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Low Attainment of Treatment Targets for Cardiovascular Risk Factors in Indonesian Adults With Established Coronary
Dian Sidik Arsyad1,2, Nurul Qalby1,3, Andriany Qanitha4,5
1Division of Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands.
Insights
Coronary artery disease patients often miss risk factor targets, with only 1.8% meeting all goals. Low-density lipoprotein-cholesterol control is particularly poor, highlighting an urgent need for improved cardiovascular disease management.
Area of Science:
- Cardiology
- Public Health
- Preventive Medicine
Background:
- Established coronary artery disease (CAD) patients face elevated risks of recurrent cardiovascular events and mortality.
- This increased risk is often linked to suboptimal control of key risk factors.
Purpose of the Study:
- To assess the achievement of recommended risk factor control targets in CAD patients.
- Evaluation was based on Indonesian national guidelines for cardiovascular disease (CVD) prevention.
Main Methods:
- 395 CAD patients were recruited from Makassar Cardiac Center, Indonesia.
- Assessment included systolic blood pressure (SBP), LDL-cholesterol (LDL-C), BMI, smoking status, and antithrombotic use.
- Logistic regression identified subgroups needing more intensive monitoring.
Main Results:
- Only 1.8% of patients met all risk factor targets.
- Lowest attainment was for LDL-C (5.1%), followed by BMI (59.7%) and SBP (62.8%).
- Non-smoking status (94.4%) and antithrombotic use (76.7%) showed higher attainment, though SBP control was lower in older adults and women.
Conclusions:
- There is an urgent need for enhanced management strategies for CAD patients.
- Particular focus on improving LDL-C control is critical.
- Addressing these gaps is vital for reducing the CVD burden, especially in low- and middle-income countries like Indonesia.
Rationale:
Established coronary artery disease (CAD) patients are at increased risk for recurrence of cardiovascular events and mortality due to non-attainment of recommended risk factor control targets.
Objective:
We aimed to evaluate the attainment of treatment targets for risk factor control among CAD patients as recommended in the Indonesian CVD prevention guidelines.
Methods:
Patients were consecutively recruited from the Makassar Cardiac Center at Wahidin Sudirohusodo Hospital, Indonesia. Targets for systolic blood pressure (SBP < 140 mmHg), low-density lipoprotein-cholesterol (LDL-C < 1.8 mmol/L), body mass index (BMI: 20-25 kg/m2), non-smoking status and antithrombotic use were assessed according to the national guideline. Attainment levels were evaluated in CAD population subgroups using logistic regression to identify patients who required more intensive monitoring.
Results:
A total of 395 CAD patients (median age: 57 years (IQR: 49-65), 63.8% men) were recruited between February and June 2021. We observed that 1.8% of the CAD patients met all risk factor treatment targets. LDL-C had the lowest attainment level (5.1%), followed by BMI (59.7%), SBP (62.8%), antithrombotic usage (76.7%) and non-smoking status (94.4%). Apart from lower attainment of SBP control in the 50+ years age group (aOR: 0.57, 95% CI: 0.35-0.94) and women (aOR: 0.53, 95% CI: 0.34-0.83), the attainment levels of other risk factors were consistently low across age, sex, marital status and educational subgroups.
Conclusion:
These findings emphasize the urgent need for effective management and heightened awareness, particularly for controlling LDL-C in the CAD population. Action to address this issue is crucial for mitigating the CVD burden, particularly in low- and middle-income countries such as Indonesia.
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