Tesis

Efek Latihan Resistensi Terhadap Kadar Pro Protein Convertase Subtilisin Kexin-9 pada Pasien pasca Bedah Pintas Arteri Koroner yang Menjalani Program Rehabilitasi Fase II = The Effect of Resistance Training on Pro-Protein Convertase Subtilisin Kexin-9 level in Post-Coronary Artery Bypass Graft Surgery Patients who undergo Phase II Cardiac Rehabilitation.

Latar Belakang. Proprotein convertase subtilisin kexin-9 (PCSK-9) merupakan protein yang berperan dalam proses degradasi reseptor low density lipoprotein (LDL) sehingga penurunan kadarnya dapat menurunkan kadar LDL dan risiko kardiovaskular. Sebagai bagian dari pencegahan sekunder, latihan resistensi direkomendasikan pada pasien pasca bedah pintas arteri koroner (BPAK) sebagai pelengkap komponen latihan aerobik. Keamanan dan manfaatnya pada perbaikan kekuatan dan daya tahan otot telah dibuktikan. Meskipun demikian, tidak terdapat studi yang meneliti pengaruh latihan resistensi terhadap kadar PCSK-9. Tujuan. Mengetahui efek tambahan latihan resistensi terhadap kadar PCSK-9 dan profil lipid pada pasien pasca bedah pintas arteri koroner yang menjalani rehabilitasi fase II. Metode. Studi ini merupakan studi eksperimental, randomisasi acak tersamar tunggal. 87 pasien pasca BPAK dibagi dua kelompok. Kelompok kontrol (n=43) adalah pasien yang menjalani rehabilitasi fase II standar sementara kelompok intervensi (n=44) adalah pasien yang menjalani rehabilitasi fase II ditambah dengan latihan resistensi dengan supervisi. Latihan resistensi terdiri dari 3 tahap bertingkat. Kadar PCSK-9 diperiksa sebelum dan sesudah rehabilitasi fase II pada kedua kelompok. Hasil. Setelah menyelesaikan rehabilitasi fase II, didapatkan perbedaan kadar PCSK-9 yang bermakna antara kelompok kontrol dan intervensi (377,1 (SD 125) vs 316,6 (111,1) ng/ml, β= -60,5 ng/ml, 95%CI -7,5(-113,4), p=0.026). Tidak didapatkan perbedaan bermakna pada kadar LDL (p=0,07), kolesterol total (p=0,99), high density lipoprotein (HDL) (p=0,44), dan trigliserid (p=0,56) antara kedua kelompok pada akhir rehabilitasi fase II. Kesimpulan. Tambahan latihan resistensi dapat menurunkan kadar PCSK-9 secara bermakna pada pasien pasca bedah pintas arteri koroner yang menjalani rehabilitasi fase II.
Kata kunci: bedah pintas arteri koroner, latihan resistensi, PCSK-9


Background. Pro-protein Convertase Subtilisin Kexin 9 (PCSK-9) is a protein that plays a role in the process of degradation of low density lipoprotein (LDL) receptor so that its drop can lower LDL levels and cardiovascular risk. As part of secondary prevention, resistance training is recommended in patients after coronary artery bypass surgery (CABG) as a complement to aerobic exercise component. The safety and benefits in muscle strength and endurance have been demonstrated. Nevertheless, there are no studies that examined the effects of resistance training on PCSK-9 levels. Objective. To determine the effects of additional resistance training on PCSK-9 levels and lipid profile in post-coronary artery bypass graft surgery patients who undergo phase II cardiac rehabilitation. Methods. A single-blinded randomized clinical trial was performed to 87 pasien post CABG, devided into two groups. The control group (n=43) consisted of patients who received standard phase II cardiac rehabilitation program. In the another group, the intervention group (n=44) consisted of patients who receive standard phase II cardiac rehabilitation program with an addition of supervised resistance training. This incrimental training consisted of 3 phase during the program. PCSK-9 level and lipid profile examination were performed in every patients pre- and post- training. Results. After completion of phase II cardiac rehabilitation, mean PCSK9 levels in intervention group decrease significantly compared to control group (control vs intervention, 377,1 (SD 125) vs 316,6 (111,1) ng/ml, β= -60,5 ng/ml, 95%CI -7,5(113,4), p=0.026). Nonetheless, there are still no significant changes in terms of LDL level (p=0,07), total cholesterol (p=0,99), high density lipoprotein (p=0,44) and triglyseride levels (p=0,56) pre- and post-intervention between two groups. Kesimpulan. The additional resistance training can reduce significantly PCSK-9 levels in patients after coronary artery bypass surgery who underwent phase II cardiac rehabilitation.
Keywords: coronary artery bypass surgery, resistance training, PCSK-9