Fakultas Kedokteran
Unviversitas Sumatera Utara
Disusun oleh :
150100109 Johannes Tanaka
BAB I | PENDAHULUAN BAB II | TINJAUAN PUSTAKA BAB III | KESIMPULAN DAFTAR PUSTAKA
1. Latar Belakang 1. Definisi CVD Total : 18
2. Tujuan Penulisan 2. Epidemiologi CVD 7. Penegakan Diagnosis CVD 15 Journals
3. Manfaat Penulisan 3. Etiologi CVD 6. Tatalaksana CVD 1 Scientific Article
4. Faktor Risiko CVD 7. Komplikasi CVD 1 Report
5. Patofisiologi CVD 8. Framingham Heart Study 1 Website
6. Manifestasi Klinis CVD 9. Penilaian Risiko CVD berdasarkan 2008 : 1 2018 : 2
Framingham Heart Study 2016 : 3 2019 : 6
2017 : 3 2020 : 3 2
PENDAHULUAN
3
Referensi :
● Mensah, G. A., Roth, G. A., Fuster V. 2019, ‘The Global Burden of Cardiovascular Diseases and Risk Factors’, Journal of The American College of Cardiology, vol. 74, no. 2, pp. 2529-31.
● Maharani, A., Sujarwoto, Praveen, D., et al. 2019, ‘Cardiovascular Disease Risk Factor Prevalence and Estimated 10-Year Cardiovascular Risk Scores in Indonesia: The SMARThealth Extend Study’, Plos One, vol. 14, no. 4, pp. 1-11.
● Santos, P. 2020, ‘The Role of Cardiovascular Risk Assessment in Preventive Medicine: A Perspective from Portugal Primary Health-Care Cardiovascular Risk Assessment’, Journal of Enviromental and Public Health, pp. 1-6.
● Virani, S. S., Alonso, A., Benjamin, E. J., et al. 2020, ‘Heart Disease and Stroke Statistics 2020 Update. AHA Journals, vol. 141, pp. 139-596.
4
https://framinghamheartstudy.org/
Referensi :
● Andersson, C., Johnson, A., D., Benjamin, E., J., et al. 2019, ’70-Year Legacy of The Framingham Heart Study’, Nature Reviews Cardiology, vol. 16, pp. 687-98. .
● Santos, P. 2020, ‘The Role of Cardiovascular Risk Assessment in Preventive Medicine: A Perspective from Portugal Primary Health-Care Cardiovascular Risk Assessment’, Journal of Enviromental and Public Health, pp. 1-6.
● Studzinski, K., Tomasik, T., Krzyszton, J., et al. 2019, ‘Effect of Using Cardiovascular Risk Scoring in Routine Risk Assessment in Primary Prevention of Cardiovascular Disease : An Overview of Systemic Reviews’, BMC Cardiovascular Disorders, vol. 19, no. 11, pp. 1-15.
5
Persyaratan
P3D
Penerapan
Teori
Peningkatan
Wawasan
6
PENYAKIT KARDIOVASKULAR
Referensi :
● Agostino, R., B., Vasan, R., S., Pencina, M., J, et al. 2008, ‘General Cardiovascular Risk Profile for Use in Primary Care: The Framingham Heart Study’, Journal of The American Heart Association, vol. 117, pp. 743-53.
● Virani, S. S., Alonso, A., Benjamin, E. J., et al. 2020, ‘Heart Disease and Stroke Statistics 2020 Update. AHA Journals, vol. 141, pp. 139-596.
7
PENYAKIT KARDIOVASKULAR
Referensi :
●World Health Organization. 2019, ‘World Health Organization Cardiovascular Disease Risk Chart: Revised Models to Estimate Risk in 21 Global Regions’, Lancet Global Health, vol. 7, pp. 1332-45.
8
PENYAKIT KARDIOVASKULAR
Referensi :
● Departemen Kesehatan Republik Indonesia. 2018, ‘Hasil Utama Riskesdas 2018’, Badan penelitian dan Pengembangan Kementerian Kesehatan Republik Indonesia. 2018; P. 79-88.
9
PENYAKIT KARDIOVASKULAR
Referensi :
● Departemen Kesehatan Republik Indonesia. 2018, ‘Hasil Utama Riskesdas 2018’, Badan penelitian dan Pengembangan Kementerian Kesehatan Republik Indonesia. 2018; P. 79-88.
10
PENYAKIT KARDIOVASKULAR
Referensi :
● Departemen Kesehatan Republik Indonesia. 2018, ‘Hasil Utama Riskesdas 2018’, Badan penelitian dan Pengembangan Kementerian Kesehatan Republik Indonesia. 2018; P. 79-88.
11
PENYAKIT KARDIOVASKULAR
Referensi :
● Departemen Kesehatan Republik Indonesia. 2018, ‘Hasil Utama Riskesdas 2018’, Badan penelitian dan Pengembangan Kementerian Kesehatan Republik Indonesia. 2018; P. 79-88.
12
PENYAKIT KARDIOVASKULAR
Referensi :
● Departemen Kesehatan Republik Indonesia. 2018, ‘Hasil Utama Riskesdas 2018’, Badan penelitian dan Pengembangan Kementerian Kesehatan Republik Indonesia. 2018; P. 79-88.
13
PENYAKIT KARDIOVASKULAR
Referensi :
● Departemen Kesehatan Republik Indonesia. 2018, ‘Hasil Utama Riskesdas 2018’, Badan penelitian dan Pengembangan Kementerian Kesehatan Republik Indonesia. 2018; P. 79-88.
14
PENYAKIT KARDIOVASKULAR
Referensi :
● Departemen Kesehatan Republik Indonesia. 2018, ‘Hasil Utama Riskesdas 2018’, Badan penelitian dan Pengembangan Kementerian Kesehatan Republik Indonesia. 2018; P. 79-88.
15
PENYAKIT KARDIOVASKULAR
Referensi :
● Departemen Kesehatan Republik Indonesia. 2018, ‘Hasil Utama Riskesdas 2018’, Badan penelitian dan Pengembangan Kementerian Kesehatan Republik Indonesia. 2018; P. 79-88.
16
PENYAKIT KARDIOVASKULAR
Referensi :
● Departemen Kesehatan Republik Indonesia. 2018, ‘Hasil Utama Riskesdas 2018’, Badan penelitian dan Pengembangan Kementerian Kesehatan Republik Indonesia. 2018; P. 79-88.
17
PENYAKIT KARDIOVASKULAR
Referensi :
● Departemen Kesehatan Republik Indonesia. 2018, ‘Hasil Utama Riskesdas 2018’, Badan penelitian dan Pengembangan Kementerian Kesehatan Republik Indonesia. 2018; P. 79-88.
18
PENYAKIT KARDIOVASKULAR
1. Kerusakan Endotel Pembuluh Darah
● Timbul lesi
● Peradangan lokal
● Mobilisasi sistem imun
● Perkembangan fibrofatty atherosclerotic plaque
● Penyempitan arteri
2. Pecahnya plak aterosklerotik
Pembentukan bekuan darah
Oklusi arteri
Terhentinya aliran darah ke jantung (infark miokard)
Terhentinya aliran darah ke otak (stroke tromboemboli)
Referensi :
● Reis, A., H. 2016, ‘On The Etiology of Cardiovascular Diseases: A New Framework for Understanding Literature Results’, Medical Hypotheses, vol. 92, pp. 94-9. .
19
PENYAKIT KARDIOVASKULAR
Referensi :
● Santos, P. 2020, ‘The Role of Cardiovascular Risk Assessment in Preventive Medicine: A Perspective from Portugal Primary Health-Care Cardiovascular Risk Assessment’, Journal of Enviromental and Public Health, pp. 1-6. .
20
PENYAKIT KARDIOVASKULAR
Merokok menjadi faktor risiko yang paling umum pada pria (64,9%) di Indonesia diikuti oleh
peningkatan kolesterol total, hipertensi, kelebihan berat badan, dan diabetes. Sedangkan pada
wanita, peningkatan kolesterol total adalah faktor risiko yang paling umum dijumpai (39,6%),
diikuti oleh kelebihan berat badan, hipertensi, dan diabetes.
Referensi :
● Hussain, M., A., Mamun, A., A., Peters S., A., et al. 2016, ‘The Burden of Cardiovascular Disease Attributable to Major Modifiable Risk Factors in Indonesia.’, Journal of Epidemiology, vol. 26, no. 10, pp. 515-21. .
19
PENYAKIT KARDIOVASKULAR
Asidemia
● Kadar kortisol
● Asidosis metabolik yg disebabkan oleh CKD
● Asidosis metabolik yg diinduksi obat
Obat muatan H+ : biguanides, antiletroviral, isoniazid, dll
Obat muatan HCO3- : carbonic anhydrase inhibitors, ifosfamide, dll
Metformin dikaitkan asidosis : ST-elevasi pada infark miokard akut
● Hipoventilasi
Ventilasi tidak cukup mengambil O2 & mengeluarkan CO2
CO2 dalam darah (hiperkapnia) : asidosis respiratorik
Referensi :
● Reis, A., H. 2016, ‘On The Etiology of Cardiovascular Diseases: A New Framework for Understanding Literature Results’, Medical Hypotheses, vol. 92, pp. 94-9. .
19
PENYAKIT KARDIOVASKULAR
Asidemia
● Kompensasi
Ventilasi alveolar
Kadar CO2 dalam darah normal : enzim karbonat anhydrase
Pengurangan asam volatil melalui ekspirasi
Pengurangan asam melalui keringat, urin, dan feses
● Alkalosis paru lokal
Perubahan signifikan sifat-sifat darah yang mengalir dari paru-paru ke antrium kiri jantung
Darah mengandung pH , konsentrasi kalsium bebas , (+) vesikel asam lemak
● Kerusakan sel-sel endotel pembuluh darah
Jika proses terus berkembang bertahun-tahun, dapat menimbulkan kalsifikasi arteri progresif
Referensi :
● Reis, A., H. 2016, ‘On The Etiology of Cardiovascular Diseases: A New Framework for Understanding Literature Results’, Medical Hypotheses, vol. 92, pp. 94-9. .
20
PENYAKIT KARDIOVASKULAR
● Nyeri dada menyebar ke daerah bahu, lengan, punggung, leher, gigi, dan rahang
● Sesak napas dengan pernapasan yang dalam (kussmaul)
● Lightheadedness
Vasokontriksi pembuluh darah di otak
● Keringat
Kompensasi tubuh mengeluarkan asam berlebih
Referensi :
● Reis, A., H. 2016, ‘On The Etiology of Cardiovascular Diseases: A New Framework for Understanding Literature Results’, Medical Hypotheses, vol. 92, pp. 94-9. .
21
PENYAKIT KARDIOVASKULAR
Referensi :
●Tefera, Y., G., Abegaz, T., M., Abebe, T., M. et al. 2017, ‘The Changing Trend of Cardiovascular Disease and Its Clinical Characteristics in Ethiopia: Hospital-Based Observational Study’, Dove Press Journal, vol. 13, pp. 143-51. .
22
PENYAKIT KARDIOVASKULAR
Anamnesis
● Identitas pasien
● Keluhan utama
Dewasa
Bayi atau anak : riwayat kehamilan, kelahiran, pasca lahir
● Pemeriksaan fisik jantung
Observasi Perkusi
Inspeksi Auskultasi
Palpasi
● Pemeriksaan Penunjang
Pemeriksaan laboratorium Pemeriksaan fungsional
Pemeriksaan anatomis Circulating biomarkers
Referensi :
● Andersson, C., Johnson, A., D., Benjamin, E., J., et al. 2019, ’70-Year Legacy of The Framingham Heart Study’, Nature Reviews Cardiology, vol. 16, pp. 687-98..
● Raynaldo, A., H., Muhar, A., M., Prayugo, B. et al. 2017 ‘Blok Sistem Kardiovaskular’, Modul Keterampilan Klinis, pp. 2-4.
23
PENYAKIT KARDIOVASKULAR
PERKI
● Panduan Praktik Klinis (PPKK) & Clinical Pathway (CP) Penyakit Jantung & Pembuluh Darah
Referensi :
● Perhimpunan Dokter Spesialis Kardiovaskular Indonesia, 2016, ‘Panduan Praktik Klinis (PPK) dan Clinical Pathway (CP) Penyakit Jantung dan Pembuluh Darah’, pp.1-368.
24
PENYAKIT KARDIOVASKULAR
RISK ASSESSMENT
● Globorisk
● ASCVD (Atherosclerotic Cardiovascular Disease)
● Reynold Estimator/Reynold Risk Score
● PROCAM Calculator
● QRISK2
Direkomendasikan NICE (National Health and Care Excellent) di Inggris
● JBS3 (Joint British Societies 3) Risk Calculator
● ASSIGN-SCORE
Direkomendasikan Scottish Intercollege Guidelines Network
● CUORE Project Risk Estimator
Referensi :
● Santos, P. 2020, ‘The Role of Cardiovascular Risk Assessment in Preventive Medicine: A Perspective from Portugal Primary Health-Care Cardiovascular Risk Assessment’, Journal of Enviromental and Public Health, pp. 1-6.
25
PENYAKIT KARDIOVASKULAR
● Saat ini belum ada data menunjukkan prognosis penyakit kardiovaskular secara umum
● Komplikasi yang paling ditakuti adalah kematian
● Komplikasi lainnya adalah :
Lamanya rawat inap
Cacat fisik : lumpuh & infeksi sekunder tambahan lainnya
Biaya perawatan
● Penderita gagal jantung dengan HFrEF < 35% akibat aritmia
Mengancam jiwa
Direkomendasikan memakai ICD (Implantable-Cardioverter Defibrilator) : Pasien NYHA II-IV
Referensi :
● Lopez, E., O. 2019, ‘Cardiovascular Disease’, StatPearls, pp. 1-6.
26
● Terkait erat dengan kematian Presiden Amerika Serikat (Franklin D. Roosevelt) akibat HHD & Stroke, 1945
● 1940-an, Penyakit kardiovaskular merupakan penyebab kematian nomor 1 di USA
1 dari 2 kematian
Pencegahan dan perawatan sangat kurang dipahami saat itu
Kematian akibat penyakit jantung ini dianggap wajar terjadi
● 1948, FHS didirikan
Proyek bersama Boston University dan NHLBI (National Heart, Lung, and Blood Institute) USA
Identifikasi faktor-faktor umum atau karakteristik yang berkontribusi pada penyakit kardiovaskular
Mengikuti perkembangan partisipan dalam waktu lama dan jumlah besar
Referensi :
● Hajar, R. 2016, ‘Framingham Contribution to Cardiovascular Disease’, Journal of The Gulf Heart Association, vol. 17, no. 2, pp. 78-81. .
27
Referensi :
● Andersson, C., Johnson, A., D., Benjamin, E., J., et al. 2019, ’70-Year Legacy of The Framingham Heart Study’, Nature Reviews Cardiology, vol. 16, pp. 687-98.
● Hajar, R. 2016, ‘Framingham Contribution to Cardiovascular Disease’, Journal of The Gulf Heart Association, vol. 17, no. 2, pp. 78-81. .
28
Referensi :
● Andersson, C., Johnson, A., D., Benjamin, E., J., et al. 2019, ’70-Year Legacy of The Framingham Heart Study’, Nature Reviews Cardiology, vol. 16, pp. 687-98.
● Hajar, R. 2016, ‘Framingham Contribution to Cardiovascular Disease’, Journal of The Gulf Heart Association, vol. 17, no. 2, pp. 78-81. .
29
Referensi :
● Andersson, C., Johnson, A., D., Benjamin, E., J., et al. 2019, ’70-Year Legacy of The Framingham Heart Study’, Nature Reviews Cardiology, vol. 16, pp. 687-98.
● Hajar, R. 2016, ‘Framingham Contribution to Cardiovascular Disease’, Journal of The Gulf Heart Association, vol. 17, no. 2, pp. 78-81. .
30
Referensi :
● Andersson, C., Johnson, A., D., Benjamin, E., J., et al. 2019, ’70-Year Legacy of The Framingham Heart Study’, Nature Reviews Cardiology, vol. 16, pp. 687-98.
● Hajar, R. 2016, ‘Framingham Contribution to Cardiovascular Disease’, Journal of The Gulf Heart Association, vol. 17, no. 2, pp. 78-81. .
31
Referensi :
● Andersson, C., Johnson, A., D., Benjamin, E., J., et al. 2019, ’70-Year Legacy of The Framingham Heart Study’, Nature Reviews Cardiology, vol. 16, pp. 687-98.
32
Referensi :
● Agostino, R., B., Vasan, R., S., Pencina, M., J, et al. 2008, ‘General Cardiovascular Risk Profile for Use in Primary Care: The Framingham Heart Study’, Journal of The American Heart Association, vol. 117, pp. 743-53. .
33
Referensi :
● Agostino, R., B., Vasan, R., S., Pencina, M., J, et al. 2008, ‘General Cardiovascular Risk Profile for Use in Primary Care: The Framingham Heart Study’, Journal of The American Heart Association, vol. 117, pp. 743-53. .
34
Referensi :
● Agostino, R., B., Vasan, R., S., Pencina, M., J, et al. 2008, ‘General Cardiovascular Risk Profile for Use in Primary Care: The Framingham Heart Study’, Journal of The American Heart Association, vol. 117, pp. 743-53. .
35
Referensi :
● Agostino, R., B., Vasan, R., S., Pencina, M., J, et al. 2008, ‘General Cardiovascular Risk Profile for Use in Primary Care: The Framingham Heart Study’, Journal of The American Heart Association, vol. 117, pp. 743-53. .
36
Referensi :
● Agostino, R., B., Vasan, R., S., Pencina, M., J, et al. 2008, ‘General Cardiovascular Risk Profile for Use in Primary Care: The Framingham Heart Study’, Journal of The American Heart Association, vol. 117, pp. 743-53. .
37
Referensi :
● Agostino, R., B., Vasan, R., S., Pencina, M., J, et al. 2008, ‘General Cardiovascular Risk Profile for Use in Primary Care: The Framingham Heart Study’, Journal of The American Heart Association, vol. 117, pp. 743-53. .
38
Referensi :
● Agostino, R., B., Vasan, R., S., Pencina, M., J, et al. 2008, ‘General Cardiovascular Risk Profile for Use in Primary Care: The Framingham Heart Study’, Journal of The American Heart Association, vol. 117, pp. 743-53. .
39
Usia Kardiovaskular :
Usia seseorang dengan prediksi
risiko yang sama tetapi semua
kadar faktor risiko lain dalam
rentang normal
Referensi :
● Agostino, R., B., Vasan, R., S., Pencina, M., J, et al. 2008, ‘General Cardiovascular Risk Profile for Use in Primary Care: The Framingham Heart Study’, Journal of The American Heart Association, vol. 117, pp. 743-53. .
40
10,5%
Referensi :
● Agostino, R., B., Vasan, R., S., Pencina, M., J, et al. 2008, ‘General Cardiovascular Risk Profile for Use in Primary Care: The Framingham Heart Study’, Journal of The American Heart Association, vol. 117, pp. 743-53. .
41
Referensi :
● Agostino, R., B., Vasan, R., S., Pencina, M., J, et al. 2008, ‘General Cardiovascular Risk Profile for Use in Primary Care: The Framingham Heart Study’, Journal of The American Heart Association, vol. 117, pp. 743-53. .
42
https://framinghamheartstudy.org/fhs-risk-functions/
Referensi :
● Agostino, R., B., Vasan, R., S., Pencina, M., J, et al. 2008, ‘General Cardiovascular Risk Profile for Use in Primary Care: The Framingham Heart Study’, Journal of The American Heart Association, vol. 117, pp. 743-53. .
KESIMPULAN
43
Sistem kardiovaskular terdiri atas jantung dan pembuluh darah. Terdapat beragam masalah yang
mungkin timbul dalam sistem kardiovaskular. Manifestasi hingga komplikasi yang timbul akibat
penyakit kardiovaskular beraneka ragam, mulai dari asimtomatik hingga kematian. Oleh karena itu,
selain tatalaksana dengan pengobatan, langkah lainnya adalah dengan penilaian risiko penyakit
kardiovaskular tersebut. Penilaian risiko tersebut nantinya dapat digunakan, baik sebagai pencegahan
primer maupun sekunder pada pasien. Framingham Risk Score (FRS) merupakan salah satu platform
penialaian risiko penyakit kardiovaskular yang sederhana dan dapat mudah diakses dan digunakan.
Framingham Heart Study (FHS) yang telah berjalan selama 72 tahun ini telah menghasilkan banyak
algoritma penilaian risiko yang sederhana dan praktis digunakan, salah satunya risk calculator.
Dalam konteks ini, pencegahan dan perawatan jangka panjang merupakan kunci dalam pelayanan
primer di setiap fasilitas kesehtan. Penilaian risiko dan penerapannya dalam usaha pencegahan dan
perawatan diharapkan mampu mengurangi prevalensi penyakit kardiovaskular.
50
44
● Agostino, R., B., Vasan, R., S., Pencina, M., J, et al. 2008, ‘General Cardiovascular Risk Profile for Use in Primary Care: The Framingham Heart Study’, Journal of The American Heart Association, vol. 117, pp. 743-53.
● Andersson, C., Johnson, A., D., Benjamin, E., J., et al. 2019, ’70-Year Legacy of The Framingham Heart Study’, Nature Reviews Cardiology, vol. 16, pp. 687-98.
● Departemen Kesehatan Republik Indonesia. 2018, ‘Hasil Utama Riskesdas 2018’, Badan penelitian dan Pengembangan Kementerian Kesehatan Republik Indonesia. 2018; P. 79-88.
● Framingham Heart Study. 2020, A Project of Boston University and The National Heart, Lung, and Blood Institute, accesed 28th March 2020, available at: https://framinghamheartstudy.org/fhs-risk-functions/
● Hajar, R. 2016, ‘Framingham Contribution to Cardiovascular Disease’, Journal of The Gulf Heart Association, vol. 17, no. 2, pp. 78-81.
● Hussain, M., A., Mamun, A., A., Peters S., A., et al. 2016, ‘The Burden of Cardiovascular Disease Attributable to Major Modifiable Risk Factors in Indonesia.’, Journal of Epidemiology, vol. 26, no. 10, pp. 515-21.
● Khambati, J., Ratick, M., A., Dhindsa, D. 2017, ‘The Art of Cardiovascular Risk Assessment’, Clinical Cardiology, pp. 677-82.
● Lopez, E., O. 2019, ‘Cardiovascular Disease’, StatPearls, pp. 1-6.
● Mensah, G. A., Roth, G. A., Fuster V. 2019, ‘The Global Burden of Cardiovascular Diseases and Risk Factors’, Journal of The American College of Cardiology, vol. 74, no. 2, pp. 2529-31.
● Maharani, A., Sujarwoto, Praveen, D., et al. 2019, ‘Cardiovascular Disease Risk Factor Prevalence and Estimated 10-Year Cardiovascular Risk Scores in Indonesia: The SMARThealth Extend Study’, Plos One, vol. 14, no. 4, pp. 1-11.
● Perhimpunan Dokter Spesialis Kardiovaskular Indonesia, 2016, ‘Panduan Praktik Klinis (PPK) dan Clinical Pathway (CP) Penyakit Jantung dan Pembuluh Darah’, pp.1-368 Raynaldo, A., H., Muhar, A., M., Prayugo, B. et al. 2017 ‘Blok Sistem Kardiovaskular’, Modul Keterampilan Klinis, pp. 2-4.
● Reis, A., H. 2016, ‘On The Etiology of Cardiovascular Diseases: A New Framework for Understanding Literature Results’, Medical Hypotheses, vol. 92, pp. 94-9.
● Santos, P. 2020, ‘The Role of Cardiovascular Risk Assessment in Preventive Medicine: A Perspective from Portugal Primary Health-Care Cardiovascular Risk Assessment’, Journal of Enviromental and Public Health, pp. 1-6.
● Studzinski, K., Tomasik, T., Krzyszton, J., et al. 2019, ‘Effect of Using Cardiovascular Risk Scoring in Routine Risk Assessment in Primary Prevention of Cardiovascular Disease : An Overview of Systemic Reviews’, BMC Cardiovascular Disorders, vol. 19, no. 11, pp. 1-15.
● Tefera, Y., G., Abegaz, T., M., Abebe, T., M. et al. 2017, ‘The Changing Trend of Cardiovascular Disease and Its Clinical Characteristics in Ethiopia: Hospital-Based Observational Study’, Dove Press Journal, vol. 13, pp. 143-51.
● Vani, C., Narayana, B., L., Prashanti, P., et al. 2018, ‘Analyzing The Impact of Statins Use in Type-2 Diabetes Mellitus Patients’, Journal of Pharmacy and Biological Science, vol. 13, no. 1, pp. 45-53.
● Virani, S. S., Alonso, A., Benjamin, E. J., et al. 2020, ‘Heart Disease and Stroke Statistics 2020 Update. AHA Journals, vol. 141, pp. 139-596.
● World Health Organization. 2019, ‘World Health Organization Cardiovascular Disease Risk Chart: Revised Models to Estimate Risk in 21 Global Regions’, Lancet Global Health, vol. 7, pp. 1332-45.
51
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