Heart Disease and Stroke Statistics2009 Update.

A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee Wylie-Rosett and Yuling Hong Steinberger, Thomas Thom, Sylvia Wasserthiel-Smoller, Nathan Wong, Judith Roger, Wayne Rosamond, Ralph Sacco, Paul Sorlie, Randell Stafford, Julia Meigs, Dariush Mozaffarian, Graham Nichol, Christopher O'Donnell, Veronique Kittner, Daniel Lackland, Lynda Lisabeth, Ariane Marelli, Mary McDermott, James Nancy Haase, Susan Hailpern, Michael Ho, Virginia Howard, Brett Kissela, Steven Bruce Ferguson, Katherine Flegal, Earl Ford, Karen Furie, Alan Go, Kurt Greenlund, Donald Lloyd-Jones, Robert Adams, Mercedes Carnethon, Giovanni De Simone, T.

On the basis of pooled data from the FHS, ARIC, and CHS studies of the NHLBI: The percentages dead 1 year after a first stroke were as follows: E At _40 years of age: 21% of men and 24% of women. E At 40 to 69 years of age: 14% of white men, 20% of white women, 19% of black men, and 19% of black women. E At _70 years of age: 24% of white men, 27% of white women, 25% of black men, and 22% of black women. The percentages dead within 5 years after a first stroke were as follows: E At _40 years of age: 47% of men and 51% of women. E At 40 to 69 years of age: 32% of white men, 32% of white women, 34% of black men, and 42% of black women.

Age-adjusted estimates show that in 20042005, diagnosed chronic conditions that were more prevalent among older women than men included hypertension (51% for women, 45% for men). Ever-diagnosed conditions that were more prevalent among older men than older women included heart disease (33% for men, 26% for women) and diabetes (17% for men, 15% for women).6

The age-adjusted prevalence of high LDL cholesterol in US adults was 26.6% in 19881994 and 25.3% in 19992004 (NHANES/NCHS). Between 19881994 and 19992004, awareness increased from 39.2% to 63.0%, and use of pharmacological lipid-lowering treatment increased from 11.7% to 40.8%. LDL cholesterol control increased from 4.0% to 25.1% among those with high LDL cholesterol. In 19992004, rates of LDL cholesterol control were lower among adults 20 to 49 years of age than among those _65 years of age (13.9% versus 30.3%, respectively), among non-Hispanic blacks and Mexican Americans than among non-Hispanic whites (17.2% and 16.5% versus 26.9%, respectively), and among males than among females (22.6% versus 26.9%, respectively).10

The

prevalence of silent cerebral infarction between 55 and 64 years of age is _11%. This prevalence increases to 22% between 65 and 69 years of age, 28% between 70 and 74 years of age, 32% between 75 and 79 years of age, 40% between 80 and 85 years of age, and 43% at _85 years of age. Application of these rates to 1998 US population estimates results in an estimated 13 million people with prevalent silent stroke.4,5 Data from the Strong Heart Study show that the prevalence of stroke in American Indian men 45 to 74 years of age ranges from 0.2% to 1.4%. Among American Indian women in the same age group, the prevalence ranges from 0.2% to 0.7%.6 The prevalence of stroke symptoms was found to be relatively high in a general population free of a prior diagnosis of stroke or transient ischemic attack. On the basis of data from 18 462 participants enrolled in a national cohort study, 17.8% of the population _45 years of age reported at least 1 symptom. Stroke symptoms were more likely among blacks than whites, among those with lower income and less education, and among those with fair to poor perceived health status. Symptoms also were more likely in participants with higher Framingham Stroke Risk Score (REGARDS, NINDS).7

Mens stroke incidence rates are greater than womens at younger ages but not at older ages. The male-to-female incidence ratio was 1.25 in those 55 to 64 years of age, 1.50 in those 65 to 74 years of age, 1.07 in those 75 to 84 years of age, and 0.76 in those _85 years of age (ARIC and CHS studies, NHLBI).18 The Brain Attack Surveillance in Corpus Christi (BASIC, NINDS) demonstrated an increased incidence of stroke among Mexican Americans compared with non-Hispanic whites in this community. The crude cumulative incidence was 168 per 10 000 in Mexican Americans and 136 per 10 000 in non-Hispanic whites. Specifically, Mexican Americans have a higher cumulative incidence for ischemic stroke at younger ages (45 to 59 years of age: risk ratio, 2.04; 95% CI, 1.55 to 2.69; 60 to 74 years of age: risk ratio, 1.58; 95% CI, 1.31 to 1.91) but not at older ages (_75 years of age: risk ratio, 1.12; 95% CI, 0.94 to 1.32). Mexican Americans also have a higher incidence of intracerebral hemorrhage and subarachnoid hemorrhage than non-Hispanic whites, adjusted

for age, as well as a higher incidence of ischemic stroke and TIA at younger ages than non-Hispanic whites.20

In the Framingham Offspring Study, 2040 individuals free of clinical stroke had an MRI scan to detect silent cerebral infarct (SCI). Prevalent SCI was associated with the Framingham Stroke Risk Profile score (OR, 1.27; 95% CI, 1.10 to 1.46), hypertension (OR, 1.56; 95% CI, 1.15 to 2.11), elevated plasma homocysteine (OR, 2.23; 95% CI, 1.42 to 3.51), AF (OR, 2.16; 95% CI, 1.07 to 4.40), carotid stenosis _25% (OR, 1.62; 95% CI, 1.13 to 2.34), and increased carotid intimal-medial thickness (OR, 1.65; 95% CI, 1.22 to 2.24).39

Stroke Risk in Women Analysis of NHANES 19992004 data found that women 45 to 54 years of age are more than twice as likely as men to suffer a stroke. Women in the 45- to 54-year age group had a _4-fold higher likelihood of having a stroke than women 35 to 44 years of age.42 Stroke is a major health issue for women, particularly for postmenopausal women, which raises the question of whether increased incidence is due to aging or to hormone status and whether hormone therapy affects risk.43 Among postmenopausal women who were generally healthy, the Womens Health Initiative, a randomized trial of 16 608 women (95% of whom had no preexisting CVD), found that estrogen plus progestin increased ischemic stroke risk by 44%, with no effect on hemorrhagic stroke. The excess risk was apparent in all age groups, in all categories of baseline stroke risk, and in women with and without hypertension or prior history of CVD. 44 In the Womens Health Initiative trial, among 10 739 women with hysterectomy, it was found that conjugate equine estrogen alone increased the risk of ischemic stroke by 55% and that there was no significant effect on hemorrhagic stroke. The excess risk of total stroke conferred by estrogen alone was 12 additional strokes per 10 000 person-years.45 In postmenopausal women with known CHD, the Heart and Estrogen/Progestin Replacement Study (HERS), a secondary CHD prevention trial, found that a combination of estrogen plus progestin (conjugated equine estrogen [0.625 mg] and medroxyprogesterone acetate [2.5 mg]) hormone therapy did not reduce stroke risk.46 The Womens Estrogen for Stroke Trial (WEST) found that estrogen alone (1 mg 17_-estradiol) in women with a mean age of 71 years also had no significant overall effect on recurrent stroke or fatality, but there was an increased rate of fatal stroke and an early rise in overall stroke rate in the first 6 months.47 Clinical trial data indicate that the use of estrogen plus progestin, as well as estrogen alone, increases stroke risk in postmenopausal, generally healthy women and provides no protection for women with established heart disease.44,48 A study of _37 000 women _45 years of age participating in the Womens Health Study suggests that a healthy lifestyle that consists of abstinence from smoking, low BMI, moderate alcohol consumption, regular exercise, and a healthy diet was associated with a significantly reduced

risk of total and ischemic stroke but not of hemorrhagic stroke.49

.berterimakasihlah kepada kesulitan, yang selalu menemani kita di sepanjang perjalanan, yang mengajari dan mendewasakan.. (inspired form Mario Teguh)

Stroke merupakan penyebab utama morbiditas dan mortalitas di Amerika Serikat dan meskipun rata-rata kejadian stroke menurun, tetapi jumlah penderita stroke tetap meningkat yang diakibatkan oleh meningkatnya jumlah populasi tua/meningkatnya harapan hidup. Terdapat beberapa variasi terhadap insidensi dan outcome stroke di berbagai negara (Ali dkk, 2009; Morris dkk, 2000) Sampai dengan tahun 2005 dijumpai prevalensi stroke pada laki-laki 2,7% dan 2,5% pada perempuan dengan usia 18 tahun. Diantara orang kulit hitam, prevalensi stroke adalah 3,7% dan 2,2% pada orang kulit putih serta 2,6 % pada orang Asia. (Ali dkk, 2009; carnethon dkk, 2009) Diantara Warga Amerika Indian yang berusia 65-74 tahun, insiden rata-rata/1000 populasi dengan kejadian stroke yang baru dan berulang pertahunnya adalah 6,1% pada laki-laki dan 6,6% pada perempuan. Rata-rata mortalitas stroke mengalami perubahan dari tahun 1980 hingga 2005. Penurunan mortalitas stroke pada laki-laki lebih besar daripada perempuan dengan rasio laki-laki dibandingkan dengan perempuan menurun dari 1,11 menjadi 1,03. Juga dijumpai penurunan mortalitas stroke pada usia 65 tahun pada laki-laki dibandingkan perempuan (National Center for Health Statistics, 2008) Universitas Sumatera Utara Dari Survey ASNA di 28 RS seluruh Indoneisia, diperoleh gambaran bahwa penderita laki-laki lebih banyak dari pada perempuan dan profil usia 45 tahun yaitu 11,8%, usia 45-64 tahun berjumlah 54,2% dan diatas usia 65 tahun 33,5%. Data-data lain dari ASNA Stroke Collaborative Study diperoleh angka kematian sebesar 24,5% (Misbach dkk, 2007).

Setiap tahunnya, 795.000 orang mengalami kejadian stroke yang baru atau rekuren. Lebih kurang 610.000 orang diantaranya mengalami serangan pertama dan 185.000 orang merupakan rekuren. Insiden stroke pada laki-laki lebih banyak dibandingkan dengan perempuan pada usia lebih muda, tetapi tidak demikian halnya pada usia tua. Rasio insiden pria terhadap wanita pada usia 55-64 tahun adalah 1,25, pada usia 65-74 tahun adalah 1,50, pada usia 75-84 tahun adalah 1,07 dan pada usia 85 tahun adalah 0,76 (Carnethon dkk, 2009). Di Indonesia, penelitian berskala cukup besar pernah dilakukan oleh ASNA (ASEAN Neurological Association) di 28 Rumah Sakit (RS) seluruh Indonesia. Studi epidemiologi stroke ini bertujuan untuk melihat profile klinis stroke dimana dari 2065 pasien stroke akut, dijumpai rata-rata usia adalah 58,8 tahun (range 18-95 tahun) dengan kasus pada pria lebih banyak dari pada wanita. Rata-rata waktu masuk ke RS adalah lebih dari 48,5 jam (range 1-968 jam) dari onset. Rekuren stroke dijumpai hampir pada 20% pasien dan frekuensi stroke iskemik adalah yang paling sering terjadi (Misbach dkk, 2007) . 1. Pengertian Usia harapan Hidup

Usia harapan hidup (Life Expectancy Rate) merupakan lama hidup manusia di dunia. Usia harapan hidup perempuan lebih tinggi dibandingkan laki-laki. Harapan hidup penduduk Indonesia mengalami peningkatan jumlah dan proporsi sejak 1980. Harapan hidup perempuan adalah 54 tahun pada 1980, kemudian 64,7 tahun pada 1990, dan 70 tahun pada 2000. Meningkatnya usia harapan hidup penduduk Indonesia membawa implikasi bertambahnya jumlah lansia. Berdasarkan data, wanita Indonesia yang memasuki masa menopause saat ini semakim meningkat setiap tahunnya. Meningkatnya jumlah itu sebagai akibat bertambahnya populasi penduduk usia lanjut dan tingginya usia harapan hidup diiringi membaiknya derajat kesehatan masyarakat. 1. Menapause Keberhasilan pembangunan termasuk pembangunan kesehatan telah meningkatkan status kesehatan dan gizi masyarakat antara lain meningkatnya umur harapan hidup (UHH) di Indonesia dari tahun ke tahun. Disamping itu terjadi pula pergeseran umur menopause dari 46 tahun pada tahun 1980 menjadi 49 tahun pada tahun 2000. Jumlah dan proporsi penduduk perempuan yang berusia diatas 50 tahun dan diperkirakan memasuki usia menopause dari tahun ke tahun juga mengalami peningkatan yang sangat signifikan. Berdasarkan Sensus Penduduk tahun 2000 jumlah perempuan berusia diatas 50 tahun baru mencapai 15,5 juta orang atau 7,6% dari total penduduk, sedangkan tahun 2020 jumlahnya diperkirakan meningkat menjadi 30,0 juta atau 11,5% dari total penduduk. Pada usia 50 tahun, perempuan memasuki masa menopause sehingga terjadi penurunan atau hilangnya hormon estrogen yang menyebabkan perempuan mengalami keluhan atau gangguan yang seringkali mengganggu aktivitas sehari-hari bahkan dapat menurunkan kualitas hidupnya. Padahal estrogen tersebut mempunyai manfaat yang beragam, sehingga menurunnya produksi hormon akan berpengaruh terhadap beberapa perubahan penting dalam tubuh.
Depkes.9 Juni 2007.Terjadi Pergeseran Umur Menopause.http://www.mkia-kr.ugm.ac.id.13 Mei 2008.

UNO, 2003 Another factor to take into account was that OxLDL

was significantly higher in stroke patients than in age matched controls, and it continued to increase with age. Patients older than 70 years also had a markedly high incidence of cortical infarcts. It has been reported in previous studies that old people often have dysfunction of their endothelial cells and are vulnerable to oxidative stress.26 27. LDL oxidation, normally maintained within certain limits by an internal defence system against oxidative stress, may overcome the defences after ischaemic cerebral stroke. As a result, uncontrolled oxidative damage, both in brain cells and in the blood stream,may occur after an insult.

Faktor lain untuk mempertimbangkan adalah bahwa OxLDL secara signifikan lebih tinggi pada pasien stroke dibanding pada usia cocok kontrol, dan itu terus meningkat dengan usia. pasien yang lebih tua dari 70 tahun juga memiliki insiden nyata tinggi kortikal infark. Telah dilaporkan dalam studi sebelumnya yang orang-orang tua sering memiliki disfungsi sel endotel mereka dan rentan terhadap oksidatif stress.26 27. Oksidasi LDL, biasanya dipertahankan dalam batas-batas tertentu dengan sistem pertahanan internal yang melawan stres oksidatif, dapat mengatasi pertahanan setelah iskemik serebral stroke. Sebagai oksidatif, hasilnya tidak terkontrol kerusakan, baik dalam sel-sel otak dan dalam aliran darah, dapat terjadi setelah Data kami menunjukkan insult.28 bahwa plasma OxLDL terus meningkat selama tiga sampai 14 hari setelah onset stroke pada pasien dengan infark kortikal suppor Mortality CHOLESTEROL WOMENCholesterol Predicts Stroke Mortality in the Women's

Pooling Project 2002 AHA Richard B. Horenstein, Dean E. Smith and Lori Mosca Studies relating serum cholesterol and stroke incidence in blacks have been particularly scarce.3 Elevated blood cholesterol may contribute to stroke risk through several mechanisms, including heart disease and a consequent increase in atrial fibrillation and left ventricular dysfunction that promote mural thrombi that can cause

embolic strokes. Cholesterol also contributes to atherosclerosis of the carotid arteries and cerebral vessels that may promote atheroembolic and atherothrombotic events. Results from various HMG-CoA reductase inhibitor trials suggest that lowering cholesterol levels reduces cardiac and cerebrovascular events, although statins may work through other mechanisms in addition to cholesterol lowering, such as Studi yang berkaitan kolesterol serum dan kejadian stroke pada orang kulit hitam telah sangat scarce.3 Kolesterol dalam darah dapat menyebabkan risiko stroke melalui beberapa mekanisme, termasuk penyakit jantung dan konsekuen peningkatan fibrilasi atrium dan ventrikel kiri disfungsi yang mempromosikan trombi mural yang dapat menyebabkan stroke emboli. Kolesterol juga memberikan kontribusi untuk aterosklerosis dari arteri karotis dan pembuluh darah otak yang dapat mempromosikan acara atheroembolic dan atherothrombosis. Hasil dari berbagai HMG-CoA reductase inhibitor percobaan menunjukkan bahwa menurunkan kadar kolesterol mengurangi jantung dan serebrovaskular peristiwa, meskipun statin dapat bekerja melalui lainnya mekanisme selain menurunkan kolesterol, seperti
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