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"Latar belakang : Setiap tahapan gangguan metabolisme glukosa pada disglikemia berhubungan dengan peningkatan risiko kejadian kardiovaskular. Pada disglikemia perlu diketahui prediktor serta stratifikasi risiko individu mengalami kejadian kardiovaskular sehingga dapat dilakukan pencegahan primer. Penelitian ini bertujuan mengembangkan model prediktor kejadian kardiovaskular pada disglikemia.Metode : Penelitian ini merupakan penelitian kohort retrospektif pada “Studi Kohort Faktor Risiko Penyakit Tidak Menular Bogor” tahun 2011-2018. Pada awal penelitian dilakukan pencatatan usia, jenis kelamin, tekanan darah, indeks massa tubuh, lingkar perut, glukosa darah, kolesterol, kebiasaan merokok, riwayat penyakit kardiovaskular dalam keluarga dan aktivitas fisik. Selanjutnya dilakukan pengamatan kejadian kardiovaskular yaitu penyakit jantung koroner, stroke atau all cause cardiovascular mortality dalam enam tahun. Hubungan variabel yang secara independen yang mempengaruhi kejadian kardiovaskular dianalisis dengan cox proportional hazards regression, lalu dilakukan pembuatan model prediksi, penilaian diskriminasi dengan menggunakan kurva ROC dan kalibrasi dengan Hosmer -Lemeshow.Hasil : Sebanyak 1.085 subjek masuk dalam penelitian ini dengan 73,5% subjek adalah perempuan. Insidens kejadian kardiovaskular dalam enam tahun adalah 9,7%. Faktor prediktor kejadian kardiovaskular pada disglikemia dalam enam tahun pada penelitian yaitu usia 45-65 tahun (HR=2,737; IK 95% 1,565-4,787) dan hipertensi (HR=2,580;IK 95% 1,619-4,112). Total skor pada model prediktor adalah dua dengan probabilitas kejadian kardiovaskular dalam enam tahun 17,2%. Hasil analisis kurva ROC didapatkan nilai Area Under the Curve (AUC) model prediktor sebesar 0,689 dengan p < 0,001 (IK 95% 0,641-0,737).

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Background: Each stage of impaired glucose metabolism in dysglycemia is associated with an increased risk of cardiovascular events. In dysglycemia, it is necessary to acknowledge the predictors and the risk stratification in individuals at high risk for cardiovascular disease so that primary prevention can be done. This study aims to develop a predictive model of cardiovascular events in dysglycemia.

Method: This is a retrospective cohort study conducted in the “The Bogor Cohort Study of Noncommunicable Diseases Risk Factors" from 2011 to 2018. Data associated with age, gender, blood pressure, body mass index, waist circumference, blood glucose, cholesterol, smoking habits, family history of cardiovascular disease, and physical activity were obtained. Cardiovascular events in six years were observed include coronary heart disease, stroke, or all-cause cardiovascular mortality. Cox proportional hazards regression models were used to determine independent predictors of cardiovascular events. Model discrimination was evaluated by the ROC curve, while the Hosmer-Lemeshow test evaluated the calibration.

Results: A total of 1085 subjects included in this study, with 73.5% are female. The incidence of cardiovascular events in six years is 9.7%. Predictors of cardiovascular events in dysglycemia are age 45-65 (HR=2.737;95% CI 1.565-4.787) and hypertension (HR=2.580;95% CI 1.619-4.112). The predictor model's total score is two, with a six-year probability of cardiovascular events being 17.2%. The ROC curve analysis showed that the AUC value for the predictor model was 0.689 with p < 0.001 (95% CI 0.641-0.737).

Conclusion: Age 45-65 and hypertension were predictors of cardiovascular events in six years in dysglycemia patients. The scoring system has adequate performance, with a total score of two and the probability of cardiovascular events in six years 17.2%."

"Studi terbaru mendasari pentingnya permeabilitas usus dan inflamasi kronis dalam patogenesis DMT2. Studi kami membandingkan konsentrasi FABP2 dan YKL40 sebagai penanda permeabilitas usus dan peradangan di antara normoglikemia, pradiabetes, dan DMT2. Kami merekrut 122 peserta (45 normoglikemik, 26 pradiabetes, dan 51 DMT2) di antaranya kami mengukur kadar FABP2 dan YKL-40 serum puasa menggunakan metode ELISA. Tingkat FABP2 secara signifikan lebih tinggi pada kelompok DMT2 [2,890(1,880 – 4,070)] dibandingkan dengan kedua pradiabetes [2,025 (1,145 – 2,343), p=0,0085] dan kelompok normoglikemia [1,72 (1,250 – 2,645), p=0,011 ]. Tingkat YKL-40 juga secara signifikan lebih tinggi pada kelompok DMT2 [68,70 (44,61 – 166,6)] dibandingkan dengan kedua pradiabetes [28,85 (20,64 – 41,53), p<0,0001] dan kelompok normoglikemia [28,64 (19,25 – 43,87), p<0,001]. Studi kami mengamati bahwa kadar FABP2 dan YKL-40 tertinggi pada kelompok T2DM yang mendukung bukti yang tersedia tentang peran gangguan permeabilitas usus dan peradangan kronis tingkat rendah dalam patogenesis T2DM.

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Recent studies underlie the importance of intestinal permeability and chronic inflamamation in the pathogenesis of T2DM. Our study compared the concentrations of FABP2 and YKL40 as markers of intestinal permeability and inflammation among normoglycemia, prediabetes and T2DM. We recruited 122 participants (45 normoglycemic,  26 prediabetes, and 51 T2DM) of whom we measured the fasting serum levels of FABP2 and YKL-40 using ELISA method. The levels of FABP2 were significantly higher in the T2DM group [2.890(1.880 – 4.070)] in comparison to both prediabetes [2.025 (1.145 – 2.343), p=0.0085] and normoglycemia group [1.72 (1.250 – 2.645), p=0.011]. The levels of YKL-40 were also significantly higher in the T2DM group [68.70 (44.61 – 166.6)] in comparison to both prediabetes [28.85 (20.64 – 41.53), p<0.0001] and normoglycemia group [28.64 (19.25 – 43.87), p<0.001]. Our study observed that the levels of  FABP2 and YKL-40 were highest in the T2DM group supporting the available evidences on the role of intestinal permeability disruption and chronic low-grade inflammation in the pathogenesis of T2DM."

"ABSTRAK Latar belakang: disglikemia adalah keadaan intoleransi glukosa berupa peningkatan kadar gula darah yang berhubungan dengan risiko penyakit kardiovaskular. Seiring dengan waktu, pada akhirnya diabetes akan menimbulkan kerusakan pada target organ, salah satu yang penting adalah pada sistem organ kardiovaskular, dapat berupa penyakit jantung koroner, kardiomiopati diabetes, penyakit serebrovaskuler, dan penyakit arteri perifer. Diabetes juga meningkatkan risiko terjadinya gagal jantung. Pada kardiomiopati diabetes, proses fibrosis yang masih reversibel sudah mulai terjadi bahkan ketika penderita masih asimtomatik. Pemeriksaan baku emas untuk mendeteksi terjadinya fibrosis miokard secara dini adalah pemeriksaan histopatologi jaringan miokardium melalui biopsi. Akan tetapi pemeriksaan ini sangat invasif dan tidak nyaman bagi subjek. Pemeriksaan yang kemudian berkembang adalah pencitraan menggunakan Cardiac Magnetic Resonance Imaging (CMRI). Akan tetapi pemeriksaan ini cukup mahal, dan tidak tersedia pada semua fasilitas kesehatan. Sementara itu, ST2 adalah penanda enzim jantung yang menggambarkan derajat proses fibrosis yang sedang terjadi pada miokard, terutama pada keadaan gagal jantung. Pemeriksaan menggunakan penanda enzim dapat menjadi alternatif dengan keuntungan lebih murah, dapat terjangkau luas dan mudah tersedia. Tujuan: Mengetahui hubungan antara kadar ST2 serum dengan fibrosis miokard interstisial pada penderita disglikemia. Metode: Pasien disglikemia yang lolos kriteria eksklusi berupa komorbid kardiovaskular akan menjalani pemeriksaan kadar ST2 serum dan T1 relaxation time menggunakan Cardiac MRI. Selanjutnya dilakukan analisis hubungan antara kadar ST2 serum dan T1 relaxation time. Hasil penelitian: Sebanyak 34 pasien diikutsertakan ke dalam penelitian ini. Didapatkan kisaran nilai kadar ST2 serum antara 12.40-53.22 ng/dL (median 19.95 ng/dL). Rerata nilai T1 relaxation time didapatkan sebesar 443.39 ± 113.35 ms. Terdapat korelasi bermakna antara kadar ST2 serum dengan fibrosis diffuse miokardium (Spearman correlation r = -0,547, p < 0.01). Pada analisa multivariat hubungan antara kadar ST2 serum dan T1 relaxation time tidak dipengaruhi oleh faktor perancu yang telah ditetapkan (r = -0,44, p = 0,033). Kesimpulan: Hasil penelitian ini menunjukkan kadar ST2 serum berkolerasi dengan fibrosis diffuse miokardium pada populasi disglikemia.ABSTRACT Background: disglycemia is a state of glucose intolerance include increased blood sugar levels associated with risk of cardiovascular disease. Over time, eventually diabetes will cause damage to the target organ, especially the cardiovascular system, which include coronary heart disease, diabetic cardiomyopathy, diabetes, cerebrovascular disease, and peripheral arterial disease. Diabetes also increases the risk of heart failure. The clinical appearance of the disease is wide ranging from asymptomatic to symptomatic heart failure. Gold standard examination to detect the occurrence of early myocardial fibrosis is histopathological examination of myocardial tissue via biopsy. However, these tests are very invasive and uncomfortable for the subject. Examination which later evolved is imaging using cardiac magnetic resonance imaging (CMRI). However, these tests are quite expensive, and not available at all health facilities. Meanwhile, ST2 is a cardiac enzyme marker that describes the degree of fibrosis process in the myocardium, especially in the state of heart failure. Examination using enzyme markers can be a cheaper alternative, widely accessible and readily available. Aim: Knowing the relationship between serum levels of ST2 with myocardial interstitial fibrosis in disglycemic patients. Methods: Disglycemic patients who passed from the exclusion criteria (cardiovascular comorbid), will undergo a serum ST2 levels and T1 relaxation time using cardiac MRI. Then we analyzed the relationship between serum levels of ST2 and T1 relaxation time. Results: A total of 34 patients were included in this study. The range values of serum ST2 levels were between 12.40-53.22 ng/dL (median 19.95 ng/dL). The mean value of T1 relaxation time were 443.39 ± 113.35 ms. There is a significant correlation between serum levels of ST2 with diffuse myocardial fibrosis (Spearman correlation r = -0.547, p <0:01). Multivariate analysis showed the relationship between serum levels of ST2 and T1 relaxation time is not influenced by confounding factors (r = -0.44, p = 0.033). Conclusion: ST2 serum levels correlates with diffuse myocardial fibrosis on disglycemic population.;Background: disglycemia is a state of glucose intolerance include increased blood sugar levels associated with risk of cardiovascular disease. Over time, eventually diabetes will cause damage to the target organ, especially the cardiovascular system, which include coronary heart disease, diabetic cardiomyopathy, diabetes, cerebrovascular disease, and peripheral arterial disease. Diabetes also increases the risk of heart failure. The clinical appearance of the disease is wide ranging from asymptomatic to symptomatic heart failure. Gold standard examination to detect the occurrence of early myocardial fibrosis is histopathological examination of myocardial tissue via biopsy. However, these tests are very invasive and uncomfortable for the subject. Examination which later evolved is imaging using cardiac magnetic resonance imaging (CMRI). However, these tests are quite expensive, and not available at all health facilities. Meanwhile, ST2 is a cardiac enzyme marker that describes the degree of fibrosis process in the myocardium, especially in the state of heart failure. Examination using enzyme markers can be a cheaper alternative, widely accessible and readily available. Aim: Knowing the relationship between serum levels of ST2 with myocardial interstitial fibrosis in disglycemic patients. Methods: Disglycemic patients who passed from the exclusion criteria (cardiovascular comorbid), will undergo a serum ST2 levels and T1 relaxation time using cardiac MRI. Then we analyzed the relationship between serum levels of ST2 and T1 relaxation time. Results: A total of 34 patients were included in this study. The range values of serum ST2 levels were between 12.40-53.22 ng/dL (median 19.95 ng/dL). The mean value of T1 relaxation time were 443.39 ± 113.35 ms. There is a significant correlation between serum levels of ST2 with diffuse myocardial fibrosis (Spearman correlation r = -0.547, p <0:01). Multivariate analysis showed the relationship between serum levels of ST2 and T1 relaxation time is not influenced by confounding factors (r = -0.44, p = 0.033). Conclusion: ST2 serum levels correlates with diffuse myocardial fibrosis on disglycemic population.;Background: disglycemia is a state of glucose intolerance include increased blood sugar levels associated with risk of cardiovascular disease. Over time, eventually diabetes will cause damage to the target organ, especially the cardiovascular system, which include coronary heart disease, diabetic cardiomyopathy, diabetes, cerebrovascular disease, and peripheral arterial disease. Diabetes also increases the risk of heart failure. The clinical appearance of the disease is wide ranging from asymptomatic to symptomatic heart failure. Gold standard examination to detect the occurrence of early myocardial fibrosis is histopathological examination of myocardial tissue via biopsy. However, these tests are very invasive and uncomfortable for the subject. Examination which later evolved is imaging using cardiac magnetic resonance imaging (CMRI). However, these tests are quite expensive, and not available at all health facilities. Meanwhile, ST2 is a cardiac enzyme marker that describes the degree of fibrosis process in the myocardium, especially in the state of heart failure. Examination using enzyme markers can be a cheaper alternative, widely accessible and readily available. Aim: Knowing the relationship between serum levels of ST2 with myocardial interstitial fibrosis in disglycemic patients. Methods: Disglycemic patients who passed from the exclusion criteria (cardiovascular comorbid), will undergo a serum ST2 levels and T1 relaxation time using cardiac MRI. Then we analyzed the relationship between serum levels of ST2 and T1 relaxation time. Results: A total of 34 patients were included in this study. The range values of serum ST2 levels were between 12.40-53.22 ng/dL (median 19.95 ng/dL). The mean value of T1 relaxation time were 443.39 ± 113.35 ms. There is a significant correlation between serum levels of ST2 with diffuse myocardial fibrosis (Spearman correlation r = -0.547, p <0:01). Multivariate analysis showed the relationship between serum levels of ST2 and T1 relaxation time is not influenced by confounding factors (r = -0.44, p = 0.033). Conclusion: ST2 serum levels correlates with diffuse myocardial fibrosis on disglycemic population.;Background: disglycemia is a state of glucose intolerance include increased blood sugar levels associated with risk of cardiovascular disease. Over time, eventually diabetes will cause damage to the target organ, especially the cardiovascular system, which include coronary heart disease, diabetic cardiomyopathy, diabetes, cerebrovascular disease, and peripheral arterial disease. Diabetes also increases the risk of heart failure. The clinical appearance of the disease is wide ranging from asymptomatic to symptomatic heart failure. Gold standard examination to detect the occurrence of early myocardial fibrosis is histopathological examination of myocardial tissue via biopsy. However, these tests are very invasive and uncomfortable for the subject. Examination which later evolved is imaging using cardiac magnetic resonance imaging (CMRI). However, these tests are quite expensive, and not available at all health facilities. Meanwhile, ST2 is a cardiac enzyme marker that describes the degree of fibrosis process in the myocardium, especially in the state of heart failure. Examination using enzyme markers can be a cheaper alternative, widely accessible and readily available. Aim: Knowing the relationship between serum levels of ST2 with myocardial interstitial fibrosis in disglycemic patients. Methods: Disglycemic patients who passed from the exclusion criteria (cardiovascular comorbid), will undergo a serum ST2 levels and T1 relaxation time using cardiac MRI. Then we analyzed the relationship between serum levels of ST2 and T1 relaxation time. Results: A total of 34 patients were included in this study. The range values of serum ST2 levels were between 12.40-53.22 ng/dL (median 19.95 ng/dL). The mean value of T1 relaxation time were 443.39 ± 113.35 ms. There is a significant correlation between serum levels of ST2 with diffuse myocardial fibrosis (Spearman correlation r = -0.547, p <0:01). Multivariate analysis showed the relationship between serum levels of ST2 and T1 relaxation time is not influenced by confounding factors (r = -0.44, p = 0.033). Conclusion: ST2 serum levels correlates with diffuse myocardial fibrosis on disglycemic population."