Correlation of Total Cholesterol, LDL-C & HDL-C With Coronary Heart Disease Among Different Ethnic Groups in Northern Pakistan
DOI:
https://doi.org/10.61919/jhrr.v3i2.117Keywords:
Coronary Heart Disease, Lipid Profiles, Ethnic Groups, Cholesterol, LDL and HDL Correlation, Abdominal Surgeries, Pakistani Ethnic Health StudyAbstract
Background: Coronary heart disease (CHD) is a leading cause of morbidity and mortality in adults, causing angina, MI, and sudden death. Total cholesterol and LDL-C are biochemical markers that increase CHD risk, while HDL-C reduces it. About 7.5 million deaths occur globally. The study aims to establish the association between test parameters like Total Cholesterol, LDL-C, and HDL-C with Coronary Heart Disease (CHD) among different ethnic groups of Pakistani population. High cholesterol, low LDL, and low HDL levels can cause serious cardiac complications.
Objective: The objective is to find out a correlation between increase in blood levels of Total Cholesterol, LDL-C & HDL-C levels with increased risk of Coronary Heart Disease (CHD) in the patients from various ethnic groups of Northern Pakistan.
Methodology: A prospective study was conducted at RIC Rawalpindi's Department of Pathology, collecting blood samples from 200 patients with heart-related complaints diagnosed as having coronary heart disease (CHD). The study examined serum levels of total cholesterol, HDL cholesterol, and LDL cholesterol using biochemical kits. The results were analyzed using SPSS version 23 and collected from both diseased cases and healthy controls.
Results: The study reveals significant variations in lipid profiles in patients with coronary heart disease (CHD) compared to the control group. Total cholesterol and low-density lipoprotein-cholesterol levels were higher in CHD patients, while high-density lipoprotein-cholesterol levels were lower. Out of 200 subjects, 100 were confirmed with CHD and 100 were a control group. Age-related changes were observed in males (82%), females (77%), and males (23%).
Conclusions: This study confirms a strong positive relationship between cholesterol and LDL levels and heart disease, with a higher prevalence in patients over 45 years old, indicating that lipid profile increases with age, making individuals more susceptible to cardiac diseases.
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References
World Health Organization. Global Status Report on Noncommunicable Diseases 2014. Geneva, Switzerland: World Health Organization; 2014.
Ross R. Atherosclerosis - an inflammatory disease. N Engl J Med. 1999;340:2115-26.
Prospective Studies Collaboration. Blood cholesterol and vascular mortality by age, sex, and blood pressure: a meta-analysis of individual data from 61 prospective studies with 55,000 vascular deaths. Lancet. 2007;370(9602):1829-1839.
Gordon DJ, Probstfield JL, Garrison RJ, Neaton JD, Castelli WP, Knoke JD, et al. High-density lipoprotein cholesterol and cardiovascular disease. Four prospective American studies. Circulation. 1989;79(1):8-15.
Law MR, Wald NJ, Rudnicka AR. Quantifying effect of statins on low-density lipoprotein cholesterol, ischaemic heart disease, and stroke: systematic review and meta-analysis. BMJ. 2003;326(7404):1423.
Dawber TR, Moore FE, Mann GV. Coronary heart disease in the Framingham study. Am J Public Health Nations Health. 1957;47:4–24.
Mann GV, Pearson G, Gordon T, Dawber TR, Lyell L, Shurtleff D. Diet and coronary heart disease in the Framingham study: I. Measurement of dietary intake. Am J Clin Nutr. 1962;11(3):200-225.
Anitschkow N. On experimental cholesterin steatosis and its significance in the origin of some pathological processes (1913). Arteriosclerosis. 1983;3:178-182.
Wang D, van der Horst K, Jacquier E, Afeiche M, Eldridge A. Snacking patterns in children: A comparison between Australia, China, Mexico, and the US. Nutrients. 2018;10(2):198.
Keast D, Fulgoni V, Nicklas T, O'Neil C. Food sources of energy and nutrients among children in the United States: National Health and Nutrition Examination Survey 2003–2006. Nutrients. 2013;5(1):283-301.
O'Neil C, Keast D, Fulgoni V, Nicklas T. Food sources of energy and nutrients among adults in the US: NHANES 2003–2006. Nutrients. 2012;4(12):2097-2120.
Shekelle RB, Stamler J. Dietary cholesterol and ischaemic heart disease. Lancet. 1989;1:1177–1179.
Kushi LH, Lew RA, Stare FJ, Ellison CR, El Lozy M, Bourke G, et al. Diet and 20-year mortality from coronary heart disease: the Ireland–Boston Diet–Heart Study. N Engl J Med. 1985;312(13):811-818.
Rong Y, Chen L, Zhu T, Song Y, Yu M, Shan Z, et al. Egg consumption and risk of coronary heart disease and stroke: dose-response meta-analysis of prospective cohort studies. BMJ. 2013;346:e8539.
Shin JY, Xun P, Nakamura Y, He K. Egg consumption in relation to risk of coronary heart disease and diabetes: a systematic review and meta-analysis. Am J Clin Nutr. 2013;98(1):146-159.
Virtanen JK, Mursu J, Virtanen HE, Fogelholm M, Salonen JT, Koskinen TT, et al. Associations of egg and cholesterol intakes with carotid intima-media thickness and risk of incident coronary heart disease according to apolipoprotein E phenotype in men: the Kuopio Ischaemic Heart Disease Risk Factor Study. Am J Clin Nutr. 2016;103(3):895-901.
Goldstein JL, Hazzard WR, Schrott HG, Bierman EL, Motulsky AG. Hyperlipidemia in coronary heart disease I. Lipid levels in 500 survivors of myocardial infarction. J Clin Invest. 1973;52(7):1533-1543.
Salel AF, Riggs K, Mason DT, Amsterdam EA, Zelis R. The importance of type IV hyperlipoproteinemia as a predisposing factor in coronary heart disease. Am J Med. 1974;57(6):897-903.
Heyden S, Heiss G, Hames CG, Bartel AG. Fasting triglycerides as predictors of total and CHD mortality in Evans County, Georgia. J Chronic Dis. 1980;33(5):275-282.
Kannel WB, Dawber TR, Friedman GD, Glennon WE, McNamara PM. Risk factors in coronary heart disease: an evaluation of several serum lipids as predictors of coronary heart disease: The Framingham Study. Ann Intern Med. 1964;61(5_Part_1):888-899.
Awan ZA, Baseer A. A Study of Serum Triglyceride and Lipoproteins Cholesterol in Coronary Heart Disease Patients. JOURNAL-PAKISTAN MEDICAL ASSOCIATION. 1995;45:263-265.
Awan ZA, Baseer A. A Study of Serum Triglyceride and Lipoproteins Cholesterol in Coronary Heart Disease Patients. JOURNAL-PAKISTAN MEDICAL ASSOCIATION. 1995;45:263-265.
Gordon T, Castelli WP, Hjortland MC, Kannel WB, Dawber TR. High-density lipoprotein as a protective factor against coronary heart disease: the Framingham Study. The American journal of medicine. 1977;62(5):707-714.
Naito HK. The association of serum lipids, lipoproteins, and apolipoproteins with Coronary Heart Disease assessed by coronary arteriography. Annals of the New York Academy of Sciences. 1985;454(1):230-238.
Shefique M, Mirza WB, Hussain S. Study of lipoproteins in patients of myocardial infarction in BV Hospital. Bahawalpur Pak. J. Med. Res. 1988;27:186-90.
Shefique M, Mirza WB, Hussain S. Study of lipoproteins in patients of myocardial infarction in BV Hospital. Bahawalpur Pak. J. Med. Res. 1988;27:186-90.
Pearson TA, Bulkley BH, Achuff SC, Kwiterovich PO, Gordis L. The association of low levels of HDL cholesterol and arteriographically defined Coronary Heart Disease. American journal of epidemiology. 1979;109(3):285-295.
Gordon T, Castelli WP, Hjortland MC, Kannel WB, Dawber TR. High-density lipoprotein as a protective factor against coronary heart disease: the Framingham Study. The American journal of medicine. 1977;62(5):707-714.
Anderson DW, Nichols AV, Pan SS, Lindgren FT. High-density lipoprotein distribution: resolution and determination of three major components in a normal population sample. Atherosclerosis. 1978;29(2):161-179.
Ascherio A, Willett WC. New directions in dietary studies of coronary heart disease. The Journal of nutrition. 1995;125(suppl_3):647S-655S.
Zilversmit DB. Atherogenic nature of triglycerides, postprandial lipidemia, and triglyceride-rich remnant lipoproteins. Clinical chemistry. 1995;41(1):153-158.
Awan ZA, Baseer A. A Study of Serum Triglyceride and Lipoproteins Cholesterol in Coronary Heart Disease Patients. JOURNAL-PAKISTAN MEDICAL ASSOCIATION. 1995;45:263-265.
National Health and Nutrition Examination Survey [PDF]. United States Center for Disease Control. Retrieved 28 January 2012.
Lecerf JM, De Lorgeril M. Dietary cholesterol: from physiology to cardiovascular risk. British Journal of Nutrition. 2011;106(1):6-14.
Goudev A, Kyurkchiev S, Gergova V, Karshelova E, Georgiev D, Atar D, et al. Reduced concentrations of soluble adhesion molecules after antioxidant supplementation in postmenopausal women with high cardiovascular risk profiles–a randomized double-blind study. Cardiology. 2000;94(4):227-232.
Soliman HA, El-Desouky MA, Hozayen WG, Ahmed RR, Khaliefa AK. Hepatoprotective effects of parsley, basil, and chicory aqueous extracts against dexamethasone-induced in experimental rats. Journal of intercultural ethnopharmacology. 2016;5(1):65.
Lee IM, Sesso HD, Oguma Y, Paffenbarger Jr RS. Relative intensity of physical activity and risk of coronary heart disease. Circulation. 2003;107(8):1110-1116.
Williams RR, Hunt SC, Heiss G, Province MA, Bensen JT, Higgins M, et al. Usefulness of cardiovascular family history data for population-based preventive medicine and medical research (the Health Family Tree Study and the NHLBI Family Heart Study). The American journal of cardiology. 2001;87(2):129-135.
Gaze PC. Clinical cardiology–a bedside approach.
Rifai N, Bachorik PS, Albers JJ. Lipids, lipoproteins and apolipoproteins. Tietz textbook of clinical chemistry.
Spieker LE, Sudano I, Hürlimann D, Lerch PG, Lang MG, Binggeli C, et al. High-density lipoprotein restores endothelial function in hypercholesterolemic men. Circulation. 2002;105(12):1399-1402.
Hague W, Forder P, Simes J, Hunt D, Tonkin A; LIPID Investigators. Effect of pravastatin on cardiovascular events and mortality in 1516 women with coronary heart disease: results from the Long-Term Intervention with Pravastatin in Ischemic Disease (LIPID) study. American heart journal. 2003;145(4):643-651.
Gupta S, Lakhani KK, Munshi H. A study of risk factors in young patients of acute coronary syndrome. International Journal of Contemporary Medical Research. 2017;4:2144-2147.
Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults. JAMA. 2001;285(19):2486.
Conte JV, Baumgartner WA, Dorman T, Owens SG. The Johns Hopkins Manual of Cardiac Surgical Care: Mobile Medicine Series. Elsevier Health Sciences. 2007.
Rahilly-Tierney C, Bowman TS, Djoussé L, Sesso HD, Gaziano JM. Change in high-density lipoprotein cholesterol and incident coronary heart disease in apparently healthy male physicians. The American journal of cardiology. 2008;102(12):1663-1667.
Singh IM, Shishehbor MH, Ansell BJ. High-density lipoprotein as a therapeutic target: a systematic review. JAMA. 2007;298(7):786-798.
Gaziano TA, Bitton A, Anand S, Abrahams-Gessel S, Murphy A. Growing epidemic of coronary heart disease in low- and middle-income countries. Current problems in cardiology. 2010;35(2):72-115.
Furberg CD, Goldberg RB, Howard BV, Stein JH, Witztum JL. Lipoprotein Management in Patients With Cardiometabolic Risk: Consensus statement from the American Diabetes Association and the American College of Cardiology Foundation. Diabetes Care. 2008;31(4):811.
Nazareth IAP, Vernekar SR, Gad RS, Naik GM. A Study of cholesterol percentage in blood tissue in the presence of salt.
Tanyanyiwa DM, Marais AD, Byrnes P, Jones S. The influence of ApoE genotype on the lipid profile and lipoproteins during normal pregnancy in a Southern African population. African health sciences. 2016;16(3):853-859.
Lewington S, Whitlock G, Clarke R, Sherliker P, Emberson J, Halsey J, et al. Blood cholesterol and vascular mortality by age, sex, and blood pressure: a meta-analysis of individual data from 61 prospective studies with 55,000 vascular deaths. Lancet. 2007;370(9602):1829-1839.
National Institutes of Health. National Heart, Lung and Blood Institute. Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) Final Report [PDF]. 1 September 2002. Retrieved 27 October 2008.
van der Steeg WA, Holme I, Boekholdt SM, Larsen ML, Lindahl C, Stroes ES, et al. High-density lipoprotein cholesterol, high-density lipoprotein particle size, and apolipoprotein AI: significance for cardiovascular risk: the IDEAL and EPIC-Norfolk studies. Journal of the American College of Cardiology. 2008;51(6):634-642.
Robinson JG, Wang S, Jacobson T. Meta-analysis of comparison of effectiveness of lowering apolipoprotein B versus low-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol for cardiovascular risk reduction in randomized trials. The American journal of cardiology. 2012;110(10):1468-1476.
Kronmal RA, Kosinski AS, Mock MB. The relationship between cholesterol level and myocardial infarction or mortality risk in patients with Coronary Heart Disease: a report from the coronary artery surgery study (CASS) registry. Annals of epidemiology. 1992;2(1-2):129-136.
Lamon-Fava S, Wilson PW, Schaefer EJ. Impact of body mass index on coronary heart disease risk factors in men and women: the Framingham Offspring Study. Arteriosclerosis, thrombosis, and vascular biology. 1996;16(12):1509-1515.
Segrest JP, Jones MK, De Loof H, Dashti N. Structure of apolipoprotein B-100 in low-density lipoproteins. Journal of Lipid Research. 2001;42(9):1346-1367.
Campos H. LDL Particle Size Distribution. Arteriosclerosis, Thrombosis, and Vascular Biology. 1992;12(12):1410-1419.
Kumar V, Butcher SJ, Öörni K, Engelhardt P, Heikkonen J, Kaski K, et al. Three-dimensional cryoEM reconstruction of native LDL particles to 16Å resolution at physiological body temperature. PLoS One. 2011;6(5):e18841.
Daphale A, Acharya S, Shukla S. Detection of Asymptomatic Coronary Heart Disease (CHD) in Newly detected Type 2 Diabetes Mellitus (DM) by Exercise Treadmill Test. Int J Contemp Med Res. 2017;4:2269-2275.
Daphale A, Acharya S, Shukla S. Detection of Asymptomatic Coronary Heart Disease (CHD) in Newly detected Type 2 Diabetes Mellitus (DM) by Exercise Treadmill Test. Int J Contemp Med Res. 2017;4:2269-2275.
Bonow RO, Carabello BA, Chatterjee K, De Leon AC, Faxon DP, Freed MD, et al. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing Committee to Revise the 1998 guidelines for the management of patients with valvular heart disease) developed in collaboration with the Society of Cardiovascular Anesthesiologists endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. J Am Coll Cardiol. 2006;48(3):e1-e148.
Nkomo VT, Gardin JM, Skelton TN, Gottdiener JS, Scott CG, Enriquez-Sarano M. Burden of valvular heart diseases: a population-based study. Lancet. 2006;368(9540):1005-1011.
Soliman GA. Dietary cholesterol and the lack of evidence in cardiovascular disease. Nutrients. 2018;10(6):780.
Daphale A, Acharya S, Shukla S. Detection of Asymptomatic Coronary Heart Disease (CHD) in Newly detected Type 2 Diabetes Mellitus (DM) by Exercise Treadmill Test. Int J Contemp Med Res. 2017;4:2269-2275.
Dubois C, Armand M, Mekki N, Portugal H, Pauli AM, Bernard PM, et al. Effects of increasing amounts of dietary cholesterol on postprandial lipemia and lipoproteins in human subjects. J Lipid Res. 1994;35(11):1993-2007.
Goldbourt U, Yaari S, Medalie JH. Isolated low HDL cholesterol as a risk factor for coronary heart disease mortality: a 21-year follow-up of 8000 men. Arterioscler Thromb Vasc Biol. 1997;17(1):107-113.
Assmann G, Cullen P, Schulte H. The Münster Heart Study (PROCAM). Results of follow-up at 8 years. Eur Heart J. 1998;19:A2-11.
Lamarche B, Despre JP, Moorjani S, Cantin B, Dagenais GR, Lupien PJ. Prevalence of dyslipidemic phenotypes in ischemic heart disease (prospective results from the Quebec cardiovascular study). Am J Cardiol. 1995;75(17):1189-1195.
Hippisley-Cox J, Coupland C, Vinogradova Y, Robson J, May M, Brindle P. Derivation and validation of QRISK, a new Coronary Heart Disease risk score for the United Kingdom: prospective open cohort study. BMJ. 2007;335(7611):136.
Robson J. Lipid modification: cardiovascular risk assessment and the modification of blood lipids for the primary and secondary prevention of cardiovascular disease. Heart. 2008;94(10):1331-1332.
Bibow S, Polyhach Y, Eichmann C, Chi CN, Kowal J, Albiez S, et al. Solution structure of discoidal high-density lipoprotein particles with a shortened apolipoprotein AI. Nat Struct Mol Biol. 2017;24(2):187.
Huang CX, Zhang YL. The target of regulating the ATP-binding cassette A1 protein (ABCA1): promoting ABCA1-mediated cholesterol efflux in different cells. Curr Pharm Biotechnol. 2013;14(6):623-631.
Ferri FF. Coronary Heart Disease. In: Ferri's Clinical Advisor 2016. Philadelphia, PA: Mosby Elsevier; 2016.
Coronary heart disease. National Lung, Heart, and Blood Institute. http://www.nhlbi.nih.gov/health/health-topics/topics/CHD. Accessed Oct. 12, 2015.
Usatine RP, et al., eds. Coronary Heart Disease. In: The Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013.
Understanding blood pressure readings. American Heart Association. http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/AboutHighBloodPressure/Understanding-Blood-Pressure-Readings_UCM_301764_Article.jsp. Accessed Oct. 13, 2015.
Seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. Bethesda, MD: National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health-pro/guidelines/current/hypertension-jnc-7. Accessed Oct. 12, 2015.
Wilson PWF. Overview of the possible risk factors for cardiovascular disease. http://www.uptodate.com/home. Accessed Oct. 13, 2015.
Longo DL, et al. Ischemic heart disease. In: Harrison's Principles of Internal Medicine. 18th ed. New York, NY: The McGraw-Hill Companies; 2012.
Your guide to lowering your cholesterol with therapeutic lifestyle changes (TLC). National Heart, Lung, and Blood Institute.
Eckel RH, et al. 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk. Circulation. 2014;129:S76.
Franzese CJ, et al. Relation of fish oil supplementation to markers of atherothrombotic risk in patients with Coronary Heart Disease not receiving lipid-lowering therapy. Am J Cardiol. 2015;115:1204.
Omega-3 supplements: An introduction. National Center for Complementary and Alternative Medicine.
Laman Fava S, Wilson PW, Schaefer EJ. Impact of body mass index on coronary heart disease risk factors in men and women. The Framingham Offspring Study. Arterioscler Thromb Vasc Biol. 1996;16(12):1509-1515.
Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem. 1972;18(6):499-502.
Werner M, Gabrielson DG, Eastman J. Ultramicro determination of serum triglycerides by bioluminescent assay. Clin Chem. 1981;27(2):268-271.
BeLue R, Okoror TA, Iwelunmor J, Taylor KD, Degboe AN, Agyemang C, Ogedegbe G. An overview of cardiovascular risk factor burden in sub-Saharan African countries: a socio-cultural perspective. Globalization and health. 2009;5(1):10.
Yusuf S, Hawken S, Ôunpuu S, Dans T, Avezum A, Lanas F, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. The Lancet. 2004;364(9438):937-952.
Castelli WP, Anderson K, Wilson PW, Levy D. Lipids and risk of coronary heart disease The Framingham Study. Ann Epidemiol. 1992;2(1-2):23-28.
Gotto AM. Cholesterol intake and serum cholesterol level.
Hokanson JE, Austin MA. Plasma triglyceride level is a risk factor for Coronary Heart Disease independent of high-density lipoprotein cholesterol level: a meta-analysis of population-based prospective studies. J Cardiovasc Risk. 1996;3(2):213-219.
Hokanson JE, Austin MA. Plasma triglyceride level is a risk factor for Coronary Heart Disease independent of high-density lipoprotein cholesterol level: a meta-analysis of population-based prospective studies. J Cardiovasc Risk. 1996;3(2):213-219.
Hokanson JE, Austin MA. Plasma triglyceride level is a risk factor for Coronary Heart Disease independent of high-density lipoprotein cholesterol level: a meta-analysis of population-based prospective studies. J Cardiovasc Risk. 1996;3(2):213-219.
Panagiotakos DB, Toutouzas PK. Importance of LDL/HDL cholesterol ratio as a predictor for coronary heart disease events in patients with heterozygous familial hypercholesterolaemia: a 15-year follow-up (1987-2002). Curr Med Res Opin. 2003;19(2):89-94.
Multiple Risk Factor Intervention Trial Research Group. Mortality rates after 10.5 years for participants in the Multiple Risk Factor Intervention Trial. Findings related to a priori hypotheses of the trial. JAMA. 1990;263(13):1795-1801.
Greenland P, Knoll MD, Stamler J, Neaton JD, Dyer AR, Garside DB, Wilson PW. Major risk factors as antecedents of fatal and nonfatal coronary heart disease events. JAMA. 2003;290(7):891-897.
Nishtar S, Bile KM, Ahmed A, Amjad S, Iqbal A. Integrated population-based surveillance of noncommunicable diseases: the Pakistan model. Am J Prev Med. 2005;29(5):102-106.
Nishtar S. Vision 2030 of the Planning Commission of Pakistan–strategic health imperatives. Heartfile. 2006;5:1-11.
Kannel WB, Schwartz MJ, McNamara PM. Blood pressure and risk of coronary heart disease: the Framingham study. Dis Chest. 1969;56(1):43-52.
Roger VL, American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics-2011 update: a report from the American Heart Association. Circulation. 2011;123:e18-e209.
Barolia R, Sayani AH. Risk factors of Coronary Heart Disease and its recommendations in Pakistani context. J Pak Med Assoc. 2017;67(11):1723.
BMJ 2013;347doi:http;//doi.org/10.1136/bmj.f5446 (Published 01 Oct 2013) Cite this as: BMJ 2013;347:f5446.
Samani NJ, Erdmann J, Hall AS, Hengstenberg C, Mangino M, Mayer B, et al. Genomewide association analysis of Coronary Heart Disease. N Engl J Med. 2007;357(5):443-453.
Kronmal RA, Kosinski AS, Mock MB. The relationship between cholesterol level and myocardial infarction or mortality risk in patients with Coronary Heart Disease: a report from the coronary artery surgery study (CASS) registry. Ann Epidemiol. 1992;2(1-2):129-136.
Nishtar S, Khalid F, Ikram A, Javad A, Jaffer H, Brown K, Badsha T. Protecting the poor against health impoverishment in Pakistan: Proof of concept of the potential within innovative web and mobile phone technologies. World Health Report. 2010;55.
Krishnadath IS, Jaddoe VW, Nahar-van Venrooij LM, Toelsie JR. Ethnic differences in prevalence and risk factors for hypertension in the Suriname Health Study: a cross-sectional population study. Popul Health Metrics. 2016;14(1):33.
Blas E, Kurup AS, eds. Equity, social determinants and public health programmes. World Health Organization. 2010.
Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2224-2260.
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