√ HIPERLIPIDEMIA : 11 Terapi Pengobatan Hiperlipidemia

Terapi pengobatan penyakit hiperlipidemia – Pasti anda penasaran apa itu penyakit hiperlipidemia? Apa gejala hiperlipidemia? Bagaimana terapi pengobatan hiperlipidemia? Itu adalah pertanyaan yang banyak ditanyakan seseorang yang baru mendengar tentang penyakit hiperlipidemia. Hiperlipidemia atau lebih tepatnya disebut hiperlipoproteinemia. Definisi hiperlidemia adalah keadaan dimana kadar protein dalam darah meningkat karena predisposisi genetik (keturunan) dan atau yang berhubungan dengan diet individual. Pada umumnya orang lebih mengenal penyakit ini dengan istilah kolesterol tinggi.
penyakit hiperlipidemia kolesterol tinggi
penyakit hiperlipidemia kolesterol tinggi
Terapi pengobatan pada penderita penyakit hiperlidemiabiasanya menggunakan jenis obat – obat antihiperlipidemik (hipolipidemika) adalah golongan obat antihiperlipidemiayang digunakan untuk menurunkan kadar lipida darah yang melebihi ambang batas normal. Lipida darah (lipida plasma) terdiri dari lemak – lemak netral (trigliserida), kolesterol (kolesterin) dan fosfolipida. Karena lipid tidak larut dalam air, zat tersebut dibawa dalam plasma dari jaringan ke jaringan dengan cara terikat pada protein. Lipid yang terikat dengan protein plasma ini disebut dengan lipoprotein. Berdasarkan densitas nya lipoprotein dibagi menjadi 4 macam golongan.
Macam – macam Jenis Lipoprotein Menurut Densitas
a. Kilomikron
Dibentuk di dinding usus dari trigliserida dan kolesterol berasal dari makanan.
b. VLDL ( Very Low Density Lipoprotein ) atau lipoprotein densitas sangat rendah
Bersama kilomikron mengangkut sebagian besar trigliserida dan asam lemak bebas dari hati ke jaringan otot dan lemak. Berat jenil VLDL rendah sekali.
c. LDL ( Low Density Lipoprotein ), atau lipoprotein densitas rendah
Mengangkut sebagian besar kolesteroll darah dari hati ke jaringan.
d. HDL ( Hight Density Lipoprotein ) atau lipoprotein densitas tinggi
Mengangkut kelebihan kolesterol dan asam lemak yang tidak dapat diggunakan oleh jaringan perifer kembali ke hati untuk diubah menjadi asam empedu.
HDL memiliki prosentase protein lebih banyak dan prosentase lipid lebih sedikit. Fungsinya adalah untuk menghilangkan kolesterol yang tertimbun di aliran darah dan membawanya ke hati. Karena itu HDL dikatakan bekerja melindungi tubuh dari aterosklerosis sehingga HDL diseut kolesterol “baik”. Kilomikron, VLDL dan LDL terdiri dari kolesterol dan trigliserida dan membantu terjadinya aterosklerosis, sehingga ketiganya ini biasa disebut kolesterol “jahat”.
Kadar lipida darah dan lipoprotein dapat meningkat karena faktor lingkungan (hiperlipidemia/ hiperlipoproteinemia sekunder) seperti karena faktor berat badan berlebih karena cara diet yang salah, konsumsi alkohol dan penyakit metabolisme (hipotiroid, DM, pirai), atau kelainan genetik (hiperlipidemia/ hiperlipoproteinemia primer). Jika kolesterol, trigliserida dan LDL meningkat maka resiko seseorang menderita penyakit jantung koroner (PJK) semakin meningkat pula.
Berikut tabel berbagai lipida darah dan nilai normalnya sesuai klasifikasi berdasarkan risiko.
Kadar plasma
Ideal mg% (mmol)
Normal mg%
Meningkat sedang
Sangat
Kolesterol
< 200
200 – 225
>  225
>  250
< 195 (5)
195 – 250
>  250 (6.5)
>  310 (8.0)
Trigliserida
< 200
200 – 240
>  240
>  1000
< 90 (1.0)
90 -180
>  180 (2.0)
>  550 (6.0)
LDL
< 130
130 – 160
>  160
>  200
< 140 (360)
140 – 175
>  175 (4.5)
>  220 (5.7)
HDL
> 60
35 – 60
< 35

obat penyakit hiperlipidemia kolesterol tinggi
obat penyakit hiperlipidemia kolesterol tinggi

Pengobatan hiperlipidemia dapat dilakukan dengan 2 cara yaitu terapi hiperlipidemia secara non farmakologi dan terapi hiperlipidemia secara farmakologi.

A. Terapi Non Farmakologi Hiperlidemia
Terapi non farmakologi yang dilakukan adalah dengan diet, merupakan terapi permulaan bagi hiperlipidemia sebelum mempertimbangkan terapi farmakologi atau farmakoterapi. Pengaturan diet dilakukan dengan :
1. Pengurangan konsumsi lemak jenuh. Lemak jenuh terdapat dalam daging hewani termasuk daging ikan, minyak tumbuhan (minyak kelapa dan minyak kelapa sawit) dan susu yang dapat diganti susu rendah lemak, mentega lunak dan minyaktumbuhan cair.
2. Konsumsi lemak tak jenuh (poly dan mono unsaturated) sebagai pengganti minyak lemak jenuh. Terdapat pada minyak tumbuhan, margarin, minyak zaitun dan canola.
3. Pengurangan konsumsi kolesterol. Terdapat pada kuning telur, hati, ginjal, otak dan roti tart.
4. Meningkatkan konsumsi buah-buahan segar, sayur dan produk biji-bijian utuh untuk menambah keragaman gizi serta serat.
5. Untuk mendukung upaya diet, perlu diikuti upaya penunjang yaitu menurunkan berat badan karena dapat meningkatkan kadar HDL dan olahraga karena dapat menurunkan kadar trigliserida, kolesterol dan meningkatkan kadar HDL. Pada banyak kasus, diet saja ternyata tidak cukup untuk menurunkan kadar lipid dalam darah, karena 75 – 80 % kolesterol darah berasal dari bahan-bahan dari dalam tubuh sendiri (endogen). Diet hanya akan menurunkan kolesterol total sebanyak 10 – 30 %. Jika hiperlipidemia tidak dapat dikendalikan dengan diet dan olahraga, maka terapi farmakologi merupakan alternatif pilihan selanjutnya.
B. Terapi Farmakologi Hiperlipidemia
Terapi farmakologi atau farmakoterapi menggunakan obat-obatan antihiperlipidemia meliputi :
6. Asam Nikotinat
Obat ini mempunyai kemampuan menurunkan lipid, tetapi penggunaan klinis terbatas karena efek samping yang tidak menyenangkan.
Mekanisme kerja : menghambat lipolisis trigliserida menjadi asam lemak bebas. Di hati, asam lemak bebas adalah bahan sintesis trigliserida yang diperlukan untuk sintesis VLDL. VLDL adalah bahan utama untuk sintesis LDL. Dengan demikian obat ini dapat menurunkan kadar trigliserida ( dalam VLDL ) dan kolesterol ( dalam VLDL dan LDL ).
Efek samping : kemerahan pada kulit (disertai perasaan panas) dan pruritus (rasa gatal pada kulit), pada bagian pasien mengalami mual dan sakit pada abdomen, meningkatkan kadar asam urat (hiperurikemia) dengan menghambat sekresi tubular asam urat, toleransi glukosa dan hepatotoksik.
7. Derivat Fibrat
Termasuk golongan ini adalah Fibrat, Klofibrat, Simfibrat, Fenofibrat, Bezafibrat dan Gemfibrozil yang menurunkan kadar trigliserida darah. Obat ini sedikit menurunkan kadar kolesterol. Digunakan terutama untuk menurunkan VLDL pada hiperlipidemia tipe IIb, III dan V.
Mekanisme kerja : memacu aktivitas lipase lipoprotein, sehingga menghidrolisis trigliserida pada kilomikron dan VLDL.
Efek samping : terdapat gangguan pencernaan ringan, pembentukan batu empedu, ada pula yang terjadi peradangan otot polos.
8. Damar Penukar Anion atau Pengikat Asam Empedu
Termasuk golongan ini adalah Kolesteramin dan Kolestipol.
Mekanisme kerja : obat ini merupakan resin (damar) penukar ion yang bersifat basa, yang mempunyai afinitas tinggi terhadap asam empedu. Asam empedu akan diikat oleh resin ini, membentuk senyawa yang tidak larut dan tidak dapat direabsorbsi untuk selanjutnya diekskresi melalui feses. Dengan demikian ekskresi asam empedu yang biasanya sedikit akibat peredaran darah enterohepaik, dapat ditingkatkan hampir 10 kalinya. Kekurangan asam empedu didapat dari sintesis baru dari kolesterol (yang terdapat dalam LDL), dengan demikian kadar LDL plasma menurun.
Efek samping : menganggu absorbsi vitamin yang larut dalam lemak (vitamin A, D, E dan K) pada resin dosis tinggi, menimbulkan rasa tidak nyaman pada saluran pencernaan seperti konstipasi, ras amual dan kembung (flatulen).
Obat golongan ini sebaiknya diminum sebbelum makan da dicampur dengan air jeruk atau jus lainnya, dan tidak diperbolehkan diminum bersama dnegan obat lain.
9. Probukol
Obat ini selain menurunkan kadar LDL juga menurunkan kadar HDL, sehingga tidak disukai. Namum sifat antioksidannya penting dalam menghambat aterosklerosis.
Mekanisme kerja : menghambat oksidasi kolesterol, sehingga terjadi penguraian LDL-kolesterol yang teroksidasi oleh makrofag. Makrofag yang dimuati oleh kolesterol , menjadi sel busa yang menempel pada vaskular dan menurunkan dasar pembentukan plak pada aterosklerosis. Dengan demikian, pencegahan oksidasi kolesterol akan menghambat perkembangan aterosklerosis.
Efek samping : gangguan pencernaan ringan.
10. Statin
Termasuk golongan ini adalah Lovastatin, Pravastatin, Simvastatin dan Fluvastatin.
Mekanisme kerja : menghambat enzim HMG Co A reduktase dalam sintesis kolesterol, dengan demikian akan meningkatkan penguraian kolesterol intrasel sehingga mengurangi simpanan kolesterol intrasel.
Efek samping : kelainan biokimia fungsi hati dan gangguan otot (miopati)
Interaksi obat : meningkatkan kadar Kumarin (antikoagulan) sehingga meningkatkan risiko pendarahan.
Golongan ini tidak boleh diberikan pada wanita hamil dan menyusui, anak – anak dan remaja.
11. Obat Lain
– Minyak Ikan
Sediaan minyak ikan yang kaya akan trigliserida laut omega-3, bermanfaat dalam engobatan hipertrigliseridemia berat. Meskipun demikian, kadang – kadang minyak ikan dapat memperburuk hiperkolesteromia.
– Bawang Putih
Memiliki khasiat antiaterogen (menurunkan LDL, menghambat agregasi trombosit dan menurunkan tekanan darah), berguna sebagai obat tambahan pada penanganan dan pencegahan aterosklerosis.Memiliki khasiat antiaterogen (menurunkan LDL, menghambat agregasi trombosit dan menurunkan tekanan darah), berguna sebagai obat tambahan pada penanganan dan pencegahan aterosklerosis.
C. Terapi Kombinasi Obat Antihiperlipidemia
Kadang – kadang perlu memberikan dua jenis obat antihiperlipidemia untuk mendapatkan kadar lipid plasma yang signifikan, misalnya :
a. Kombinasi Niasin dan resin pengikat empedu (Kolesteramin), efektif menurunkan kadar kolesterol LDL dan VLDL plasma.
b. Kombinasi HMG CoA reduktase dengan Resin pengikat empedu, efektif dalam menurunkan kolesterol LDL.
Demikian tadi informasi mengenai definisi penyakit hiperlipidemia, gejala hiperlipidemia, penyebab hiperlipidemia dan obat hiperlipidemia atau yang lebih dikenal dengan penyakit kolesterol tinggi semoga bermanfaat dan menambah wawasan anda.

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