Low Attainment of Treatment Targets for Cardiovascular Risk Factors in Indonesian Adults With Established Coronary Artery Disease

Abstract

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.