Number of comorbidities and the risk of delay in seeking treatment for coronary heart disease: a longitudinal study in Bogor City, Indonesia.

BACKGROUND: The aim of this study was to investigate the relationship between the number of patient comorbidities and the delays in seeking treatment for coronary heart disease (CHD). METHODS: This longitudinal study utilized secondary data from the Non-Communicable Disease Risk Factor (NCDRF) cohort study conducted in Bogor City. Individuals who participated in the NCDRF cohort study and were diagnosed with CHD within the 6-year study period met the inclusion criteria. Respondents who were not continuously monitored up to the 6th year were excluded. The final sample included data from respondents with CHD who participated in the NCDRF cohort study and were monitored for the full 6-year duration. The final logistic regression analysis was conducted on data collected from 812 participants. RESULTS: Among the participants with CHD, 702 out of 812 exhibited a delay in seeking treatment. The risk of a delay in seeking treatment was significantly higher among individuals without comorbidities, with an odds ratio (OR) of 3.5 (95% confidence interval [CI], 1.735-7.036; p<0.001). Among those with a single comorbidity, the risk of delay in seeking treatment was still notable (OR, 2.6; 95% CI, 1.259-5.418; p=0.010) when compared to those with 2 or more comorbidities. These odds were adjusted for age, sex, education level, and health insurance status. CONCLUSION: The proportion of patients with CHD who delayed seeking treatment was high, particularly among individuals with no comorbidities. Low levels of comorbidity also appeared to correlate with a greater tendency to delay in seeking treatment.

Cardiovascular disease prediction model for Indonesian adult population with prediabetes and diabetes mellitus: The Bogor Cohort study of Noncommunicable Diseases Risk Factors.

BACKGROUND AND AIMS: This study aims to develop a predictive model of cardiovascular events in dysglycemia among the Indonesian adult population. METHODS: This is a retrospective cohort study conducted on subjects over 25 years in the "The Bogor Cohort Study of Noncommunicable Diseases Risk Factors" from 2011 to 2018. Data associated with age, gender, blood pressure, body mass index, waist circumference, blood glucose, cholesterol, smoking habits, family history of cardiovascular disease, and physical activity were obtained. Cardiovascular events in six years were observed; this included coronary heart disease, stroke, or all-cause cardiovascular mortality. Cox proportional hazards regression models were used to determine independent predictors of cardiovascular events. RESULTS: A total of 1085 subjects with prediabetes and diabetes mellitus were included in this study, with 73.5% female. The cumulative incidence of cardiovascular events in six years was 9.7%. Predictors of cardiovascular events were age ≥45 years (HR = 2.737; 95% CI 1.565-4.787) and hypertension (HR = 2.580; 95% CI 1.619-4.112). CONCLUSIONS: Age ≥45 years and hypertension were predictors of cardiovascular events in six years among the adult Indonesian population with prediabetes and diabetes, necessitating targeted intervention among these subjects.

Adherence to Treatment and Glycemic Control in Patients with Type 2 Diabetes Mellitus: A 4-Year Follow-up PTM Bogor Cohort Study, Indonesia.

PURPOSE: Large-scale evaluation of the treatment adherence in patients with type 2 diabetes mellitus (DM) in Indonesian is limited. We aim to evaluate the treatment adherence of Indonesian type 2 DM patients using national "big data" and investigate its association with glycemic parameters. PATIENTS AND METHODS: We analyzed baseline and fourth-year data sets from 2011 to 2018 obtained from the Indonesian Ministry of Health Cohort Study of Non-Communicable Disease Risk Factors in Bogor, West Java (the PTM Bogor Cohort Study). This was a retrospective cohort study in which the sample was divided into two groups. One group adhered to treatment from primary health centers and followed the prescribed medicine/treatment regimen (treated group), while the other did not follow the treatment (untreated group). We evaluated changes in fasting blood glucose (FBG) and post-prandial blood glucose (PPBG) by controlling for other variables. RESULTS: From 5690 subjects, 593 were type 2 DM diagnosed and 342 were eligible at the baseline. At 4-year observation, 212 eligible patients remained, consisting of 62 subjects who adhered to treatment, and more than double that number who were untreated (150 subjects). More significant decreases in FBG and PPBG were found in the treated group (FBG 80.6%, PPBG 90.3%) than in the untreated group (FBG 42.0%, PPBG 67.3%). The results of the multivariate analysis showed that after 4 years observation, treated patients have reduced FBG 3.304 times more and PPBG 3.064 times more than untreated patients, with control factors such as decrease in LDL levels and use of oral drugs. CONCLUSION: There were less than half as many treated patients as untreated patients involved in the PTM Bogor Study Group. At the fourth-year follow-up, treated patients experienced three times more significant decreases in FBG and PPBG than those who were untreated, even after being controlled by several confounding factors. Given the importance of these findings, it is suggested that immediate strategic action be taken to improve Indonesian patients' adherence to treatment.

Visceral adiposity index and lipid accumulation product as a predictor of type 2 diabetes mellitus: The Bogor cohort study of non-communicable diseases risk factors.

OBJECTIVES: Lipid accumulation product (LAP) index and Visceral Adiposity Index (VAI) are simple calculations to measure fat accumulation and visceral fat respectively. We aim to study the use of LAP index and VAI as diagnostic parameter and predictor of T2DM. METHODS: We analysed the baseline and longitudinal data from the Indonesian Ministry of Health Cohort Study of Non-communicable Diseases Risk Factors in West Java, comprising 846 men and 2437 women aged 25-65 years. At baseline, the odds ratio for the diagnosis of prediabetes and T2DM among subjects with high LAP Index and VAI was analysed using logistic regression analysis. In the longitudinal analysis, LAP index and VAI as predictor of prediabetes and T2DM was analysed with cox regression analysis. RESULT: Worsening glycemia status was associated with an increased LAP index and VAI (p < 0.001). Subjects with high VAI had an increased OR of having T2DM in both men [OR, 95%CI, 2.29(1.15-4.56), p = 0.018] and women [1.95(1.49-2.54), p < 0.001)]. Association of high LAP with T2DM was found only in women [OR, 95%CI, 2.11(1.16-1.52), p < 0.001]. In terms of T2DM prediction, only women [RR, 95% CI, 2.59 (1.05-6.39), p = 0.038)], with high VAI had an increased risk of T2DM in the future. High LAP index was not associated with an in increased risk of T2DM in the future in both sexes. CONCLUSION: High LAP index was associated with an increased risk of T2DM diagnosis in women but it could not predict the development of T2DM. High VAI was associated with an increased risk of T2DM diagnosis in both sexes, however, it could only predict the development of T2DM in women.

Cardiovascular Disease Risk Factors Among Blue and White-collar Workers in Indonesia.

BACKGROUND: cardiovascular diseases (CVD) is the most common cause of death in Indonesia. We aimed to examine risks of CVD in workers aged 40 to 69 year related to their occupational status. METHODS: a cross-sectional study in all provinces of Indonesia. Data from a large-scale national health survey called RISKESDAS were used to analyze factors associated with CVD. Analysis was restricted to the working population aged 40 to 69 year. There were 137,378 subjects included in the analysis. Cox's regression analysis was modified to calculate prevalence ratio for the association of CVD with diabetes mellitus (DM), hypertension, stress, body mass index (BMI), smoking, and particular demographic factors. RESULTS: CVD was associated with occupation; white collar workers were about 1.6 times as likely to be diagnosed with CVD as to blue collar workers.  However, blue collar workers were more likely to report symptoms of CVD than white collar workers. Prevalence of CVD was higher in women than men, increasing by age and education attainment. Hypertension, DM, stress, and increased BMI added the prediction of CVD: prevalence ratio (PR) was 1.72 (95% CI 1.59-1.86), 3.89 (95% CI 3.43-4.44), 3.02 (95% CI 2.77-3.29) and 1.42 (95% CI 1.28-1.57) for BMI ≥27 relative to <25 kg/m2, respectively. The study could not explain the association with smoking. CONCLUSION: this study added evidence of major risk factors which could be modified to reduce CVD. Some associations were likely to reflect access to health care.