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PATRICIO LÓPEZ-JARAMILLO MD PhD FACP

LECCIONES APRENDIDAS DE LOS ESTUDIOS INTERHEART, INTERSTROKE Y PURE. PATRICIO LÓPEZ-JARAMILLO MD PhD FACP DIRECTOR DE INVESTIGACION Y DE LA CLINICA DE SINDROMEMETABOLICO, PREDIABETES Y DIABETES. FOSCAL DIRECTOR DE INVESTIGACIONES DE LA FACULTAD DE MEDICINA DE LA UNIVERSIDAD DE SANTANDER UDES

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PATRICIO LÓPEZ-JARAMILLO MD PhD FACP

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  1. LECCIONES APRENDIDAS DE LOS ESTUDIOS INTERHEART, INTERSTROKE Y PURE PATRICIO LÓPEZ-JARAMILLO MD PhD FACP DIRECTOR DE INVESTIGACION Y DE LA CLINICA DE SINDROMEMETABOLICO, PREDIABETES Y DIABETES. FOSCAL DIRECTOR DE INVESTIGACIONES DE LA FACULTAD DE MEDICINA DE LA UNIVERSIDAD DE SANTANDER UDES BUCARAMANGA-COLOMBIA

  2. DEATHS FROM CVD WORLDWIDE Over 70% of the global burden of heart attack and stroke is in developing countries CVD Deaths (millions) 6 5 19 9 1990 2020 KS Reddy. NEJM 2004; 350:2438

  3. Epidemiological data indicates a continuous relationship between blood pressure level and CAD related mortality

  4. COMPARISON OF THE LA INTERHEART STUDY RISK FACTOR PROFILES WITH THE OVERALL INTERHEART STUDY Lanas, et al. Circulation.2007;115:1067-1074

  5. ODDS RATIOS OF ACUTE MYOCARDIAL INFARCTION AND CORRESPONDING POPULATION-ATTRIBUTABLE RISKS BY GENDER Lanas, et al. Circulation. 2007;115:1067-1074

  6. EPIDEMIC OF OVERWEIGHT AND OBESITY IN LATIN AMERICA AND THE CARIBBEAN Rueda-Clausen et al. International Journal of Cardiolology. 2008;125:111-112.

  7. LA TRIADA CARDIOMETABOLICA DIABETES / ENFERMEDAD CARDIO-CEREBRO VASCULAR OBESIDAD ABDOMINAL HIPERINSULINISMO/ RESISTENCIA A LA INSULINA INFLAMACION DE BAJO GRADO

  8. RAS EXPRESSION IN HUMAN ADIPOSE TISSUE . Karlsson C, et al. J Clin Endocrinol Metab. 1998; 83: 3925-3929

  9. ANGIOTENSIN II ENHANCES ENDOTHELIAL TNF ΑLPHA PROTEIN PRODUCTION Arenas et al, Am J Physiol. Cell Physiol. 2004 ; 286 : C779-C784

  10. MEAN VALUES OF CONTINUOUS RISK FACTORS FOR HIGH BLOOD PRESSURE BY HYPERTENSION STATUS Risk factor Overall Hypertensive Nonhypertensives P value mean%mean%mean% (n=300) (n=138) (n=162) ____________________________________________________________________________________ Age (years) 59.8 65.2 55.2 <0.001 BMI (kg/m2) 28.6 29.6 27.8 0.002 Waist circunf 103.2 104.8 101.9 0.008 Fasting glicemia (mg/dL, mean) 100.2 107.0 94.3 <0.001 ____________________________________________________________________________________ BMI, body mass index Bautista et al. J Hypertens 2001;19:857-861

  11. CRUDE AND SEX AND AGE ADJUSTED PREVALENCE FOR HYPERTENSION BY C-REACTIVE PROTEIN QUARTILES Bautista et al. J Hypertens 2001;19:857-861

  12. TUMOR NECROSIS FACTOR ALPHA AND FLOW MEDIATED VASODILATATION López-Jaramillo et al. Rev Esp Cardiol. 2007;60:168-178

  13. BLOOD PRESSURE AND C REACTIVE PROTEIN IN A HISPANIC PEDIATRIC POPULATION López-Jaramillo et al. Am J Hypertens 2008; 21: 527-532

  14. PLASMA ASYMMETRIC DIMETHYLARGININE AND C-REACTIVE PROTEIN CONCENTRATIONS Garcia et al. Int J Cardiol 2007;127:176-178

  15. INSULIN RESISTANCE: FOCUS ON SIGNALING PATHWAYS BK NO BK2 receptor + NO Glucose transport Akt1 + Insulin receptor + + + GLUT-4 trans-location Insulin IRS-1 PI3-K + - GLUT-4 biosynthesis - GLUT-4 AT1 receptor Ang II Adapted from Henriksen EJ, Jacob S. J Cell Physiol. 2003;196:171-9.

  16. GLYCEMIA & CV EVENTS: META-REGRESSION 3 2.5 2 1.5 1 Relative Risk Relative Risk 3 2-hour glucose Fasting glucose 2.5 2 1.5 1 10 11 8 9 5 4 4 6 7 6 8 72 90 108 126 144 162 72 108 144 180 198 @ 2 hr G = 7.8 mM (140 mg%)… @ Fasting G = 6.1 mM (110 mg%)… RR=1.58 (1.19-2.10) RR=1.33 (1.06-1.67) After removal of any DM: p=0.0006 for 2 h G p=0.06 for FPG Coutinho M, Gerstein HC, et al. Diabetes Care. 1999;22:233-240.

  17. DYSGLYCEMIA >> NORMOGLYCEMIA IN ACUTE AND STABLE CV DISEASE 10% New DM 15% 30% 31% % 100 Known DM 80 22% IGT 22% 60 3% IFG 3% 40 NGT 35% 29% 20 0 Acute Elective • Consecutive pts: 2107 in-pts; 2854 out-pt elective CV consultsin Europe (71% men; mean age 66) • OGTT/old DM in 1587 (75%) acute & 1857 (66%) elective pts before discharge or within 2 mo. Euro Heart Survey Bartnik et al; Eur Ht J 2004;1880

  18. DISGLICEMIA >> A NORMOGLICEMIA EN PACIENTES CON PRIMER INFARTO DM de novo 9.49 % • Grupo de estudio: 458 pacientes admitidos con un primer infarto agudo de miocardio en diferentes centros nacionales y 1 centro internacional (27.2 % mujeres, 72.8 hombres) % 100 Leyendas 15,8% Antedecente DM 80 17.7 % Glicemia Alterada en ayunas e intolerancia OG 60 11.3 % 15.1 % 40 Intolerancia OG Glicemia alterada en ayunas 20 30,4 % Glicemia Normal 0 Pacientes IAM Lopez-Jaramillo et al. Journal of Diabetes 2011; 3 (Suppl 1): 73

  19. HYPERINSULINEMIA IS A PREDICTOR OF NEW CARDIOVASCULAR EVENTS Garcia et al. Int J Cardiol. 2011; 145:85-90

  20. HYPERINSULINEMIA IS A PREDICTOR OF NEW CARDIOVASCULAR EVENTS Garcia et al. Int J Cardiol. 2011;145:85-90

  21. HYPERINSULINEMIA IS A PREDICTOR OF NEW CARDIOVASCULAR EVENTS Garcia et al. Int J Cardiol. 2011; 145: 85-90

  22. HYPERINSULINEMIA IS A PREDICTOR OF NEW CARDIOVASCULAR EVENTS Garcia et al. Int J Cardiol. 2011: 145: 85-90

  23. REACTIVIDAD VASCULAR Anillos de Arteria mamaria interna (2 a 3 mm) Curvas Dosis – Respuesta: • Cloruro Potásico (KCl) • Acetilcolina (ACh) • Fenilefrina (PE) • Nitropusiato Sódico (SNP) • Angiotensina II (AII) Rueda-Clausen et al. Int J Cardiol 2010,139: 32-41

  24. REACTIVIDAD VASCULAR Rueda-Clausen et al. Int J Cardiol 2010,139: 32-41

  25. PLASMA LEVELS OF LEPTIN AND ADIPONECTIN IN RELATION TO WAIST CIRCUNFERENCE Rueda-Clausen et al. Int J Cardiol 2010,139: 32-41

  26. Epigeneticand Epigenomic

  27. Published online: 17 May 2006 http://www.springerlink.com/content/j3tj16543664/

  28. OBESITY AND METABOLIC SYNDROME ARE A NORMAL BIOLOGICAL RESPONSE TO AN ABNORMAL DEVELOPMENT OF SOCIETY

  29. MECHANISMS POSSIBLY PARTICIPATING IN THE GENESIS OF METABOLIC SYNDROME AND CARDIOVASCULAR MORTALITY IN DEVELOPING COUNTRIES López-Jaramillo et al. Rev Esp Cardiol. 2007;60:168-178

  30. MATERNAL MALNUTRITION AND FETAL PROGRAMMING ASSOCIATED WITH GREATER CV RISK IN ADULT LIFE López-Jaramillo P. Rev Esp Cardiol. 2009; 62: 670-676

  31. POPULATION URBAN AND RURAL EPIDEMIOLOGY (PURE STUDY)

  32. PURE: Prevalence of HTN by countries within economic regions and by urban vs. rural

  33. HTN control amongst all PUREparticipants with HTN urban vs. rural

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