Repositorio Universidad de Santander :: Buscando por browse.metadata.author "López López, Jose"

Examinando por Autor "López López, Jose"

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Combatir la epidemia de diabetes mellitus tipo 2 en Latinoamérica : características especiales que demandan acciones innovadoras
(2011-03) Lopez-Jaramillo, Patricio; Rey, Juan José; Gómez Arbeláez, Diego; Rodríguez, Yudy A.; López López, Jose
Latin American countries have an accelerated growth in the prevalence of type 2 diabetes mellitus (DM2) associated with increased rates of obesity and overweight. This increase is due to the rapid urbanization experienced in recent years, which has led to changes in physical activity and dietary habits. In addition, the fetal programming of malnourished mothers during pregnancy increases the tendency of children with low birth weight to develop insulin resistance and low-grade inflammation. This is especially so when these children are subjected to an environment of excess food to which they were not programmed, leading them to develop abdominal obesity and an increased risk of DM2. This article reviews some of the factors that may be associated with the DM2 epidemic in Latin America. These factors are basically caused by the contradiction between the need of the fetus to adapt to poor maternal nutrition or placental insufficiency due to diseases such as preeclampsia, and the need of the adult to adapt to the urban lifestyle full of excess food with a high intake of saturated fats, flours and sweetened beverages, as well as a sedentary lifestyle, which lead to insulin resistance and DM2. A full understanding of these conditions is essential to combat the DM2 epidemic in Latin America, as well as acceptance that effective prevention of DM2 requires a concerted effort by all of the actors in society, not just health teams.
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Development, Testing, and Implementation of a Training Curriculum for Nonphysician Health Workers to Reduce Cardiovascular Disease
(2018-06) Lopez-Jaramillo, Patricio; Khan, Maheer; Lamelas, Pablo M.; Musa, Hadi; Paty, Jared; McCready, Tara; Nieuwlaat, Robby; Ng, Eleonor; López López, Jose; Yusoff, Khalid; Majid, Fadhlina A.; Ng, Kien Keat; Garis, Len; Onuma, Oyere; Yusuf, Salim; Schwalm, Jon-David
Abstract Background Cardiovascular disease (CVD) is the leading cause of death worldwide. The need to address CVD is greatest in low- and middle-income countries where there is a shortage of trained health workers in CVD detection, prevention, and control. Objectives Based on the growing evidence that many elements of chronic disease management can be shifted to nonphysician health care workers (NPHW), the HOPE-4 (Heart Outcomes Prevention and Evaluation Program) aimed to develop, test, and implement a training curriculum on CVD prevention and control in Colombia, Malaysia, and low-resource settings in Canada. Methods Curriculum development followed an iterative and phased approach where evidence-based guidelines, revised blood pressure treatment algorithms, and culturally relevant risk factor counseling were incorporated. Through a pilot-training process with high school students in Canada, the curriculum was further refined. Implementation of the curriculum in Colombia, Malaysia, and Canada occurred through partner organizations as the HOPE-4 team coordinated the program from Hamilton, Ontario, Canada. In addition to content on the burden of disease, cardiovascular system pathophysiology, and CVD risk factors, the curriculum also included evaluations such as module tests, in-class exercises, and observed structured clinical examinations, which were administered by the local partner organizations. These evaluations served as indicators of adequate uptake of curriculum content as well as readiness to work as an NPHW in the field. Results Overall, 51 NPHW successfully completed the training curriculum with an average score of 93.19% on module tests and 84.76% on the observed structured clinical examinations. Since implementation, the curriculum has also been adapted to the World Health Organization's HEARTS Technical Package, which was launched in 2016 to improve management of CVD in primary health care. Conclusions The robust curriculum development, testing, and implementation process described affirm that NPHW in diverse settings can be trained in implementing measures for CVD prevention and control.
Acceso abierto
Fetal programming and cardiometabolic diseases : The role of angiotensin II and infl ammation
(2010-12) Lopez-Jaramillo, Patricio; López López, Jose
Acceso abierto
The goal of blood pressure in the hypertensive patient with diabetes is defined : Now the challenge is go from recommendations to practice
(2014-03-04) Lopez-Jaramillo, Patricio; López López, Jose; López López, Cristina; Rodríguez Alvarez, Miguel I
The recent Latin American and European guidelines published this year has proposed as a goal for blood pressure control in patients with diabetes type 2 a value similar or inferior to 140/90 mmHg. High blood pressure is the leading cause of cardiovascular diseases and deaths globally. Although once hypertension is detected, 80% of individuals are on a pharmacologic therapy only a minority is controlled. Diabetes also is a risk factor for other serious chronic diseases, including cardiovascular disease. Whether specifically targeting lower fasting glucose levels can reduce cardiovascular outcomes remains unknown. Hypertension is present in 20% to 60% of patients with type 2 diabetes, depending on age, ethnicity, obesity, and the presence of micro or macro albuminuria. High blood pressure substantially increases the risk of both macro and micro vascular complications, doubling the risk of all-cause mortality and stroke, tripling the risk of coronary heart disease and significantly hastening the progression of diabetic nephropathy, retinopathy, and neuropathy. Thus, blood pressure lowering is a major priority in preventing cardiovascular and renal events in patients with diabetes and hypertension. During many years the BP goals recommended in patients with diabetes were more aggressive than in patients without diabetes. As reviewed in this article many clinical trials have demonstrated not only the lack of benefits of lowering the BP below 130/80 mmHg, but also the J-shaped relationship in DM patients. Overall we discuss the importance of define the group of patients in whom significant BP reduction could be particularly dangerous and, on the other hand, those with a high risk of stroke who could benefit most from an intensive hypotensive therapy. In any case, the big challenge now is avoid the therapeutic inertia (leaving diabetic patients with BP values of 140/90 mmHg or higher) at all costs, as this would lead to an unacceptable toll in terms of human lives, suffering, and socioeconomic costs.
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Is there a space for incretin mimetics as a therapy for excess weight, obesity and cardiometabolic disease prevention?
(2016-01) Lopez-Jaramillo, Patricio; Di Stefano, Karina A.; Velásquez, Elizabeth; Camacho López, Paul Anthony; López López, Jose
Introduction: During the last decades there has been a gradual increase of cardiovascular diseases, who have become the main cause of death in the world and especially in Latin American countries, despite having identified preventable cardiovascular risk factors that explain around 90% of myocardial infarctions and cerebrovascular accidents. Therefore, it is require to implement actions that will allow to control cardiovascular risk factors, including being overweight or obese. Motivation: To review the effect of GLP-1 receptor agonists, including liraglutide, in controlling cardiovascular risk factors, particularly excess weight and obesity and the subsequent prevention of cardiovascular diseases. Methods: Evidence were searched by means of boolean operators and cross references in databases MEDLINE, LILACS and Google Scholar. Conclusions: GLP-1 receptor agonists can be a pharmacological alternative to control excess weight and obesity, and may help in preventing cardiovascular disease, though some questions remain regarding the benefits of its use in our field.
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Lecciones aprendidas de dos grandes estudios epidemiológicos de enfermedades cardio-cerebrovasculares en las que ha participado Colombia
(2010-09) Lopez-Jaramillo, Patricio; López López, Jose
Dos recientes estudios epidemiológicos de gran envergadura en los que participó Colombia, elINTERHEART y el INTERSTROKE, demostraron que en Latinoamérica en general y en Colombia en particular,el principal factor de riesgo para la presentación de infarto agudo del miocardio y accidente cerebro vascularisquémico y hemorrágico es la obesidad abdominal, a diferencia del resto del mundo donde el principal factorde riesgo fue el aumento en las concentraciones plasmáticas del colesterol total y del colesterol LDL, en elprimer caso, y la hipertensión arterial, en el segundo. Estos datos dan soporte a la propuesta de que enLatinoamérica la transición rápida de los modelos económicos experimentados en los últimos años junto conla urbanización acelerada son la causa del explosivo aumento de la obesidad abdominal, la diabetes mellitustipo 2 y las enfermedades cardio-cerebro-vasculares.
Acceso abierto
The Link between Fetal Programming, Inflammation, Muscular Strength, and Blood Pressure
(2015) López López, Jose; Lopez-Jaramillo, Patricio; Camacho López, Paul Anthony; Gómez Arbeláez, Diego; Cohen, Daniel Dylan
Hypertension affects one billion individuals worldwide and is considered the leading cause of cardiovascular death, stroke, and myocardial infarction. This increase in the burden of hypertension and cardiovascular diseases (CVD) is principally driven by lifestyle changes such as increased hypercaloric diets and reduced physical activity producing an increase of obesity, insulin resistance, and low-grade inflammation. Visceral adipocytes are the principal source of proinflammatory cytokines and systemic inflammation participates in several steps in the development of CVD. However, maternal and infant malnutrition also persists as a major public health issue in low- to middle-income regions such as Latin America (LA). We propose that the increased rates of cardiovascular and metabolic diseases in these countries could be the result of the discrepancy between a restricted nutritional environment during fetal development and early life, and a nutritionally abundant environment during adulthood. Maternal undernutrition, which may manifest in lower birth weight offspring, appears to accentuate the relative risk of chronic disease at lower levels of adiposity. Therefore, LA populations may be more vulnerable to the pathogenic consequences of obesity than individuals with similar lifestyles in high-income countries, which may be mediated by higher levels of proinflammatory markers and lower levels of muscle mass and strength observed in low birth weight individuals.
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Maternal undernutrition and cardiometabolic disease : A Latin American perspective
(2015-03-02) Lopez-Jaramillo, Patricio; Gómez Arbeláez, Diego; Sotomayor Rubio, Aristides; Mantilla Garcia, Daniel; López López, Jose
The current epidemic of obesity and cardiometabolic diseases in developing countries is described as being driven by socioeconomic inequalities. These populations have a greater vulnerability to cardiometabolic diseases due to the discrepancy between the maternal undernutrition and its consequence, low-birth weight progeny, and the subsequent modern lifestyles which are associated with socioeconomic and environmental changes that modify dietary habits, discourage physical activity and encourage sedentary behaviors. Maternal undernutrition can generate epigenetic modifications, with potential long-term consequences. Throughout life, people are faced with the challenge of adapting to changes in their environment, such as excessive intake of high energy density foods and sedentary behavior. However, a mismatch between conditions experienced during fetal programming and current environmental conditions will make adaptation difficult for them, and will increase their susceptibility to obesity and cardiovascular diseases. It is important to conduct research in the Latin American context, in order to define the best strategies to prevent the epidemic of cardiometabolic diseases in the region.
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Rationale and design of a cluster randomized trial of a multifaceted intervention in people with hypertension : The Heart Outcomes Prevention and Evaluation 4 (HOPE-4) Study
(2018-09) Lopez-Jaramillo, Patricio; Reid Schwalm, Jon-David; McCready, Tara; Lamelas, Pablo M.; Musa, Hadi; Yusoff, Khalid; McKee, Martin; Camacho López, Paul Anthony; López López, Jose; Majid, Fadhlina A.; Thabane, Lehana; Islam, Shofiqul; Yusuf, Salim
Background: Cardiovascular disease is the leading cause of death throughout the world, with the majority of deaths occurring in low- and middle-income countries. Despite clear evidence for the benefits of blood pressure reduction and availability of safe and low-cost medications, most individuals are either unaware of their condition or not adequately treated. Objective: The primary objective of this study is to evaluatewhether a community-based, multifaceted intervention package primarily provided by nonphysician health workers can improve long-term cardiovascular risk in people with hypertension by addressing identified barriers at the patient, health care provider, and health system levels. Methods/design: HOPE-4 is a community-based, parallel-group, cluster randomized controlled trial involving 30 communities (1,376 participants) in Colombia and Malaysia. Participants ≥50 years old and with newly diagnosed or poorly controlled hypertension were included. Communities were randomized to usual care or to amultifaceted intervention package that entails (1) detection, treatment, and control of cardiovascular risk factors by nonphysician health workers in the community, who use tablet-based simplified management algorithms, decision support, and counseling programs; (2) free dispensation of combination antihypertensive and cholesterol-loweringmedications, supervised by local physicians; and (3) support from a participant-nominated treatment supporter (either a friend or family member). The primary outcome is the change in Framingham Risk Score after 12 months between the intervention and control communities. Secondary outcomes including change in blood pressure, lipid levels, and Interheart Risk Score will be evaluated. Significance: If successful, the study could serve as a model to develop low-cost, effective, and scalable strategies to reduce cardiovascular risk in people with hypertension.
Acceso abierto
Relationship among the leptin-to-adiponectin ratio, systemic inflammation, and anisocytosis
(Polish Cardiac Society, 2020-05-25) Lopez-Jaramillo, Patricio; Gómez Arbeláez, Diego; López López, Jose; Masira
Acceso abierto
Repercutirán las nuevas cifras de las guías AHA/ACC en la definición y manejo de la hipertensión en Latinoamérica?
(Scopus, 2019-08-07) Lopez-Jaramillo, Patricio; López López, Jose; Forero-Trillos, M.F.; Rueda-Quijano, S.M.; Camacho López, Paul Anthony; Esmeral-Ordoñez, D.; Otero, Johanna; Everest
Las nuevas guías de la Asociación Americana del Corazón (AHA) y del Colegio Americano del Corazón (ACC) han generado una importante discusión sobre los criterios diagnósticos y el manejo de hipertensión arterial (HTA), ya que estas nuevas guías proponen cambios importantes en la definición de la HTA, pasando su diagnóstico de cifras de presión arterial (PA) iguales o superiores a 140/90 mmHg a cifras iguales o superiores a 130/80 mmHg. Además, las nuevas guías proponen que las metas a alcanzar para definir el control adecuado de la HTA también sean más bajas, con cifras de PA menores de 130/80 mmHg, con lo cual en términos globales se espera un incremento importante en el número de individuos considerados hipertensos, algunos de los cuales necesitarán más medicamentos para alcanzar las nuevas metas de adecuado control, todo lo que ha llevado al cuestionamiento sobre la viabilidad de la aplicabilidad clínica de estas nuevas guías, dado el enorme incremento financiero que significa el tratar con medicamentos a los nuevos millones de pacientes hipertensos. Además de estos inconvenientes prácticos, también se ha cuestionado la validez académica de las nuevas guías AHA/ACC, dado el hecho de que las recomendaciones emergen básicamente de los resultados obtenidos de un solo estudio, el cual tiene importantes diferencias metodológicas con la mayoría de estudios realizados previamente; además, sus resultados son inconsistentes con lo demostrado en otros estudios, lo que ha determinado que algunas sociedades científicas, como la Sociedad Latinoamericana de Hipertensión (LASH), mantengan las recomendaciones anteriores.
Acceso abierto
The role of leptin/adiponectin ratio in metabolic syndrome and diabetes
(2014-04-18) Lopez-Jaramillo, Patricio; Gómez Arbeláez, Diego; López López, Jose; López López, Cristina; Martínez-Ortega, Javier; Gomez Rodriguez, Andrea; Triana Cubillos, Stefany
The metabolic syndrome comprises a cluster of cardiometabolic risk factors, with insulin resistance and adiposity as its central features. Identifying individuals with metabolic syndrome is important due to its association with an increased risk of coronary heart disease and type 2 diabetes mellitus. Attention has focused on the visceral adipose tissue production of cytokines (adipokines) in metabolic syndrome and type 2 diabetes mellitus, as the levels of the anti-inflammatory adipokine adiponectin are decreased, while proinflammatory cytokines are elevated, creating a proinflammatory state associated with insulin resistance and endothelial dysfunction. In this review, we will give special attention to the role of the leptin/adiponectin ratio. We have previously demonstrated that in individuals with severe coronary artery disease, abdominal obesity was uniquely related to decreased plasma concentrations of adiponectin and increased leptin levels. Leptin/adiponectin imbalance was associated with increased waist circumference and a decreased vascular response to acetylcholine and increased vasoconstriction due to angiotensin II. Leptin and adiponectin have opposite effects on subclinical inflammation and insulin resistance. Leptin upregulates proinflammatory cytokines such as tumor necrosis factor-α and interleukin-6; these are associated with insulin resistance and type 2 diabetes mellitus. In contrast, adiponectin has anti-inflammatory properties and downregulates the expression and release of a number of proinflammatory immune mediators. Therefore, it appears that interactions between angiotensin II and leptin/adiponectin imbalance may be important mediators of the elevated risk of developing type 2 diabetes mellitus and cardiovascular diseases associated with abdominal obesity.
Acceso abierto
Role of the autonomic nervous system in the endothelial dysfunction of the metabolic syndrome
(2011) Lopez-Jaramillo, Patricio; Molina, Dora I.; Aguillon, Alba; Gómez Arbeláez, Diego; Sotomayor Rubio, Aristides; López López, Jose
In the last decade there has been an accelerated growth in the prevalence of metabolic syndrome (MS), especially in Latin American countries, which has led an increased risk of cardiovascular disease (CVD) and type 2 diabetes mellitus (DM2). Recently has been raised the relationship between the autonomic nervous system (ANS), endothelial dysfunction (ED) and the appearance of MS. In the present article we review the evidence that support the proposal that abdominal obesity (AO) produce adypokines that result in insulin resistance and low degree inflammation, which increase the activity of ANS, causing vasoconstriction, hypertension, decreased peripheral glucose uptake, and decreased secretion of insulin, leading to hyperglycemia and increased lipolysis and hypertriglyceridemia. All these factors cause ED, explaining the higher risk of the patients with MS of developing DM2 and CVD.
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The simultaneous assessment of glycosylated hemoglobin, fasting plasma glucose and oral glucose tolerance test does not improve the detection of type 2 diabetes mellitus in Colombian adults
(2018-04-13) Cohen, Daniel Dylan; Lopez-Jaramillo, Patricio; López López, Jose; Garay, Jennifer; Wandurraga, Edwin; Camacho López, Paul Anthony; Higuera Escalante, Fernando
Guidelines recommend early detection of type 2 diabetes mellitus (DM2). The objective of the present study was to evaluate the capacity to identify DM2 in subjects that were screened for DM2 simultaneously with all three of the tests recommended—fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1c) and a 2-hour post 75-g oral glucose tolerance test (OGTT). Methods and results The present analysis of an anonymous database of 1113 adults from a reference clinical laboratory in Bucaramanga, Colombia, was an observational, descriptive, cross-sectional secondary source study. 259 individuals met at least one of the criteria for DM2: FPG 126mg/dL (7.0mmol/L), HbA1c 6.5% (48mmol/mol) and OGTT 200mg/dL (11.1mmol/L). 30 subjects (2.7%) were diabetic according to FPG, 56 subjects (5.0%) by HbA1c and 250 subjects (22.5%) by OGTT. In total 259 subjects (23.3% [IC 95%: 20.7%– 25.8%] were diabetic either by FPG, OGTT or HbA1c. Discussion The largest number of patients were identified as diabetic with the OGTT. The combination of two or three tests did not increase the detection of new cases of DM2. Our findings suggest that routinely requesting FPG, OGTT and HbA1c at the same time may be inappropriate in at risk individuals, as this approach does not significantly improve the diagnostic capacity compared to using FPG+OGTT and substantially increases the financial burden on the health system, insurers or individual.
Acceso abierto
Sodium intake recommendations : A subject that needs to be reconsidered
(2015-04) Lopez-Jaramillo, Patricio; López López, Jose; López López, Cristina
Hypertension affects 1 billion people worldwide and is considered the leading cause of death, stroke, myocardial infarction and congestive heart failure. Sodium intake is reported to be a modifiable determinant of hypertension and reductions in its consumption have been widely recommended. Various strategies have been proposed to address the observed epidemic of cardiovascular diseases, particularly in medium and low-income countries. Among these strategies, reducing dietary sodium intake and increasing dietary potassium intake are commonly included in guidelines for the treatment of hypertension and the prevention of cardiovascular disease. In the present article, we review the results of recent studies that have raised questions about potential adverse effects associated with low sodium intake on important health outcomes, including cardiovascular diseases and death. It is clear from these studies, that there are contradictory and irreconcilable positions in the interpretation of the evidence, a situation that indicates that there is an urgent need for international randomized controlled trials that consistently demonstrate that the low levels of sodium intake recommended in the guidelines are safe and beneficial for different populations around the world. In the interim, and in accordance with a number of experts, we agree that the current evidence argues against the reduction of dietary sodium as an isolated public health recommendation and that an alternative approach of recommending high quality, potassium rich diets, might achieve greater health benefits, including blood-pressure reduction, than aggressive sodium reduction alone.
Acceso abierto
Survey of knowledge for diagnosing and managing prediabetes in Latin-America: Cross-sectional study
(Diabetology & Metabolic Syndrome, 2019-12-04) Garay, Jennifer; Camacho López, Paul Anthony; López López, Jose; Alvernia, Juliana; García, Lina Marcela; Cohen, Daniel Dylan; Calderón, Carlos A.; Lopez-Jaramillo, Patricio; Everest
Abstract Background: Prediabetes has been proposed as a risk factor for the development of type 2 diabetes mellitus (DM2) and cardiovascular disease (CVD). Despite the clinical importance of prediabetes, little is known about the level of knowledge, beliefs and barriers to screening and treating prediabetes amongst care health providers in Latin America. The aim of the present survey was to evaluate the knowledge and beliefs about prediabetes amongst in Latin Ameri‑can health care providers. Methodology: In a cross-sectional study, we adapted the written survey designed by the Johns Hopkins University group, and applied it to health care providers across Latin America during three meetings, in 2017, and with physi‑cians from primary care centers in Bucaramanga, Colombia convened in 2017. The survey consisted of questions under four headings, diabetes screening, management of prediabetes, harmacological treatment—metformin use, and demographic information. We perform a descriptive analysis to determine the diferences in responses between diferent medical specialties. Results: The majority of the care providers that answered the survey were Colombian physicians, 54.5% of respond‑ents had 10 years or more since completing their training and more women responded. Only 9.5% identifed the 12 prediabetes risk factors described in the literature. The most common risk factor identifed was a family history of diabetes, followed by overweight, a sedentary lifestyle and dyslipidemia, while ethnicity was the risk factor least com‑monly. 47.1% answered that laboratory tests to detect prediabetes are fasting glucose and HbA1C, 82.5% correctly identifed fasting plasma glucose as the best test, 35.9% correctly responded that to the recommended weight loss goal is 5 to 7% and 49.1% that 150 min is considered the minimum level of physical activity per week. 78% agreed that the identifcation and treatment of prediabetes is important. 56% believed that patients with prediabetes progress more rapidly to diabetes and 40.6% considered that metformin could reduce the risk of diabetes in patients already diagnosed with prediabetes. Conclusion: These results demonstrate that there are important gaps in the knowledge of the diagnosis, clinical implications and management of prediabetes amongst Latin America health providers.

Examinando por Autor "López López, Jose"

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