MANAGEMENT OF CORONARY ARTERY DISEASE AND HEART FAILURE FOR CURING EVEN STROKE PREVENTION

The cardiovascular continuum of events

Myocardial Ischemia

CAD

plaque
Atherosclerosis

Risk Factors ( DYSLIPIDEMIA , BP, DM, Insulin Resistance, Platelets, Fibrinogen, etc)

Adapted from Dzau et al. Am Heart J. 1991;121:1244-1263

etc) Adapted from Dzau et al.121:1244-1263 .The cardiovascular continuum of events Coronary Thrombosis Myocardial Ischemia CAD Atherosclerosis Risk Factors ( DYSLIPIDEMIA . Am Heart J. Fibrinogen. 1991. DM. Insulin Resistance. Platelets. BP.

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Penyumbatan pembuluh darah Pembuluh darah normal Al ir a Pembuluh n darah darah Plak akibat kolesterol Yang menempel pada dinding pembuluh kolesterol Plak Pembuluh darah dengan kadar kolesterol tinggi .

Otak yang terkena stroke Penyumbatan karena plak Arteri .

DM. Insulin Resistance. Platelets. etc) Adapted from Dzau et al. 1991. BP.121:1244-1263 . Am Heart J.The cardiovascular continuum of events ACS Coronary Thrombosis Myocardial Ischemia CAD Atherosclerosis Risk Factors ( DYSLIPIDEMIA . Fibrinogen.

DM. Am Heart J. etc) .  BP. Platelets. 1991. Insulin Resistance.121:1244-1263 Atherosclerosis Primary prevention Risk Factors ( Dyslipidemia.The cardiovascular continuum of events ACS Secondary prevention Coronary Thrombosis Arrhythmia and Loss of Muscle Myocardial Ischemia Remodeling CAD Ventricular Dilatation Congestive Heart Failure End-stage Heart Disease Adapted from Dzau et al. Fibrinogen.

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1993) .6 Smoking x6 x4 Dyslipidemia (Adapted from Poulter et al.5 x9 x16 x1..Levels of Risk Associated with Smoking. Hypertension and Hypercholesterolemia Hypertension x3 x4.

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JAMA 2003.JNC VII: Classification of blood pressure Blood pressure classification Normal Prehypertension Stage 1 hypertension Stage 2 hypertension Systolic BP (mm Hg) <120 120-139 140-159 >160 or or Diastolic BP (mm Hg) <80 80-89 90-99 >100 or or The JNC VII.289:2560-72 .

JAMA 2003.289:2560-2572 .INDICATIONS FOR INDIVIDUAL DRUG CLASSES Diuretic blocker Heart failure Post-MI High coronary disease risk Diabetes Chronic kidney disease Stroke prevention ACE inhibitor ARB CCB Aldoantagonist • • • • • • • • • • • • • • • • • • • • • The JNC VII Report.

MOST PATIENTS NEED TWO OR MORE ANTIHYPERTENSIVE AGENTS TO CONTROL THEIR BLOOD PRESSURE .

Possible combinations of antihypertensive agents Diuretics -blockers ACs -blockers CCBs ACE inhibitors 2003 ESH/ESC guidelines for the management of arterial hypertension .

Possible combinations of antihypertensive agents Diuretics -blockers ACs -blockers CCBs ACE inhibitors 2003 ESH/ESC guidelines for the management of arterial hypertension .

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JAMA 2001.285:2486-2497 .NCEP Classification of Blood Lipid Values In Adults Lipid Value (mg/dl) <100 100-129 130-159 160-189 190 <200 200-239 240 Classification Optimal Near or above optimal Borderline high High Very high Desirable Borderline high High LDL-C TC HDL-C <40 60 <150 150-199 200-499 500 Low (increased risk) High (cardioprotective) Normal Borderline high High Very high TG NCEP-ATP III guidelines.

NCEP-ATP III: TARGET OF TREATMENT

ELEVATED LDL CHOLESTEROL

METABOLIC SYNDROME

NCEP-ATP III. JAMA 2001;285:2486-2497

Pleiotropic effects of a drug are actions other than those for which the agents was specifically developed. as side It may be or

undesireble

(such

effects

toxicity), neutral, or, as is especially the case with statin, beneficial.

Davignon J. Circulation 2004;109[suppl III]:III-39–III-43

PLANTS RESOURCE FOR PREVENTION EVEN FOR CURING STROKE

Allii Sativi Bulbus (Garlic) Clasification Kingdom : Plantae Division : Spermatophyta Subdivision : Angiospermae Class : Monocotyledonae Ordo : Liliales Famili : Liliaceae Genus : Alium Spesies : Allium sativum Linn .

solid. subtended by membraneous. Leaf sheaths form a pseudostem. Fruit is a small loculicidal capsule. grasslike leaves. stamens 6. 30-60 cm long.Description 1. Flowers are on slender pedicels. flowers are variable in number and sometimes absent. 4. consisting of perianth of 6 segments. 2. 5. 3-locular. 9. scape smooth. anthers excerted. seldom open and may wither in bud. 1. ovary superior. flat. about 4-6mm long. 30-60 cm tall. the bulb gives rise above ground to a number of narrow. long-beaked spathe. and has an acute apex. round. . 6. pinkish. keeled. 7. The underground portion consists of a compound bulb with numerous fibrous rootlets.5cm wide.0-2. 3. 8. and coiled at first. The leaf blade is linear. Inflorescences are umbellate. solid. splitting on one side and remaining attached to umbel. strong smelling when crushed.

STRUCTURE AND SUBSTANCE Allicin Alliin .

Active substance of this effect is unknow 5. Changes of potential membraneHyperpolarizationKalium chanel open frequentlyCa Chanel closedVasodilatation 4. rabbit. mice) causing decreasing blood presure 2.PHARMACOLOGY 1. Reducing vascular resistension with smooth muscle relaxation 3. In-vivo (dog. Increasing NO synthesisdecreasing blood presure .

PHARMACOLOGY ANTIPLATELET AGGREGATION IN THE ACTIVATING EFFECT OF GARLIC ON FIBRINOLYSIS AND ITS INHIBITORY EFFECT ON PLATELET AGGREGATION HAVE BEEN DEMONSTRATED IN TOTAL 16 EXPERIMENTAL STUDIES. Phytomedicine 2 (1) : 73-91 . THE STUDIED SHOWED THAT THE GARLIC ACT TO STIMULATE ANDOGENOUS FIBRINOLYSIS AND INHIBIT PLATELET AGGREGATION Reuteur HD. IN VITRO AND VIVO. Allium sativum and Allium ursinum : Part 2 Pharmacology and Medicinal Aplication.

43(2) : 119-122 . GUAZZALOCA G. E... EUROPEAN JOURNAL OF CLINICAL PHARMACOLOGY. et al. et al. 1993. PLACEBO CONTROLLED STUDY ON 60 VOLUNTEERS WITH GARLIC POWDER OVER 4 WEEKS. JUNG.. FRASCARO M. 1993. ARZZNEIMITTEL FORSCHING.F.M. THE RESULT LED TO A SIGNIFICANT REDUCTION IN PLATELET AGGREGRATION KIESELWETTER H.LUNG.. 45 : 336-338 LEGNANI C.PHARMACOLOGY ANTIPLATELET AGGREGATION A PLATELET INHIBITING EFFECT HAD BEEN STUDIED IN A DOUBLE BLIND.

53 : 211-212 . 1995.PHARMACOLOGY ANTI THROMBOXANE CONSUMPTION OF GARLIC DAILY FOR PERIOD OF 16 WEEKS REDUCED THROMBOXANE BY ABOUT 80 % ALI M.. THOMSON.. LEUKOTRIENES AND ESSENTIAL FATTY ACIDS. PROSTAGLANDINS.

1991. Abstrac Int Garlic Symposium Pharmacy.PHARMACOLOGY ANTIPLATELET AGGREGATION MECHANISM OF ACTION REDUCED THE FORMATION OF THROMBOXANE FROM EXOGENOUS ARACHIDONATE INHIBIT THE DEGRADATION OF PHOSPHOLIPID INDUCED BY Ca2+ IONOPHORE REDUCE THE GENERATION OF THROMBOXANE AND 12-LIPOXYGENASE PRODUCT FROM ARACHIDONATE PLATELETS INHIBIT THE INCORPORATION OF ARACHIDONATE INTO PLATELET PHOSPHOLIPIDS Srivasta K. Pharmacology and Clinical Application of Allium sativum. .C. Antiplatelet Constituens of Garlic and their Mechanism of Action.

arachidonate metabolism. Thrombosis Research 32: 155-169. indometacin and dipyridamole on human platelets. realcascreation and platelet ultrastructure. . et al. 1983.PHARMACOLOGY ANTIPLATELET AGGREGATION SEVERAL IN VITRO STUDIES REPORT THAT GARLIC. Apitz-Castro R. the antiplatelet priciple of Garlic. Ajoen. Effect of Garlic and of three pure components isolated from it on human platelet aggregation. Thrombosis Research 42: 303-311. 1986. REDUCE PLATELET AGGREGATION INDUCED BY ADP COLLAGEN OR ADRENALIN •Apitz-Castro R. et al. synergetically potentiates the anti-aggregation of prostacyclin. foskolin. OR ITS EXTRACTS.

GARLIC PHARMACOKINETICS After oral administration. .M. WORLD SCIENTIFIC. PHILADELPHIA. 1986 : 88. the total in all Organs reached in 4 hours. (CHANG H. and in 8 hours it was reduced to half of the peak value. PHARMACOLOGY AND APPLICATIONS OF CHINESE MATERIA MEDIKA.

M.V INJECTION WAS 134. AND LUNG.9 mg/kg BW.V WAS 70 mg/kg BW AND BY ORAL WAS 600 mg/kg BW. PHILLADELPHIA.. PHARMACOLOGY AND APPLICATION OF CHINESE MATERIA MEDIKA. SPLEEN. 1986 : 88) . (CHANG H. LD 50 OF NATURAL DIALLYLTHIOSULPHONATE BY I. WORLD SCIENTIFIC. ADRENAL GLANDS.GARLIC TOXICITY LD 50 OF THE GARLIC OIL IN MICE BY I. NO PATHOLOGICAL CHANGE WAS OBSERVED IN LIVER.

Analysis Qualitative and quantitative assay for sulfer constituents (alliin. .) : by High-Performance Liquid Chromatography or gas chromatography-mass spectroscopy methods. allicin etc.

Apii graveolentis Herbs (Celery) Clasification Kingdom Division Class Subclass Ordo Family Genus Species : Plantae : Magnoliophyta : Magnoliosidae : Rosidae : Apiales : Apiaceae : Apium :Apium graveolens L .

Leaves has complex fin. 5. brownish texture until gray. spicy.5 cm long. Short stalk with stretch out skeleton.7 cm long. 3. Green texture until brownish. If it cut a half has 10 mm diameter. 2 mm wide. rounded. 9. 4. Aromatic smell. 6. It have much Sub root with style like yarn and has 15 cm long. 2-5 cm wide. Sub stalk 1-2. brittle Sub leaves amount 3 –7 pieces. 2. and thicken taste. thin.DESCRIPTIONS 1. .5 cm long. Sturdy root with cylinder shape. stretch out. 7. 8. 2 – 7. Main stalk has 12.

STRUCTURE AND SUBSTANCE Apiose.Glu O O OH OH OH O O Apiin O HOCH 2 OH O OH HO O OH Apigenin .

Preface analysis showed that hypotension effect caused by chemoreseptor stimulation at karotid and aorta. Another experiment showed that hypotension effect is related to nerve integrity sympatic system.PHARMACOLOGY 1. 2. 4. On the perfusion experiment believe that apigenin has vasodilator perifer effect 3. 200 g fresh celery can causes diuretic effect .

) content by means of high-performance liquid chromatography. Apigenin etc. .Analysis Qualitative and quantitative assay for Celery constituents (Apiin.

Syzygium polyanthum folium (Indonesian Bay-Leaf) Clasification Division Subdivision Class Spermatophyta Angiospermae Magnoliatae Subclass Order Family Species Rosidae Myrtales Myrtaceae Syzygium polyanthum (Wight) Waplers .

later brown. The flowers are pink and somewhat fragrant while the fruits are round.DESCRIPTIONS 1. 4. The seeds are small and brown. Indonesian bay leaf can reach a height of 90 feet although 60 feet is more common. The dried brown leaves of Indonesian Bay-leaf are aromatic and somewhat sour . 3. red at first. Tree with spreading branches and simple leaves 2. 5.

STRUCTURE AND SUBSTANCE OH OCH 3 CH 2CH=CH 2 Eugenol .

.PHARMACOLOGY Antihypertension effect was showed by decreasing of arterial blood tension in male rat that became Hypertension by difference of decreasing model with verapamil.

2.g Eugenol Gas chromatography methodsContain of sesquiterpenes-lactone. High-performance liquid chromatographyIndonesian Bay-leaf has 28 essential oils.Analysis 1. . e.

Rauwolfiae serpentina Radix .

• brown colour • length 5-15 cm . • feel bitterly. • odourless.DESCRIPTIONS Rauwolfiae Radix consist of dry root of Rauwolfia serpentina ( L).

rescinnamine and deserpidine (group of reserpine) .STRUCTURE AND SUBSTANCE contains at least 1% alkaloids: .ajmaline.reserpine. raupine. yohimbine and serpentine (ajmaline group) .ajmalicine (raubasine) N OH 3C N H H H H O OC OCH 3 O C OCH 3 Reserpin .

. Ajmalicine (= raubasine) works central and peripheral vessel-extending and contributes to the blood pressure-lowering total effect. but short continuing blood pressure lowering by blockade of a. epinefrin and norepinefrin and central sedative properties ajmaline group cause a quickly acting.adrenoreceptors.PHARMACOLOGY Reserpine possesses antisympathicus (reduces catecolamines reserve.

Analysis Qualitative and quantitative assay for Celery constituents (Reserpin.) content by means of highperformance liquid chromatography. serpentine etc. .

Temulawak Klasifikasi botani temu lawak adalah sebagai berikut: Divisi Sub divisi Kelas Ordo Keluarga Genus Spesies :Spermatophyta :Angiospermae :Monocotyledonae :Zingiberales :Zingiberaceae :Curcuma :Curcuma xanthorrhiza Roxb. .

Kandungan Kimia Rimpang Temulawak • Fraksi pati • Fraksi kurkuminoid • Fraksi minyak atsiri .

Kurkuminoid Temulawak Fraksi kurkuminoid rimpang temulawak terdiri atas dua komponen yaitu kurkumin dan desmetoksikurkumin. asam asetat glasial. Rumus kimia : kurkumin = C21H20O6 (BM = 368) desmetoksikurkumin = C20H18O5 (BM = 338) . alkohol. dan alkali hidroksida. larut dalam aseton. berwarna kuning atau kuning jingga. berbentuk serbuk dengan rasa sedikit pahit.

7-bis(4-hydroxy-3-methoxyphenyl)hepta-1.Struktur kurkuminoid Kurkumin : 1.6.diene-3.5-dione O O OH OMe OMe OH Desmetoksikurkumin : O O OH OMe OH .

RES.. C.PHARMACOLOGY CURCUMIN INHIBITED THROMBOXANE B2 PRODUCTION SRVASTA. 40:413-417 .. DIKSHAR M. 1985.. THROMB. SRIMED R.

B. AN INFLAMATORY MEDIATOR.. 36 (4) : 715-17 . B.N.C. 1985...PURI. ARZNEIMFORSCH.N. V. AntiThrombotic effect of Curcumin. REFF : SRIVASTA.SRIMAL.SRIMAL. R. DIKSHIT. 1986.C. DHAWAN. R. R. THROMBOSIS RES. Effect of Curcumin on Platelet Aggregation and Vascular Prostacyclin Synthesis. R.DHAWAN. 40 (3) : 413-417 SRIVASTA. M.PHARMACOLOGY CURCUMIN HAD DEMONSTRATED ANTI THROMBOTIC ACTION WHILE PRESERVING PROSTACYCLIN.

.PHARMACOLOGY CURCUMIN HAD SHOWN NUMEROUS ANTI INFLAMATORY EFFECTS IN VITRO AND IN VIVO. inhibit platelet aggregation and alter alcosaniod biosynthesis in human blood platelets. Extract from two frequently consumed spices. 37 (1) : 57-64. 1991. PLANTA MEDICA. SUCH AS ARACHIDONIC ACID PATHWAY ENZYME MODIFICATION. M. H. DIMINISHED NEUTROPHYL RESPONSES STABILIZATION OF INFLAMATORY CELL MEMBRANS..P. PROSTAGLANDIN LEUKOT ESSENT FATTY ACIDS. 1989. K.C.T and WAHL. Pharmacology of Curcuma longa. Cumin (Cucinum cyminum) and tumeric (Curcuma longa). AND INHIBITION OF PLATELET AGGREGATION REFF : AMMON... 57 : 5-6 SRIVASTA.

B. 1999. BIOCHEM PHARMACOL... AND ARACHIDONIC ACID REFF : SHAH. 58 (7) : 1167-1172. ADP. Inhibitory effect of Curcumin. . COLLAGEN. et al.H.. PLATELET ACTIVATING FACTOR (PAF). A food spice from Tumeric on platelet activating factor and arachidonic acid mediated platelet aggregation through inhibition of Thromboxane formation and Ca++ signaling.PHARMACOLOGY CURCUMIN INHIBITED PLATELET AGGREGATION MEDIATED BY THE PLATELET AGONIST EPINEPHRIN.

PROSTAGLANDIN LEUKOT ESSENT FATTY ACIDS.. ADRENALIN.K. K. BORDIA A. Curcumin. a major component of food spice turmeric (Curcuma longa) inhibits aggregation and alters alcosanoid metabolism in human blood platelets. VERMA. S..PHARMACOLOGY CURCUMIN INHIBITED PLATELET AGGREGATION INDUCED BY ARACHIDONATE.. AND COLAGEN.C. 52 (4) : 223-227 . IT INHIBITED THROMBOXANE B2 (TXB2) PRODUCTION FROM EXOGENOUS ARACHIDONATE WITH CONCOMITANT INCREASE IN THE FORMATION OF 12-LIPOXYGENASE PRODUCTS REFF : SRIVASTA. 1995..

TXB2 12-HETE 2961 ± 338 2122 ± 646 (**) 1620 ± 510 (**) 1168 ± 548 (**) 898 ± 414 (**) p < 0. K.EFFECT OF TURMERIC EXTRACT ON THE CONVERSION OF ARACHIDONIC ACID TO TXB2 AND 12-HETE IN HUMAN PLATELETS CONTROL DOSE 1 (10 μg/mL) N=8 DOSE 2 (20 μg/mL) N=8 DOSE 3 (40 μg/mL) N=7 DOSE 4 (80 μg/mL) N=3 (*) p < 0.01 10796 ± 2301 11956 ± 2620 (*) 13630 ± 3021 (**) 15262 ± 3801 (**) 17923 ± 2575 .. 1989. 37 (1) : 57-64.05 REFF : SRIVASTA. PROSTAGLANDINS LEUKOT ESSENT FATTY ACID.C.

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