internet]. 2018;47(1):51–63. Available from: https://doi.org/10.1016/j.ecl.2017.10.010
Abdul-Ghani M, DeFronzo RA, Del Prato S, Chilton R, Singh R, Ryder REJ. Cardiovascular disease and type 2 diabetes: Has the dawn of a new era arrived? Diabetes Care. 2017;40(7):813–20.
Tadesse K, Amare H, Hailemariam T, Gebremariam T. Prevalence of Hypertension among Patients with Type 2 Diabetes Mellitus and Its Socio Demographic Factors in Nigist Ellen Mohamed Memorial Hospital Hosanna, Southern Ethiopia. J Diabetes Metab. 2018;9(4):4–10.
Abdullah F, Han TM, Nor MBM, Mohd Aznan MA, Ismail IZ. Prevalence of hypertension and glycaemic control in adult type-2 diabetes patients: A preliminary retrospective cohort study in Kuantan, Pahang, Malaysia. Int Med J Malaysia. 2017;16(1):115–22.
Narindrarangkura P, Bosl W, Rangsin R, Hatthachote P. Prevalence of dyslipidemia associated with complications in diabetic patients: A nationwide study in Thailand. Lipids Health Dis. 2019;18(1):1–8.
Sarwar N, Gao P, Kondapally Seshasai SR, Gobin R, Kaptoge S, Di Angelantonio E, et al. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: A collaborative meta-analysis of 102 prospective studies. Lancet [Internet]. 2010;375(9733):2215–22. Available from: http://dx.doi.org/10.1016/S0140-6736(10)60484-9
Sliwinska-Mosson M, Milnerowicz H. The impact of smoking on the development of diabetes and its complications. Diabetes Vasc Dis Res. 2017;14(4):265–76.
Bajaj M. Nicotine and insulin resistance: When the smoke clears. Diabetes. 2012;61(12):3078–80.
George P, Mamali A, Papafloratos S, Zerva E. Effects of Smoking on Cardiovascular Function: The Role of Nicotine and Carbon Monoxide Institution of Athens (TEI-A), Greece 2. Physical Therapy Department, Technological Educational Institution of Athens (TEI-A), Greece 3. Physical Therapy Department, T. Heal Sci J [Internet]. 2014;8(2):274–90. Available from: http://www.hsj.gr/medicine/effects-of-smoking-on-cardiovascular-function-the-role-of-nicotine-and-carbon-monoxide.pdf
Brennan MB, Huang ES, Lobo JM, Kang H, Guihan M, Basu A, et al. Longitudinal trends and predictors of statin use among patients with diabetes. J Diabetes Complications. 2018;32(1):27–33.
Ghadiri-Anari A, Jafari-Mehdiabad AH, Afkhami-Ardekani M, Rezapour M, Chavoshzadeh-Tafti F. Prevalence of Aspirin Use among Type 2 Diabetic Patients in Iran. Iran J Diabetes Obes. 2013;5(4):171–5.
Smith SC, Benjamin EJ, Bonow RO, Braun LT, Creager MA, Franklin BA, et al. AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: A guideline from the American Heart Association and American College of Cardiology Foundation. Circulation. 2011;124(22):2458–73.
Jellinger PS, Handelsman Y, Rosenblit PD, Bloomgarden ZT, Fonseca VA, Garber AJ, et al. American Association of Clinical Endocrinologists and American College of Endocrinology Guidelines for Management of Dyslipidemia and Prevention of Cardiovascular Disease. Endocr Pract. 2017;23(2):1–87.
Rodriguez F, Maron DJ, Knowles JW, Virani SS, Lin S, Heidenreich PA. Association between intensity of statin therapy and mortality in patients with atherosclerotic cardiovascular disease. JAMA Cardiol. 2017;2(1):47–54.
Navarese EP, Robinson JG, Kowalewski M, Kołodziejczak M, Andreotti F, Bliden K, et al. Association between baseline LDL-C level and total and cardiovascular mortality after LDL-C lowering a systematic review and meta-analysis. JAMA - J Am Med Assoc. 2018;319(15):1566–79.
Martinez-Hervas S, Carmena R, Ascaso JF. Significance of LDL-C lowering therapy in diabetic patients. Clin Lipidol. 2011;6(4):389–99.
Rohilla A, Rohilla S, Kumar A, Khan MU, Deep A. Pleiotropic effects of statins: A boulevard to cardioprotection. Arab J Chem [Internet]. 2016;9:S21–7. Available from: http://dx.doi.org/10.1016/j.arabjc.2011.06.025
Kementerian Kesehatan Republik Indonesia. Formularium Nasional HK.01.07/MENKES/707/2017. 2018;121.
Elnaem MH, Nik Mohamed MH, Huri HZ, Azarisman SM. Patterns of statin therapy prescribing among hospitalized patients with type 2 diabetes mellitus in two Malaysian tertiary hospitals. Trop J Pharm Res. 2017;16(12):3005–11.
Rhee E, Kim HC, Kim JH, Lee EY, Kim BJ, Kim EM, et al. 2018 Guidelines for the management of dyslipidemia Cardiovascular disease in Koreans. Korean J Intern Med [Internet]. 2019;34(4):723–71. Available from: http://kjim.org/journal/view.php?doi=10.3904/kjim.2019.188
Nicolucci A, Standl E. Antiplatelet therapy for every diabetic person? Diabetes Care. 2011;34(SUPPL. 2):S150–4.
Godley RW, Hernandez-Vila E. Aspirin for primary and secondary prevention of cardiovascular disease. Texas Hear Inst J. 2016;43(4):318–9.
Collins R, Peto R, Hennekens C, Doll R, Bubes V, Buring J, et al. Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. Lancet [Internet]. 2009;373(9678):1849–60. Available from: http://dx.doi.org/10.1016/S0140-6736(09)60503-1
Simpson SH, Gamble JM, Mereu L, Chambers T. Effect of aspirin dose on mortality and cardiovascular events in people with diabetes: A meta-analysis. J Gen Intern Med. 2011;26(11):1336–44.
Bell DSH. Aspirin in the prevention of cardiovascular events in patients with diabetes. Postgrad Med [Internet]. 2016;128(2):180–90. Available from: http://dx.doi.org/10.1080/00325481.2016.1131106
Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke a guideline for healthcare professionals from the American Heart Association/American Stroke A. Vol. 50, Stroke. 2019. 344-418 p.
Hackam DG, Spence JD. Antiplatelet therapy in ischemic stroke and transient ischemic attack: An overview of major trials and meta-analyses. Stroke. 2019;50(3):773–8.
Eikelboom JW, Hirsh J, Spencer FA, Baglin TP, Weitz JI. Antiplatelet drugs - Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest [Internet]. 2012;141(2 SUPPL.):e89S–e119S. Available from: http://dx.doi.org/10.1378/chest.11-2293
Downloads
Published
Issue
Section
License
The copyright to this article is transferred to Universitas Hasanuddin (UNHAS) if and when the article is accepted for publication. The undersigned hereby transfers all rights in and to the paper including without limitation all copyrights to UNHAS. The undersigned hereby represents and warrants that the paper is original and that he/she is the author of the paper, except for material that is clearly identified as to its original source, with permission notices from the copyright owners where required. The undersigned represents that he/she has the power and authority to make and execute this assignment.
We declare that:
- This paper has not been published in the same form elsewhere.
- It will not be submitted anywhere else for publication prior to acceptance/rejection by this Journal.
- A copyright permission is obtained for materials published elsewhere and which require this permission for reproduction.
Furthermore, I/We hereby transfer the unlimited rights of publication of the above-mentioned paper in whole to UNHAS The copyright transfer covers the exclusive right to reproduce and distribute the article, including reprints, translations, photographic reproductions, microform, electronic form (offline, online) or any other reproductions of similar nature.
The corresponding author signs for and accepts responsibility for releasing this material on behalf of any and all co-authors. This agreement is to be signed by at least one of the authors who have obtained the assent of the co-author(s) where applicable. After submission of this agreement signed by the corresponding author, changes of authorship or in the order of the authors listed will not be accepted.
