Identifikasi Aterosklerosis Berdasarkan Perbedaan Kadar Kolesterol dan Kreatinin di Indonesia dengan Analisis Ragam Peubah Ganda

Abstract

Aterosklerosis merupakan penyakit inflamasi kronik berupa terbentuknya plak pada pembuluh arteri akibat dislipidemia. Diagnosis dislipidemia ditentukan berdasarkan peningkatan kolesterol total, low-density lipoprotein (LDL), trigliserida dan penurunan kolesterol high density lipoprotein (HDL) serta ketika fungsi ginjal terganggu akibat peningkatan kadar kreatinin dalam darah. Pengendalian aterosklerosis akan berimplikasi kepada penanganan penyakit tidak menular (PTM) karena dapat dijadikan sebagai deteksi dini khususnya terhadap potensi penyakit kardiovaskular akibat kebiasaan makan dan gaya hidup yang tidak sehat. Kebiasaan makan yang berbeda di setiap daerah akibat perbedaan budaya berpotensi mengakibatkan keberagaman dislipidemia sebagai salah faktor risiko aterosklerosis. Sehingga sangat menarik untuk menentukan apakah aterosklerosis juga akan berbeda seiring perbedaan budaya setiap daerah di Indonesia. Penelitian ini bertujuan untuk mengidentifikasi aterosklerosis berdasarkan perbedaan kadar kolesterol total, HDL, LDL, trigliserida dan kreatinin 35.509 penduduk dari 33 provinsi dan desa-kota di Indonesia. Metode analisis yang digunakan adalah uji MANOVA 2 faktor interaksi dalam menentukan perbedaan keterkaitan kadar kolesterol total, HDL, LDL, trigliserida dan kreatinin penduduk antar provinsi, desa-kota, dan desa-kota setiap provinsi di Indonesia. Analisis dilanjutkan dengan uji ANOVA serta uji lanjut Tukey apabila pada tahap uji MANOVA 2 faktor diperoleh perbedaan yang nyata. Identifikasi aterosklerosis juga dilakukan dengan mengontrol usia penduduk sebagai kovariat yang diyakini mampu meningkatkan akurasi dan presisi pengujian karena melibatkan pengaruh tidak langsung kovariat. Metode analisis yang digunakan adalah uji MANCOVA 2 faktor interaksi. Hasil pada penelitian ini adalah terdapat perbedaan keterkaitan kadar kolesterol total, HDL, LDL, trigliserida dan kreatinin penduduk antar provinsi dan desa dan kota serta desa dan kota setiap provinsi di Indonesia. Penduduk Provinsi Kepualauan Bangka Belitung dan Sulawesi Utara berisiko paling tinggi mengalami aterosklerosis, sementara penduduk Provinsi Jambi dan Bengkulu berisiko paling rendah mengalami aterosklerosis. Penduduk kota cenderung berisiko mengalami aterosklerosis akibat kadar LDL tidak normal (tinggi). Sementara penduduk desa cenderung disebabkan oleh kadar HDL tidak normal (rendah) atau kadar kreatinin tidak normal (tinggi). Terdapat perbedaan keterkaitan kadar kolesterol total, HDL, LDL, trigliserida dan kreatinin penduduk antar provinsi, desa dan kota serta desa dan kota setiap provinsi di Indonesia setelah memperhitungkan pengaruh kovariat usia. Penambahan kovariat usia berpengaruh positif terhadap peningkatan kadar kolesterol total, HDL, LDL, trigliserida dan kreatinin penduduk di Indonesia

Atherosclerosis is a chronic inflammatory disease in the form of arterial plaque due to dyslipidemia. The diagnosis of dyslipidemia is based on increased total cholesterol, low-density lipoprotein (LDL), triglycerides and decreased high-density lipoprotein (HDL) and when kidney function is impaired due to increased levels of blood creatinine. Control of atherosclerosis will have implications for managing non-communicable diseases (PTM) because it can be used for early detection, especially for potential cardiovascular diseases due to unhealthy eating habits and lifestyles. Different eating habits in each region due to cultural differences have the potential to result in a dyslipidemia as a risk factor for atherosclerosis. Therefore, it is very interesting to determine whether atherosclerosis will also differ along with the cultural differences of each region in Indonesia. This study aimed to identify atherosclerosis based on differences in total cholesterol, HDL, LDL, triglyceride, and creatinine levels of 35,509 residents from 33 provinces and rural-urban areas in Indonesia. The 2-factor MANOVA with interaction was used to determine the differences in the relationship between total cholesterol, HDL, LDL, triglyceride, and creatinine levels in the population between provinces, rural-urban, and rural-urban of each province in Indonesia. The analysis was continued with the ANOVA test and Tukey's follow-up test if at the 2-factor MANOVA test stage a significant difference was obtained. The identification is also carried out by controlling age of the residents which is believed to increase the accuracy and precision of the test using 2-factor MANCOVA with interaction. The results of this study showed that there were differences in the correlation between total cholesterol, HDL, LDL, triglyceride and creatinine levels between provinces and rural-urban and rural-urban populations of each province in Indonesia. Residents of the Bangka Belitung Islands and North Sulawesi provinces are at the highest risk of developing atherosclerosis, whereas residents of the Jambi province have the most balanced condition. City dwellers tend to be at risk of developing atherosclerosis because of their high LDL levels. On the other hand, villagers tend to have low HDL levels or high creatinine levels. There were differences in the correlation between total cholesterol, HDL, LDL, triglyceride, and creatinine levels in the population between provinces and rural-urban and rural-urban of each province in Indonesia after controlling for age covariates. The addition of the covariate had a positive effect on increasing total cholesterol, HDL, LDL, triglyceride, and creatinine levels in the Indonesian population.