Smoking, Obesity, Hypertension, and Lifestyle are Associated with Coronary Heart Disease: A Cross-Sectional Study in Central Sulawesi, Indonesia
Abstract
Introduction: Cardiovascular disease is the leading cause of death globally, with 17.9 million deaths in 2019, of which 85% were caused by stroke and coronary heart disease (CHD). In Indonesia, CHD accounts for 26.4% of all deaths; therefore, controlling risk factors is a priority. This study aimed to analyze the relationship between modifiable risk factors (smoking, obesity, hypertension, and lifestyle) and the incidence of CHD.
Methods: This analytical study used a cross-sectional design with accidental sampling and was conducted at the Heart Polyclinic of the Undata Hospital, Central Sulawesi, in August 2025. A total of 112 respondents aged ?35 years who sought treatment were included in this study. Data were collected through direct measurements (blood pressure, height, and weight) and questionnaires assessing smoking habits, lifestyle, and medical histories. Ethical approval was obtained from the Health Research Ethics Committee of Poltekkes Kemenkes Palu. Data analysis included univariate, chi-squared (95% CI), and logistic regression tests.
Results: Among 112 respondents, 56 (50%) were diagnosed with CHD. There was a significant association between CHD and smoking (p < 0.001), obesity (p = 0.004), hypertension (p = 0.001), and lifestyle habits (p = 0.031). Logistic regression analysis identified smoking as the strongest predictor of CHD (odds ratio [OR] = 16.626; p = 0.009).
Conclusion: Smoking, obesity, hypertension, and lifestyle were significant risk factors for CHD, with smoking emerging as the main determinant. Preventive strategies should prioritize smoking cessation, weight control, hypertension management, and promotion of healthy lifestyles.
References
Alemu YM, Bagheri N, Wangdi K, Chateau D. Articles Individual-level and community-level factors for 10-year cardiovascular disease risk in Ethiopia : a retrospective , population-based , cross-sectional , observational study. Lancet Glob Heal. 2025;13(9):e1574–82.
World Health Organization. Cardiovascular diseases (CVDs). 2025.
Collaborators GB of CD and R 2023. Global, regional, and national burden of cardiovascular diseases and risk factors in 204 countries and territories, 1990-2023. J Am Coll Cardiol. 2025;
Martin SS, Aday AW, Allen NB, Almarzooq ZI, Anderson CAM, Arora P, et al. 2025 heart disease and stroke statistics: a report of US and global data from the American Heart Association. Circulation. 2025;151(8):e41–660.
Kemenkes RI. Hasil Riset Kesehatan Dasar Tahun 2018. Kementrian Kesehat RI. 2018;53(9):1689–99.
Kemenkes RI. Cegah Penyakit Jantung dengan Menerapkan Perilaku CERDIK dan PATUH. 2023.
sharifzadeh M, setayesh L, Emami MR, Salim SJ, Javanbakht M hammad H. The effects of omega-3 fatty acid supplementation on serum myostatin, body composition, blood glucose, lipid profile and hs-CRP level in overweight men with coronary heart disease: A randomized double-blind placebo controlled clinical trial. Hum Nutr Metab. 2024;36(July 2023):200248.
Björnson E, Adiels M, Bergström G, Gummesson A. The relationship between genetic liver fat and coronary heart disease is explained by apoB-containing lipoproteins. Atherosclerosis. 2024;388(November 2023).
Wang X, Jiang J, Hu W, Hu Y, Qin LQ, Hao Y, et al. Dynapenic Abdominal Obesity and Risk of Heart Disease among Middle-Aged and Older Adults: A Prospective Cohort Study. J Nutr Heal Aging. 2023;27(9):752–8.
Khadoura KJ, Kahlout A, Habib MH. Nontraditional risk factors of coronary artery disease among Palestinians: A case-control study. J Vasc Nurs. 2022;40(1):35–42.
Noordam R, Brochard TA, Drewes YM, Gussekloo J, Mooijaart SP, Willems van Dijk K, et al. Cardiovascular risk factors and major recurrent coronary events: A genetic liability study in patients with coronary artery disease in the UK Biobank. Atherosclerosis. 2023;376(December 2022):19–25.
Afrianto R, Indriyani N, Sudiro TY, Noor A, Syarifin K. Pengaruh Extra Virgin Olive Oil ( EVOO ) Terhadap Kadar Lipid dan Indeks Massa Tubuh Wanita Obesitas Usia Produktif The Effect of Extra Virgin Olive Oil ( EVOO ) on Level of Lipid and Body Mass Index of Obese Women of Childbearing Age. 2022;16(2):184–90.
Zakai NA, Minnier J, Safford MM, Koh I, Irvin MR, Fazio S, et al. Race-Dependent Association of High-Density Lipoprotein Cholesterol Levels With Incident Coronary Artery Disease. J Am Coll Cardiol. 2022;80(22):2104–15.
PERKI. Panduan Prevensi Penyakit Kardiovaskular Arterosklerosis. Irsad Andi A, editor. Perhimpunan Dokter Spesialis Kardiovaskular Indonesia 2022. Jakarta; 2022. 1–23 p.
Brørs G, Dalen H, Allore H, Deaton C, Fridlund B, Osborne RH, et al. Health Literacy and Risk Factors for Coronary Artery Disease (From the CONCARDPCI Study). Am J Cardiol. 2022;179:22–30.
Rajashekhar VG, Vanajakshamma V, Durgaprasad R. Risk Factor Analysis And Angiographic Profile In Young Patients With Coronary Artery Disease. Indian Heart J. 2022;74:S40.
Kumbhalkar A, Aher A, Kumbhalkar S. The study of conventional cardiovascular risk factor profile in first-degree relatives of patients with premature coronary artery disease. Indian Heart J. 2022;74:S48.
Li K, Li K, Yao Q, Shui X, Zheng J, He Y, et al. The potential relationship of coronary artery disease and hyperuricemia: A cardiometabolic risk factor. Heliyon. 2023;9(5):e16097.
Damigou E, Kouvari M, Chrysohoou C, Barkas F, Kravvariti E, Pitsavos C, et al. Lifestyle Trajectories Are Associated with Incidence of Cardiovascular Disease: Highlights from the ATTICA Epidemiological Cohort Study (2002–2022). Life. 2023 May;13(5):1142.
Jafari N, Alivand S, Molaee H, Shahabi Rabori V, Asadian A, Abbasian S, et al. How lifestyle factors can contribute to cardiovascular disease incidence; a review study. J Prev Epidemiol. 2023 Dec;9(1):e35232.
Ren Z, Simons PIHG, Wesselius A, Stehouwer CDA, Brouwers MCGJ. Relationship between NAFLD and coronary artery disease: A Mendelian randomization study. Hepatology. 2023;77(1):230–8.
Choi J, Wen W, Jia G, Tao R, Long J, Shu XO, et al. Lifestyle factors, genetic susceptibility to obesity and their interactions on coronary artery disease risk: A cohort study in the UK Biobank. Prev Med (Baltim). 2024;180(January):107886.
Martens LG, van Hamersveld D, le Cessie S, Willems van Dijk K, van Heemst D, Noordam R. The impact of sociodemographic status on the association of classical cardiovascular risk factors with coronary artery disease: a stratified Mendelian randomization study. J Clin Epidemiol. 2023;162:56–62.
Koliaki C, Liatis S, Kokkinos A. Obesity and cardiovascular disease: revisiting an old relationship. Metabolism. 2019;92:98–107.
Parmar MP, Kaur M, Bhavanam S, Mulaka GSR, Ishfaq L, Vempati R, et al. A Systematic Review of the Effects of Smoking on the Cardiovascular System and General Health. Cureus. 2023 Apr;
Mao C, Li D, Zhou E, Zhang J, Wang C, Xue C. Nicotine exacerbates atherosclerosis through a macrophage-mediated endothelial injury pathway. Aging (Albany NY). 2021 Mar;13(5):7627–43.
Klein J, Diaba-Nuhoho P, Giebe S, Brunssen C, Morawietz H. Regulation of endothelial function by cigarette smoke and next-generation tobacco and nicotine products. Pflügers Arch - Eur J Physiol. 2023 Jul;475(7):835–44.
Rina T, Jurana, Dandi K, Alfrida Semuel R. Hubungan Gaya Hidup dengan Terjadinya Hipertensi pada Lansia Di Puskesmas Talise Relationship between Lifestyle and Hypertension in the Elderly at Puskesmas Talise. 2022;xxx(xxx).
Hendras Ratri Mustika, Marsanti AS, Widiarini R. Family History and Smoking on Coronary Heart Disease. J Ilm Kesehat. 2024 Apr;6(1):179–86.
Gallucci G, Tartarone A, Lerose R, Lalinga AV, Capobianco AM. Cardiovascular risk of smoking and benefits of smoking cessation. J Thorac Dis. 2020 Jul;12(7):3866–76.
Ma M, Wu Y, He X, Zhang M, Han Y, Guo R, et al. Associations between smoking and coronary heart disease: mediating role of RDW. Front Public Heal. 2024 Nov;12.
Mambo A, Yang Y, Mahulu E, Zihua Z. Investigating the interplay of smoking, cardiovascular risk factors, and overall cardiovascular disease risk: NHANES analysis 2011–2018. BMC Cardiovasc Disord. 2024 Apr;24(1):193.
Chang JT, Anic GM, Rostron BL, Tanwar M, Chang CM. Cigarette Smoking Reduction and Health Risks: A Systematic Review and Meta-analysis. Nicotine Tob Res. 2021 Mar;23(4):635–42.
Liu M, Zheng M, He S. Association between tobacco smoking and heart disease in older adults: a cross-sectional study based on the Chinese Longitudinal Healthy Longevity Survey. Ann Transl Med. 2023 Jan;11(2):63–63.
Islam MS, Wei P, Suzauddula M, Nime I, Feroz F, Acharjee M, et al. The interplay of factors in metabolic syndrome: understanding its roots and complexity. Mol Med. 2024 Dec;30(1):279.
Kim MS, Kim WJ, Khera A V, Won HH. Association between adiposity and cardiovascular outcomes: an umbrella review and meta-analysis. 2020.
Gao Y, Simino JM, Hsu C hsieh, Correa A, Min N. Abstract EP43: Obesity And Incident Cardiovascular Disease (CVD): The Jackson Heart Study. Circulation. 2022 Mar;145(Suppl_1).
Szabo L, McCracken C, Cooper J, Rider OJ, Vago H, Merkely B, et al. The role of obesity-related cardiovascular remodelling in mediating incident cardiovascular outcomes: a population-based observational study. Eur Hear J - Cardiovasc Imaging. 2023 Jun;24(7):921–9.
Rocha IM, OLIVEIRA AVR. A RELAÇÃO ENTRE OBESIDADE, RISCO CARDIOVASCULAR E DOENÇA ATEROSCLERÓTICA. In: Anais do III Congresso Brasileiro de Doenças Crônicas. Revista Multidisciplinar em Saúde; 2024.
Xue Y, Yang X, Liu G. Association of combined body mass index and central obesity with cardiovascular disease in middle-aged and older adults: a population-based prospective cohort study. BMC Cardiovasc Disord. 2024 Aug;24(1):443.
Zeliger HI. Atherosclerosis. In: Oxidative Stress. Elsevier; 2023. p. 285–9.
Kim HL. Arterial stiffness and hypertension. Clin Hypertens. 2023;29(1).
Poznyak A V., Sadykhov NK, Kartuesov AG, Borisov EE, Melnichenko AA, Grechko A V., et al. Hypertension as a risk factor for atherosclerosis: Cardiovascular risk assessment. Front Cardiovasc Med. 2022 Aug;9.
Tiwari MN, Kumar PRS, Kumar ZN, Seema M, Srivastava MN, Prakash DP. “Understanding the Role of Hypertension in Atherosclerosis and Myocardial Infarction: Implications for Prevention and Management.” J Chem Heal Risks. 2023 Oct;
Zhang X, He X, Mao F, Zhang R, You X, Li J. Relationship between blood pressure and the risk of acute myocardial infarction in Chinese adults: a prospective study. 2023.
XIAO LX, WANG ZY, LI JT, WANG HM, HAO YM, ZHOU P, et al. Association of cardiometabolic multimorbidity with all-cause and cardiovascular disease mortality among Chinese hypertensive patients. J Geriatr Cardiol. 2024 Feb;21(2):211–8.
Ciofani JL, Han D, Allahwala UK, Woolf B, Gill D, Bhindi R. Lipids, Blood Pressure, and Diabetes Mellitus on Risk of Cardiovascular Diseases in East Asians: A Mendelian Randomization Study. Am J Cardiol. 2023 Oct;205:329–37.
Lee JY, Bak JK, Kim M, Shin HG, Park KI, Lee SP, et al. Long-term cardiovascular events in hypertensive patients: full report of the Korean Hypertension Cohort. Korean J Intern Med. 2023 Jan;38(1):56–67.
Lee JE, Kityo A, Lee SA. Lifestyle Factors, Sociodemographic Characteristics and Incident Hypertension: A Prospective Analysis of the Korean National Health Insurance Service Sample Cohort. J Pers Med. 2024 Sep;14(9):959.
Oh SH, Kim D, Hwang J, Kang JH, Kwon Y, Kwon JW. Association of Uncontrolled Hypertension or Diabetes Mellitus With Major Adverse Cardiovascular Events and Mortality in South Korea: Population-Based Cohort Study. JMIR Public Heal Surveill. 2023 Feb;9:e42190.
Fakhrul Alam LCDM. Dyslipidemia Associated with Hypertension Increases the Risks for Coronary Heart Disease: A Case-Control Study in a tertiary level hospital in Bangladesh. J Med Sci Clin Res. 2021 Feb;09(02).
Hasan MH. Coronary Heart Disease among Male Patients of Age between 25-39- and 40-70-Years Attending Cardiology Outdoor of BSMMU, Dhaka, Bangladesh. SAS J Med. 2023 Sep;9(09):1009–13.
Chowdhury R, Naheed A, Monower MM, Shahzad S, Raqib R, Tasmin I, et al. Conventional and regionally distinctive risk factors for first-onset myocardial infarction: the Bangladesh Risk of Acute Vascular Events (BRAVE) case–control study. Lancet Reg Heal - Southeast Asia. 2025 Jan;32:100519.
Burnier M, Damianaki A. Hypertension as Cardiovascular Risk Factor in Chronic Kidney Disease. Circ Res. 2023 Apr;132(8):1050–63.
Nurreyhan Hanaputra A, Dwi.suryantoro S, Mustika A. Interplay of Hypertension and Chronic Kidney Disease: A Comprehensive Review on Pathophysiology, Risk Factors, Clinical Manifestations, Diagnosis, and Management Strategies. Int J Res Publ. 2023 Dec;140(1).
Hartopo AB, Inggriani MP, Jhundy BW, Fachiroh J, Rosha PT, Wardani RK, et al. Modifiable risk factors for coronary artery disease in the Indonesian population: a nested case-control study. Cardiovasc Prev Pharmacother. 2023 Jan;5(1):24–34.
Harmadha WSP, Muharram FR, Gaspar RS, Azimuth Z, Sulistya HA, Firmansyah F, et al. Explaining the increase of incidence and mortality from cardiovascular disease in Indonesia: A global burden of disease study analysis (2000–2019). Nejadghaderi SA, editor. PLoS One. 2023 Dec;18(12):e0294128.
Alfaqeeh M, Alfian S, Abdulah R. Factors Associated with Hypertension Among Adults: A Cross-Sectional Analysis of the Indonesian Family Life Survey. Vasc Health Risk Manag. 2023 Dec;Volume 19:827–36.
Schmidt-Trucksäss A, Lichtenstein AH, von Känel R. Lifestyle factors as determinants of atherosclerotic cardiovascular health. Atherosclerosis. 2024 Aug;395:117577.
Mathur K, Sharma S, Hussain MS. Mini-review on the Management of Lifestyle Disorders: Attempting to Keep Indians Healthy for a Bright Future. Dis Diagnosis. 2023 Jun;12(3):144–50.
Sousa M de M e, Xavier LCF, Pereira R do N, Miranda CJC de P. Assessment of the Risk of Cardiovascular Diseases and its Relationship with Heart Rate Variability in Physically Active and Sedentary Individuals. Int J Adv Eng Res Sci. 2023;10(3):084–96.
Li X, Ma H, Zhou T, Qi L. Replacing Sedentary Behavior Time With Physical Activities, Recommended Physical Activity, and Incident Coronary Heart Disease. Mayo Clin Proc. 2023 Jan;98(1):111–21.
Newport MT, Dayrit FM. The Lipid–Heart Hypothesis and the Keys Equation Defined the Dietary Guidelines but Ignored the Impact of Trans-Fat and High Linoleic Acid Consumption. Nutrients. 2024 May;16(10):1447.
Ishida M, Sakai C, Kobayashi Y, Ishida T. Cigarette Smoking and Atherosclerotic Cardiovascular Disease. J Atheroscler Thromb. 2024 Mar;31(3):RV22015.
Hoang Anh Nguyen V, Thi Bich Nguyen U, Nguyen Ai Tran T, Thi Hoai Phan Y, Truong NA, Luu-Thi HT, et al. The Relationship between Depression, Doing Exercise, Age and Cigarettes Smoking in ARV-HIV Patients. J Public Heal Pharm [Internet]. 2024;4(2):98–112. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85200872513&doi=10.56338%2Fjphp.v4i2.5044&partnerID=40&md5=e3660e626517aae66218f98ef55ea311
Deni. Smoking Behavioral Intentions of Nursing Students in Kendari. J Public Heal Pharm. 2023;3(2):36–9.
Sunarti S, Sansuwito TB, Nugroho PS, Amalia N, Masnina R, Suwarni L. The Role of Education in Preventing E-Smoking Behavior is to Increase Student Knowledge and Attitudes. J Public Heal Pharm [Internet]. 2024;4(1):80–9. Available from: https://www.jurnal.unismuhpalu.ac.id/index.php/jphp/article/download/5025/3781
JAVAID A, ALI L, RAZZAQ K, SADIQ R. Modifiable Risk Factors And Coronary Artery Disease Severity: Insights From A Case-Control Analysis. Biol Clin Sci Res J. 2023 Dec;2023(1):577.
DiCaro M V., Ogurek I, Tak N, Dawn B, Tak T. Optimizing Cardiovascular Health: A Narrative Review of Lifestyle, Psychobehavioral, and Alternative Strategies for Management and Prevention. Hear Mind. 2025 Jan;9(1):29–39.
Omar Baoum S, Anbarserri FM, Alhassan SE, Hani HF Al, Almutairi FN, Sulayman ML, et al. Evaluating the impact of lifestyle modifications on hypertensive heart disease. Int J Community Med Public Heal. 2024 Dec;12(1):565–9.
Sisca M. The Effectiveness of Community-Based Cardiac Rehabilitation Programs in Reducing The Relapse Rate of Post-Myocardial Infarction Patients. Action Res Lit. 2024 Dec;8(12):3533–43.
Pusat Kebijakan Kesehatan Global dan Teknologi Kesehatan, Badan Kebijakan Pembangunan Kesehatan KKRI. Rencana Aksi Kegiatan Tahun 2022-2024. Jakarta; 2022.
Kemenkes RI. Laporan Riskesdas 2018 Nasional.pdf. Lembaga Penerbit Balitbangkes. Badab Penelitian dan Pengembvangan Kesehatan; 2018. p. hal 156.
Dinkes Sulawesi Tengah. Profil Kesehatan Dinas Kesehatan Sulawesi Tengah. Profil Kesehat Provinsi Sulawesi Teng. 2023;1–368.
World Health Organization. Regional Action Plan for the Prevention and Control of Noncommunicable Diseases (2022–2030. 2022.
Sabatina VB, Handajani YS, Widjaja NT, Handajani YS. The association between body mass index , hypertension , and lifestyle on cardiovascular disease in Indonesian elderly. 2022;6(2):45–9.
Copyright (c) 2025 Media Publikasi Promosi Kesehatan Indonesia (MPPKI)
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Authors who publish with Media Publikasi Promosi Kesehatan Indonesia retain the copyright of their work. The journal applies a Creative Commons Attribution-ShareAlike 4.0 International License (CC BY-SA 4.0), which grants the following rights:
-
Copyright Retention: Authors retain the copyright of their work, maintaining full control over their intellectual property without restrictions.
-
Right of First Publication: Authors grant the journal the right of first publication of their work. This ensures that the work is initially published and credited in Media Publikasi Promosi Kesehatan Indonesia.
-
License to Share and Reuse: The work is licensed under CC BY-SA 4.0, allowing others to copy, distribute, remix, and build upon the work for any purpose, even commercially, as long as proper credit is given to the authors, and any new creations are licensed under the same terms.
