The Effect of Traditional Jamu with Polyphenol-Rich Mixture Content on Cholesterol Levels in the Elderly with Coronary Heart Disease

Abstract


INTRODUCTION
As we grow older, our cardiovascular system undergoes both structural and physiological changes.These changes include a decrease in heart rate, thickening of the left ventricular wall, an increase in collagen coupled with a decrease in elastin in the heart muscle and blood vessel walls, and an increase in left atrial size.Furthermore, aortic distensibility and vascular tone decrease, leading to a decrease in myocardial muscle contraction and subsequent cardiac output.We also experience a decrease in diastolic pressure, diastolic filling, and beta-adrenergic stimulation.Conversely, our arterial pressure, systolic pressure, wave velocity, and left ventricular end-diastolic pressure increase.
Additionally, muscle contraction, muscle relaxation, and the ventricular relaxation phase all lengthen [1].
Coronary heart disease, also known as ischemic heart disease, is a collection of medical conditions that block blood flow to the heart muscle either partially or completely.When the coronary artery is obstructed, it can lead to myocardial ischemia, which is an imbalance between the heart's oxygen supply and demand.If the oxygen supply is unable to meet the heart's needs, it can result in myocardial infarction or death of the heart muscle.Atherosclerosis is a common cause of coronary heart disease, and it can lead to angina, myocardial infarction, and sudden death [1] [2].Millions of people are affected by coronary artery disease (CAD), also known as ischemic heart disease or heart disease (CHD) each year in many countries [3].
Coronary heart disease, also known as ischemic heart disease, is the most commonly diagnosed heart condition around the world.and lowering total cholesterol (TC) [11], [12].

Design, Population, and Sample
The

RESULTS
The total research respondents are 55 elderly people who enrolled in the study (intervention group = 28; control group =27).
One respondent from the control group was unable to complete the post-test due to travel to another city.
From the data presented in  Similarly, the percentage of traditional herbal medicine group respondents who exercised for at least 30 minutes was greater (82.1%) compared to the control group (81.5%).
These findings suggest that diet and exercise are important factors to consider when managing high cholesterol levels.To lower total and LDL cholesterol, it is recommended to limit your intake of trans fats, saturated fats, sugar, and cholesterol.Additionally, increasing physical activity may help to decrease LDL cholesterol and increase HDL cholesterol (considered "good" cholesterol) levels [14].Consuming traditional herbal medicine, maintaining a low-cholesterol diet, and exercising for more than 30 minutes daily can lower cholesterol levels in the elderly.Garlic has been known as an herbal ingredient for the prevention and treatment of cardiovascular disease [15].Has benefits as an antioxidant, antiatherosclerosis, antidiabetic, anticarcinogenic, and immunomodulator in mice.Garlic contains the sulfur-containing enzyme allinase which has cardioprotective and antihypertensive effects [12], [13].Previous research shows garlic is effective in lowering lipids, cholesterol levels, and triglycerides [15].
Ginger (zingiber officinale).Ginger is recommended as a traditional herbal medicine to cure CHD, hypertension, and palpitations [16].Ginger as an antihypercholesterolemia and antioxidant, can protect blood vessels and relax the ring of blood vessels in porcine coronary arteries.
Ginger research results that have been tested on humans with a low dose of 5 grams show significant activation of anti-thrombocytes.[17].
The results showed that apple cider vinegar is hypolipidemic, lowers triglycerides (TG), reduces cholesterol by inhibiting cholesterol absorption, reduces hyperlipidemia, and is anti-inflammatory in rats [12].Clinical trials of apple cider vinegar can reduce cholesterol levels in hyperlipidemia patients [20].
Honey.Honey is one of the most valuable 000) DISCUSSION According to a recent study, the use of traditional herbal medicine that includes a high concentration of polyphenols (PRM) may have a significant impact on lowering cholesterol levels in the elderly with CHD.This marks the first time such a benefit has been observed in this particular demographic, as compared to the control group that was monitored for a duration of 4 weeks.The research indicates that individuals who ingested a 15ml dose of traditional herbal medicine on a daily basis experienced a notable reduction in their cholesterol levels after the 4-week period.The decrease in the average score of cholesterol levels before and after the intervention period in the herbal medicine consumption group was significantly greater than the average score in the control group (d = -1.44).Based on the demographic data, it appears that "jamu" group has a higher percentage of respondents who consumed traditional herbal medicine and followed a low-cholesterol diet (85.7%) compared to the control group (74.1%).
Traditional herbal medicine containing PRM reduces cholesterol levels in the elderly with CHD, this can be explained based on the results of previous research [10] [11].The elderly with CHD have experienced decreasing cholesterol levels based on reduced signs and symptoms of the disease such as chest pain, heavy chest, arrhythmias, increased blood pressure, easy to feel sick, easily tired, and migraines after consuming traditional herbal medicine containing PRM, [11] and there are elderly with CHD who can give up doctor's medicine and simply consume traditional herbal medicine while maintaining a healthy diet and regular exercise.The emotional perception of the elderly with CHD is feel healthier, fitter, and satisfied with traditional herbal medicine products.Traditional herbal medicine supports the work of doctors' medicines, there are no side effects from traditional herbal medicine, and they want to tell family members or relatives who suffer from the same disease to consume this herbal medicine [9] [11].The elderly with CHD consume traditional herbal medicine in the morning and are given a break before the elderly take the doctor's medicine for 4-5 hours.Reducing cholesterol, experiencing decreased signs and symptoms of CHD, and good emotional perception indicate the benefits of traditional herbal medicine containing PRM.This is due to the content of the herbal medicine.The herbal ingredients consist of garlic (Allium sativum), ginger (zingiber officinale), lemon (citrus limon), apple vinegar (malus domestica), and honey.
medicines used since ancient times.Honey can function as a cardioprotective agent in CHD[21].Various studies on honey, both in vitro studies, in vivo, and clinical trials have revealed that honey has a positive influence on risk factors for heart problems by improving plasma lipid profiles mean oxidase, attenuates the increase in markers of heart damage (CK-MB, AST, ALT), increases the activity of antioxidant enzymes, and increases LDL resistance to oxidation induced by oxidative stress in heart disease [22]-[26].A traditional herbal medicine containing PRM has four important effects, namely hypolipidemic, antioxidant, anti-diabetic, and hepato-protective[12].The benefits of traditional herbal medicine containing ginger, garlic, lemon, apple cider vinegar, and honey are as a polyphenol-rich mixture (PRM), which contains hypolipidemic activity in humans which can reduce cholesterol levels and function to inhibit cholesterol absorption and increase cholesterol transport and excretion in multiple organs[10].There were 60.7% of respondents who had a duration of Jamu consumption of <1 year, 28.6% of respondents who had a duration of Jamu consumption of 1-5 years, and 10.7% of respondents who had a duration of Jamu consumption of 6-10 years in the intervention group.This corresponds to the duration of consumption PRM in rats for 24 days which could give cardioprotective effects and anti-, increase HDL (High-Density Lipoprotein), and decrease total cholesterol (TC) levels[12].The results of this study looked at the effect of reducing cholesterol after 4 weeks of consuming traditional herbal medicine containing PRM in elderly with CHD, where this study strengthened the findings of research data.NURSING IMPLICATION It is hoped that this research will become an evidence-based practice in utilizing traditional herbal medicine containing polyphenol-rich mixture (PRM) in the elderly, especially elderly with CHD to lower cholesterol levels to be able to control risk factors that are the main cause of heart attack.Nurses are the front line caring for society, where the largest population is the elderly.Most of the Indonesian elderly are at home or in the community, so the presence of community nurses and gerontic nurses is needed.The main challenge in caring for the elderly today is finding new ideas that are in line with local wisdom, especially those with chronic diseases that many elderly suffer, one of which is CHD, and pharmaceutical knowledge is needed to support the care of elderly CHD sufferers with complementary therapy, namely traditional herbal medicine.LIMITATION The decrease in cholesterol levels cannot be solely attributed to the consumption of traditional jamu due to uncontrolled variables such as medication and lifestyle.CONCLUSION The present study highlights a new finding regarding the implication of a combination of traditional jamu, medication, low-cholesterol diet, and exercise lasting more than 30 minutes in mutually supporting the reduction of cholesterol levels.The data suggests that the interplay among these four factors plays a crucial role in supporting each other towards reducing cholesterol levels, which could benefit individuals at risk for cardiovascular diseases.Therefore, the findings of this study could have significant implications for individuals with high cholesterol levels and those who wish to adopt a healthy lifestyle to reduce the risk of developing cardiovascular diseases.The next research topic could continue to know the effect of herbal medicine on LDL and HDL of CHD patients.ACKNOWLEDGMENT Many thanks to STIKes Panti Waluya Malang and Home Industry Herbal Medicine for the support of the research.

Table 2
Comparison of the difference of cholesterol levels before and after intervention