The Burden of Cardiovascular Disease Attributable to Major Modifiable Risk Factors in Indonesia.

Mohammad Akhtar Hussain,Abdullah Al Mamun,Mark Woodward,Sanne Ae Peters,Rachel R Huxley

doi:10.2188/jea.je20150178

Abstract

BackgroundIn Indonesia, coronary heart disease (CHD) and stroke are estimated to cause more than 470 000 deaths annually. In order to inform primary prevention policies, we estimated the sex- and age-specific burden of CHD and stroke attributable to five major and modifiable vascular risk factors: cigarette smoking, hypertension, diabetes, elevated total cholesterol, and excess body weight.MethodsPopulation attributable risks for CHD and stroke attributable to these risk factors individually were calculated using summary statistics obtained for prevalence of each risk factor specific to sex and to two age categories (<55 and ≥55 years) from a national survey in Indonesia. Age- and sex-specific relative risks for CHD and stroke associated with each of the five risk factors were derived from prospective data from the Asia-Pacific region.ResultsHypertension was the leading vascular risk factor, explaining 20%–25% of all CHD and 36%–42% of all strokes in both sexes and approximately one-third of all CHD and half of all strokes across younger and older age groups alike. Smoking in men explained a substantial proportion of vascular events (25% of CHD and 17% of strokes). However, given that these risk factors are likely to be strongly correlated, these population attributable risk proportions are likely to be overestimates and require verification from future studies that are able to take into account correlation between risk factors.ConclusionsImplementation of effective population-based prevention strategies aimed at reducing levels of major cardiovascular risk factors, especially blood pressure, total cholesterol, and smoking prevalence among men, could reduce the growing burden of CVD in the Indonesian population.

Highlights

Indonesia is the fourth most populous country in the world, with a population of 250 million people, and has experienced rapid economic growth over the past couple of decades.[1]
Risk factor assessment The prevalence estimates included in this analysis were derived from a published report of Riskesdas 2013, a nationally representative survey conducted by the Republic of Indonesia’s Ministry of Health in 2013.18 The details about survey methodology, ethical clearance, data collection, validation, and analysis are explained in detail in the Riskesdas report 2013.18 Briefly, the survey included 1 027 763 subjects at all ages from 33 districts of the country sampled through a probabilistic multi-stage process
Of the risk factors included in this analysis, cigarette smoking was the most prevalent risk factor in men (64.9%), followed by elevated total cholesterol, hypertension, excess bodyweight, and diabetes (Figure 1)

Summary

Introduction

Indonesia is the fourth most populous country in the world, with a population of 250 million people, and has experienced rapid economic growth over the past couple of decades.[1]. In order to inform primary prevention policies, we estimated the sex- and age-specific burden of CHD and stroke attributable to five major and modifiable vascular risk factors: cigarette smoking, hypertension, diabetes, elevated total cholesterol, and excess body weight. Smoking in men explained a substantial proportion of vascular events (25% of CHD and 17% of strokes) Given that these risk factors are likely to be strongly correlated, these population attributable risk proportions are likely to be overestimates and require verification from future studies that are able to take into account correlation between risk factors. Conclusions: Implementation of effective population-based prevention strategies aimed at reducing levels of major cardiovascular risk factors, especially blood pressure, total cholesterol, and smoking prevalence among men, could reduce the growing burden of CVD in the Indonesian population

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Conclusion