Indonesia-INTERASPIRE study: an Indonesian cross-sectional multicenter survey on cardiovascular secondary prevention in coronary heart disease
DOI:
https://doi.org/10.13181/mji.oa.257833Keywords:
cardiovascular diseases, guideline, rehabilitation, secondary preventionAbstract
BACKGROUND Cardiovascular disease (CVD) is projected to affect more than 23.3 million people by 2030. Therefore, CVD prevention strategies were established to decrease morbidity and mortality while enhancing overall well-being. The Joint European Societies (JES) guidelines on CVD prevention were developed to enhance preventive cardiology practices. This study aimed to evaluate the adherence to JES guidelines for cardiovascular prevention in routine clinical practice for secondary prevention.
METHODS This multicenter cross-sectional study was conducted in 7 centers between August 2020 and June 2021. Patients under 80 years old who had undergone percutaneous transluminal coronary angioplasty, coronary artery bypass graft, percutaneous coronary intervention, or experienced acute coronary syndrome were identified from medical records and interviewed a year later. Descriptive statistics were used to calculate the occurrence of risk variables, medication use, and index events associated with low-density lipoprotein cholesterol (LDL-C), hemoglobin A1c, and blood pressure (BP).
RESULTS A total of 402 participants (13.9% female) were interviewed, and their medical records were reviewed. Among the study population, 74.4% had a smoking history, 35.4% had dyslipidemia, 33.1% did not meet the BP target, and only 28.4% achieved the LDL-C target. Additionally, less than half (43.8%) participated in physical activity for >150 min/week. Only 15.6% of the patients among the centers who had scored >8 for the guideline-based target score.
CONCLUSIONS Most patients did not meet the guidelines for secondary prevention, primarily due to the high prevalence of dyslipidemia and physical inactivity, although some achieved the LDL-C target.
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References
Gaziano TA. Cardiovascular diseases worldwide. In: Prabhakaran D, Anand S, Reddy KS, editors. Public health approach to cardiovascular disease prevention & management. Boca Raton: CRC Press; 2022. https://doi.org/10.1201/b23266-2
Appelman Y, van Rijn BB, Ten Haaf ME, Boersma E, Peters SA. Sex differences in cardiovascular risk factors and disease prevention. Atherosclerosis. 2015;241(1):211−8. https://doi.org/10.1016/j.atherosclerosis.2015.01.027
Pająk A, Jankowski P, Zdrojewski T. The burden of cardiovascular disease risk factors: a current problem. Kardiol Pol. 2022;80(1):5−15. https://doi.org/10.33963/KP.a2022.0018
Maharani A, Sujarwoto, Praveen D, Oceandy D, Tampubolon G, Patel A. Cardiovascular disease risk factor prevalence and estimated 10-year cardiovascular risk scores in Indonesia: the SMARThealth Extend study. PLoS One. 2019;14(4):e0215219. https://doi.org/10.1371/journal.pone.0215219
Hussain MA, Al Mamun A, Peters SA, Woodward M, Huxley RR. The burden of cardiovascular disease attributable to major modifiable risk factors in Indonesia. J Epidemiol. 2016;26(10):515−21. https://doi.org/10.2188/jea.JE20150178
Lin CF, Chang YH, Chien SC, Lin YH, Yeh HY. Epidemiology of dyslipidemia in the Asia Pacific region. Int J Gerontol. 2018;12(1):2-6. https://doi.org/10.1016/j.ijge.2018.02.010
Balakumar P, Maung-U K, Jagadeesh G. Prevalence and prevention of cardiovascular disease and diabetes mellitus. Pharmacol Res. 2016;113(Pt A):600−9. https://doi.org/10.1016/j.phrs.2016.09.040
Yusuf S, Wood D, Ralston J, Reddy KS. The World Heart Federation's vision for worldwide cardiovascular disease prevention. Lancet. 2015;386(9991):399−402. https://doi.org/10.1016/S0140-6736(15)60265-3
Kotseva K, Wood D, De Bacquer D, De Backer G, Rydén L, Jennings C, et al. EUROASPIRE IV: a European Society of Cardiology survey on the lifestyle, risk factor and therapeutic management of coronary patients from 24 European countries. Eur J Prev Cardiol. 2016;23(6):636−48. https://doi.org/10.1177/2047487315569401
Kotseva K, De Backer G, De Bacquer D, Rydén L, Hoes A, Grobbee D, et al. Primary prevention efforts are poorly developed in people at high cardiovascular risk: a report from the European Society of Cardiology EURObservational Research Programme EUROASPIRE V survey in 16 European countries. Eur J Prev Cardiol. 2021;28(4):370−9. https://doi.org/10.1177/2047487320908698
De Backer G, Jankowski P, Kotseva K, Mirrakhimov E, Reiner Ž, Rydén L, et al. Management of dyslipidaemia in patients with coronary heart disease: results from the ESC-EORP EUROASPIRE V survey in 27 countries. Atherosclerosis. 2019;285:135−46. https://doi.org/10.1016/j.atherosclerosis.2019.03.014
Weir CB, Jan A. BMI classification percentile and cut off points. 2023. In: StatPearls [Internet]. Treasure Island: StatPearls Publishing; 2025.
McEvoy JW, Jennings C, Kotseva K, De Bacquer D, De Backer G, Erlund I, et al. Variation in secondary prevention of coronary heart disease: the INTERASPIRE study. Eur Heart J. 2024;45(39):4184−96. https://doi.org/10.1093/eurheartj/ehae558
Lu M, Xia H, Ma J, Lin Y, Zhang X, Shen Y, et al. Relationship between adherence to secondary prevention and health literacy, self-efficacy and disease knowledge among patients with coronary artery disease in China. Eur J Cardiovasc Nurs. 2020;19(3):230−7. https://doi.org/10.1177/1474515119880059
Khan R, Kaul P, Islam S, Savu A, Bagai A, van Diepen S, et al. Drug adherence and long-term outcomes in non-revascularized patients following acute myocardial infarction. Am J Cardiol. 2021;152:49−56. https://doi.org/10.1016/j.amjcard.2021.04.031
Graham I, Atar D, Borch-Johnsen K, Boysen G, Burell G, Cifkova R, et al. European guidelines on cardiovascular disease prevention in clinical practice: executive summary: fourth joint task force of the European Society of Cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of nine societies and by invited experts). Eur Heart J. 2007;28(19):2375−414. https://doi.org/10.1093/eurheartj/ehm316
Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, Verschuren M, et al. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). The fifth joint task force of the European Society of Cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of nine societies and by invited experts). Eur Heart J. 2012;33(13):1635−701. Erratum in: Eur Heart J. 2012;33(17):2126. https://doi.org/10.1093/eurheartj/ehs092
Wu AD, Lindson N, Hartmann-Boyce J, Wahedi A, Hajizadeh A, Theodoulou A, et al. Smoking cessation for secondary prevention of cardiovascular disease. Cochrane Database Syst Rev. 2022;8(8):CD014936. https://doi.org/10.1002/14651858.CD014936.pub2
De Bacquer D, Jennings CS, Mirrakhimov E, Lovic D, Bruthans J, De Smedt D, et al. Potential for optimizing management of obesity in the secondary prevention of coronary heart disease. Eur Heart J Qual Care Clin Outcomes. 2022;8(5):568−76. https://doi.org/10.1093/ehjqcco/qcab043
Soran H, Dent R, Durrington P. Evidence-based goals in LDL-C reduction. Clin Res Cardiol. 2017;106(4):237−48. https://doi.org/10.1007/s00392-016-1069-7
Irawati S, Prayudeni S, Rachmawati R, Wita IW, Willfert B, Hak E, et al. Key factors influencing the prescribing of statins: a qualitative study among physicians working in primary healthcare facilities in Indonesia. BMJ Open. 2020;10(6):e035098. https://doi.org/10.1136/bmjopen-2019-035098
Oesterle A, Laufs U, Liao JK. Pleiotropic effects of statins on the cardiovascular system. Circ Res. 2017;120(1):229−43. Erratum in: Circ Res. 2018;123(8):e20. https://doi.org/10.1161/CIRCRESAHA.116.308537
Kavalipati N, Shah J, Ramakrishan A, Vasnawala H. Pleiotropic effects of statins. Indian J Endocrinol Metab. 2015;19(5):554−62. https://doi.org/10.4103/2230-8210.163106
Laiteerapong N, Ham SA, Gao Y, Moffet HH, Liu JY, Huang ES, et al. The legacy effect in type 2 diabetes: impact of early glycemic control on future complications (the diabetes & aging study). Diabetes Care. 2019;42(3):416−26. https://doi.org/10.2337/dc17-1144
Ni Z, Dardas L, Wu B, Shaw R. Cardioprotective medication adherence among patients with coronary heart disease in China: a systematic review. Heart Asia. 2019;11(2):e011173. https://doi.org/10.1136/heartasia-2018-011173
Marzà-Florensa A, Drotos E, Gulayin P, Grobbee DE, Irazola V, Klipstein-Grobusch K, et al. Prevalence of cardioprotective medication use in coronary heart disease patients in South America: systematic review and meta-analysis. Glob Heart. 2022;17(1):37. https://doi.org/10.5334/gh.1124
Tucker WJ, Fegers-Wustrow I, Halle M, Haykowsky MJ, Chung EH, Kovacic JC. Exercise for primary and secondary prevention of cardiovascular disease: JACC Focus Seminar 1/4. J Am Coll Cardiol. 2022;80(11):1091−106. https://doi.org/10.1016/j.jacc.2022.07.004
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Copyright (c) 2025 Ade Meidian Ambari, Harris Hasan, Bambang Dwiputra, Dwita Rian Desandri, Rita Hamdani, Citra Kiki Krevani, Muhammad Syaoqi, Muhammad Ridwan, Hesti Anandini, Maha Fitra, Irsad Andi Arso, Vita Yanti Anggraeni, Anggoro Budi Hartopo, Yasmine Fitrina Siregar, Cholid Tri Tjahjono, Badai Bhatara Tiksnadi, Mega Febrianora, Najmi Fauzan Tarsidin, Dean Arityanti, Faqrizal Ria Qhabibi, Indira Kalyana Makes, Eliana Susilowati, Nabila Erina Erwan, Indah Widyasari Hergaf, Abdul Halim Raynaldo
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