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"Kondisi hipertiroidisme berkorelasi dengan kejadian atherosclerosis cardiovascular disease (ASCVD). Hal ini dapat terjadi melalui jalur resistensi insulin, metabolisme lipid, dan inflamasi yang dapat menyebabkan disfungsi endotel. Sebaliknya, pemberian obat antitiroid seperti propiltiourasil (PTU) atau metimazol memiliki potensi untuk memperbaiki disfungsi endotel yang terjadi. PTU memiliki keunggulan dibandingkan metimazol dalam hal menghambat migrasi dan proliferasi otot polos vaskular. Studi ini bertujuan untuk mempelajari peran hormon tiroid dan pengobatannya pada pasien Graves terhadap penanda dini aterosklerosis.Studi ini merupakan uji klinis tersamar tunggal yang dilakukan di RSUPN Dr. Cipto Mangunkusumo (RSCM) pada pasien Graves baru yang diberikan PTU atau metimazol selama 3 bulan. Kedua kelompok diperiksakan HOMA-IR,LDL-R, NF-kB, sICAM-1, sVCAM-1 dan sE-selektin serta pulse wave velocity (PWV) dan carotid intima media thickness (cIMT) saat sebelum terapi, setelah terapi 1 bulan dan 3 bulan. Dilakukan uji Pearson atau Spearman untuk menilai korelasi antar variabel. Perubahan variabel dalam 3 bulan dinilai dengan uji repeated ANOVA. Perbedaan pada kelompok PTU dan metimazol dinilai dengan uji general linear model.Selama bulan Juli 2019 hingga Agustus 2020, didapatkan 36 pasien Graves baru. Pada uji korelasi didapatkan konsentrasi T4 bebas berkorelasi dengan sICAM-1(r = 0,41; p = 0,013) dan sVCAM-1 (r = 0,458; p = 0,005), begitu juga T3 total berkorelasi dengan sICAM-1 (r = 0,513; p = 0,001) dan sVCAM-1 (r = 0,567;p < 0,001). Pada tindak lanjut 3 bulan, didapatkan 24 subjek (13 kelompok PTU dan 11 kelompok metimazol) yang menyelesaikan pemeriksaan dan mencapai eutiroid. Pada kelompok PTU, didapatkan penurunan LDL-R (p = 0,017),sICAM-1 (p = 0,001), sVCAM-1 (p < 0,001) dan sE-selektin (p = 0,045). Pada kelompok metimazol terjadi penurunan hanya pada LDL-R (p = 0,011) dan sVCAM-1 (p = 0,001). Namun pada perbandingan kedua kelompok tidak berbeda bermakna. Parameter PWV dan cIMT juga tidak berbeda bermakna.Simpulan: Pada penelitian ini kondisi hipertiroid pasien Graves berkorelasi dengan peningkatan sICAM-1 dan sVCAM-1 sebagai penyebab aterosklerosis. Pemberian obat antitiroid dapat menurunkan LDL-R, sICAM-1, sVCAM-1 dan sE-selektin. PTU memiliki mekanisme yang berbeda dari metimazol dalam patofisiologi aterosklerosis. Akan tetapi, belum didapatkan bukti pada perubahan PWV dan cIMT

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Hyperthyroidism is correlated with atherosclerosis cardiovascular disease (ASCVD). The basic mechanisms are through insulin resistance, lipid metabolism, and inflammation resulted in endothelial dysfunction. On the other hand, antithyroid drugs such as propiltiourasil (PTU) or methimazole have the potential to improve the endothelial dysfunction. PTU is believed to have a better profile than methimazole in reducing smooth muscle cells migration and proliferation. This study aims to investigate the effect of thyroid hormone and its treatment in Graves’ disease to early marker of atherosclerosis.

This study is a single-blinded clinical trial conducted in dr. Cipto Mangunkusumo General Hospital (RSCM) to newly diagnosed Graves’ patient treated with PTU or methimazole for 3 months. Both groups were examined for LDL-R, NF-ĸB, sICAM-1, sVCAM-1, sE-selectin, pulse wave velocity (PWV) and carotid intima media thickness (cIMT) at baseline, after 1 month and 3 months treatment. Pearson or Spearman test was done to analyze correlation between tested variables. Repeated ANOVA test was done to analyze the changes in those variables during 3 months treatment. Difference between PTU and methimazole groups was analyzed with general linear model test.

From July 2019 to August 2020, 36 newly diagnosed Graves’ patients were included in the study. Correlation test showed free T4 concentration correlated to sICAM-1 (r = 0.41; p = 0.013) and sVCAM-1 (r = 0.458; p = 0.005), and total T3 also correlated to sICAM-1 (r = 0.513; p = 0.001) and sVCAM-1 (r = 0.567; p < 0.001). After 3 months follow up, 24 subjects (13 from PTU group and 11 from methimazole group) reached euthyroid state and included in the analysis. In PTU group, we found reduction in LDL-R (p = 0.017), sICAM-1 (p = 0.001),

sVCAM-1 (p < 0.001) and sE-selectin (p = 0.045). While in methimazole groups, we only found reduction in LDL-R (p = 0.011) and sVCAM-1 (p = 0.001). However, after comparing both groups, the differences were not statistically significant. We found no significant changes in PWV and cIMT parameter.

In conclusions, this study found that hyperthyroidism in Graves’ patient correlated with increase in sICAM-1 and sVCAM-1, which are the early markers of atherosclerosis. Antithyroid drugs can lower LDL-R, sICAM-1, sVCAM-1 and sE-selectin. PTU had a different mechanism in pathophysiology of atherosclerosis compared to methimazole. However, we found no evidence in PWV and cIMT changes"

"Latar Belakang: Artritis Reumatoid (AR) adalah penyakit inflamasi kronik progresif, yang selain menyebabkan peningkatan morbiditas akibat kecacatan sendi, juga menyebabkan peningkatan mortalitas terkait kejadian kardiovaskular. Salah satu prediktor peningkatan risiko mortalitas kardiovaskular adalah kekakuan arteri (KA) lokal. Proses inflamasi pada AR yang dicerminkan oleh derajat aktivitas penyakit berupa disease activity score (DAS) 28, baik yang dinilai dengan c reactive protein (CRP) dan laju endap darah (LED) diduga memiliki hubungan terhadap KA. Penelitian ini dimaksudkan untuk mengetahui korelasi antara derajat aktivitas penyakit dengan kekakuan arteri pada penderita AR. Metode: Penelitian ini merupakan studi potong lintang pada penderita AR yang berobat di poliklinik Reumatologi RSCM dalam periode April-Mei 2014. Dilakukan pengukuran KA lokal dengan USG arteri karotis komunis menggunakan teknik rf-echotracking untuk mendapatkan nilai pulse wave velocity (PWV) serta penilaian DAS 28-CRP dan DAS 28-LED. Data penyerta yang juga dikumpulkan adalah data demografis, durasi dan jenis pengobatan, glukosa darah sewaktu, profil lemak darah, kreatinin, dan faktor risiko tradisional kejadian kardiovaskular. Hasil: Sebanyak 74 subjek diikutsertakan pada penelitian ini, dengan 68 (91,9%) adalah wanita. Rerata nilai KA (PWV) yaitu 7,89 (SB 1,92) m/detik yang termasuk dalam kategori kaku. Rerata nilai DAS 28-CRP 2,46 (SB 0,82) dan DAS 28-LED 3,49 (SB 0,91) yang masing-masing termasuk dalam kelompok aktivitas penyakit rendah dan sedang. Pada analisis bivariat didapatkan korelasi DAS 28-CRP dan DAS 28-LED terhadap KA, masing-masing dengan nilai r = 0,529 (p = 0,001) dan r = 0,493 (p = 0,001). Simpulan: Terdapat korelasi positif sedang yang bermakna antara derajat aktivitas penyakit (DAS 28-CRP dan DAS 28-LED) dengan kekakuan arteri (PWV).

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Background: Rheumatoid arthritis (RA) is a chronic progressive inflammatory disease related to increase in morbidity due to joint deformity and increase in mortality due to cardiovascular event. One of cardiovascular event predictor is local arterial stiffness (AS). Inflammatory process in RA that is reflected on disease activity score (DAS) 28 calculated by c-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) suspect to be related with AS. This study was aimed to find correlation between disease activity score and arterial stiffness in RA patients.

Methods: a cross sectional study was conducted in Rheumatology outpatient clinic, Cipto Mangunkusumo Hospital between April-May 2014. Arterial stiffness was measured by carotid artery ultrasound using echotracking technic to get pulse wave velocity (PWV) value, also DAS 28-CRP and DAS 28-ESR measurement was done in every subject. Others data which also collected in this study are demographic profile, duration and drugs of treatment, random blood glucose, lipid profile, creatinin, and others cardiovascular risk factors.

Results: 74 subjects met the inclusion criteria, with 68 (91,9%) are women. Mean of AS (PWV) 7,89 (SD 1,92) m/second, which categorized in stiff artery. Mean of DAS 28-CRP 2,46 (SD 0,82) and DAS 28-ESR 3,49 (SD 0,91), each of them was categorized in low and moderate disease activity. In bivariate analysis we found correlation of DAS 28-CRP and DAS 28 ESR to AS (PWV) r = 0,529 (p= 0,001) and r = 0,493 (p = 0,001).

Conclusion: There was positive and significant correlation between disease activity score (DAS 28-CRP and DAS 28-ESR) with arterial stiffness (PWV)."

"ABSTRAKBackground: periodontitis is a major cause of chronic infection in diabetic patients. Diabetic patients have four-fold risk of having cardiovascular disease. Chronic inflammation caused by periodontitis, a non-traditional cardiovascular risk factor is widely known to play a major role in atherogenesis. Among non-diabetics, an association has been found between periodontitis and arterial stiffness, but in diabetic patients the result is inconsistent. No study has investigated either the proportion of periodontitis or its correlation with arterial stiffness in type 2 diabetes population in Indonesia. Methods: this study was a cross-sectional study involving 97 patients with type 2 diabetics, who were recruited on Endocrinology Clinic from April to August 2017. Periodontitis was measured for pocket depth, clinical attachment loss and bleeding on probing by a periodontist. Carotid-femoral PWV (Pulse Wave Velocity) was measured using SphygmoCor Xcel with cuff-based tonometry technique. Results: periodontitis was found in 99% type 2 diabetic subjects and 78% of them had severe periodontitis. There was no significant correlation found between pocket depth, clinical attachment loss and cfPWV (r=0.024, p=0.407 and r=0.011, p=0.456); whereas there was a weak positive correlation between pocket depth and PWV (r=0.294, p=0.041) in well-controlled type 2 diabetics. Conclusion: most of type-2 diabetics had severe periodontitis; however, the correlation between periodontitis and arterial stiffness could not be concluded in this study."

"ABSTRAKLatar Belakang : Penyakit kardiovaskular merupakan ancaman bagi pasien lupus eritematosus sistemik LES . Penilaian indeks massa tubuh IMT sebagai faktor risiko tradisional penyakit kardiovaskular bersifat tidak akurat akibat terjadinya kaheksia reumatoid pada pasien LES. Pengukuran persentase lemak viseral secara khusus diperkirakan dapat menggantikan IMT. Kekakuan arteri KA merupakan prediktor penyakit kardiovaskular dan penelitian yang ada membuktikan bahwa terjadi peningkatan kekakuan arteri pada pasien LES. Penelitian ini dimaksudkan untuk mengetahui korelasi antara persentase lemak viseral dengan kekakuan arteri pada pasien LES. Metode : Penelitian ini merupakan studi potong lintang pada pasien LES yang berobat di poliklinik Reumatologi/ Alergi-Imunologi RSCM dalam periode Maret-Mei 2016. Dilakukan pengukuran KA lokal dengan USG arteri karotis komunis menggunakan teknik rf-echotracking untuk mendapatkan nilai pulse wave velocity PWV serta penilaian persentase lemak viseral menggunakan Bioelectrical Impedance Analysis BIA - Karada Scan HBF-214.Hasil Penelitian : Sebanyak 56 pasien perempuan yang menderita LES diikutsertakan dalam penelitian ini. Rerata nilai KA PWV yaitu 7,23 1,40 m/detik yang termasuk dalam kategori kaku. Rerata persentase lemak viseral didapatkan 4,28 2,74 yang termasuk dalam kategori normal. Pada analisis bivariat tidak didapatkan korelasi persentase lemak viseral dengan KA, dengan nilai r = 0,101 p = 0,458 Kesimpulan : Tidak terdapat korelasi antara persentase lemak viseral dengan kekakuan arteri pada pasien LES yang memiliki persentase lemak viseral yang normal.

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ABSTRACTBackground Cardiovascular disease is a threat for systemic lupus erythematosus SLE patients. Assessment of body mass index BMI as the traditional risk factor for cardiovascular disease is not accurate due to the occurrence of rheumatoid cachexia. The measurement of visceral fat percentage is expected to replace the assesment of BMI . Arterial stiffness AS is a predictor of cardiovascular disease and many studies have shown arterial stiffness in SLE patients. This study was aimed to find correlation between visceral fat percentage and arterial stiffness in SLE patients. Methods A cross sectional study was conducted at Cipto Mangunkusumo Hospital rheumatology allergy immunology outpatient clinic between March May 2016. Arterial stiffness was measured by carotid artery ultrasound using rf echotracking technic to get pulse wave velocity PWV value. Assessment of visceral fat percentage was measured by using bioelectrical impedance analysis BIA Karada Scan HBF 214 . Results 56 SLE female subjects met the inclusion criteria. Mean of PWV 7,23 1,40 m s, which was categorized in stiff artery. Mean of visceral fat percentage 4,28 2,74 , which was categorized in normal. In bivariate analysis we found no correlation between visceral fat percentage with arterial stiffness r 0,101 p 0,458 Conclusion There was no correlation between visceral fat percentage with arterial stiffness PWV in SLE patients with normal percentage of visceral fat. "