Research Article: Cardiovascular disease risk factor prevalence and estimated 10-year cardiovascular risk scores in Indonesia: The SMARThealth Extend study

Date Published: April 30, 2019

Publisher: Public Library of Science

Author(s): Asri Maharani, Devarsetty Praveen, Delvac Oceandy, Gindo Tampubolon, Anushka Patel, Geofrey Musinguzi.


The brunt of cardiovascular disease (CVD) burden globally now resides within low- and middle-income countries, including Indonesia. However, little is known regarding cardiovascular health in Indonesia. This study aimed to estimate the prevalence of elevated CVD risk in a specific region of Indonesia.

We conducted full household screening for cardiovascular risk factors among adults aged 40 years and older in 8 villages in Malang District, East Java Province, Indonesia, in 2016–2017. 10-year cardiovascular risk scores were calculated based on the World Health Organization/International Society of Hypertension’s region-specific charts that use age, sex, blood pressure, diabetes status and smoking behaviour.

Among 22,093 participants, 6,455 (29.2%) had high cardiovascular risk, defined as the presence of coronary heart disease, stroke or other atherosclerotic disease; estimated 10-year CVD risk of ≥ 30%; or estimated 10-year CVD risk between 10% to 29% combined with a systolic blood pressure of > 140 mmHg. The prevalence of high CVD risk was greater in urban (31.6%, CI 30.7–32.5%) than in semi-urban (28.7%, CI 27.3–30.1%) and rural areas (26.2%, CI 25.2–27.2%). Only 11% and 1% of all the respondents with high CVD risk were on blood pressure lowering and statins treatment, respectively.

High cardiovascular risk is common among Indonesian adults aged ≥40 years, and rates of preventive treatment are low. Population-based and clinical approaches to preventing CVD should be a priority in both urban and rural areas.

Partial Text

The ongoing demographic transition, combined with epidemiological and nutritional transitions, is contributing to the continued shift of the cardiovascular diseases (CVDs) burden from developed to developing countries [1, 2]. Ischaemic Heart Disease and stroke are the leading cause of death in the middle-income countries and Disability-Adjusted Life Years (DALYs) in most countries [3]. In Indonesia, CVDs are the leading cause of both morbidity and mortality, responsible for a third of all deaths in Indonesia [4]. Years of life lost due to the premature mortality from coronary heart disease (CHD) and cerebrovascular diseases are estimated to be 3,299 and 2,555 years of life lost/100,000, respectively [5].

The study received ethics approval from the Ethical Committee, Ministry of Research, Technology, and Higher Education, Medical Faculty of Brawijaya University (330/EC/KEPK/08/2016) and was registered on the Clinical Trial Registry of India (CTRI/2017/08/009387). Written informed consent was obtained from all participants contributing data to the analyses.

This study is the first large, cross-sectional, population-based study to address the prevalence of the 10-year risk of CVD using the WHO/ISH scoring system [17] in Indonesia. We found that high CVD risk was very common in Malang district, with almost 30% of the adult population aged 40 years and above affected. With respect to other studies that used the WHO/ISH risk scores, the prevalence of high 10-year cardiovascular risk that we found in Indonesia is higher than those of rural India (10.2%) with the same age range of sample (40 years and older [18]. A study with respondents aged 40 until 64 years old in three countries shows that the prevalence of high CVD risk in Mongolia (33.3%) is similar with our study, and those in Cambodia (10.4%) and Malaysia (20.8%) were lower than our study [19].

High cardiovascular risk is common in Malang District, with almost 30% of adults aged 40 years and older at high 10-year risk of developing CVD. However, only 24% of those at high risk were receiving treatment. Increasing awareness of CVD risk and screening programmes are needed to reduce the prevalence of CVD events. Furthermore, providing primary preventive approaches to ensure that people with low CVD risk retain that status should be a focus for policy-makers at the national level.




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