Abstract Body: Background
Cardiovascular disease (CVD), especially ischemic heart disease and stroke, is a leading cause of death in low- and middle-income countries (LMICs), including Thailand. There has been limited evidence regarding the predicted CVD risk among Thai individuals with hypertension (HTN). We examined trends in CVD risk factors and predicted 10-year CVD risk from 2011 to 2018 and evaluated the potential impact of optimizing modifiable risk factors.
Methods
We conducted a serial cross-sectional study using data from the Thailand DM/HT study. The predicted 10-year CVD risk was calculated based on World Health Organization risk scores. The laboratory-based model included age (years), sex (men and women), SBP (mmHg), diabetes (yes/no), current smoking status (yes/no), and total cholesterol (TC) (mmol/L). The non-laboratory-based approach used body mass index (BMI) instead of TC and diabetes mellitus. High predicted CVD risk was defined as a risk score of ≥ 20%. Generalized linear models were used to assess mean and prevalence trends between 2011 and 2018.
Results
A total of 226,420 Thai adults with HTN were included. Between 2011 and 2018, the prevalence of CVD risk factors, including smoking, diabetes, uncontrolled HTN (≥140/90 mmHg), and hyperlipidemia, declined significantly. However, obesity (BMI ≥25 kg/m²) increased from 44.9% to 48.0% (p-trend <0.001). Using the non-laboratory model, the mean predicted 10-year CVD risk rose from 7.7% (2011) to 8.0% (2014), and then declined to 7.8% (2018), with high-risk prevalence being 1.5% (2011) and 1.4% (2018). In the laboratory-based model, the mean predicted risk decreased from 8.9% (2011) to 8.4% (2018) (p-trend = 0.001), with high-risk prevalence declining from 4.2% to 3.1% (p-trend = 0.0001). The most significant reduction in predicted risk was obtained by lowering SBP to less than 120 mmHg. Simultaneously, smoking cessation, preventing diabetes mellitus, optimizing HTN control, and managing hyperlipidemia (TC<4 mmol/L) can reduce the prevalence of high-risk conditions by 3.1% overall, 5.1% in men, and 2.0% in women.
Conclusion
From 2011 to 2018, Thailand saw improvements in CVD risk factors among people with HTN, despite a rise in obesity rates. Optimizing modifiable risk factors, especially hypertension control, can lower CVD risk. Our results have implications for health policy and public health initiatives in Thailand and other LMIC, which can reduce cardiovascular disease in the population.