Chapter I

Introduction

1.1

Background
Cardiovascular disease has become the leading cause of death among
people in the world. An estimated 17,3 million people died from
cardiovascular disease in 2008, representing 30% of all global deaths.
WHO estimated that there will be almost 23,6 million people die from this
disease in 2030, meanwhile the cardiovascular mortality rate in Indonesia
is also increasing over the years, from only 5% in 1975 to almost 30% in
2004. Data from Basic Health Research in 2007 shows the prevalence of
cardiac disease nationally is 7,2% which means there are about 18,4
million Indonesian people had the cardiac disease. Cardiovascular disease
itself is a group of disorders of the heart and blood vessels. One of them is
the coronary heart disease and may has the first manifestation in
myocardial infarction which holds the highest incidence with 7,9 million
people among the cardiovascular prevalence, therefore it is very important
to know about how to prevent the occurence of myocardial infarction.

Myocardial infarction or MI is defined in pathology as myocardial cell

death due to prolonged ischaemia. Possible ischaemic symptoms include
various combinations of chest, upper extremity, mandibular or epigastric
diffuse discomfort or an ischaemic equivalent such as dyspnea or fatigue
and may be accompanied by diaphoresis, nausea or syncope. MI has
various underlying causes, including the oxidative stress that occurs when
an increased production or an altered cellular mechanism of protection
makes the oxidant metabolites exert their toxic effect. Recent study
showed apoptosis or programmed cell death which takes part of event of
free radical-induced ischemia injury was the predominant mode of cardiac
cell death induced by coronary artery occlusion. Because of the strong
evidence and studies believe that oxidative stress molecule may have
important role in pathophysiology of MI, an anti free radical agents would

be needed to prevent the disease. Melatonin would be come one of the

solution to this problem.

Melatonin or N-acetyl-5-methoxytryptamine is a free radical scavenger

and stimulator of antioxidative enzyme activity. It can detoxify numerous
reactive oxygen species (ROS) including hydrogen peroxide (H2O2),
hydroxyl radical (.OH), peroxyl radicals (ROO.), singlet oxygen (1O2), and
also reactive nitrogen species (RNS) such as nitric oxide radical (NO.) and
peroxinitrite (ONOO-). Melatonin involves in the regulation of many
physiological systems, including cardiovascular system.

Indeed, in this review we will discuss about possible role of melatonin

especially in myocardial infarction.

1.2

Problem identification
This review will identify several problems such as:

1.3

1.2.1

How does oxidative damage induce myocardial infarction?

1.2.2

How does the mechanism of melatonin?

1.2.3

How does melatonin play a role in myocardial infarction?

Aimes
This review aims to several points such as:

1.4

1.3.1

To know how oxidative damage induces myocardial infarction

1.3.2

To know the mechanism of melatonin

1.3.3

To know how melatonin plays a role in myocardial infarction

Benefits
The benefits of this review such as:
1.4.1 To give helpful assistance in understanding role of melatonin in
myocardial infarction
1.4.2 To review and support the understanding of research related to the
role of melatonin in myocardial infarction