Very High Risk of Recurrent Cardiovascular Events in Indonesian Patients with Established Coronary Heart Disease

Background: Risk prediction for recurrent cardiovascular events and death is advocated by prevention guidelines. Using the recently updated Secondary Manifestations of ARTerial disease (SMART)2 risk score algorithm – recalibrated and validated for the Asian population – we aim to describe the 10-year risk of recurrent events among coronary heart disease (CHD) patients, and to estimate the achievable residual risk after modifying the risk factors according to national guidelines. Methods: Patients at Makassar Cardiac Center Hospital, Indonesia, with established CHD were included. The 10-year recurrent event risk, residual risk and potential absolute risk reduction obtained with risk-factor reduction (systolic blood pressure <140 mmHg, LDL cholesterol <1.8 mmol/l, smoking cessation and use of antithrombotics) was estimated using the SMART2 risk score. Results: In total, 395 CHD patients were enrolled (mean age 57 ± 12 years; 64% men). The 10-year risk of recurrent events in the baseline was 36% (interquartile range 27–51); 65% of participants were considered as very high risk (risk ≥30%). If the risk factors were modified to the optimal targets, the residual risk would decrease to 23% (interquartile range 17–34). Nevertheless, one-third of patients remain in the very high risk category. Conclusion: The risk of recurrent events is extremely high in Indonesian CHD patients. Intensive preventive actions are required to reduce these extremely high risks, but a single, one-size approach is inappropriate due to the large variation in residual risks. Identifying patients that may benefit the most from intensified treatment is crucial, especially in regions where secondary prevention agents are often limited.