PENCEGAHAN PENY JANTUNG

DAN PEMB DARAH

DR. I K. GERUDUG., MPH.
BAG. ILMU KESEHATAN MASYARAKAT DAN KEDOKTERAN PENCEGAHAN
FAKULTAS KEDOKTERAN UNIVERSITAS MATARAM
Mataram, 2013

GLOBAL DEATHS BY CAUSE, ALL AGES 2005
*NCD are the mayor of deaths in the world
**Sumber: WHO dan WorldBank 2005
CARDIO-
VASCULAR
DISEASES
CANCER
CHRONIC
RESPIRATORY
DISEASE
DIABETES
17.528.000
7.586.000
4.057.000
1.125.000
MALARIA
TUBER-
CULOSIS
HIV/AIDS
883.000
1.607.000
2.830.000
10 PERINGKAT UTAMA PENYAKIT MENURUT DTD PENYEBAB
KEMATIAN DI RUMAH SAKIT INDONESIA TAHUN 2002
Catt:
DTD: Daftar Tabulasi Dasar
Sumber: Statistik RS di Indonesia Ed. 2003, Ditjen Yanmed

Kecenderungan peningkatan Incidens dan
prevalensi sejak 3 dekade terakhir
Transisi epidemiologi dari penyakit
menular--- peny. tidak menular
Double-burden
Perubahan pola struktur masy, scr global,
regional dan lokal dari agraris ke industri -
perub. sosial ekonomi, gaya hidup.

Preventive medicine encompasses both
the care of individual patients, and
public health practice, and as is evident in
the name, focuses on the prevention of
disease rather than treatment, per se.

The fields of preventive medicine and public
health share the objectives of
promoting general health,
preventing specific diseases,
and applying the concepts and techniques
of epidemiology toward these goals.
(Leavell and Clark, 1965),
all physician and other health professional activities
have the goal of prevention. What is to be prevented
depends on the context, and the patients position
on the spectrum from health to disease.
Primary prevention keeps the disease process from
becoming established by eliminating causes of disease
or increasing resistance to disease.
Secondary prevention interrupts the disease
process before it becomes symptomatic.
Tertiary prevention limits the physical and social
consequences of symptomatic disease.

The goals of medicine are to promote
health, to preserve health, to restore
health when it is impaired, and to minimize
suffering and distress.

These goals are embodied in the word
"prevention"
Determinants of Prevention
Successful prevention depends upon:
a knowledge of causation,
dynamics of transmission,
identification of risk factors and risk groups,
availability of prophylactic or early detection and
treatment measures,
an organization for applying these measures to
appropriate persons or groups, and
continuous evaluation of and development of
procedures applied
Leavells Levels of Prevention
Stage of disease Level of prevention Type of response
Pre-disease Primary Prevention Health promotion and
Specific protection
Latent Disease
Secondary prevention
Pre-symptomatic
Diagnosis and
treatment
Symptomatic Disease Tertiary prevention Disability limitation for
early symptomatic disease
Rehabilitation for late
Symptomatic disease
PENCEGAHAN :

* PRIMORDIAL
MENCEGAH MUNCULNYA
PREDISPOSING FACTORS
Primordial prevention
Primordial prevention consists of actions
and measures that inhibit the emergence
of risk factors in the form of environmental,
economic, social, and behavioral
conditions and cultural patterns of living
etc.

Primordial prevention (cont.)
In primordial prevention, efforts are
directed towards discouraging children
from adopting harmful lifestyles

The main intervention in primordial
prevention is through individual and mass
education

Primordial prevention (cont.)
It is the prevention of the emergence or
development of risk factors in countries or
population groups in which they have not
yet appeared

For example, many adult health problems
(e.g., obesity, hypertension) have their
early origins in childhood, because this is
the time when lifestyles are formed (for
example, smoking, eating patterns,
physical exercise).


PRIMER
PENYULUHAN FAKTOR RESIKO
TERUTAMA KELOMPOK RISTI.
Primary prevention
Primary prevention can be defined as the action
taken prior to the onset of disease, which
removes the possibility that the disease will ever
occur.
It signifies intervention in the pre-pathogenesis
phase of a disease or health problem.
Primary prevention may be accomplished by
measures of Health promotion and specific
protection
Primary prevention (cont.)
It includes the concept of "positive health", a
concept that encourages achievement and
maintenance of "an acceptable level of health
that will enable every individual to lead a socially
and economically productive life".
Primary prevention may be accomplished by
measures designed to promote general health
and well-being, and quality of life of people or by
specific protective measures.
Approaches for Primary Prevention
The WHO has recommended the following
approaches for the primary prevention of
chronic diseases where the risk factors are
established:

a. Population (mass) strategy
b. High -risk strategy
Population (mass) strategy
Population strategy" is directed at the whole population
irrespective of individual risk levels.

For example, studies have shown that even a small
reduction in the average blood pressure or serum
cholesterol of a population would produce a large
reduction in the incidence of cardiovascular disease

The population approach is directed towards socio-
economic, behavioral and lifestyle changes
High -risk strategy

The high -risk strategy aims to bring
preventive care to individuals at special
risk.

This requires detection of individuals at
high risk by the optimum use of clinical
methods.
SEKUNDER :

MENCEGAH BERULANG
MERUBAH POLA HIDUP
MEMPERTAHANKAN NILAI
PROGNOSTIK DAN
MENURUNKAN KEMATIAN
Secondary prevention
It is defined as action which halts the progress of a disease at its
incipient stage and prevents complications.

The specific interventions are: early diagnosis (e.g. screening tests,
and case finding programs.) and adequate treatment.

Secondary prevention attempts to arrest the disease process,
restore health by seeking out unrecognized disease and treating it
before irreversible pathological changes take place, and reverse
communicability of infectious diseases.

It thus protects others from in the community from acquiring the
infection and thus provide at once secondary prevention for the
infected ones and primary prevention for their potential contacts.
Secondary prevention (cont.)
Secondary prevention attempts to arrest the
disease process, restore health by seeking out
unrecognized disease and treating it before
irreversible pathological changes take place,
and reverse communicability of infectious
diseases.

It thus protects others from in the community
from acquiring the infection and thus provide at
once secondary prevention for the infected ones
and primary prevention for their potential
contacts.

Early diagnosis and treatment
WHO Expert Committee in 1973 defined early
detection of health disorders as the detection of
disturbances of homoeostatic and compensatory
mechanism while biochemical, morphological
and functional changes are still reversible.

The earlier the disease is diagnosed, and
treated the better it is for prognosis of the case
and in the prevention of the occurrence of other
secondary cases.
TERSIER :
MENCEGAH KOMPLIKASI
YANG LEBIH BERAT
Tertiary prevention
It is used when the disease process has
advanced beyond its early stages.
It is defined as all the measures available to
reduce or limit impairments and disabilities, and
to promote the patients adjustment to
irremediable conditions.
Intervention that should be accomplished in the
stage of tertiary prevention are disability
limitation, and rehabilitation.


Penyakit
jantung koroner
Stroke
Diabetes komplik.
Penyakit
pembuluh darah
Kanker
Penyakit paru
obstruksi kronis
Titik Akhir


Faktor Risiko /
Penyakit Antara
Hipertensi
Diabetes
Obesitas
Hiperlipidemia
Faktor Risiko
Perilaku
Tembakau
Gizi
Alkohol
Aktifitas Fisik
Risiko Yg Melekat
Umur, Sex
Keturunan
Kondisi
Sosio-economi, Budaya &
Lingkungan
Faktor Risiko PTM
dan Titik Akhir
Maximilian de Courten - Surveillance, NMH
Interrelationship between Various NCD and Modifiable Risk Factors, USA
Cardiovas dis
Cancer PPOK
Diabetes
Rokok + + +
Alkohol +
Hipercholest
+
Hipertensi
+
Diet + + +
Inact.phsys
+ + +
Obesitas
+ + +
Low Sosec
+ + + +
Pass .smok
+ +
Pekerjaan
+ +
Pollusi + + +
Trend Prevalensi Faktor Risiko di Daerah Studi Intervensi
Proyek Monica di 3 Kecamatan Jakarta Selatan
Tahun 1988 s.d. 2001
FAKTOR
RISIKO
JENIS
KELAMIN
SURVEI
NASIONAL
MONICA
(di 3 Kecamatan Jakarta Selatan
2001 1988 1993 2000
Hipertensi*
Laki-laki
Perempuan
27%
29%
13,6%
13,6%
16,5%
17,0%
22,0%
22,7%
Obesitas*
Laki-laki
Perempuan
1,3%
4,6%
2,6%
8,9%
3,6%
10,3%
6,3%
12,0%
Hiperkolester
olemia*
Laki-laki
Perempuan
12,3%
16,0%
14,8%
17,8%
12,2%
17,1%
Perokok
Laki-laki
Perempuan
54,5%**
1,2%**
59,9%
5,9%
56,9%
6,2%
38,5%
1,8%
Olah raga >3
per minggu
14,3% 22,5% 22,7% 59,2%
Sumber: Kusmana Dede dkk, RSJHK, 2001
* Population over 25 years of age
** Population over 10 years of age
F A K T O R R E S I K O
PENGERTIAN

RISK FACTORS ARE CHARACTERISTICS, SIGNS, SYMPTOMS IN DISEASE
FREE INDIVIDUAL WHICH ARE STATISTICALLY ASSOCIATED WITH AN
INCREASED INCIDENCE OF SUBSEQUENT DISEASE (SIMBORG D.W.).
KEGUNAAN IDENTIFIKASI FAKTOR RESIKO
1. PREDIKSI
Utk meramalkan kejadian penyakit. Misal : perokok berat mempunyai
kemungkinan 10 kali untuk kanker paru daripada bukan perokok.
2. PENYEBAB
Kejelasan faktor resiko dapat mengangkatnya menjadi faktor
penyebab, setelah menghapuskan pengaruh dan faktor
pengganggu ( Confounding Faktor ).
3. DIAGNOSIS
Membantu proses diaognosis
4. PREVENSI
Jika satu faktor juga sebagai penyebab, pengulangan dapat
digunakan untuk pencegahan penyakit meskipun mekanisme
penyakit sudah diketahui atau tidak.

FAKTOR RESIKO
FAKTOR PENYEBAB + FAKTOR
EPIDEMIOLOGIS YG
BERHUBUNGAN DENGAN
PENYAKIT.
FAKTOR YANG TAK BISA DIUBAH :
UMUR
JENIS KELAMIN
ANATOMI
METABOLISME
YANG BISA DIUBAH :
HIPERTENSI
MEROKOK
KOLESTEROL
KENCING MANIS
STRES
MAKAN SALAH
LIFE STYLE
FRAKSI LEMAK ( TG, HDL, LDL)
OLAH RAGA.

What is a healthy diet?
Emphasizes fruits, vegetables, whole grains,
and fat-free or low-fat milk and milk products;
Includes lean meats, poultry, fish, beans, eggs,
and nuts; and
Is low in saturated fats, trans fats, cholesterol,
salt (sodium), and added sugars.
The United States Department of Agriculture
(USDA) Dietary Guidelines describe a healthy
diet as one that:
Information for this section taken from the following Web site:
www.mypyramid.gov
Food tips:
Vary your veggies
Focus on fruit
Go lean with protein
Get your calcium
rich foods
Make half your grains whole
Find your balance between food and
physical activity
Limit sugar intake:
Foods high in sugar often
have too many calories and
not enough nutrients.
Sugar also promotes tooth
decay.
Limit salty foods:
Salty foods can
increase your risk
of high blood
pressure.
Choose a diet high in fruits,
vegetables and grain products.
These foods provide
vitamins, minerals, fiber
and complex
carbohydrates.
This will reduce your
risk of heart attack,
certain cancers, and
will help maintain a
healthy weight.
Eat foods that are low in fat,
saturated fat and
cholesterol.
Limit alcohol intake:
Alcohol is high in
calories and provides
little or no nutrition.

BERDASARKAN ANGKA INSIDENCE DAN PREVALENSI
PERHATIAN DIARAHKAN PD PENY. JANTUNG DAN
PEMBULUH DARAH UTAMA YAITU:
ARTEROSKLEROSIS,
HYPERTENSI,
PENY. JANTUNG KORONER
CEREBROVASKULER.
MAJOR FACTORS MENURUT
FRAMINGHAM STUDY ADALAH :
HIPERTENSI,
HIPERKOLESTEROL, DAN
ROKOK.

HIPERTENSI
Prevalensi 6 15 % pada orang dewasa
Sebagai suatu proses degeneratif, hipertensi
tentu hanya ditemukan pada gol. Dewasa.
Ditemukan kecenderungan peningkatan
prevalensi menurut peningkatan usia.

50 % penderita tdk menyadari diri sebagai
penderita HT. Karena itu mereka cenderung
untuk hipertensi yg lebih berat karena tdk
berubah dan menghindari faktor rIsiko.


70 % adalah HT ringan
Karena itu hipertensi banyak diacuhkan
atau terabaikan sampai saat menjadi
ganas ( Hipertensi ringan ).

90 % HT esensial , mereka dengan HT
yang tdk diketahui seluk beluk
penyebabnya. Artinya sulit untuk
mencari bentuk intervensi dan
pengobatannya.
Penentuan batasan hipertensi sangat penting karena
perubahan tingginya hipertensi sangat mempengaruhi
perhitungan prevalensi dalam populasi.
Sebagai contoh :
Perubahan prevalensi hipertensi akibat perubahan
batasan hipertensi pada pendudukan lelaki putih
Amerika Serikat usia 65 74 tahun berikut ini :


Tekanan darah
( Sistolik/Diastolik)
Presentase
Populasi
> 140 / 90
> 160 / 95
> 170 / 95
53
24
17

PJK

PENYAKIT YANG
BERHUBUNGAN DENGAN
TERGANGGUNYA SUPLY
DARAH KE OTOT JANTUNG
YANG MENGAKIBATKAN
KURANGNYA OKSIGEN DAN
SEGALA MANIFESTASINYA.

Faktor Resiko Hipertensi
Adapun faktor faktor yg dapat dimasukkan sebagai faktor
resiko Hipertensi adalah :
1. Umur : BP meningkat sesuai umur, > 40 thn
2. Ras/Suku : Orang kulit hitam > white
Besar variasi antarsuku di Indonesia
Terendah : Lembah Balim Jaya ( 0,6 % )
Tertinggi : Sukabumi, Jabar ( 28,6 % )
3. Urban/Rural : Kota > Desa
4. Geografis : Pantai > pegunungan
5. Seks : Wanita > lelaki
6. Gemuk : Gemuk > Kurus
7. Stres
8. Personality type A : A > B
9. Diet : Tinggi garam

10. DM
11. Water composition : - Sodium : inconsistent
- Cadmium : ada bukti dari studi
- Lead : kemungkinan ada hubungan.
12. Alhokol : Meninggi bila minum > 3 X/hari
Moderate amount may be protective
13. Rokok : non significant
14. Kopi : Belum ditemukan
15. Pil KB : Riks meninggi dengan lama pakai,
Meninggi 5 kali dibandingkan pakai 1 tahun

PJK

BENTUK UTAMA DARI SAKIT JANTUNG
PENYEBAB KEMATIAN TERBESAR
DAPAT DITULARKAN MELALUI
PENULARAN SOSIAL
MENGENAI BANYAK ORANG NAMUN
SELEKTIF
MODERNISASI DIANGGAP SEBAGAI
AGENT
SANGAT BERBAHAYA, NAMUN DAPAT
DICEGAH
PERJALANAN PENYAKIT--------, KRONIK
GEJALA KLINIK :
ANGINA PEKTORIS
BAJI MATI JANTUNG
PAYAH JANTUNG
MATI MENDADAK

TANDA TANDA UMUM :
NYERI DADA (CHEST PAIN)
SAKIT DIBAWAH BELIKAT KIRI
RASA SAKIT MENJALAR DARI LENGAN BAWAH
KE ATAS, BAHU KIRI, LEHER DAN RAHANG
BAWAH

FREKWENSI DAN DISTRIBUSI
NEGARA BERKEMBANG KEJADIAN >>
PERKOTAAN >> PEDESAAN
SOS. EK MENEGAH KEATAS >> LEMAH
PRIA >> WANITA ; KEMATIAN WANITA >>
FREK. MENINGGI PADA GOL UMUR 40
TAHUN, RESTI --- 50 TAHUN
KEMATIAN >> HIDUP
Kematian karena
Komplikasi PJK /
Dekompensasi
Kondisi lingkungan
dan sosial tidak
menguntungkan
Kesehatan
Pola Perilaku
merugikan
Kesehatan
Populasi dengan
Faktor Risiko
tinggi
Kematian Mendadak/
Serangan Pertama
Berisiko untuk
Kambuh kembali/
Hendaya(cacat)
Realitas Saat Ini
Hidup berkualitas
baik sampai
meninggal
Kondisi Lingkungan
dan Sosial
menguntungkan
Kesehatan
Pola Perilaku
yang
mempromosikan
Kesehatan
Risiko
Populasi
rendah
Kejadian
Kasus sedikit/
Kematian
jarang
Resiko kambuh
rendah / kapasitas
fungsional
maksimal
Visi Masa Depan
Pencegahan
KEBIJAKAN DAN STRATEGI DALAM PENGENDALIAN PENYAKIT
JANTUNG DAN PEMBULUH DARAH DI INDONESIA

PJ dan PD
Total populasi
256.455.954
Total populasi
256.455.954
( >75%)
Merokok 62%
TD tinggi 14%
TC 13,6%
DM 12,8%
obesitas 18%


Stroke
MI
Gagal jantung Kongestif
Stroke
MI
Gagal jantung Kongestif
Target populasi
Peningkatan Hidup Sehat dan Berkualitas(Qaly)
GOL 1

Masyarakat Indonesia Sehat 2010
GOL 2

GOL 3 GOL 4

Eliminasi Disparitas

Perubahan
Perilaku

Deteksi Faktor Risiko &
Pengendalian Faktor
risiko


Program-Program Intervensi

Pengobatan
Kebijakan dan
Perubahan Lingkungan
Layanan Gawat Darurat
dan Manajemen Kasus
Akut
Rehabilitasi dan Manaj.
Kasus Jangka Panjang
panjang
Perawatan sampai
Akhir Hayat