Determinants of coronary heart disease among adults: a case-control study

Main Article Content

Sudikno Sudikno
Srilaning Driyah
Julianty Pradono


According to recent World Health Organization data, coronary heart disease (CHD) remains the leading cause of death worldwide. Although the risk factors of this disease are well known, the strength of these factors varies in different populations. The aim of the study was to assess the determinants of CHD in Indonesian adults aged 25 years and over.

A case–control study was carried out involving 592 subjects aged 25 years and over (444 controls and 148 cases). Participants were interviewed using validated questionnaires. Physical examinations and supporting examinations were conducted. The Chi square test, Fisher’s exact test, and independent t test were used to analyze the data. To determine independent predictors of CHD, the odds ratio (OR) was determined via the multiple logistic regressions test.

The CHD subjects (case group) showed higher blood sugar and systolic pressure than non-CHD subjects (controls), with mean fasting blood sugar of 92.53±27.05 mg/dL vs 88.29 ±23.43 mg/dL (p=0.038), 2-hour postprandial blood sugar of 133.15±65.09 mg/dL vs 120.87±44.60 mg/dL (p=0.000), and systolic blood pressure of 89±27.62 mmHg vs 129.98±10.58 mmHg (p=0.002). The logistic regression analysis in the case group showed that higher education (college) had a 2.32-fold greater effect (95% CI. 1.01-5.35) on CHD incidence compared to the control group.

This study has demonstrated that the most frequent risk factor for CVD in adults aged 25 years and over is higher education. Control and prevention of CHD need to be done with regular control of blood sugar levels and blood pressure to stabilize them within normal limits.

Article Details

How to Cite
Sudikno, S., Driyah, S. ., & Pradono, J. . (2023). Determinants of coronary heart disease among adults: a case-control study. Universa Medicina, 42(1), 41–51.
Original Articles


. Roth GA, Johnson C, Abajobir A, et al. Global, regional, and national burden of cardiovascular diseases for 10 Causes , 1990 to 2015. J Am Coll Cardiol 2017;70:1-25. doi: 10.1016/j.jacc.2017.04. 052.

Finucane MM, Paciorek CJ, Danaei G, Ezzati M.Bayesian estimation of population-level trends in measures of health status. Stat Sci 2014;29:18–25. doi: 10.1214/13-STS427.

Sanchis-Gomar F, Perez-Quilis C, Leischik R, Lucia A. Epidemiology of coronary heart disease and acute coronary syndrome. Ann Transl Med 2016; 4:256. doi: 10.21037/atm.2016.06.33

Benjamin EJ, Muntner P, Alonso A, et al. On behalf of the American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics — 2019 update: a report from the American Heart Association. Circulation 2019;139:e56-e528.

Indonesian Health Research and Development Agency. Hasil utama laporan Riskesdas 2018. [Main results of Riskesdas 2018]. Jakarta: Indonesian Health Research and Development Agency; 2018. Indonesian.

Suhaema S, Masthalina H. Pola konsumsi dengan terjadinya sindrom metabolik. [Consumption pattern with occurrence of metabolic syndrome]. Kesmas Natl Public Heal J 2015;9:340. Indonesian.

Rustika R, Oemiati R. Coronary heart disease with obesity in Kebon Kalapa Village, Bogor. Bul Penelit Sist Kesehat 2014;17:385–93.

Azab AE, Albasha MO, Mansour AM. Evaluation of cardiovascular disease risk factors among diabetic patients with hypertension in Messelata region, Libya. J Diabetes Metab Disorder Control 2020;7:14 29. DOI: 10.15406/jdmdc.2020.07.0 0195

Aragaw S, Tesfahun E, Derseh BT, et al. Determinants of selected cardiovascular diseases among adult ptients at cardiac clinic of Debre Berhan referral hospital, Ethiopia: unmatched case-control study. Cardiovasc Ther 2020;2020. doi:10.1155/2020/7036151.

Ram RV, Trivedi AV. Behavioral risk factors of coronary artery disease: A paired matched case control study. J Cardiovasc Dis Res 2012;3:212–7. doi: 10.4103/0975-3583.98896.

Mirzaeipour F, Seyedmazhari M, Pishgooie AH, Hazaryan M. Assessment of risk factors for coronary artery disease in military personnel: a study from Iran. J Fam Med Prim Care 2019;8:1347–51. doi: 10.4103/jfmpc.jfmpc_109_19.

Tuminah S, Riyadina W. Hubungan konsusmsi kopi terhadap stroke atau penyakit jantung koroner. [Relationship of coffee consumption with stroke or coronary heart disease]. Gizi Indon 2014; 37:29–40. Indonesian.

Rustika, Oemiati R. Penyakit jantung koroner (PJK) dengan obesitas di Kelurahan Kebon Kalapa, Bogor (Baseline Studi Kohor Faktor Risiko PTM). [Coronary heart disease [CHD] with obesity in Kebon Kalapa Village, Bogor. [Baseline cohort study of non-communicable diseases risk factors]]. Bul Penelit Sist Kesehat 2014;17:385–93. Indonesian.

Darjoko ST, Wahyuningsih T, Sudikno. High carbohydrate intake increases risk of coronary heart disease in adults: a prospective cohort study. Univ Med 2019;38:90-9. doi: 10.18051/UnivMed.2019. v38.90-99

Driyah S, Oemiati R, Rustika, Hartati MS. Prediktor sindrom metabolik: studi kohor prospektif selama enam tahun di Bogor. [Predictors of metabolic syndrome: prospective cohort study of six years duration in Bogor]. Media Litbangkes 2019;29: 215-24. Indonesian. DOI:

Setia MS. Methodology Series Module 2: Case-control studies. Indian J Dermatol 2016 ;61:146-51. doi: 10.4103/0019-5154.177773.

Alexander CM, Landsman PB, Teutsch SM, Haffner SM. NCEP-defined metabolic syndrome, diabetes, and prevalence of coronary heart disease among NHANES III participants age 50 years and older. Diabetes 2003;52:1210–4.

Lee YY, Tsao YC, Yang CK. Association between risk factors of metabolic syndrome with lung function. Eur J Clin Nutr 2020;74:811–7. doi: 10.1038/s41430-018-0369-6.

Bragg F, Halsey J, Guo Y, et al. Blood pressure and cardiovascular diseases in Chinese adults with type 2 diabetes: a prospective cohort study. Lancet Reg Health West Pac 2021;7:100085. doi: 10.1016/j.lanwpc.2020.100085.

Sudikno S, Tuminah S. Hubungan indeks massa tubuh, lingkar perut, tekanan darah, dan profil lipid dengan kejadian penyakit jantung koroner: analisis data studi faktor risiko penyakit tidak menular di kota Bogor. [Relationship of body mass index, waist circumference, blood pressure, and lipid profile with incidence of coronary heart disease: data analysis of the study of risk factors of non-communicable diseases in Bogor city]. Penelit Gizi Makanan 2020;43:21–9.

Qi Y, Han X, Zhao D, et al. Long-term cardiovascular risk associated with stage 1 hypertension defined by the 2017 ACC/AHA hypertension guideline. J Am Coll Cardiol 2018;72: 1201–10. doi:10.1016/j.jacc.2018.06.056.

Turin TC, Okamura T, Afzal AR, et al. Impact of hypertension on the lifetime risk of coronary heart disease. Hypertens Res 2016;39:548–51. doi: 10.1038/hr.2016.23.

Bhagavathula AS, Shehab A, Ullah A, Rahmani J. The burden of cardiovascular disease risk factors in the Middle East: a systematic review and meta-analysis focusing on primary prevention. Curr Vasc Pharmacol 2021;19:379-89. doi: 10.2174/1573406416666200611104143.

Chen R, Yang Y, Miao F, et al. 3-year risk prediction of coronary heart disease in hypertension patients: a preliminary study. Proc Annu Int Conf IEEE Eng Med Biol Soc EMBS 2017;1182–5. doi: 10.1109/EMBC.2017.8037041.

Singh O, Gupta M, Khajuria V. Cardiometabolic risk factors in bank employees. Natl J Physiol Pharm Pharmacol 2015;5:258–62. doi: 10.5455/njppp.2015.5.1202201534.

Mirrahimi A, de Souza RJ, Chiavaroli L, et al. Associations of glycemic index and load with coronary heart disease events: a systematic review and meta-analysis of prospective cohorts. J Am Heart Assoc 2012;1:e000752. doi: 10.1161/JAHA.112.000752.

Angelantonio DE. World Health Organization cardiovascular disease risk charts: revised models to estimate risk in 21 global regions. Lancet Glob Health 2019;7:1332–45. doi: 10.1016/S2214-109X(19)30318-3

Vinik AI, Erbas T. Diabetic autonomic neuropathy. Handb Clin Neurol. 2013;117:279-94. doi: 10.1016/B978-0-444-53491-0.00022-5.

Pradono J, Werdhasari A. Faktor determinan penyakit jantung koroner pada kelompok umur 25-65 tahun di Kota Bogor, Data Kohor 2011-2012. [Determinants of coronary heart disease in the 25-65-year age group in Bogor City, Cohort data for 2022-2012]. Bul Penelit Kesehat 2018;46:23–34.

Widjaja FF, Widjaja IR, Astria Y, Suwita CS, Waspadji S. Metabolic syndrome and Framingham risk score in obese young adults. Med J Indones 2013;22:100–6. DOI:

Jiang J, Zhao L, Lin L, et al. Postprandial blood glucose outweighs fasting blood glucose and HbA1c in screening coronary heart disease. Sci Rep 2017;7:14212. doi: 10.1038/s41598-017-14152-y.

Yuan Z, Yang Y, Wang C, et al. Trajectories of long-term normal fasting plasma glucose and risk of coronary heart disease: a prospective cohort study. J Am Heart Assoc 2018;7:e007607. doi: 10.1161/JAHA.117.007607.

DiNicolantonio JJ, Lucan SC, O’Keefe JH. The evidence for saturated fat and for sugar related to coronary heart disease. Prog Cardiovasc Dis 2016;58:464–72. doi: 10.1016/j.pcad.2015.11.006.

Venkataraman K, Khoo CM, Leow MKS, et al. New measure of insulin sensitivity predicts cardiovascular disease better than HOMA estimated insulin resistance. PLoS ONE 2013;8: e74410. doi:10.1371/journal.pone.0074410.

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: e0215219. doi: 10.1371/journal.pone.0215219.

Tillmann T, Vaucher J, Okbay A, et al. Education and coronary heart disease: mendelian randomisation study. BMJ 2017;358:j3542. doi: 10.1136/bmj.j3542.

Khazanah W, Mulyani NS, Ramadhaniah, Rahma CSN. Konsumsi natrium, lemak jenuh dan serat berhubungan dengan kejadian penyakit jantung koroner di rumah sakit dr. Zainoel Abidin, Banda Aceh. [Consumption of sodium, saturated fats, and fiber is associated with incidence of coronary heart disease in dr. Zainoel Abidin hospital, Banda Aceh]. J Kesehat 2019;7:40–4.