Ischemia Heart Disease: Current Diagnosis, Treatment Methods, and Genetic Research.

Manoj Mouli; Gagana H P; Kavya B L; Divya R; Gagana K M; Goutham H G; Yunus Pasha

doi:10.52794/hujpharm.1498649

Review

BibTex

RIS

Cite

Ischemia Heart Disease: Current Diagnosis, Treatment Methods, and Genetic Research.

Year 2024, , 373 - 389, 01.12.2024

Manoj Mouli , Gagana H P , Kavya B L , Divya R , Gagana K M , Goutham H G , Yunus Pasha

https://doi.org/10.52794/hujpharm.1498649

Abstract

Ischemic heart disease (IHD) is a top non-infectious disease that causes more deaths worldwide and it increases progressively over the years. It becomes a burden to low and middle-income countries. The management and treatment of ischemic heart disease have become more challenging due to improper lifestyle, adverse effects of currently available drugs, limited access to various diagnostic methods, genetic variations, and lack of knowledge among healthcare professionals. In this comprehensive survey, the different kinds of diagnostic approaches and modes of therapy, current research, molecular and genetic basis, future directions like integrative therapy and precision medicine, and global health initiatives related to IHD were summarized. This review is based on a literature survey of studies published between 2001 and 2024 using databases such as PubMed, Scopus, Web of Science, and relevant website like the World Health Organisation. The main goal of this literature survey is to create awareness that will help healthcare professionals save patients’ lives and aid researchers in developing new molecules to treat IHD.

Keywords

Heart, IHD, Diagnostic methods, Genetic basis.

References

1. Seki A, Fishbein MC. Ischemic Heart Disease. Pathobiology of Human Disease, Elsevier; 2014, p. 995–1013. https://doi.org/10.1016/B978-0-12-386456-7.03305-0
2. Severino P, D’Amato A, Pucci M, Infusino F, Adamo F, Birtolo LI, et al. Ischemic Heart Disease Pathophysiology Paradigms Overview: From Plaque Activation to Microvascular Dysfunction. Int J Mol Sci. 2020;21(21):8118. https://doi.org/10.3390/ijms21218118
3. The top 10 causes of death n.d. 2024. [Cited May 2024]. Available from: https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death.
4. Yan D, Liu K, Li F, Shi D, Wei L, Zhang J, et al. Global burden of ischemic heart disease associated with high red and processed meat consumption: an analysis of 204 countries and territories between 1990 and 2019. BMC Public Health. 2023;23(1):1-15. https://doi.org/10.1186/s12889-023-16954-4
5. Khatib R, McKee M, Shannon H, Chow C, Rangarajan S, Teo K, et al. Availability and affordability of cardiovascular disease medicines and their effect on use in high-income, middle-income, and low-income countries: an analysis of the PURE study data. Lancet. 2016;387(10013):61–9. https://doi.org/10.1016/S0140-6736(15)00469-9
6. Racca V, Spezzaferri R, Modica M, Mazzini P, Jonsdottir J, De Maria R, et al. Functioning and disability in ischaemic heart disease. Disabil Rehabil. 2010;9(5):1–15. https://doi.org/10.3109/09638288.2010.511691
7. Morrow DA. The Fourth Universal Definition of Myocardial Infarction and the Emerging Importance of Myocardial Injury. Circ. 2020;141(3):172–5. https://doi.org/10.1161/CIRCULATIONAHA.119.044125
8. Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP, et al. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease. Circ. 2012;126(5):e354-471. https://doi.org/10.1161/CIR.0b013e318277d6a0
9. Task Force Member, Montalescot G, Sechtem U, Achenbach S, Andreotti F, Arden C, et al. 2013 ESC guidelines on the management of stable coronary artery disease. Eur Heart J. 2013;34(38):2949–3003. https://doi.org/10.1093/eurheartj/eht296
10. Skinner JS, Smeeth L, Kendall JM, Adams PC, Timmis A. NICE guidance. Chest pain of recent onset: assessment and diagnosis of recent onset chest pain or discomfort of suspected cardiac origin. Heart. 2010;96(12):974–8. https://doi.org/10.1136/hrt.2009.190066
11. Virani SS, Newby LK, Arnold S V., Bittner V, Brewer LC, Demeter SH, et al. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circ. 2023;148(9): e9-e119. https://doi.org/10.1161/CIR.0000000000001168
12. Hundley WG, Bluemke DA, Finn JP, Flamm SD, Fogel MA, Friedrich MG, et al. ACCF/ACR/AHA/NASCI/SCMR 2010 Expert Consensus Document on Cardiovascular Magnetic Resonance. Circ. 2010;121(22):2462–508. https://doi.org/10.1161/CIR.0b013e3181d44a8f
13. Knuuti J, Wijns W, Saraste A, Capodanno D, Barbato E, Funck-Brentano C, et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J. 2020;41(3):407–77. https://doi.org/10.1093/eurheartj/ehz425
14. Dilsizian V, Bacharach SL, Beanlands RS, Bergmann SR, Delbeke D, Dorbala S, et al. ASNC imaging guidelines/SNMMI procedure standard for positron emission tomography (PET) nuclear cardiology procedures. JNC. 2016;23(5):1187–226. https://doi.org/10.1007/s12350-016-0522-3
15. American Society of Nuclear Cardiology and Society of Nuclear Medicine and Molecular Imaging Joint Position Statement on the Clinical Indications for Myocardial Perfusion PET. JNC. 2016;23(5):1227–31. https://doi.org/10.1007/s12350-016-0626-9
16. Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, et al. Fourth Universal Definition of Myocardial Infarction (2018). J Am Coll Cardiol. 2018;72(18):2231–64. https://doi.org/10.1016/j.jacc.2018.08.1038
17. Aboyans V, Criqui MH, Abraham P, Allison MA, Creager MA, Diehm C, et al. Measurement and Interpretation of the Ankle-Brachial Index. Circ. 2012;126(24):2890–909. https://doi.org/10.1161/CIR.0b013e318276fbcb
18. Naghavi M, Atlas K, Jaberzadeh A, Zhang C, Manubolu V, Li D, et al. Validation of Opportunistic Artificial Intelligence-Based Bone Mineral Density Measurements in Coronary Artery Calcium Scans. JACR. 2024;21(4):624–32. https://doi.org/10.1016/j.jacr.2023.05.006
19. de Oliveira Laterza Ribeiro M, Correia VM, Herling de Oliveira LL, Soares PR, Scudeler TL. Evolving Diagnostic and Management Advances in Coronary Heart Disease. Life. 2023;13(4):1-27. https://doi.org/10.3390/life13040951
20. Virk HUH, Escobar J, Rodriguez M, Bates ER, Khalid U, Jneid H, et al. Dual Antiplatelet Therapy: A Concise Review for Clinicians. Life. 2023;13(7):1580. https://doi.org/10.3390/life13071580
21. Gawaz M, Geisler T, Borst O. Current concepts and novel targets for antiplatelet therapy. Nat Rev Cardiol. 2023;20(9):583–99. https://doi.org/10.1038/s41569-023-00854-6
22. Kadoglou NPE, Stasinopoulou M. How to Use Statins in Secondary Prevention of Atherosclerotic Diseases: from the Beneficial Early Initiation to the Potentially Unfavorable Discontinuation. Cardiovasc Drugs Ther. 2023;37(2):353–62. https://doi.org/10.1007/s10557-021-07233-8
23. Khan O, Patel M, Tomdio AN, Beall J, Jovin IS. Beta-Blockers in the Prevention and Treatment of Ischemic Heart Disease. Heart Views. 2023;24(1):41–9. https://doi.org/10.4103/heartviews.heartviews_75_22
24. Iragavarapu T. Beta Blockers—Still the Best Option or an Obligation. Indian J Clin Cardiol. 2024;5(1):22–32. https://doi.org/10.1177/26324636231226031
25. Ziff OJ, Samra M, Howard JP, Bromage DI, Ruschitzka F, Francis DP, et al. Beta-blocker efficacy across different cardiovascular indications: an umbrella review and meta-analytic assessment. BMC Med. 2020;18(1):103. https://doi.org/10.1186/s12916-020-01564-3
26. Kalyuzhin V V., Teplyakov AT, Bespalova ID, Kalyuzhina E V., Terentyeva NN, Grakova E V., et al. Promising directions in the treatment of chronic heart failure: improving old or developing new ones. Bull Siberian Med. 2022;21(3):181–97. https://doi.org/10.20538/1682-0363-2022-3-181-197
27. de Oliveira Laterza Ribeiro M, Correia VM, Herling de Oliveira LL, Soares PR, Scudeler TL. Evolving Diagnostic and Management Advances in Coronary Heart Disease. Life. 2023;13(4):951-15. https://doi.org/10.3390/life13040951
28. Sethi Y, Patel N, Kaka N, Kaiwan O, Kar J, Moinuddin A, et al. Precision Medicine and the future of Cardiovascular Diseases: A Clinically Oriented Comprehensive Review. J Clin Med. 2023;12(5):1799. https://doi.org/10.3390/jcm12051799
29. Bottardi A, Prado GFA, Lunardi M, Fezzi S, Pesarini G, Tavella D, et al. Clinical Updates in Coronary Artery Disease: A Comprehensive Review. J Clin Med. 2024;13(16):4600. https://doi.org/10.3390/jcm13164600
30. Manolis AA, Manolis TA, Manolis AS. Managing chronic coronary syndrome: how do we achieve optimal patient outcomes. Expert Rev Cardiovasc Ther. 2024;22(6):243–63. https://doi.org/10.1080/14779072.2024.2357344
31. Pedretti RFE, Hansen D, Ambrosetti M, Back M, Berger T, Ferreira MC, et al. How to optimize the adherence to a guideline-directed medical therapy in the secondary prevention of cardiovascular diseases: a clinical consensus statement from the European Association of Preventive Cardiology. Eur J Prev Cardiol. 2023;30(2):149–66. https://doi.org/10.1093/eurjpc/zwac204
32. Sapna F, Raveena F, Chandio M, Bai K, Sayyar M, Varrassi G, et al. Advancements in Heart Failure Management: A Comprehensive Narrative Review of Emerging Therapies. Cureus. 2023;15(10). e46486. https://doi.org/10.7759/cureus.46486
33. Clappers N, Brouwer MA, Verheugt FWA. Antiplatelet treatment for coronary heart disease. Heart. 2005;93(2):258–65. https://doi.org/10.1136/hrt.2005.071209
34. Oikawa T, Sakata Y, Nochioka K, Miura M, Tsuji K, Onose T, et al. Prognostic Impact of Statin Intensity in Heart Failure Patients With Ischemic Heart Disease: A Report From the CHART‐2 (Chronic Heart Failure Registry and Analysis in the Tohoku District 2) Study. J Am Heart Assoc. 2018;7(6):7524-34. https://doi.org/10.1161/JAHA.117.007524
35. Khan O, Patel M, Tomdio A, Beall J, Jovin I. Beta-blockers in the prevention and treatment of ischemic heart disease: Evidence and clinical practice. Heart Views. 2023;24(1):41-9. https://doi.org/10.4103/heartviews.heartviews_75_22
36. O’Keefe JH, Wetzel M, Moe RR, Brosnahan K, Lavie CJ. Should an angiotensin-converting enzyme inhibitor be standard therapy for patients with atherosclerotic disease. J Am Coll Cardiol. 2001;37(1):1–8. https://doi.org/10.1016/S0735-1097(00)01044-5
37. Böhm M, Baumhäkel M, Mahfoud F, Werner C. From Evidence to Rationale: Cardiovascular Protection by Angiotensin II Receptor Blockers Compared with Angiotensin-Converting Enzyme Inhibitors. Cardiol. 2010;117(3):163–73. https://doi.org/10.1159/000320094
38. Shemin DG, Dworkin LD. Calcium Channel Blockers. Therapy in Nephrology & Hypertension. Elsevier; 2008, p. 610–9. https://doi.org/10.1016/B978-141605484-9.50055-1
39. Giuseppe C, Paul J, Hans-Ulrich I. Use of nitrates in ischemic heart disease. Expert Opin Pharmacother. 2015;16(11):1567–72. https://doi.org/10.1517/14656566.2015.1052742
40. Chaudhary R, Garg J, Shah N, Sumner A. PCSK9 inhibitors: A new era of lipid lowering therapy. World J Cardiol. 2017;9(2):76-87. https://doi.org/10.4330/wjc.v9.i2.76
41. He G, Yang G, Huang X, Luo D, Tang C, Zhang Z. SGLT2 inhibitors for prevention of primary and secondary cardiovascular outcomes: A meta-analysis of randomized controlled trials. Heart & Lung. 2023;59:109–16. https://doi.org/10.1016/j.hrtlng.2023.02.009
42. Muscoli S, Barillà F, Tajmir R, Meloni M, Della Morte D, Bellia A, et al. The New Role of SGLT2 Inhibitors in the Management of Heart Failure. Curr Evid Futur Perspect 2022;14(8):1730-45. https://doi.org/10.3390/pharmaceutics14081730
43. Turgeon RD, Ackman ML, Babadagli HE, Basaraba JE, Chen JW, Omar M, et al. The Role of Direct Oral Anticoagulants in Patients With Coronary Artery Disease. J Cardiovasc Pharmacol Ther. 2019;24(2):103–12. https://doi.org/10.1177/1074248418795889
44. Chiarito M, Cao D, Cannata F, Godino C, Lodigiani C, Ferrante G, et al. Direct Oral Anticoagulants in Addition to Antiplatelet Therapy for Secondary Prevention After Acute Coronary Syndromes. JAMA Cardiol. 2018;3(3):234-45. https://doi.org/10.1001/jamacardio.2017.5306
45. Ahmad M, Mehta P, Reddivari AKR, Mungee S. Percutaneous Coronary Intervention; 2024. 112 P.
46. Bhatt DL. Percutaneous Coronary Intervention in 2018. JAMA. 2018;319(20):2127-28. https://doi.org/10.1001/jama.2018.5281
47. Serruys PW, Morice M-C, Kappetein AP, Colombo A, Holmes DR, Mack MJ, et al. Percutaneous Coronary Intervention versus Coronary-Artery Bypass Grafting for Severe Coronary Artery Disease. New England Journal of Medicine. 2009;360(10):961–72. https://doi.org/10.1056/NEJMoa0804626
48. Spadaccio C, Benedetto U. Coronary artery bypass grafting (CABG) vs. percutaneous coronary intervention (PCI) in the treatment of multivessel coronary disease: quo vadis? —a review of the evidences on coronary artery disease. Ann Cardiothorac Surg. 2018;7(4):506–15. https://doi.org/10.21037/acs.2018.05.17
49. Tsai I-T, Sun C-K. Stem Cell Therapy against Ischemic Heart Disease. Int J Mol Sci. 2024;25(7):3778. https://doi.org/10.3390/ijms25073778
50. Jameel MN, Zhang J. Stem Cell Therapy for Ischemic Heart Disease. Antioxid Redox Signal. 2010;13(12):1879–97. https://doi.org/10.1089/ars.2010.3434
51. Jyotsna F, Ikram J, Nageeta F, Komal F, Anjlee F, Patel H, et al. Unlocking the Potential of Immunotherapy in Cardiovascular Disease: A Comprehensive Review of Applications and Future Directions. Cureus. 2023;15(8):e42790. https://doi.org/10.7759/cureus.42790
52. Rurik JG, Aghajanian H, Epstein JA. Immune Cells and Immunotherapy for Cardiac Injury and Repair. Circ Res. 2021;128(11):1766–79. https://doi.org/10.1161/CIRCRESAHA.121.318005
53. Maruthur NM, Wang N-Y, Appel LJ. Lifestyle Interventions Reduce Coronary Heart Disease Risk. Circ. 2009;119(15):2026–31. https://doi.org/10.1161/CIRCULATIONAHA.108.809491
54. Semaev S, Shakhtshneider E. Genetic Risk Score for Coronary Heart Disease: Review. J Pers Med. 2020;10(4):239-48. https://doi.org/10.3390/jpm10040239
55. Shi Y, Zhang H, Huang S, Yin L, Wang F, Luo P, et al. Epigenetic regulation in cardiovascular disease: mechanisms and advances in clinical trials. Signal Transduct Target Ther. 2022;7(1):200-19. https://doi.org/10.1038/s41392-022-01055-2
56. Xu R, Ma L, Cui S, Chen L, Xu H. Abordagem de Bioinformática e Biologia de Sistemas para Identificar a Ligação Patogenética entre Insuficiência Cardíaca e Sarcopenia. Arq Bras Cardiol. 2023;120(10). https://doi.org/10.36660/abc.20220874
57. Crea F. Ischaemic heart disease: prevention, management, mechanisms, and new therapeutic targets. Eur Heart J. 2024;45(9):637–41. https://doi.org/10.1093/eurheartj/ehae114
58. Sesso HD, Lee I-M, Gaziano JM, Rexrode KM, Glynn RJ, Buring JE. Maternal and Paternal History of Myocardial Infarction and Risk of Cardiovascular Disease in Men and Women. Circ. 2001;104(4):393–8. https://doi.org/10.1161/hc2901.093115
59. Lloyd-Jones DM, Nam B-H, D’Agostino SRB, Levy D, Murabito JM, Wang TJ, et al. Parental Cardiovascular Disease as a Risk Factor for Cardiovascular Disease in Middle-aged Adults. JAMA. 2004;291(18):2204-15. https://doi.org/10.1001/jama.291.18.2204
60. Zdravkovic S, Wienke A, Pedersen NL, Marenberg ME, Yashin AI, De Faire U. Heritability of death from coronary heart disease: a 36‐year follow‐up of 20 966 Swedish twins. J Intern Med. 2002;252(3):247–54. https://doi.org/10.1046/j.1365-2796.2002.01029.x
61. Sánchez-Hernández RM, Civeira F, Stef M, Perez-Calahorra S, Almagro F, Plana N, et al. Homozygous Familial Hypercholesterolemia in Spain. Circ Cardiovasc Genet. 2016;9(6):504–10. https://doi.org/10.1161/CIRCGENETICS.116.001545
62. Alonso R, Díaz-Díaz JL, Arrieta F, Fuentes-Jiménez F, de Andrés R, Saenz P, et al. Clinical and molecular characteristics of homozygous familial hypercholesterolemia patients: Insights from SAFEHEART registry. J Clin Lipidol. 2016;10(4):953–61. https://doi.org/10.1016/j.jacl.2016.04.006
63. Dawn Teare M, Barrett JH. Genetic linkage studies. Lancet. 2005;366(9490):1036–44. https://doi.org/10.1016/S0140-6736(05)67382-5
64. Kathiresan S, Srivastava D. Genetics of Human Cardiovascular Disease. Cell. 2012;148(6):1242–57. https://doi.org/10.1016/j.cell.2012.03.001
65. Varret M, Rabès J-P, Saint-Jore B, Cenarro A, Marinoni J-C, Civeira F, et al. A Third Major Locus for Autosomal Dominant Hypercholesterolemia Maps to 1p34.1-p32. Am J Hum Genet. 1999;64(5):1378–87. https://doi.org/10.1086/302370
66. Wang L, Fan C, Topol SE, Topol EJ, Wang Q. Mutation of MEF2A in an Inherited Disorder with Features of Coronary Artery Disease. Science. 2003;302(5650):1578–81. https://doi.org/10.1126/science.1088477
67. Lohmueller KE, Pearce CL, Pike M, Lander ES, Hirschhorn JN. Meta-analysis of genetic association studies supports a contribution of common variants to susceptibility to common disease. Nat Genet. 2003;33(2):177–82. https://doi.org/10.1038/ng1071
68. McPherson R, Pertsemlidis A, Kavaslar N, Stewart A, Roberts R, Cox DR, et al. A Common Allele on Chromosome 9 Associated with Coronary Heart Disease. Science. 2007;316(5830):1488–91. https://doi.org/10.1126/science.1142447
69. Deloukas P, Kanoni S, Willenborg C, Farrall M, Assimes TL, Thompson JR, et al. Large-scale association analysis identifies new risk loci for coronary artery disease. Nat Genet. 2013;45(1):25–33. https://doi.org/10.1038/ng.2480
70. Lappalainen I, Almeida-King J, Kumanduri V, Senf A, Spalding JD, ur-Rehman S, et al. The European Genome-phenome Archive of human data consented for biomedical research. Nat Genet. 2015;47(7):692–5. https://doi.org/10.1038/ng.3312
71. Won H-H, Natarajan P, Dobbyn A, Jordan DM, Roussos P, Lage K, et al. Disproportionate Contributions of Select Genomic Compartments and Cell Types to Genetic Risk for Coronary Artery Disease. PLoS Genet. 2015;11(10):e1005622. https://doi.org/10.1371/journal.pgen.1005622
72. Zanoni P, Khetarpal SA, Larach DB, Hancock-Cerutti WF, Millar JS, Cuchel M, et al. Rare variant in scavenger receptor BI raises HDL cholesterol and increases risk of coronary heart disease. Science. 2016;351(6278):1166–71. https://doi.org/10.1126/science.aad3517
73. Dib I, Khalil A, Chouaib R, El-Makhour Y, Noureddine H. Apolipoprotein C-III and cardiovascular diseases: when genetics meet molecular pathologies. Mol Biol Rep. 2021;48(1):875–86. https://doi.org/10.1007/s11033-020-06071-5
74. Churilin MI, Kononov SI, Luneva Yu V., Kazanov VA, Azarova IE, Klyosova EYu, et al. Polymorphisms of Intracellular Cholesterol Transporters Genes: Relationship to Blood Lipid Levels, Carotid Intima-Media Thickness, and the Development of Coronary Heart Disease. Russ J Genet. 2020;56(2):234–41. https://doi.org/10.1134/S1022795420020040
75. Kathiresan S. Developing Medicines That Mimic the Natural Successes of the Human Genome. J Am Coll Cardiol. 2015;65(15):1562–6. https://doi.org/10.1016/j.jacc.2015.02.049
76. Morelli MB, Chavez C, Santulli G. Angiopoietin-like proteins as therapeutic targets for cardiovascular disease: focus on lipid disorders. Expert Opin Ther Targets. 2020;24(1):79–88. https://doi.org/10.1080/14728222.2020.1707806
77. Tarugi P, Bertolini S, Calandra S. Angiopoietin-like protein 3 (ANGPTL3) deficiency and familial combined hypolipidemia. J Biomed Res. 2019;33(2):73-90. https://doi.org/10.7555/JBR.32.20170114
78. Pirim D, Wang X, Radwan ZH, Niemsiri V, Hokanson JE, Hamman RF, et al. Lipoprotein lipase gene sequencing and plasma lipid profile. J Lipid Res. 2014;55(1):85–93. https://doi.org/10.1194/jlr.M043265
79. Kuchenbaecker K, Gilly A, Suveges D, Southam L, Giannakopoulou O, Kilian B, et al. Insights into the genetic architecture of haematological traits from deep phenotyping and whole-genome sequencing for two Mediterranean isolated populations. Sci Rep. 2022;12(1):1131-45. https://doi.org/10.1038/s41598-021-04436-9
80. Guarneri M, Mercado N, Suhar C. Integrative Approaches for Cardiovascular Disease. Nutrition in Clinical Practice. 2009;24(6):701–8. https://doi.org/10.1177/0884533609343453
81. Aggarwal M, Aggarwal B, Rao J. Integrative Medicine for Cardiovascular Disease and Prevention. Med Clin North Am. 2017;101(5):895–923. https://doi.org/10.1016/j.mcna.2017.04.007
82. Prati F, Ruscica G, Marco V, Albertucci M. ‘Precision medicine’ and ischaemic heart disease: the stage is set for the new antibody based therapies (lipid lowering and anti-inflammatory). Eur Heart J Suppl. 2019;21(4):B73–5. https://doi.org/10.1093/eurheartj/suz029
83. Yang Y, Zhang Y, Ren M, Wang Y, Cairang Z, Lin R, et al. Association of cytochrome P450 2C19 polymorphisms with coronary heart disease risk. Med. 2020;99(50):e23652. https://doi.org/10.1097/MD.0000000000023652
84. Bielecka-Dabrowa A, Lewek J, Sakowicz A, Paduszyńska A, Dąbrowa M, Orszulak-Michalak D, et al. Effects of Implementing Personalized Health Education in Ambulatory Care on Cardiovascular Risk Factors, Compliance and Satisfaction with Treatment. J Pers Med. 2022;12(10):1583-97. https://doi.org/10.3390/jpm12101583
85. Global Hearts Initiative n.d. 2024. [Cited June 2024]. Available from: https://www.who.int/news/item/15-09-2016-global-hearts-initiative.