Challenges in the use of preventive cardiovascular medications in Indonesia and the Netherlands

Although cardiovascular disease (CVD) is no longer the primary burden in the Netherlands, it is still the main cause of death in Indonesia. Optimal use of preventive cardiovascular (CV) medications plays an important role in CVD prevention. While the use of these medications has been advocated through clinical guidelines and the role of the primary health care sector in the Netherlands, there is a lack of clarity in how this strategy has been applied in Indonesia. This thesis aimed to address the challenges in using and effects of these medications in both countries. Ina systematic review, we found a different pattern of long-term risk and risk factors of CVD between both countries. We conducted several cohort studies using Jakarta Acute Coronary Syndrome (JAC) Registry (Indonesia) and the PharmLines Initiative database (the Netherlands). An association between adherence to guideline-recommended medications and risk reduction of in-hospital death was observed in Indonesian patients with high-risk of CVD. The predictors of suboptimal use of preventive medications in these patients were described. A small qualitative study revealed that the new National Health Insurance System influenced the use of statins, one of the preventive CV medications in Indonesia. In the Netherlands, statins may exert different lipid parameter response between men and women. Further studies on sex disparities in the effect of statins is needed in the Netherlands with inclusion of variables like patient adherence and dose regimen. The primary care role to optimize the use of preventive medications in Indonesia needs to be enhanced