Penyakit Jantung Diabetik, Tidak Dirasa Namun Dia Ada
Diabetic Heart Disease atau Penyakit Jantung Diabetik adalah gangguan pada struktur dan fungsi jantung pasien yang menderita penyakit Diabetes Melitus (DM),yaitu suatu kelompok penyakit metabolik dengan karakteristik kadar gula darah yang tinggi yang terjadi karena kelainan sekresi insulin, kerja insulin atau keduanya.<!--[if supportFields]>ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1161/CIRCRESAHA.120.315913","ISSN":"15244571","PMID":"32437308","abstract":"Diabetes mellitus predisposes affected individuals to a significant spectrum of cardiovascular complications, one of the most debilitating in terms of prognosis is heart failure. Indeed, the increasing global prevalence of diabetes mellitus and an aging population has given rise to an epidemic of diabetes mellitus-induced heart failure. 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Indeed, the increasing global prevalence of diabetes mellitus and an aging population has given rise to an epidemic of diabetes mellitus-induced heart failure. Despite the significant research attention this phenomenon, termed diabetic cardiomyopathy, has received over several decades, understanding of the full spectrum of potential contributing mechanisms, and their relative contribution to this heart failure phenotype in the specific context of diabetes mellitus, has not yet been fully resolved. Key recent preclinical discoveries that comprise the current state-of-the-art understanding of the basic mechanisms of the complex phenotype, that is, the diabetic heart, form the basis of this review. Abnormalities in each of cardiac metabolism, physiological and pathophysiological signaling, and the mitochondrial compartment, in addition to oxidative stress, inflammation, myocardial cell death pathways, and neurohumoral mechanisms, are addressed. Further, the interactions between each of these contributing mechanisms and how they align to the functional, morphological, and structural impairments that characterize the diabetic heart are considered in light of the clinical context: from the disease burden, its current management in the clinic, and where the knowledge gaps remain. 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Penurunan fungsi jantung pada Penyakit Jantung Diabetik seringkali tidak menimbulkan gejala secara klinis, bahkan diantara pasien-pasien diabetes melitus yang tidak menunjukan gejala,dan terkontrol tekanan darah dan gula darahnya, separuhnya dianggap menunjukkan beberapa derajat penurunan fungsi jantung.Selain itu Penyakit Jantung Diabetik seringkali tidak terdeteksi sampai stadium lanjut penyakit, salah satu tanda pertama kardiomiopati diabetik, sering kali dapat dideteksi lebih awal daripada disfungsi sistolik LV yang signifikan secara klinis <!--[if supportFields]>ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1161/CIRCRESAHA.120.315913","ISSN":"15244571","PMID":"32437308","abstract":"Diabetes mellitus predisposes affected individuals to a significant spectrum of cardiovascular complications, one of the most debilitating in terms of prognosis is heart failure. Indeed, the increasing global prevalence of diabetes mellitus and an aging population has given rise to an epidemic of diabetes mellitus-induced heart failure. Despite the significant research attention this phenomenon, termed diabetic cardiomyopathy, has received over several decades, understanding of the full spectrum of potential contributing mechanisms, and their relative contribution to this heart failure phenotype in the specific context of diabetes mellitus, has not yet been fully resolved. Key recent preclinical discoveries that comprise the current state-of-the-art understanding of the basic mechanisms of the complex phenotype, that is, the diabetic heart, form the basis of this review. Abnormalities in each of cardiac metabolism, physiological and pathophysiological signaling, and the mitochondrial compartment, in addition to oxidative stress, inflammation, myocardial cell death pathways, and neurohumoral mechanisms, are addressed. Further, the interactions between each of these contributing mechanisms and how they align to the functional, morphological, and structural impairments that characterize the diabetic heart are considered in light of the clinical context: from the disease burden, its current management in the clinic, and where the knowledge gaps remain. The need for continued interrogation of these mechanisms (both known and those yet to be identified) is essential to not only decipher the how and why of diabetes mellitus-induced heart failure but also to facilitate improved inroads into the clinical management of this pervasive clinical challenge.","author":[{"dropping-particle":"","family":"Ritchie","given":"Rebecca H.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Dale Abel","given":"E.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Circulation Research","id":"ITEM-1","issued":{"date-parts":[["2020"]]},"page":"1501-1525","title":"Basic Mechanisms of Diabetic Heart Disease","type":"article-journal"},"uris":["https://www.mendeley.com/documents/?uuid=5da3e628-bcfd-4869-8b3b-fae0865a8072"]}],"mendeley":{"formattedCitation":"(1)","plainTextFormattedCitation":"(1)","previouslyFormattedCitation":"(1)"},"properties":{"noteIndex":0},"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"}<![endif]-->(1)<!--[if supportFields]><![endif]-->
Karena itu dalam mendeteksi Penyakit Jantung Diabetik ini diperlukan dilakukannya beberapa pemeriksaan pasien dengan penyakit DM atau pre-DM. Penilaian rutin mikroalbuminuria harus dilakukan untuk mengidentifikasi pasien yang berisiko mengalami disfungsi ginjal dan/atau penyakit jantung dan pembuluh darah. Elektrokardiogram (EKG) istirahat diindikasikan pada pasien dengan DM dan hipertensi, atau jika diduga terdapat penyakit jantung dan pembuluh darah. Tes lain, seperti ekokardiografi transtoraks, skor kalsium arteri koroner (CAC), dan indeks pergelangan kaki brakialis (ABI), dapat dipertimbangkan untuk menguji penyakit jantung struktural atau sebagai pengubah risiko pada mereka yang berisiko sedang atau tinggi<!--[if supportFields]>ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1093/eurheartj/ehz486","ISSN":"15229645","PMID":"31497854","author":[{"dropping-particle":"","family":"Cosentino","given":"Francesco","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Grant","given":"Peter J.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Aboyans","given":"Victor","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Bailey","given":"Clifford 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Karena seringkali tidak terdeteksi sampai stadium lanjut penyakit, sangat baik bila kita bisa mencegah terjadinya Penyakit Jantung Diabetik ini. Perubahan gaya hidup adalah kunci untuk mencegah DM dan komplikasi penyakit jantungnya. Adapun beberapa perubahan gaya hidup yang dapat dilakukan untuk mencegah Penyakit Jantung Diabetik adalah menghindari merokok karena merokok dapat meningkatkan risiko diabetes mellitus, penyakit jantung, dan kematian dini, hal ini juga berlaku untuk perokok pasif. Direkomendasikan pada semua penderita diabetes mellitus (DM) dan pre-DM panduan oleh saran terstruktur dalam berhenti merokok Asupan alkohol dalam jumlah sedang tidak boleh dipromosikan sebagai sarana untuk melindungi dari penyakit jantung. Asupan alkohol dalam jumlah sedang tidak boleh dipromosikan sebagai sarana untuk melindungi dari penyakit jantung. Pada penderita diabetes mellitus pengurangan asupan kalori dianjurkan untuk menurunkan berat badan berlebih, kemudian Sayur-sayuran, kacang-kacangan, dan buah-buahan harus menjadi bagian dari pola makan yang sehat,sedangkan suplementasi vitamin atau mikronutrien untuk mengurangi risiko DM atau penyakit jantung pada pasien DM tidak dianjurkan. 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Referensi:
<!--[if supportFields]>ADDIN Mendeley Bibliography CSL_BIBLIOGRAPHY <![endif]-->1. Ritchie RH, Dale Abel E. Basic Mechanisms of Diabetic Heart Disease. Circ Res. 2020;1501–25.
2. Soelistijo SA, Lindarto D, Decroli E, Permana H, Sucipto KW, Kusnadi Y et. al. Pedoman pengelolaan dan pencegahan diabetes melitus tipe 2 di Indonesia 2021. 2021;46.
3. Cosentino F, Grant PJ, Aboyans V, Bailey CJ, Ceriello A, Delgado V, et al. 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J. 2020;41(2):255–323.
Sumber gambar: canva.com
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