EFFECTIVENESS OF APPLES AND STATINS IN REDUCING TOTAL CHOLESTEROL LEVELS IN HYPERCHOLESTEROLEMIA PATIENTS IN NORTH GORONTALO REGENCY
DOI:
https://doi.org/10.18623/rvd.v22.n6.3795Keywords:
Apples, Statins, Hypercholesterolemia, Polyphenols, Pectin, AntioxidantsAbstract
Apples are a type of fruit rich in bioactive polyphenols and dietary fiber. These bioactive components possess significant health potential. The first-line therapy for hypercholesterolemia is typically statin medication. The purpose of this study was to analyze the effectiveness of apples and statins in reducing total cholesterol levels in patients with hypercholesterolemia. Methode research, This study employed a quasi-experimental design the sample consisted of 30 respondents divided into two intervention groups: apples and statins. This experimental study was conducted over 14 days. The study lasted two weeks. Baseline total cholesterol levels were measured before the intervention, after which subjects received one of three interventions for two consecutive weeks. The first group was given one Malus domestica (Red Delicious variety) apple per day (approximately 150 grams), the second group received 20 mg of simvastatin daily, taken at night, and the third group received both interventions—one Red Delicious apple (approximately 150 grams) per day and 20 mg of simvastatin taken nightly. After the 2-week intervention period, The results showed that the intervention group consuming apples exhibited the most significant reduction in total cholesterol levels (p-value = 0.000) compared to the statin group (p-value = 0.188). The conclusion of this study is that apples can produce a greater reduction in cholesterol levels than statins.
References
Addisu, B., Bekele, S., Wube, T. B., Hirigo, A. T & Cheneke, W. 2023. dyslipidemia and Its Associated Factors Among Adult Cardiac Patients At ambo University Referral Hospital, Oromia Region, West Ethiopia. Bmc cardiovascular Disorders, 23(1), 1–12. Https://Doi.Org/10.1186/S12872- 023-03348-Y/Tables/4
Alvarez-Jimenez, L., Morales-Palomo, F., Moreno-Cabañas & Mora-Rodriguez, R. 2024. Time-Course Atherogenic Blood Lipid Response To Statin discontinuation In Dyslipidemic Adults. Nutrition, Metabolism And cardiovascular Diseases, 34(10), 2334–2343. https://Doi.Org/10.1016/J.Numecd.2024.05.021
Amin, S & Assafa, Z. 2025. Peran Senyawa Polifenol Dalam Mekanisme antioksidan: Tinjauan Dari Aspek Kimia Medisinal. Jurnal Ilmiah Ilmu kesehatan, 3(2), 822–832. Https://Doi.Org/10.31004/Jiik.V3i2.44456
Andersson, J., Rejnö, Å., Jakobsson, S., Hansson, P. O., Nielsen, S. J & Björck, L.
2024. Symptoms At Stroke Onset As Described By Patients: A Qualitative study. Bmc Neurology, 24(1), 1–8. Https://Doi.Org/10.1186/S12883-024- 03658-4/Tables/4
Ansal Ab & Cassagnol M. 2025. Hmg-Coa Reductase Inhibitors. [Updated 2023 jul 3]. In: Statpearls [Internet]. Treasure Island (Fl). Statpearls Publishing.
Arvanitis, M & Lowenstein, C. J. 2023. Dyslipidemia. Annals Of Internal medicine, 176(6), Itc81–Itc96. Https://Doi.Org/10.7326/Aitc202306200
Asma, U., Morozova, K., Ferrentino, G & Scampicchio, M. 2023. Apples And apple By-Products: Antioxidant Properties And Food Applications. antioxidants 2023, Vol. 12, Page 1456, 12(7), 1456.
Braga, P. G. S., Freitas, F. R., Bachi, A. L. L & Maranhão, R. C. 2023. regular practice Of Physical Activity Improves Cholesterol Transfers To High- density
Lipoprotein (Hdl) And Other Hdl Metabolic Parameters In Older adults.
Nutrients, 15(23), 4871. Https://Doi.Org/10.3390/Nu15234871/S1
Brown, A. S & Watson, K. E. 2018. Statin Intolerance. Reviews In Cardiovascular medicine, 19(S1), S9–S19. Https://Doi.Org/10.3909/Ricm19s1s0005/1530- 6550-2018-19-S1-S9.Pdf
Caponio, G. R., Wang, D. Q. H., Di Ciaula, A., De Angelis, M & Portincasa, P. 2020. Regulation Of Cholesterol Metabolism By Bioactive Components Of soy Proteins: Novel Translational Evidence. International Journal Of molecular Sciences 2021, Vol. 22, Page 227, 22(1), 227.
https://Doi.Org/10.3390/Ijms22010227
Cheon, D. Y & Jo, S.-H. 2022. Adverse Effects Of Statin Therapy And Their treatment. Cardiovascular Prevention And Pharmacotherapy, 4(1), 1–6. https://Doi.Org/10.36011/Cpp.2022 4.E4
Chou, R., Cantor, A., Dana, T., Wagner, J., Ahmed, A. Y., Fu, R & Ferencik, M. 2022. Statin Use For The Primary Prevention Of Cardiovascular Disease In adults: Updated Evidence Report And Systematic Review For The Us preventive Services Task Force. Jama, 328(8), 754–771. https://Doi.Org/10.1001/Jama.2022.12138
Climent, E., Benaiges, D & Pedro-Botet, J. 2021. Hydrophilic Or Lipophilic statins?
Frontiers In Cardiovascular Medicine, 8. https://Doi.Org/10.3389/Fcvm.2021.687585,
Collins, R., Reith, C., Emberson, J., Armitage. 2016. Interpretation Of The Evidence For The Efficacy and Safety Of Statin Therapy. The Lancet, 388(10059), 2532– 2561. https://Doi.Org/10.1016/S0140-6736(16)31357-5
Costa, R., Ferreira, C., Alves, A., Nunes, S., Reis, F., Malva, J., Viana, S., Heinrich, m., Gabriela Bungau, S & Berdimurodov, E. 2025. Frontiers In pharmacology Frontiersin.Org 01 Type Systematic Review Published. https://Doi.Org/10.3389/Fphar.2025.1541871
Febriani Dungga, E & Indiarti, Y. 2024. Faktor Risiko Pasien Diabetes Melitus tipe 2 Di Puskesmas Monano Kabupaten Gorontalo Utara. In Jambura nurisng Journal (Vol. 6, Issue 1). Http://Ejurnal.Ung.Ac.Id/Index.Php/Jnj
Filppula, A. M., Hirvensalo, P., Parviainen, H., Ivaska, V. E., Lönnberg, K. I., Deng, f., Viinamäki, J., Kurkela, M., Neuvonen, M & Niemi, M. 2021. comparative Hepatic And Intestinal Metabolism And Pharmacodynamics Of statinsxs. Drug Metabolism And Disposition, 49(8), 658–667. https://Doi.Org/10.1124/Dmd.121.000406
Gao, H., Wang, H., Shan, G., Liu, R., Chen, H., Sun, S & Liu, Y. 2021. Prevalence of Dyslipidemia And Associated Risk Factors Among Adult Residents Of shenmu City, China. Plos One, 16(5), E0250573. https://Doi.Org/10.1371/Journal.Pone.0250573
Irwan (2021) ; Metode penelitian kesehatan; Zahir Publishing Yogyakarta.
Jacobsen, A. P., Whelton, S. P., Blumenthal, R. S & Mcevoy, J. W. 2024. dyslipidemia. Hypertension: A Companion To Braunwald’s Heart Disease, 476–488. Https://Doi.Org/10.1016/B978-0-323-88369-6.00042-6
Jahdkaran, M & Sistanizad, M. 2025. From Lipids To Glucose: Investigating The role Of Dyslipidemia In The Risk Of Insulin Resistance. The Journal Of Steroid biochemistry And Molecular Biology, 250, 106744.
https://Doi.Org/10.1016/J.Jsbmb.2025.106744
Kemenkes. 2023. Survei Kesehatan Indonesia 2023 (Ski). Kemenkes, 235.
Koutsos, A., Riccadonna, S., Ulaszewska, M. M., Franceschi, P., Trošt, K., Galvin, A., braune, T., Fava, F., Perenzoni, D., Mattivi, F., Tuohy, K. M & Lovegrove, J. a. 2019. Two Apples A Day Lower Serum Cholesterol And Improve cardiometabolic Biomarkers In Mildly Hypercholesterolemic Adults: A randomized, Controlled, Crossover Trial. The American Journal Of Clinical nutrition, 111(2), 307. Https://Doi.Org/10.1093/Ajcn/Nqz282
Kris-Etherton, P. M., Sanders, L., Lawler, O., Riley, T & Maki, K. 2023. hyperlipidemia. Encyclopedia Of Human Nutrition: Volume 1-4, Fourth edition, 1–4, 361–379. Https://Doi.Org/10.1016/B978-0-12-821848- 8.00175-X
Langlois, M. R. 2025. The Friedewald Formula Strikes Back. Clinical Chemistry and Laboratory Medicine, 63(6), 1043–1045.
Liu, H., Liu, Z., Wu, Y., Zheng, L & Zhang, G. 2021. Regulatory Mechanisms Of anthocyanin Biosynthesis In Apple And Pear. International Journal Of molecular Sciences 2021, Vol. 22, Page 8441, 22(16), 8441.
https://Doi.Org/10.3390/Ijms22168441
Mach, F., Baigent, C., Catapano, A. L., Koskinas, K. C., Casula, M., Badimon, L., 2020. 2019 esc/Eas Guidelines For The Management Of Dyslipidaemias: Lipid modification To Reduce Cardiovascular Risk: The Task Force For The management Of Dyslipidaemias Of The European Society Of Cardiology (Esc) and European Atherosclerosis Society (Eas). European Heart Journal, 41(1), 111–188. Https://Doi.Org/10.1093/Eurheartj/Ehz455
Nakamura, M., Yamamoto, Y., Imaoka, W. 2020. Relationships Between Smoking Status, Cardiovascular Risk Factors, And Lipoproteins In A Large Japanese Population. Journal Of Atherosclerosis And Thrombosis, 28(9), 942. Https://Doi.Org/10.5551/Jat.56838
O’malley, P. G., Arnold, M. J., Kelley, C .2020. Management Of Dyslipidemia For cardiovascular Disease Risk Reduction: Synopsis Of The 2020 Updated U.S. department Of Veterans Affairs And U.S. Department Of Defense Clinical practice Guideline. Annals Of Internal Medicine, 173(10), 822–829. https://Doi.Org/10.7326/M20-4648,
Oyenihi, A. B., Belay, Z. A., Mditshwa, A. 2022. “An Apple A Day Keeps The Doctor away”: The Potentials Of Apple Bioactive Constituents For Chronic Disease prevention. Journal Of Food Science, 87(6), 2291–2309. https://Doi.Org/10.1111/1750-3841.16155
Pappan, Nikos, Awosika, Ayoola & Rehman, Anis. 2024. Dyslipidemia. Clinical And laboratory Medicine Textbook, 145–161. Https://Doi.Org/10.1007/978-3- 031-24958-7_14
Rambaran, T. F. 2020. Nanopolyphenols: A Review Of Their Encapsulation And anti-Diabetic Effects Sn Applied Sciences, 2(8). https://Doi.Org/10.1007/S42452-020-3110-8
Rasheed, H., Altemimi, A. B., Rabail, R. 2025. Anti-Hyperlipidemic And Anti- atherogenic Effect Of Citrus Peel Pectin Against Cholesterol And Cholic Acid induced Hyperlipidemia In Sprague Dawley Rats. Food Science And nutrition, 13(6). Https://Doi.Org/10.1002/Fsn3.70274
Ray, S. 2024. Role Of Statins In The Management Of Dyslipidaemia. Indian Heart journal, 76, S33–S37. Https://Doi.Org/10.1016/J.Ihj.2023.11.267
Rojas-Fernandez, C. H & Cameron, J. C. F. 2022. ¿Es Relevante Clínicamente El daño Cognitivo Asociado A Las Estatinas? Un Repaso Narrativo Y recomendaciones Clínicas. Annals Of Pharmacotherapy, 46(4), 549–557. https://Doi.Org/10.1345/Aph.1q620,
Rosenblat, M., Volkova, N & Aviram, M. 2023. Pomegranate Phytosterol (Β- sitosterol) And Polyphenolic Antioxidant (Punicalagin) Addition To Statin, significantly Protected Against Macrophage Foam Cells Formation. atherosclerosis, 226(1), 110–117. https://Doi.Org/10.1016/J.Atherosclerosis.2012.10.054
Roza, O., Irawati, L & Sulchan, M. 2023. Pengaruh Pemberian Jus Apel Fuji (Malus Domestica) Dan Susu Tinggi Kalsium Rendah Lemak terhadap Kadar Kolesterol Hdl Dan Ldl Pada Tikus Sprague dawley Hiperkolesterolemia. Journal Of Nutrition College. http://Ejournal-S1.Undip.Ac.Id/Index.Php/Jnc
Silveira, M. G & Chari, S. T. 2023. Pancreatitis. Mayo Clinic Medical Manual, 667– 685. Https://Doi.Org/10.1201/B14283-85
Singh, A., Museedi, A. S & Grossman, S. A. 2023. Acute Coronary Syndrome.
statpearls. Https://Www.Ncbi.Nlm.Nih.Gov/Books/Nbk459157/
Sizar, O., Khare, S., Patel, P & Talati, R. 2024. Statin Medications. Statpearls. https://Www.Ncbi.Nlm.Nih.Gov/Books/Nbk430940/
Stanley, M., Chippa, V., Aeddula, N. R., Rodriguez, B. S. Q & Adigun, R. 2024. rhabdomyolysis. Statpearls. https://Www.Ncbi.Nlm.Nih.Gov/Books/Nbk448168/
Taher, Z. A., Taher, A. A & Radi, S. 2024. An Update On Dyslipidemia management And Medications: A Review. Cureus, 16(3), E56255. https://Doi.Org/10.7759/Cureus.56255
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