The Effectiveness Of Vernonia Amygdalina (African Bitter Leaf) Tea For Reducing Cholesterol Levels In Individuals With Hypercholesterolemia

Received: September, 14, 2020 Revised: November 4, 2020 Available online: February 2021 Advances in technology and high activities at work cause a person to prefer fast food, increasing the risks of high cholesterol levels. Meanwhile, the healing of hypercholesterolemia requires a long treatment time. One of them is nonpharmacological treatment using Vernonia amygdalina (African bitter leaf) tea. This study analyzes V.amygdalina (African bitter leaf) effectiveness for reducing the cholesterol levels in individuals with hypercholesterolemia. The design of this study was a quasi-experimental design, with a non-equivalent control group design. The population involved individuals with hypercholesterolemia in the village of Kedensari RW 05 Tanggulangin, Sidoarjo. There were 40 respondents in this study using the purposive sampling technique – 20 respondents in the experimental group and 20 respondents in the control group. The independent variable was V.amygdalina tea, whereas the dependent variable was cholesterol levels. The data were analyzed using the Wilcoxon and Mann-Whitney tests. The p-value of the Wilcoxon test and MannWhitney signed-ranks test was (0.000)<α(0.005), which illustrated that V.amygdalina (African bitter leaf) tea was useful for the treatment of hypercholesterolemia.


INTRODUCTION
Technology and lifestyle alter habits in food consumption (Riansari, 2008). Nowadays, people prefer to consume fast food. The risk of fast food consumption contains high cholesterol levels, especially fried foods, due to increased heating (Tri, 2011). Maulida, Mayasari, and Rahmayani (2018) state that the primary cholesterol sources are meat, poultry, fish, and dairy products. Meanwhile, plant-based foods do not contain cholesterol. Serum cholesterol level less than 200 mg/dl is within the normal cholesterol levels. When it is more than 200 mg/dl, it is considered hypercholesterolemia (Waloya, Rimbawan, and Andarwulan, 2013).
Based on a report from the Ministry of Health of the Republic of Indonesia, in the book Profile of Non-Communicable Diseases in 2016, the number of high cholesterol cases based on the case visit to the community health post for non-communicable diseases prevention activities (from now on referred to as Posbindu-PTM) and the public health center (from now on referred to as Puskesmas) in East Java, Nowadays, the rise of the high cholesterol rate sprang by the diet and the lack of exercise. Rates individuals with High cholesterol or hypercholesterolemia continue to increase (Rahma, Natsir, and Kabo, 2014). When there is inadequate hypercholesterolemia treatment, it can lead to stroke because the blood flow to the brain is blocked. Additionally, it leads to atherosclerosis (Yani, 2015). Atherosclerosis is one of the causes of heart disease. Heart disease is the leading cause of death in the world (Hendra, 2016) (Ninaprilia, Z. and Kurniawaty, 2013). Based on the data obtained from WHO (2011)

METHOD
The design of this study was a quasi-experimental design, with a non-equivalent control group design.
Before the treatment (giving V.amygdalina tea), the authors examined cholesterol levels in both the experimental and control groups. V.amygdalina (bitter leaf) administration was given to the experimental group with a dose of 2 g/sachet three times a day for 15 days. The control group did not receive   Table 2 explains that the respondents in the experimental group 18 (90%) were mostly female, while 16 respondents (80%) in the control group were female.  Table 3 illustrates that most respondents in both groups were entrepreneurs (self-employed) in detail, eight people (40%) in the experimental group and ten people (50%) in the control group.

b. Bivariate Analysis
The bivariate analysis examined the effectiveness of treatment (African bitter leaf tea) in reducing cholesterol levels in respondents. The first analysis was the change of cholesterol levels in the experimental group between pre and post-test. Then the authors evaluated the gap in cholesterol levels in the control group between pre and post-test, followed by examining the difference (Δ) of cholesterol levels between both groups.  .000 .000 Table 5 shows a difference in the pre and post values in the experimental and control groups (p<0.05). .000 b .000 b Table 6 indicates a significant p<0.05, illustrating that giving V.Amygdalina tea reduces cholesterol levels in individuals with hypercholesterolemia.

DISCUSSION
Based on the study conducted by Ardiani (2017) Flavonoids cause liver cells to increase the formation of bile acids from cholesterol, which will reduce fat because it becomes energy (Adi Sucipto, 2008) (Tri, 2011). Tannins that react with mucosal proteins of intestinal epithelial cells can inhibit fat absorption. Saponins work in reducing the absorption of cholesterol in the intestines and reducing the absorption of bile sap. Saponins work by binding bile salts to form non-absorbable compounds. The second way of working is by making bile salts so that they can bind to polysaccharides in dietary fiber, then excreted with feces. Bile salts cannot bind to cholesterol, so the body cannot absorb cholesterol (Hasan, Subroto, and Puspasari, 2018).
African leaf has a bitter taste when consumed. V.amygdalina can detoxify the body because of its antioxidant properties (Faradisa, Marfu'ah, and Amal, 2018 (2015) states that V.amygdalina is safe for consumption both as medicines and food because of no harmful effects on the liver and kidneys. Table 2 shows that most of the respondents were female. The research conducted by Hendra (2016) showed that women tend to have higher blood cholesterol levels during childhood than men during childhood. In fact, at the age of 20, men have a higher cholesterol level than women. But when reaching menopause, there is a reduction of estrogen levels in women. Table 1 shows that the respondents' average age in the experimental group and the control group is between 36 and 45. The research conducted by Hendra (2016) on risk factors for increased cholesterol reported that in individuals over 30 years, age became the significant risk factor for increasing blood cholesterol levels. Listiana and Purbosari (2010), in their research, also said that total cholesterol levels also increased when people got older. The increase in cholesterol level triggers the risk of ischemic stroke. The increasing age will also be at risk for cerebral ischemia, regardless of ethnicity and gender.
People aged over 55 years have the risk of developing cerebral ischemia twice as much as the lower age.
The development is a transitional period for men and women to leave their physical characteristics and behaviors of adulthood and enter life with new physical characteristics and behaviors. The developmental tasks at this age take the form of further development and maturation in young adulthood. Concerning health, adults begin to accept and adapt to the physical changes that happen in them.
The control group did not receive Vernonia Amygdalina tea but received health education was showed a difference between the pre-test and post-test (Table 4). The respondents' age in the control group is between 36-45 yearsclassified into adulthood. When people enter emotional maturity and control their emotions, they can think carefully, well, and objectively (Chaplin, 2009). Therefore, they will accept knowledge and information from the surrounding environment easier. Many factors can cause high blood cholesterol levels. In addition to herbal medication, individuals must also control their diet, exercise, and avoid smoking and stress. Thus, they need to look at some of these factors to control cholesterol levels.
When the cholesterol levels are well maintained, there is a reduced risk of stroke and heart attack.

CONCLUSION
This study concludes that consuming V.amygdalina as tea reduces blood cholesterol levels in individuals with hypercholesterolemia.