Examinando por Autor "Molina, Dora I."
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- PublicaciónAcceso abiertoThe 20 × 20 Latin American society of hypertension target(2015-01) Lopez-Jaramillo, Patricio; Molina, Dora I.
- PublicaciónAcceso abiertoBlood-pressure lowering in intermediate-risk persons without cardiovascular disease(2016-04-26) Lonn, Eva; Bosch, Jackie; Lopez-Jaramillo, Patricio; Zhu, Jun; Liu, Lisheng; Pais, Prem; Diaz, Rafael; Xavier, Denis; Sliwa, Karen; Dans, Antonio; Avezum, Alvaro; Leopoldo S., Piegas; Keltai, Katalin; Keltai, Matyas; Chazova, Irina; Peters, Ron J.G.; Held, Claes; Yusoff, Khalid; Lewis, Basil S.; Jansky, Petr; Parkhomenko, Alexander; Khunti, Kamlesh; Toff, William D.; Reid, Christopher M.; Varigos, John; Leiter, Lawrence A.; Molina, Dora I.; McKelvie, Robert; Pogue, Janice; Wilkinson, Joanne; Jung, Hyejung; Dagenais, Gilles; Yusuf, Salim; HOPE-3 InvestigatorsBACKGROUND Antihypertensive therapy reduces the risk of cardiovascular events among high-risk persons and among those with a systolic blood pressure of 160 mm Hg or higher, but its role in persons at intermediate risk and with lower blood pressure is unclear. METHODS In one comparison from a 2-by-2 factorial trial, we randomly assigned 12,705 participants at intermediate risk who did not have cardiovascular disease to receive either candesartan at a dose of 16 mg per day plus hydrochlorothiazide at a dose of 12.5 mg per day or placebo. The first coprimary outcome was the composite of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke; the second coprimary outcome additionally included resuscitated cardiac arrest, heart failure, and revascularization. The median follow-up was 5.6 years. RESULTS The mean blood pressure of the participants at baseline was 138.1/81.9 mm Hg; the decrease in blood pressure was 6.0/3.0 mm Hg greater in the active-treatment group than in the placebo group. The first coprimary outcome occurred in 260 participants (4.1%) in the active-treatment group and in 279 (4.4%) in the placebo group (hazard ratio, 0.93; 95% confidence interval [CI], 0.79 to 1.10; P=0.40); the second coprimary outcome occurred in 312 participants (4.9%) and 328 participants (5.2%), respectively (hazard ratio, 0.95; 95% CI, 0.81 to 1.11; P=0.51). In one of the three prespecified hypothesis-based subgroups, participants in the subgroup for the upper third of systolic blood pressure (>143.5 mm Hg) who were in the active-treatment group had significantly lower rates of the first and second coprimary outcomes than those in the placebo group; effects were neutral in the middle and lower thirds (P=0.02 and P=0.009, respectively, for trend in the two outcomes). CONCLUSIONS Therapy with candesartan at a dose of 16 mg per day plus hydrochlorothiazide at a dose of 12.5 mg per day was not associated with a lower rate of major cardiovascular events than placebo among persons at intermediate risk who did not have cardiovascular disease. (Funded by the Canadian Institutes of Health Research and AstraZeneca; ClinicalTrials.gov number, NCT00468923.)
- PublicaciónRestringidoLatin American Consensus on the management of hypertension in the patient with diabetes and the metabolic syndrome(2019-06) Lopez-Jaramillo, Patricio; Barbosa, Eduardo; Molina, Dora I.; Sánchez, Ramiro; Diaz, Margarita; Camacho López, Paul Anthony; Lanas, Fernando; Pasquel, Miguel; Accini, Jose Luis; Ponte Negretti, Carlos I.; Alcocer, Luis; Cobos, Leonardo; Wyss, Fernando; Sebba-Barroso, Weimar; Coca, Antonio; Zanchetti, AlbertoThe prevalence of hypertension, type 2 diabetes mellitus (DM2) and the metabolic syndrome continues to increase in Latin America, while the rates of diagnosis, treatment and control of these disorders remain low. The frequency of the risk factors that constitute the metabolic syndrome and are associated with an increased risk of cardiovascular disease has not diminished since the publication of the previous consensus. This document discusses the socioeconomic, demographic, environmental and cultural characteristics of most associated Latin American countries and partially explains the lack of better results in improving clinical and public health actions that allow high morbidity and mortality rates caused by cardiovascular diseases and DM2 to be reduced through programs aligned with the so-called precision medicine, which should be predictive, preventive, personalized and participatory. The Consensus ratifies the diagnostic criteria expressed in the previous consensus to define hypertension and DM2 but, for the metabolic syndrome, and in the absence of evidence, the recommendation is to implement a cohort study that determines the abdominal perimeter value associated with hard outcomes, such as DM2 and CVD. Meanwhile, we recommend modifying the criterion to more than 94 cm in men and more than 84 cm in women according to WHO recommendations. We also recommend the carrying out of a study that identifies the situation of hypertension and DM2 in people of African ancestry who, in Latin America, exceed 75 million and whose epidemiology does not include solid studies. With respect to the proposed therapeutic targets, we recommended maintaining those defined in the previous consensus, but insisting that early pharmacological management of prediabetes with metformin should be introduced, as should the treatment of diabetic hypertensive patients with a combination therapy of two fixed-dose antihypertensive drugs and management with statins. To increase adherence, the use of different drugs combined in a single pill (polypill) is recommended. The simplification of the therapeutic regimen is accompanied by greater control of cardiovascular risk factors, both in primary and secondary prevention, and has been shown to be cost-effective. The consensus recommends the use of the currently available polypill combining an angiotensin-converting enzyme inhibitor, a statin and aspirin for secondary cardiovascular prevention and in patients with a high cardiovascular risk, such as hypertension patients with DM2.
- PublicaciónAcceso abiertoRole 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, JoseIn 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.
- PublicaciónAcceso abiertoSelf-Reported Prevalence of Chronic Non-Communicable Diseases in Relation to Socioeconomic and Educational Factors in Colombia: A Community-Based Study in 11 Departments(World Heart Federation, 2020-04-21) Camacho López, Paul Anthony; Gómez Arbeláez, Diego; Otero, Johanna; González-Gómez, Silvia; Molina, Dora I.; Sanchez, Gregorio; Arcos, Edgar; Narvaez, Claudia; García, Henry; Pérez, Maritza; Hernandez-Triana, Eric; Durán Parra, Myriam; Cure, Carlos; Sotomayor, Aristides; Rico, Alvaro; Cotes, Fresia; Rangarajan, Sumathy; Yusuf, Salim; Lopez-Jaramillo, Patricio; EverestBackground: Chronic non-communicable diseases are prevalent conditions in developing countries, such as Colombia. Several socioeconomic and educational factors have been associated with these pathologies. However, there is little country-specific information regarding the self-reported prevalence of chronic diseases and their association with the aforementioned factors in Colombia. Objectives: To evaluate the current situation of chronic non-transmissible diseases in Colombia by self-report and to analyze its potential relationship with sociodemographic, economic and educational factors. Methods: This is a cross-sectional baseline sub-analysis from the prospective, standardized collaborative PURE study in Colombia. Participants were recruited between 2005 to 2009, in 11 departments of the country, and included 7,485 subjects of 35 to 70 years old. Questionnaires of self-reported chronic non-communicable diseases, and demographic, socioeconomic and educational variables were applied. Results: Hypertension was the most prevalent chronic condition reported with a prevalence of 22.2% (21.2%–23.1%, 95% CI), followed by diabetes with a prevalence of 5.7% (5.1%–6.2%, 95% CI), asthma 2.7% (2.2%–3.0%, 95% CI), coronary heart disease 2.4% (2.0%–2.7%, 95% CI), stroke and heart failure 1.5% (1.2%–1.8%, 95% CI) each, chronic obstructive pulmonary disease 1.2% (0.6%–1.5%, 95% CI), and cancer 1.2% (1.0%–1.5%, 95% CI). Among the study sample, 23.3% (22.4%–24.3%, 95% CI) reported having one chronic NCDs, and 6.4% (5.9%–7.0%, 95% CI) reported having multiple chronic NCDs. The prevalence of multiple NCDs increased significantly with age, was more common in those from households with higher income, whereas it was significantly lower in persons with high education. The central and central-east regions of the country are those with the higher prevalence of self-reported NCDs. Conclusion: The results of the current study indicate the presence of socioeconomic and educational inequalities in the distribution of chronic NCDs in the Colombian population.
- PublicaciónAcceso abiertoSocial disparities explain differences in hypertension prevalence, detection and control in Colombia(2016-08-12) Camacho López, Paul Anthony; Gómez Arbeláez, Diego; Molina, Dora I.; Sánchez Vallejo, Gregorio; Arcos, Edgar; Narvaez, Claudia; García, Henry; Pérez, Maritza; Hernández, Erick A.; Durán Parra, Myriam; Cure, Carlos; Sotomayor Rubio, Aristides; Rico, Alvaro; David Venegas, Tannia-Melissa; Cohen, Daniel Dylan; Rangarajan, Sumathy; Yusuf, Salim; Lopez-Jaramillo, PatricioObjective: Hypertension is the principal risk factor for cardiovascular diseases. The global Prospective Urban Rural Epidemiology study showed that the levels of awareness, treatment and control of this condition are very low worldwide and show large regional variations related to a country’s income index. The aim of the present analysis was to identify associations between sociodemographic, geographic, anthropometric, behavioral and clinical factors and the awareness, treatment and control of hypertension within Colombia – a high-middle income country which participated in the global Prospective Urban Rural Epidemiology study. Methods and results: The sample comprised 7485 individuals aged 35–70 years (mean age 50.8 years, 64% women). Mean SBP and DBP were 129.12 21.23 and 80.39 11.81 mmHg, respectively. The overall prevalence of hypertension was 37.5% and was substantially higher amongst participants with the lowest educational level, who had a 25% higher prevalence (<0.001). Hypertension awareness, treatment amongst those aware, and control amongst those treated were 51.9, 77.5 and 37.1%, respectively. The prevalence of hypertension was higher amongst those with a higher BMI (<0.001) or larger waist–hip ratio (<0.001). Being male, younger, a rural resident and having a low level of education was associated with significantly lower hypertension awareness, treatment and control. The use of combination therapy was very low (27.5%) and was significantly lower in rural areas and amongst those with a low income. Conclusion: Overall Colombia has a high prevalence of hypertension in combination with very low levels of awareness, treatment and control; however, we found large variations within the country that appear to be associated with sociodemographic disparities.
- PublicaciónAcceso abiertoThe prediction of Metabolic Syndrome alterations is improved by combining waist circumference and handgrip strength measurements compared to either alone(Cardiovascular Diabetology, 2021-03-22) Lopez-Lopez, Jose; Cohen, Daniel Dylan; Ney-Salazar, Daniela; Martinez, Daniel; Otero, Johanna; Gomez-Arbelaez, Diego; Camacho-Lopez, Paul Antony; Sanchez-Vallejo, Gregorio; Arcos, Edgar; Narvaez, Claudia; Garcia, Henry; Perez, Maritza; Molina, Dora I.; Cure, Carlos; Sotomayor, Aristides; Rico, Alvaro; Hernandez-Triana, Eric; Duran Parra, Myriam; Cotes, Fresia; Leong, Darryl P.; Rangarajan, Sumathy; Yusuf, Salim; Lopez-Jaramillo, Patricio; MasiraBackground: Adiposity is a major component of the metabolic syndrome (MetS), low muscle strength has also been identifed as a risk factor for MetS and for cardiovascular disease. We describe the prevalence of MetS and evaluate the relationship between muscle strength, anthropometric measures of adiposity, and associations with the cluster of the components of MetS, in a middle-income country. Methods: MetS was defned by the International Diabetes Federation criteria. To assess the association between anthropometric variables (waist circumference (WC), waist-to-hip ratio (W/H), body mass index (BMI)), strength (hand‑grip/kg bodyweight (HGS/BW)) and the cluster of MetS, we created a MetS score. For each alteration (high triglycer‑ides, low HDLc, dysglycemia, or high blood pressure) one point was conferred. To evaluate the association an index of fat:muscle and MetS score, participants were divided into 9 groups based on combinations of sex-specifc tertiles of WC and HGS/BW. Results: The overall prevalence of MetS in the 5,026 participants (64% women; mean age 51.2 years) was 42%. Lower HGS/BW, and higher WC, BMI, and W/H were associated with a higher MetS score. Amongst the 9 HGS/BW:WC groups, participants in the lowest tertile of HGS/BW and the highest tertile of WC had a higher MetS score (OR=4.69 in women and OR=8.25 in men;p<0.01) compared to those in the highest tertile of HGS/BW and in the lowest tertile of WC. Conclusion: WC was the principal risk factor for a high MetS score and an inverse association between HGS/BW and MetS score was found. Combining these anthropometric measures improved the prediction of metabolic alterations over either alone
- PublicaciónAcceso abiertoThe spectrum of the dyslipidemia in Colombia. The PURE study(2019) Camacho López, Paul Anthony; Otero, Johanna; Pérez, Maritza; Arcos, Edgar; García, Henry; Narvaez, Claudia; Molina, Dora I.; Sánchez Vallejo, Gregorio; Durán Parra, Myriam; Cure, Carlos; Sotomayor Rubio, Aristides; Rico, Alvaro; Cotes, Fresia; Rangarajan, Sumathy; Yusuf, Salim; Cohen, Daniel Dylan; González Gómez, Silvia; Clausen, Christian; Lopez-Jaramillo, PatricioBackground Dyslipidemia is a major risk factor for cardiovascular diseases (CVD). Worldwide, a third of ischemic heart disease is due to abnormal cholesterol levels and it is the most common cause of cardiovascular deaths in Colombia. In Colombia, no representative, large-scale study has assessed the prevalence of dyslipidemia. The aim of the present analysis was to identify the magnitude of the problem in Colombia, a middle-income-country with large regional, geographic, and socio-economical differences. Material and methods The sample comprised 6628 individuals aged 35 to 70 years (mean age 50.7 years, 64.1% women) residing in the four Colombian regions. Results The overall prevalence of dyslipidemia was 87.7% and was substantially higher among participants older than 50 years, male, rural residents, and those with a lower level of education (66.8%), and with a lower income (66.4%). High non HDL-c was the most common abnormality (75.3%). The values of total cholesterol and non-HDL-cholesterol were higher in areas with the lowest health needs index than in the areas with intermediate and highest health need index, the isolated HDL-c value was much lower. Conclusion Colombia has a high prevalence of abnormalities of the lipid profile. The causes of the high rates of dyslipidemia were not well define in this study, but were more common in rural and poorer regions and among those with lower socio-economical status. Strategies to tackle the adverse lipid profile to reduce CVD are needed in Colombia, particularly in rural areas and among the areas with the higher health need index.