Cardiovascular risk markers in schoolchildren from five provinces of eastern Colombia
Keywords:
cardiovascular diseases/epidemiology, colesterol, triglycerides, homocysteine, C-reactive protein, child
Abstract
Introduction. Cardiovascular disease is a public health problem globally; it represents the second cause of mortality in Colombia. This highlights the importance of identifying risk markers from the time of childhood, in order to diminish mortality rates proactively.Objectives. The lipid profile, homocysteine and C reactive protein plasma concentrations were determined in order to identify relationships between these markers and age, sex and school type. Materials and methods. A descriptive study was undertaken in 600 schoolchildren, aged 5 to 14, where the lipid profile, and the plasmatic concentrations of homocysteine and C-reactive protein were evaluated.
Results. Higher average levels of total cholesterol, low density cholesterol and triglycerides were observed in females (p<0.05) as compared with males. The prevalences of high lipid were higher in females than in males-7.9% vs. 3.0% for total cholesterol; 11.6% vs. 4.7%for low density cholesterol and 6.9% vs. 5.7% for triglycerides. Children in private schools had higher levels of lipid than those in public ones (p<0.05).The prevalence of homocysteine levels above 6.3 µmol/L was higher (64.3%) in males than in females (56.1%). No statistically significant differences with respect to sex, age or type of school were observed when comparing the prevalence of high levels C-reactive proteins.
Conclusions. The prevalence of high lipid profile levels in female schoolchildren suggested a policy of adopting intervention measures at an early age. Other factors require further investigation, such as the homocysteine levels observed in males and the C protein levels in order to detect their contribution to cardiovascular disease.
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References
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2. Berenson GS, Srinivasan SR, Bao WB, Newman WP 3rd, Tracy RE, Wattigney WA. Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. For the Bogalusa Heart Study. N Engl J Med. 1998;338:1650-6.
3. Freedman DS, Shear CL, Srinivasan SR, Webber LS, Berenson GS. Tracking of serum lipids and lipoproteins in children over and 8 year period: the Bogalusa Heart Study. Prev Med. 1985;14:203-16.
4. Cines DB, Pollak ES, Buck CA. Implications for prevention from pathobiological determinants of atherosclerosis in youth (PDAY) research group. Prevalence and extent of atherosclerosis in adolescents and young adults. JAMA. 1999;281:727-35.
5. National Cholesterol Education Program. Report of the expert panel on blood cholesterol levels in children and adolescents. Pediatrics. 1992;89 (Suppl.) 525-84.
6. Mejía JA. Utilidad del laboratorio en el control de las dislipidemias. Colomb Med. 2002;33:41-2.
7. Eikelboom J, Lonn E, Genest J Jr, Hankey G, Yusuf S. Homocysteine and cardiovascular disease. A critical review of the epidemiologic evidence. Ann Inter Med. 1999;131:363-75.
8. Wald DS, Law M, Morris JK. Homocysteine and cardiovascular disease: evidence and casualty from a meta-analysis. BMJ. 2002;325:1202.
9. Tonstad S, Refsum H, Silverten M, Christophersen B, Ose L, Ueland PM. Relation of total homocysteine and lipids levels in children to premature cardiovascular death in male relatives. Pediatr Res. 1996;40:47-52.
10. Tonstad S, Refsum H, Ueland PM. Association between plasma total homocysteine and parental history of cardiovascular disease in children with familial hypercholesterolemia. Circulation. 1997;96:1803-8.
11. De Laet C, Wautrecht JC, Brasseur D, Dramaix M, Boeynaems JM, Decuyper J, et al. Plasma homocysteine concentration in a Belgian school age population. Am J Clin Nutr. 1999;69:968-72.
12. Welch GN, Loscalzo L. Homocysteine and atherothrombosis. N Engl J Med. 1998;338:1042-50.
13. Córdoba A, Blanco F, González F. Bases moleculares de la hiperhomocisteinemia. Química Clínica. 1998; 17:5-18.
14. Stein JH, Mcbride PE. Hyperhomocysteinemia and atherosclerotic vascular disease: pathophysiology, screening, and treatment. Arch Intern Med. 1998;158:1301-6.
15. Bolander-Gouaille C. Why do homocysteine levels increase? En: Bolander C, editor. Determination of homocysteine. Why, when and how? Helsingborg: Bolander; 1999. p.25-35.
16. Weiringa FT, Dijkhuizen MA, West CE, Northrop-Clewes CA, Muhila I. Estimation of the effect of the acute phase response on indicators of micronutrient status in Indonesian infants. J Nutr. 2002;132:3061-6.
17. Tall AR. C-reactive protein reassessed. N Engl J Med. 2004;350:1450-2.
18. Liuzzo G, Biasucci LM, Gallimore JR, Grillo RL, Rebuzzi AG, Pepys MB, et al. The prognostic value of C-reactive protein and serum amyloid a protein in severe unstable angina. N Engl J Med. 1994;331:417-24.
19. Albert MA, Glynn RJ, Ridker PM. Plasma concentration of C-reactive protein and the calculated Framingham Coronary Heart Disease Risk Score. Circulation. 2003;108:161-5.
20. Pearson TA, Mensah GA, Alexander RW, Anderson JL, Canon RO 3rd, Criqui M, et al. Markers of inflammation and cardiovascular disease: application to clinical and public health practice: A statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation. 2003;107:499-511.
21. Kuller LH, Eichner JE, Orchard TJ, Grandits GA, MaCallum L, Tracy RP. The relation between serum albumin levels and risk of coronary heart disease in the Multiple Risk Factor Intervention Trial. Am J Epidemiol. 1991;34:1266-77.
22. Ridker PM, Cushman M, Stampfer MJ, Tracy RP, Hemmekens CH. Inflammation, aspirin and the risk of cardiovascular disease in apparently healthy men. N Engl J Med. 1997;336:993-9.
23. Ridker PM, Buring JE, Shih J, Matias M, Hennekens CH. Prospective study of C-reactive protein and the risk of future cardiovascular events among apparently healthy women. Circulation. 1998;98:731-3.
24. Ministerio de Salud. Dirección Nacional de Promoción y Prevención. Sistema Nacional de Vigilancia en Salud Pública (SIVIGILA). Semana epidemiológica semana 46. Informe ejecutivo semanal. Noviembre 14-20 de 1999. Segundo Estudio Nacional de Factores de Riesgo de Enfermedades Crónicas-ENFREC II. Bogotá, D.C.: Ministerio de Salud; 1999.
25. Burstein M, Scholnick HR, Morfin R. Rapid method for isolation of lipoproteins from human serum by precipitation with polyanions. J Lipid Res. 1970; 11:583-95.
26. National Cholesterol Education Program Expert Panel. Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. The Expert Panel. Arch Intern Med. 1988;148:36-69
27. Bewster MA. Vitamins. En: Kaplan LA, Pesce AJ, editors. Clinical chemistry: Theory, analysis and correlation. 2nd. St. Louis: CV Mosby; 1989. p.543-68.
28. Stauffenberg M, Lange RA, Hillis LD, Cigarroa J, Hsu RM, Devaraj S, et al. Hyperhomocysteinemia measured by immunoassay: a valid measure of coronary artery atherosclerosis. Arch Pathol Lab Med. 2004;128:1263-6.
29. Greenlund KJ, Srinivasan SR, Xu JH, Dalferes E Jr, Myers L, Pickoff A, et al. Plasma homocysteine distribution and its association with parental history of coronary artery disease in black and white children. The Bogalusa Heart Study. Circulation 1999;99:2144-9.
30. Vilaseca MA, Moyano D, Ferrer I, Artuch R. Total homocysteine in pediatric patients. Clin Chem. 1997;43:690-2.
31. Toss H, Lindahl B, Siegbahn A, Wallentin L. Prognostic influence of increased fibrinogen and C reactive protein levels in unstable coronary artery disease. FRISC Study Group. Framing during instability in coronary artery disease. Circulation. 1997;96:4204-10.
32. Marrugat J, Solanas P, DAgostino R, Sullivan L, Ordovas J, Cordón F, et al. Estimación del riesgo coronario en España mediante la ecuación de Framingham calibrada. Rev Esp Cardiol. 2003;56:253-61.
33. Must A, Dallal GE, Dietz WH. Reference data for obesity: 85th and 95th percentiles of body mass index (wt/ht2) and triceps skin fold thickness. Am J Clin Nutr. 1991;53:839-46.
34. Hernández-Valera Y, Henríquez PG, Arenas O, García Blanco M, Cardena Y. Índice de masa corporal P/T2. Valores para diagnóstico de desnutrición en niños venezolanos de 2 a 10 años de edad. XXV Jornadas Nac Ped Puer 1986. En: Manual de crecimiento y desarrollo. Caracas: FUNDACREDESA; 1997. p.186.
35. González-Requejo A, Sánchez-Bayle M, Baeza J, Arnaiz P, Vila S, Asencio J, et al. Relations between nutrient intake and serum lipid and apolipoprotein levels. J Pediatr. 1995;127:53-7.
36. Brotons-Cruixart C, Gabriel Sánchez R, Muñiz-García J, Ribera-Solé A, Malaga-Guerrero S, et al. Patrón de distribución de colesterol total y c-HDL en niños y adolescentes españoles: estudio RICARDIN. Med Clin (Barc). 2000;115:644-9.
37. Andersen GE, Lifshitz C, Friis-Hansen B. Dietary habits and serum lipids during first 4 years of life. A study of 95 Danish children. Acta Pediatr Scand. 1979;68:165-70.
38. Srinivasan SR, Myers L, Berenson G. Distribution and correlation of non high density lipoprotein cholesterol in children. The Bogalusa Heart Study. Pediatrics. 2002;110:29.
39. Aguilar D, Yánez CD, Bina MR, Dilenque S, Peterson G, Tavella M. Lípidos y apolipoproteínas A-I y B séricos en escolares adventistas de la República Argentina. Acta Bioquíim Clin Latinoam. 2003;37:5-12.
40. Uscátegui RM, Alvarez MC, Soler W, Martinez L, Arias R, Duque B, et al. Factores de riesgo cardiovascular en niños de 6 a 18 años de Medellín (Colombia). Ann Esp Pediatría. 2003;58:411-7.
41. Dwyer T, Iwanw H, Dean K, Odagiri Y, Shimomitsu T, Blizzard L et al. Differences in HDL cholesterol concentrations in Japanese, American and Australian children. Circulation. 1997;96:2830-6.
42. Gracia B, De Plata C, Pradilla A, Leiva J. Factores de riesgo para enfermedades de mayor prevalencia en el Valle del Cauca útiles para el desarrollo de estrategias de prevención. Colombia Med. 2003;34:47-55.
43. Casanueva V, Cid X, Cancino M, Borzone L, Cid L. Homocisteína en niños y adolescentes. Relación con historia familiar de enfermedad cardiovascular. Rev Med Chile. 2003;131:997-1002.
44. van Beynum IM, den Heijer M, Thomas CM, Afman L, Oppenraay-van Emmerzaal D, Blom HJ. Total homocysteine and its predictors in Dutch children. Am J Clin Nutr. 2005;81:1110-6.
45. Fomon SJ, McCormick DB. Vitaminas del grupo B y colina. En: Fomon SJ, editor. Nutrición del lactante. 1a ed. Madrid: Mosby/Doyma; 1995. p.358-65.
46. Ueland PM, Refsum H, Beresford SA, Volilssel SE. The controversy over Homocysteine and cardiovascular risk. Am J Clin Nutr. 2000;72:324-32.
47. Soberón M, Charaja A, Agüero Y, Oriondo R, Sandoval M, Núñez M. Estudio de los niveles plasmáticos de homocisteína, ácido fólico y vitamina B-12 en una población limeña de jóvenes adultos. Anales de la Facultad de Medicina. 2004;65:89-96.
48. McCully K. Homocysteine, folate, vitamin B6 and cardiovascular disease. JAMA. 1998;279:392-3.
49. Cardo E, Monros E, Colome C, Artuch R, Campistol J, Pineda M, et al. Children with stroke: polymorphism of the MTHFR gene, mild hyperhomocysteinemia and vitamin status. J Child Neurol. 2000;15:295-8.
50.Campistol J, Vilaseca MA, Cardo E. Hiperhomocisteinemia como factor de riesgo para accidentes cerebrovasculares en la infancia. Patología molecular de la homocisteína. III Symposium SHS sobre errores congénitos del metabolismo. Barcelona: Ediciones SHS España; 2000.p.57-67.
51. Rauh M, Verwied S, Knerr I, Dorr HG, Sonmichsen A, Kaletzko B. Homocysteine concentrations in a German cohort of 500 individuals. Reference range and determinants of plasma level in healthy children and their parents. Amino Acids. 2001;20:409-18.
52. Ridker PM, Glynn RJ, Hennekens CH. C-reactive protein adds to the predictive value of total and HDL cholesterol in determining risk of first myocardial infarction. Circulation. 1998;97:2007-11.
53. García-Moll X, Kaski JC. Cardiopatía isquémica: marcadores de inflamación y riesgo cardiovascular. Rev Cubana Med. 2000;39:120-40.
54. Tsimikas S, Willerson JT, Ridker PM. C-reactive protein and other emerging blood biomarkers to optimize risk stratification of vulnerable patients. J Am Coll Cardiol. 2006;47(Suppl.8):19-31.
2. Berenson GS, Srinivasan SR, Bao WB, Newman WP 3rd, Tracy RE, Wattigney WA. Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. For the Bogalusa Heart Study. N Engl J Med. 1998;338:1650-6.
3. Freedman DS, Shear CL, Srinivasan SR, Webber LS, Berenson GS. Tracking of serum lipids and lipoproteins in children over and 8 year period: the Bogalusa Heart Study. Prev Med. 1985;14:203-16.
4. Cines DB, Pollak ES, Buck CA. Implications for prevention from pathobiological determinants of atherosclerosis in youth (PDAY) research group. Prevalence and extent of atherosclerosis in adolescents and young adults. JAMA. 1999;281:727-35.
5. National Cholesterol Education Program. Report of the expert panel on blood cholesterol levels in children and adolescents. Pediatrics. 1992;89 (Suppl.) 525-84.
6. Mejía JA. Utilidad del laboratorio en el control de las dislipidemias. Colomb Med. 2002;33:41-2.
7. Eikelboom J, Lonn E, Genest J Jr, Hankey G, Yusuf S. Homocysteine and cardiovascular disease. A critical review of the epidemiologic evidence. Ann Inter Med. 1999;131:363-75.
8. Wald DS, Law M, Morris JK. Homocysteine and cardiovascular disease: evidence and casualty from a meta-analysis. BMJ. 2002;325:1202.
9. Tonstad S, Refsum H, Silverten M, Christophersen B, Ose L, Ueland PM. Relation of total homocysteine and lipids levels in children to premature cardiovascular death in male relatives. Pediatr Res. 1996;40:47-52.
10. Tonstad S, Refsum H, Ueland PM. Association between plasma total homocysteine and parental history of cardiovascular disease in children with familial hypercholesterolemia. Circulation. 1997;96:1803-8.
11. De Laet C, Wautrecht JC, Brasseur D, Dramaix M, Boeynaems JM, Decuyper J, et al. Plasma homocysteine concentration in a Belgian school age population. Am J Clin Nutr. 1999;69:968-72.
12. Welch GN, Loscalzo L. Homocysteine and atherothrombosis. N Engl J Med. 1998;338:1042-50.
13. Córdoba A, Blanco F, González F. Bases moleculares de la hiperhomocisteinemia. Química Clínica. 1998; 17:5-18.
14. Stein JH, Mcbride PE. Hyperhomocysteinemia and atherosclerotic vascular disease: pathophysiology, screening, and treatment. Arch Intern Med. 1998;158:1301-6.
15. Bolander-Gouaille C. Why do homocysteine levels increase? En: Bolander C, editor. Determination of homocysteine. Why, when and how? Helsingborg: Bolander; 1999. p.25-35.
16. Weiringa FT, Dijkhuizen MA, West CE, Northrop-Clewes CA, Muhila I. Estimation of the effect of the acute phase response on indicators of micronutrient status in Indonesian infants. J Nutr. 2002;132:3061-6.
17. Tall AR. C-reactive protein reassessed. N Engl J Med. 2004;350:1450-2.
18. Liuzzo G, Biasucci LM, Gallimore JR, Grillo RL, Rebuzzi AG, Pepys MB, et al. The prognostic value of C-reactive protein and serum amyloid a protein in severe unstable angina. N Engl J Med. 1994;331:417-24.
19. Albert MA, Glynn RJ, Ridker PM. Plasma concentration of C-reactive protein and the calculated Framingham Coronary Heart Disease Risk Score. Circulation. 2003;108:161-5.
20. Pearson TA, Mensah GA, Alexander RW, Anderson JL, Canon RO 3rd, Criqui M, et al. Markers of inflammation and cardiovascular disease: application to clinical and public health practice: A statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation. 2003;107:499-511.
21. Kuller LH, Eichner JE, Orchard TJ, Grandits GA, MaCallum L, Tracy RP. The relation between serum albumin levels and risk of coronary heart disease in the Multiple Risk Factor Intervention Trial. Am J Epidemiol. 1991;34:1266-77.
22. Ridker PM, Cushman M, Stampfer MJ, Tracy RP, Hemmekens CH. Inflammation, aspirin and the risk of cardiovascular disease in apparently healthy men. N Engl J Med. 1997;336:993-9.
23. Ridker PM, Buring JE, Shih J, Matias M, Hennekens CH. Prospective study of C-reactive protein and the risk of future cardiovascular events among apparently healthy women. Circulation. 1998;98:731-3.
24. Ministerio de Salud. Dirección Nacional de Promoción y Prevención. Sistema Nacional de Vigilancia en Salud Pública (SIVIGILA). Semana epidemiológica semana 46. Informe ejecutivo semanal. Noviembre 14-20 de 1999. Segundo Estudio Nacional de Factores de Riesgo de Enfermedades Crónicas-ENFREC II. Bogotá, D.C.: Ministerio de Salud; 1999.
25. Burstein M, Scholnick HR, Morfin R. Rapid method for isolation of lipoproteins from human serum by precipitation with polyanions. J Lipid Res. 1970; 11:583-95.
26. National Cholesterol Education Program Expert Panel. Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. The Expert Panel. Arch Intern Med. 1988;148:36-69
27. Bewster MA. Vitamins. En: Kaplan LA, Pesce AJ, editors. Clinical chemistry: Theory, analysis and correlation. 2nd. St. Louis: CV Mosby; 1989. p.543-68.
28. Stauffenberg M, Lange RA, Hillis LD, Cigarroa J, Hsu RM, Devaraj S, et al. Hyperhomocysteinemia measured by immunoassay: a valid measure of coronary artery atherosclerosis. Arch Pathol Lab Med. 2004;128:1263-6.
29. Greenlund KJ, Srinivasan SR, Xu JH, Dalferes E Jr, Myers L, Pickoff A, et al. Plasma homocysteine distribution and its association with parental history of coronary artery disease in black and white children. The Bogalusa Heart Study. Circulation 1999;99:2144-9.
30. Vilaseca MA, Moyano D, Ferrer I, Artuch R. Total homocysteine in pediatric patients. Clin Chem. 1997;43:690-2.
31. Toss H, Lindahl B, Siegbahn A, Wallentin L. Prognostic influence of increased fibrinogen and C reactive protein levels in unstable coronary artery disease. FRISC Study Group. Framing during instability in coronary artery disease. Circulation. 1997;96:4204-10.
32. Marrugat J, Solanas P, DAgostino R, Sullivan L, Ordovas J, Cordón F, et al. Estimación del riesgo coronario en España mediante la ecuación de Framingham calibrada. Rev Esp Cardiol. 2003;56:253-61.
33. Must A, Dallal GE, Dietz WH. Reference data for obesity: 85th and 95th percentiles of body mass index (wt/ht2) and triceps skin fold thickness. Am J Clin Nutr. 1991;53:839-46.
34. Hernández-Valera Y, Henríquez PG, Arenas O, García Blanco M, Cardena Y. Índice de masa corporal P/T2. Valores para diagnóstico de desnutrición en niños venezolanos de 2 a 10 años de edad. XXV Jornadas Nac Ped Puer 1986. En: Manual de crecimiento y desarrollo. Caracas: FUNDACREDESA; 1997. p.186.
35. González-Requejo A, Sánchez-Bayle M, Baeza J, Arnaiz P, Vila S, Asencio J, et al. Relations between nutrient intake and serum lipid and apolipoprotein levels. J Pediatr. 1995;127:53-7.
36. Brotons-Cruixart C, Gabriel Sánchez R, Muñiz-García J, Ribera-Solé A, Malaga-Guerrero S, et al. Patrón de distribución de colesterol total y c-HDL en niños y adolescentes españoles: estudio RICARDIN. Med Clin (Barc). 2000;115:644-9.
37. Andersen GE, Lifshitz C, Friis-Hansen B. Dietary habits and serum lipids during first 4 years of life. A study of 95 Danish children. Acta Pediatr Scand. 1979;68:165-70.
38. Srinivasan SR, Myers L, Berenson G. Distribution and correlation of non high density lipoprotein cholesterol in children. The Bogalusa Heart Study. Pediatrics. 2002;110:29.
39. Aguilar D, Yánez CD, Bina MR, Dilenque S, Peterson G, Tavella M. Lípidos y apolipoproteínas A-I y B séricos en escolares adventistas de la República Argentina. Acta Bioquíim Clin Latinoam. 2003;37:5-12.
40. Uscátegui RM, Alvarez MC, Soler W, Martinez L, Arias R, Duque B, et al. Factores de riesgo cardiovascular en niños de 6 a 18 años de Medellín (Colombia). Ann Esp Pediatría. 2003;58:411-7.
41. Dwyer T, Iwanw H, Dean K, Odagiri Y, Shimomitsu T, Blizzard L et al. Differences in HDL cholesterol concentrations in Japanese, American and Australian children. Circulation. 1997;96:2830-6.
42. Gracia B, De Plata C, Pradilla A, Leiva J. Factores de riesgo para enfermedades de mayor prevalencia en el Valle del Cauca útiles para el desarrollo de estrategias de prevención. Colombia Med. 2003;34:47-55.
43. Casanueva V, Cid X, Cancino M, Borzone L, Cid L. Homocisteína en niños y adolescentes. Relación con historia familiar de enfermedad cardiovascular. Rev Med Chile. 2003;131:997-1002.
44. van Beynum IM, den Heijer M, Thomas CM, Afman L, Oppenraay-van Emmerzaal D, Blom HJ. Total homocysteine and its predictors in Dutch children. Am J Clin Nutr. 2005;81:1110-6.
45. Fomon SJ, McCormick DB. Vitaminas del grupo B y colina. En: Fomon SJ, editor. Nutrición del lactante. 1a ed. Madrid: Mosby/Doyma; 1995. p.358-65.
46. Ueland PM, Refsum H, Beresford SA, Volilssel SE. The controversy over Homocysteine and cardiovascular risk. Am J Clin Nutr. 2000;72:324-32.
47. Soberón M, Charaja A, Agüero Y, Oriondo R, Sandoval M, Núñez M. Estudio de los niveles plasmáticos de homocisteína, ácido fólico y vitamina B-12 en una población limeña de jóvenes adultos. Anales de la Facultad de Medicina. 2004;65:89-96.
48. McCully K. Homocysteine, folate, vitamin B6 and cardiovascular disease. JAMA. 1998;279:392-3.
49. Cardo E, Monros E, Colome C, Artuch R, Campistol J, Pineda M, et al. Children with stroke: polymorphism of the MTHFR gene, mild hyperhomocysteinemia and vitamin status. J Child Neurol. 2000;15:295-8.
50.Campistol J, Vilaseca MA, Cardo E. Hiperhomocisteinemia como factor de riesgo para accidentes cerebrovasculares en la infancia. Patología molecular de la homocisteína. III Symposium SHS sobre errores congénitos del metabolismo. Barcelona: Ediciones SHS España; 2000.p.57-67.
51. Rauh M, Verwied S, Knerr I, Dorr HG, Sonmichsen A, Kaletzko B. Homocysteine concentrations in a German cohort of 500 individuals. Reference range and determinants of plasma level in healthy children and their parents. Amino Acids. 2001;20:409-18.
52. Ridker PM, Glynn RJ, Hennekens CH. C-reactive protein adds to the predictive value of total and HDL cholesterol in determining risk of first myocardial infarction. Circulation. 1998;97:2007-11.
53. García-Moll X, Kaski JC. Cardiopatía isquémica: marcadores de inflamación y riesgo cardiovascular. Rev Cubana Med. 2000;39:120-40.
54. Tsimikas S, Willerson JT, Ridker PM. C-reactive protein and other emerging blood biomarkers to optimize risk stratification of vulnerable patients. J Am Coll Cardiol. 2006;47(Suppl.8):19-31.
How to Cite
1.
Villarreal E, Forero Y, Poveda E, Baracaldo C, López E. Cardiovascular risk markers in schoolchildren from five provinces of eastern Colombia. Biomed. [Internet]. 2008 Mar. 1 [cited 2025 Apr. 4];28(1):38-49. Available from: https://revistabiomedicaorg.biteca.online/index.php/biomedica/article/view/107
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