# Forward Bifurcation with Hysteresis Phenomena from Atherosclerosis Mathematical Model

## Authors

• Dipo Aldila Department of Mathematics, Universitas Indonesia, Depok 16424, Indonesia
• Arthana Islamilova Department of Mathematics, Universitas Indonesia, Depok 16424, Indonesia
• Sarbaz H.A. Khosnaw Department of Mathematics, University of Raparin, Ranya, Kurdistan Region, Iraq
• Bevina D. Handari Department of Mathematics, Universitas Indonesia, Depok 16424, Indonesia
• Hengki Tasman Department of Mathematics, Universitas Indonesia, Depok 16424, Indonesia

## Keywords:

atherosclerosis, forward bifurcation, backward bifurcation, hysteresis, optimal control

## Abstract

Atherosclerosis is a non-communicable disease (NCDs) which appears when the blood vessels in the human body become thick and stiff. The symptoms range from chest pain, sudden numbness in the arms or legs, temporary loss of vision in one eye, or even kidney failure, which may lead to death. Treatment in cases with severe symptoms requires surgery, in which the number of doctors or hospitals is limited in some countries, especially countries with low health levels. This article aims to propose a mathematical model to understand the impact of limited hospital resources on the success of the control program of atherosclerosis spreads. The model was constructed based on a deterministic model, where the hospitalization rate is defined as a time-dependent saturated function concerning the number of infected individuals. The existence and stability of all possible equilibrium points were shown analytically and numerically, along with the basic reproduction number. Our analysis indicates that our model may exhibit various types of bifurcation phenomena, such as forward bifurcation, backward bifurcation, or a forward bifurcation with hysteresis depending on the value of hospitalization saturation parameter and the infection rate for treated infected individuals. These phenomenon triggers a complex and tricky control program of atherosclerosis. A forward bifurcation with hysteresis auses a possible condition of having more than one stable endemic equilibrium when the basic reproduction number is larger than one, but close to one. The more significant value of hospitalization saturation rate or the infection rate for treated infected individuals increases the possibility of the stable endemic equilibrium point even though the disease-free equilibrium is stable. Furthermore, the Pontryagin Maximum Principle was used to characterize the optimal control problem for our model. Based on the results of our analysis, we conclude that atherosclerosis control interventions should prioritize prevention efforts over endemic reduction scenarios to avoid high intervention costs. In addition, the government also needs to pay great attention to the availability of hospital services for this disease to avoid the dynamic complexity of the spread of atherosclerosis in the field.

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