Sania Nishtar

Government Of Pakistan, Islāmābād, Islāmābād, Pakistan

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Publications (84)1171.04 Total impact

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    ABSTRACT: Objective To determine the relationship between proprotein convertase subtilisin kexin 9 (PCSK9) levels and atheroma burden in Pakistanis presenting to an ambulatory centre with chest pain.MethodsA prospective matched case–control study of 400 patients selected for presence/absence of angiographic disease referred between 2001 and 2003. A comprehensive cardiovascular disease risk factor profile was assessed including demographics, environmental and biochemical risk factors including insulin resistance and PCSK-9 levels. Coronary atheroma burden was quantified by Gensini score.ResultsIn this population, PCSK-9 levels were weakly correlated (r = 0.23) with male gender (p = 0.06) and number of diabetes years (p = 0.09), and inversely with log10 of lipoprotein (a) concentration (p = 0.07) but not LDL-C. In multiple regression analysis, Gensini score was associated with age (p = 0.002), established angina (p = 0.001), duration of diabetes (p = 0.05), low HDL-C (p < 0.001), lipoprotein (a) (p = 0.01), creatinine (p < 0.001), C-Reactive Protein (p = 0.02) and PSCK-9 (p = 0.05) concentrations. PCSK9 added to the regression model. Neither total cholesterol nor LDL-C were significant risk factors in this study.Conclusions Proprotein convertase subtilisin kexin 9 concentrations are correlated with atheroma burden in Indian Asian populations from the sub-continent, not taking statin therapy, independent of LDL-C or other CVD risk factors.
    International Journal of Clinical Practice 02/2015; · 2.54 Impact Factor
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    ABSTRACT: Abstract Lessons learned by countries that have successfully implemented coverage schemes for health services may be valuable for other countries, especially low- and middle-income countries (LMICs), which likewise are seeking to provide/expand coverage. The research team surveyed experts in population health management from LMICs for information on characteristics of health care coverage schemes and factors that influenced decision-making processes. The level of coverage provided by the different schemes varied. Nearly all the health care coverage schemes involved various representatives and stakeholders in their decision-making processes. Maternal and child health, cardiovascular diseases, cancer, and HIV were among the highest priorities guiding coverage development decisions. Evidence used to inform coverage decisions included medical literature, regional and global epidemiology, and coverage policies of other coverage schemes. Funding was the most commonly reported reason for restricting coverage. This exploratory study provides an overview of health care coverage schemes from participating LMICs and contributes to the scarce evidence base on coverage decision making. Sharing knowledge and experiences among LMICs can support efforts to establish systems for accessible, affordable, and equitable health care. (Population Health Management 2014;xx:xxx-xxx).
    Population Health Management 11/2014; · 1.35 Impact Factor
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    ABSTRACT: Objective To determine the relationship between troponin-T levels and atheroma burden in Pakistanis presenting to an ambulatory centre with chest pain.MethodsA prospective case–control study of 400 patients selected for presence/absence of angiographic disease referred between 2001 and 2003. A comprehensive cardiovascular disease (CVD) risk factor profile was assessed including demographics, environmental and biochemical risk factors including insulin resistance and troponin-T levels. Coronary atheroma burden was quantified by Gensini score.ResultsClinically significant elevated troponin-T levels (> 30 pmol/l) were found in 40 patients (10%) with equal numbers in groups selected with or without angiographic disease. Troponin-T elevation (> 13 pmol/l) was present in 59 vs. 47 patients (30% vs. 24%; p = 0.04). Troponin-T levels did not correlate with any measured demographical, environmental, drug therapy or biochemical risk factor. No difference was found in concentrations of lipids, apolipoproteins, insulin resistance, C-reactive protein or sialic acid in cohorts stratified by troponin-T concentrations. In univariate analysis comparing patients with high (> 30 pmol/l) and low troponin-T levels (< 13 pmol/l) higher plasma total protein (91 g/l vs. 85 g/l; p = 0.01), increased immunoglobulin levels (41 g/l vs. 36 g/l; p = 0.02) and prevalence of hyperparathyroidism (40% vs. 21%; p = 0.04) were associated with higher troponin-T concentrations.Conclusions This study shows that measurement of troponin-T is not an alternative to imaging in an Indian asian population, but that it does identify a separate potentially high-risk population that would not be identified by the use of imaging alone which is potentially at higher risk of CVD events.
    International Journal of Clinical Practice 09/2014; · 2.54 Impact Factor
  • Sania Nishtar
    The Lancet 09/2014; · 39.21 Impact Factor
  • The Lancet 06/2014; 383(9935):2124-5. · 39.21 Impact Factor
  • Sania Nishtar, Johanna Ralston
    Bulletin of the World Health Organisation 11/2013; 91(11):895-896. · 5.11 Impact Factor
  • Zulfiqar A Bhutta, Sania Nishtar
    The Lancet 10/2013; 382(9900):1246. · 39.21 Impact Factor
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    ABSTRACT: Pakistan has undergone massive changes in its federal structure under the 18th Constitutional Amendment. To gain insights that will inform reform plans, we assessed several aspects of health-systems performance in Pakistan. Some improvements were noted in health-systems performance during the past 65 years but key health indicators lag behind those in peer countries. 78·08% of the population pay out of pocket at the point of health care. The private sector provides three-quarters of the health services, and physicians outnumber nurses and midwives by a ratio of about 2:1. Complex governance challenges and underinvestment in health have hampered progress. With devolution of the health mandate, an opportunity has arisen to reform health. The federal government has constitutional responsibility of health information, interprovincial coordination, global health, and health regulation. All other health responsibilities are a provincial mandate. With appropriate policy, institutional, and legislative action within and outside the health system, the existing challenges could be overcome.
    The Lancet 05/2013; S0140-6736(13):60019-7. · 39.21 Impact Factor
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    ABSTRACT: Pakistan's enormous macroeconomic, internal, and human security challenges coexist alongside the opportunity created by a huge desire for change. With democracy taking root and a new constitutionally ushered era in state governance, The Lancet Series about Pakistan and health focuses on health as a nation-building and social-welfare agenda at a time of unprecedented social upheaval and economic hardships in the country. We call for a unified vision for the goal of universal and equitable health access. We provide recommendations for six objectives for policy and action. Higher political priority for health, increased investments, a combination of targeted and universal approaches, action in terms of the social determinants, institutionalisation of the right organisational network, and frameworks for accountability are crucial for the attainment of the health goals in Pakistan.
    The Lancet 05/2013; 381(9885). · 39.21 Impact Factor
  • Qanta A Ahmed, Sania Nishtar, Ziad A Memish
    The Lancet 04/2013; 381(9877). · 39.21 Impact Factor
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    ABSTRACT: In almost all countries, development of health systems that are responsive to the challenge of prevention and treatment of non-communicable diseases (NCDs) is a priority. NCDs consist of a vast group of conditions, but in terms of premature mortality, emphasis has been on cardiovascular disease, cancer, diabetes, and chronic respiratory diseases—diseases that were also the focus of the UN high-level meeting on NCDs, held in 2011. 1In 1990, there were 26·6 million deaths worldwide from NCDs (57·2% ...
    The Lancet 02/2013; 381(9867):690-7. · 39.21 Impact Factor
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    ABSTRACT: Substandard and falsified medicines kill patients, yet progress on the twin challenges of safeguarding the quality of genuine medicine and criminalising falsified ones has been held back by controversy over intellectual property rights and confusion over terms. Amir Attaran and colleagues propose a global treaty to overcome the problems.
    BMJ (online) 11/2012; 345:e7381. · 16.38 Impact Factor
  • Sania Nishtar
    The Lancet 03/2012; 379(9821):1084-5. · 39.21 Impact Factor
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    Miriam Rabkin, Sania Nishtar
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    ABSTRACT: The scale-up of HIV services in lower-income countries has created the first large-scale continuity care program in many settings. Although HIV and chronic noncommunicable diseases are thought of as quite different challenges and tend to be "siloed" throughout the health system, the availability of treatment has transformed HIV into a chronic condition-and HIV programs have developed the systems, tools, and approaches needed to support continuity care in the local context. In many cases, HIV programs have developed practical and contextually appropriate resources that might be used to support nascent noncommunicable diseases programs.
    JAIDS Journal of Acquired Immune Deficiency Syndromes 08/2011; 57 Suppl 2:S87-90. · 4.39 Impact Factor
  • Peter Anderson, Sania Nishtar
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    ABSTRACT: Since 2008, the World Economic Forum has identified noncommunicable diseases (NCDs) as a leading threat to the global economy both in terms of their cost and likelihood of happening. The Global Agenda Council on NCDs, a think tank of leaders in the field, was created by the World Economic Forum to raise awareness on the issue and support action leading up to the United Nations High Level Meeting on NCDs. The current special issue is the outcome of Council discussions as well as individual work of lead authors to highlight the burden of risk factors for NCDs, identify costs and solutions, and call for joint action and coordination across sectors. The special issue comprises two parts: "Risk Factors and Impact," and "Communicating and Acting on Solutions."
    Journal of Health Communication 08/2011; 16 Suppl 2:6-12. · 1.61 Impact Factor
  • Sania Nishtar, Eva Jané-Llopis
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    ABSTRACT: There is a long history of advocacy to place noncommunicable diseases higher on the global public health agenda. Although attempts have been made and action is well under way, there is still a lack of a coordinating mechanism that helps identify action, tracks progress, and stimulates multistakeholder collaboration while preventing duplication of efforts. The fast-approaching United Nations High Level Meeting on Non-Communicable Diseases and the call by all parties for more efficient responses to the growing problems of noncommunicable diseases presents a unique opportunity to create an institutional mechanism that incentivizes coordination. An apex coordinating arrangement would allow efficient global information exchange, mapping existing gaps in action, and identifying and catalyzing collaboration across sectors and regions of the world.
    Journal of Health Communication 08/2011; 16 Suppl 2:201-5. · 1.61 Impact Factor
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    ABSTRACT: Non-communicable diseases (NCDs), principally heart disease, stroke, cancer, diabetes, and chronic respiratory diseases, are a global crisis and require a global response. Despite the threat to human development, and the availability of affordable, cost-effective, and feasible interventions, most countries, development agencies, and foundations neglect the crisis. The UN High-Level Meeting (UN HLM) on NCDs in September, 2011, is an opportunity to stimulate a coordinated global response to NCDs that is commensurate with their health and economic burdens. To achieve the promise of the UN HLM, several questions must be addressed. In this report, we present the realities of the situation by answering four questions: is there really a global crisis of NCDs; how is NCD a development issue; are affordable and cost-effective interventions available; and do we really need high-level leadership and accountability? Action against NCDs will support other global health and development priorities. A successful outcome of the UN HLM depends on the heads of states and governments attending the meeting, and endorsing and implementing the commitments to action. Long-term success requires inspired and committed national and international leadership.
    The Lancet 06/2011; 378(9789):449-55. · 39.21 Impact Factor
  • Sania Nishtar, Ahmed Bilal Mehboob
    The Lancet 05/2011; 378(9792):648-9. · 39.21 Impact Factor
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    ABSTRACT: The UN High-Level Meeting on Non-Communicable Diseases (NCDs) in September, 2011, is an unprecedented opportunity to create a sustained global movement against premature death and preventable morbidity and disability from NCDs, mainly heart disease, stroke, cancer, diabetes, and chronic respiratory disease. The increasing global crisis in NCDs is a barrier to development goals including poverty reduction, health equity, economic stability, and human security. The Lancet NCD Action Group and the NCD Alliance propose five overarching priority actions for the response to the crisis--leadership, prevention, treatment, international cooperation, and monitoring and accountability--and the delivery of five priority interventions--tobacco control, salt reduction, improved diets and physical activity, reduction in hazardous alcohol intake, and essential drugs and technologies. The priority interventions were chosen for their health effects, cost-effectiveness, low costs of implementation, and political and financial feasibility. The most urgent and immediate priority is tobacco control. We propose as a goal for 2040, a world essentially free from tobacco where less than 5% of people use tobacco. Implementation of the priority interventions, at an estimated global commitment of about US$9 billion per year, will bring enormous benefits to social and economic development and to the health sector. If widely adopted, these interventions will achieve the global goal of reducing NCD death rates by 2% per year, averting tens of millions of premature deaths in this decade.
    The Lancet 04/2011; 377(9775):1438-47. · 39.21 Impact Factor

Publication Stats

1k Citations
1,171.04 Total Impact Points


  • 2013
    • Government Of Pakistan
      Islāmābād, Islāmābād, Pakistan
    • Aga Khan University, Pakistan
      Kurrachee, Sindh, Pakistan
  • 2011
    • Newcastle University
      • Institute of Health and Society
      Newcastle upon Tyne, ENG, United Kingdom
    • Columbia University
      New York City, New York, United States
  • 2007
    • University of Cape Town
      • School of Public Health and Family Medicine
      Cape Town, Province of the Western Cape, South Africa
  • 2006
    • World Heart Federation
      Genève, Geneva, Switzerland
  • 2005
    • Armed Forces Institute of Cardiology & National Institute of Heart Diseases
      Ralalpindi, Punjab, Pakistan