Oleh Admin Kalbe Medical pada April 07, 2017 07:30

Manfaat Pemberian Atorvastatin pada Pasien PAD

Peripheral arterial disease (PAD) merupakan manifestasi klinis dari aterosklerosis yang umum dijumpai pada masyarakat industri. Gejala utama dari PAD adalah klaudikasio intermiten yang digambarkan sebagai nyeri atau rasa tidak nyaman, saat beraktivitas dan menghilang dengan istirahat, pada tungkai yang terkena. Klaudikasio intermiten diperkirakan mengenai sekitar 5% individu berusia lebih dari 60 tahun. Prevalensinya terus meningkat di kalangan orang yang memiliki faktor risiko aterosklerotik seperti merokok, diabetes, hipertensi, dan hiperkolesterolemia.

Modifikasi lipid dengan statin telah diberikan sebagai salah satu terapi untuk pasien PAD bertolak pada data yang ditunjukkan beberapa uji klinis mengenai penyakit pembuluh koroner, yaitu adanya penurunan kejadian kardiovaskular terkait penggunaan statin. Heart Protection Study mengonfirmasi manfaat terapi statin dalam mengurangi risiko kematian dan kejadian kardiovaskular pada pasien dengan aterosklerosis koroner ataupun non-koroner, termasuk pasien PAD tanpa riwayat kejadian kardiovaskular sebelumnya.


Mohler-III ER, et al, melakukan studi yang meneliti apakah atorvastatin meningkatkan kemampuan treadmill dan aktivitas fisik pada pasien dengan klaudikasio. Pada studi multisenter, tersamar ganda, terkontrol-plasebo, acak, yang melibatkan 354 pasien dengan klaudikasio ini membandingkan efek pemberian atorvastatin 10 mg per hari, atorvastatin 80 mg, dan plasebo per hari selama 12 bulan. Parameter utama yang digunakan pada studi ini adalah perubahan maximal walking time (MWT) pada bulan ke-12 dan perubahan pain-free walking time (PFWT) sebagai parameter sekundernya. Pada bulan ke-12, didapati bahwa MWT pada kelompok atorvastatin 10 mg dan 80 mg menunjukkan perbaikan, namun nilainya tidak signifikan secara statistik. Namun, dijumpai perbaikan PFWT yang signifikan pada kelompok atorvastatin 80 mg.


Perbaikan PFWT pada pasien-pasien tersebut memperbaiki gaya hidup mereka, di mana atorvastatin meningkatkan pain-free walking distance dan aktivitas fisik berbasis-komunitas pada pasien dengan klaudikasio intermiten. Ketika diterapi dengan atorvastatin, pasien PAD merasakan perbaikan gejala di samping penurunan kejadian kardiovaskular yang dilaporkan studi-studi lain terkait statin.
Namun, berdasarkan data studi Hirsch, et al, walau PAD telah dikenal sebagai sindroma aterosklerotik yang umum dan berasosiasi dengan faktor risiko infark miokard, stroke dan kematian yang sangat tinggi, pasien-pasien PAD kurang diterapi dengan agresif. Penemuan manfaat atorvastatin pada pasien dengan PAD ini patut dipelajari lebih lanjut sebagai landasan terapi agresif pasien PAD untuk mengurangi komplikasi kardiovaskular yang dapat menyertai. (JCH)

Image : Ilustrasi
Referensi:
1.Mohler-III ER, Hiatt WR, Creager MA. Cholestrol reduction with atorvastatin improves walking distance in patients with peripheral arterial disease. Circulation. 2003;108:1481-6.
2.Hirsch AT, Criqui MH, Treat-Jacobson D, Regensteiner JG, Creager MA, Olin JW,  et al. Peripheral arterial disease detection, awareness, and treatment in primary care. JAMA. 2001;286:1317–24.

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