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Search Results: 1 - 10 of 56245 matches for " Carlos Gonzalez-Juanatey "
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Role of carotid ultrasonography in the evaluation of cardiovascular risk in patients with rheumatoid arthritis
Miguel A Gonzalez-Gay, Carlos Gonzalez-Juanatey, Jose A Miranda-Filloy, Javier Martin, Javier Llorca
Arthritis Research & Therapy , 2010, DOI: 10.1186/ar3186
Abstract: With respect to these interesting observations, we would like to further emphasize the importance of carotid ultrasonography in the evaluation of the cardiovascular risk of patients with RA and the importance of the duration of the disease as a predictor of severity, so it can influence the development of cardiovascular events in these patients. We previously reported that, in long-standing RA patients with no classic cardiovascular risk factors at the time of the carotid assessment, the duration of the disease was the best predictor of carotid plaques [2]. On the other hand, RA is a chronic inflammatory disease, and even in the apparently quiescent phases of the disease, the cumulative effect of the chronic inflammatory burden may account for the progression of the atherosclerosis disease. In this regard, we observed that the mean values of C-reactive protein (CRP) over an extended follow-up rather than a single determination of CRP at the time of the carotid ultrasonography evaluation were associated with the carotid IMT [3]. Moreover, we found that carotid artery IMT had a high predictive power for the development of cardiovascular events over a 5-year follow-up period in 47 patients with RA without clinically evident cardiovascular disease at the time of the carotid ultrasonography evaluation [4]. In our study, carotid IMT categorized in quartiles was strongly associated with the development of cardiovascular events [4]. When logistic regression models were performed, carotid IMT at the time of the ultrasonographic study yielded a high predictive power for the development of cardiovascular events over the 5-year follow-up period. On the other hand, the duration of the disease is also considered an important risk factor of future cardiovascular events [5].Taking all of these considerations together, we propose that ultrasonographic assessment of the carotid artery be performed on all patients with RA in order to establish a subgroup of patients with a high risk o
Carotid intima-media thickness and endothelial function: useful surrogate markers for establishing cardiovascular risk in patients with inflammatory rheumatic disease
Miguel A Gonzalez-Gay, Carlos Gonzalez-Juanatey, Tomas R Vazquez-Rodriguez, Javier Martin, Javier Llorca
Arthritis Research & Therapy , 2008, DOI: 10.1186/ar2409
Abstract: We recently reported [2] that carotid artery IMT had good ability to predict development of cardiovascular events over a 5-year period of follow up in 47 patients with RA without clinically evident cardiovascular disease at the time of evaluation by carotid ultrasonography. In our study carotid IMT, categorized in quartiles, was strongly associated with cardiovascular events; specifically, none of the RA patients with carotid IMT less than 0.77 mm suffered cardiovascular events. However, six of the 10 patients with carotid IMT greater than 0.91 mm experienced cardiovascular events. When logistic regression models were performed, carotid IMT at the time of ultrasonographic study had high power to predict development of cardiovascular events over the 5-year period of follow up. Although the area under the receiver operating characteristic curve was 0.86 when using age at the onset of the study, it was greater in models that included carotid IMT. In this regard, the area under the receiver operating characteristic curve was 0.93 for a model that included only carotid IMT. Based on these findings, we propose that ultrasonographic assessment of the carotid artery should be performed in all patients with RA in order to identify the subgroup of patients at high risk for cardiovascular complications.In the same editorial, Veldhuijzen van Zanten and Kitas [1] emphasize that endothelial function is highly dependent on current levels of inflammation. We agree entirely with the authors on this point; we observed endothelial dysfunction in patients with biopsy-proven giant cell arteritis (GCA) – an inflammatory disease that involves large and middle-sized blood vessels. However, steroid therapy was able to improve endothelial function. This effect was observed when laboratory markers of inflammation returned to normal levels [3]. Whether normalization of endothelial function might lead to 'protection' against development of accelerated atherosclerosis in chronic inflammatory dis
Response to 'Infliximab therapy increases body fat mass in early rheumatoid arthritis independently of changes in disease activity and levels of leptin and adiponectin: a randomized study over 21 months'
Miguel A Gonzalez-Gay, Carlos Gonzalez-Juanatey, Jose A Miranda-Filloy, Javier Martin, Maria T Garcia-Unzueta, Javier Llorca
Arthritis Research & Therapy , 2011, DOI: 10.1186/ar3301
Abstract: With respect to this, we have prospectively followed a cohort of patients who had RA refractory to conventional disease-modifying ant rheumatic drugs, including methotrexate, and who, owing to disease severity, underwent anti-TNF-α-infliximab therapy. Among them, a subgroup of 33 consecutive RA patients who were on periodical treatment with infliximab and who agreed to participate in the study was assessed to determine the short- term effect of this drug on insulin resistance, ghrelin, and adipokine profile. Besides noting a dramatic improvement of insulin resistance following infliximab administration [2], we observed that, upon administration of this drug, serum ghrelin concentrations (in picograms per milliliter) increased significantly (896.1 ± 314.8, median 861.2, interquartile range (IQR) 700.5 to 879.9 before infliximab at time 0 (baseline) and 976.3 ± 373.0, median 905.8, IQR 752.6 to 1,152.8 after infliximab infusion at 120 minutes; P < 0.001) and that increases in ghrelin concentrations were associated with reductions in P-selectin concentrations (r = -0.513; P = 0.002) [3]. However, ghrelin concentrations were not related to the DAS28 (disease activity score using 28 joint counts), the mean erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) from disease diagnosis or the ESR, platelet count, CRP, or cumulative prednisone dose at the time of the study [3]. Moreover, we observed a significant correlation between leptin levels and body mass index [4].Apart from stimulating growth hormone production, ghrelin regulates energy homeostasis through increasing food intake and decreasing fat utilization, leading to increased adiposity through growth hormone-independent mechanisms [5]. Ghrelin is further associated with metabolic syndrome features, and ghrelin administration has beneficial effects not only on cachexia in patients with heart failure and chronic obstructive pulmonary disease but also on insulin sensitivity in overweight patients and end
A1298C polymorphism in the MTHFR gene predisposes to cardiovascular risk in rheumatoid arthritis
Rogelio Palomino-Morales, Carlos Gonzalez-Juanatey, Tomas R Vazquez-Rodriguez, Luis Rodriguez, Jose A Miranda-Filloy, Benjamin Fernandez-Gutierrez, Javier Llorca, Javier Martin, Miguel A Gonzalez-Gay
Arthritis Research & Therapy , 2010, DOI: 10.1186/ar2989
Abstract: Six hundred and twelve patients fulfilling the 1987 American College of Rheumatology classification criteria for RA, seen at the rheumatology outpatient clinics of Hospital Xeral-Calde, Lugo and Hospital San Carlos, Madrid, were studied. Patients and controls (n = 865) were genotyped using predesigned TaqMan SNP genotyping assays.No significant differences in allele or genotype frequencies for the MTHFR gene polymorphisms between RA patients and controls were found. Also, no association between the MTHFR 677 C>T polymorphism and CV events or endothelial dysfunction was observed. However, the MTHFR 1298 allele C frequency was increased in patients with CV events after 5 years (38.7% versus 30.3%; odds ratio = 1.45; 95% confidence interval = 1.00 to 2.10; P = 0.04) and 10 years (42.2% versus 31.0%; odds ratio = 1.62; 95% confidence interval = 1.08 to 2.43; P = 0.01) follow up. Moreover, patients carrying the MTHFR 1298 AC and CC genotypes had a significantly decreased flow-mediated endothelium-dependent vasodilatation (4.3 ± 3.9%) compared with those carrying the MTHFR 1298 AA genotype (6.5 ± 4.4%) (P = 0.005).Our results show that the MTHFR 1298 A>C gene polymorphism confers an increased risk for subclinical atherosclerosis and CV events in patients with RA.Patients with rheumatoid arthritis (RA) have increased risk of cardiovascular (CV) disease due to accelerated atherosclerosis [1]. Besides classic CV risk factors, a number of nontraditional CV risk factors have also been implicated in the elevated CV mortality observed in these patients [2].In this regard, chronic inflammation and the genetic background increase the risk of CV events in RA regardless of the presence of traditional CV risk factors [3]. Hyperhomocysteinemia has been found to be an independent nontraditional risk factor for CV disease, including coronary disease, in the general population [4]. Homocysteine is an intermediary amino acid formed during the conversion of methionine to cysteine. High ele
Anti-TNF-Alpha-Adalimumab Therapy Is Associated with Persistent Improvement of Endothelial Function without Progression of Carotid Intima-Media Wall Thickness in Patients with Rheumatoid Arthritis Refractory to Conventional Therapy
Carlos Gonzalez-Juanatey,Tomas R. Vazquez-Rodriguez,Jose A. Miranda-Filloy,Ines Gomez-Acebo,Ana Testa,Carlos Garcia-Porrua,Amalia Sanchez-Andrade,Javier Llorca,Miguel A. González-Gay
Mediators of Inflammation , 2012, DOI: 10.1155/2012/674265
Abstract: To determine whether treatment with the anti-TNF-alpha blocker adalimumab yields persistent improvement of endothelial function and prevents from morphological progression of subclinical atherosclerosis in patients with rheumatoid arthritis (RA) refractory to conventional therapy, a series of 34 consecutive RA patients, attending hospital outpatient clinics and who were switched from disease modifying antirheumatic drug therapy to anti-TNF-alpha-adalimumab treatment because of severe disease, were assessed by ultrasonography techniques before the onset of adalimumab therapy (at day 0) and then at day 14 and at month 12. Values of flow-mediated endothelium-dependent vasodilatation at day 14 and at month 12 were significantly higher (mean ± standard deviation (SD): %; median: 5.7% at day 14, and mean ± SD: %; median: 6.9% at month 12) than those obtained at day 0 (mean: %; median: 3.6%; and , resp.). Endothelium-independent vasodilatation results did not significantly change compared with those obtained at day 0. No significant differences were observed when carotid artery intima-media wall thickness values obtained at month 12 (mean ± SD: ?mm) were compared with those found at day 0 ( ?mm) ( ). In conclusion, anti-TNF-alpha-adalimumab therapy has beneficial effects on the development of the subclinical atherosclerosis disease in RA. 1. Introduction Rheumatoid arthritis (RA) is a chronic inflammatory disease associated with accelerated atherosclerosis and increased incidence of cardiovascular (CV) events [1]. Besides a genetic component [2] and classic (traditional) CV risk factors [3], chronic inflammation plays a pivotal role in the development of atherogenesis in patients with RA [4]. Different validated techniques are currently available to determine subclinical atherosclerosis in patients with rheumatic diseases. Macrovascular endothelial dysfunction, an early stage in atherosclerosis, can be detected by brachial ultrasonography as the result of impaired flow-mediated endothelium-dependent vasodilatation (FMD). Carotid ultrasound studies are also useful to disclose the presence of subclinical atherosclerosis [5]. By this technique, morphological changes such as abnormally increased carotid artery intima-media wall thickness (IMT) and carotid plaques can be observed [5]. A number of studies have shown short-term improvement of endothelial function in RA refractory to disease modifying antirheumatic drugs (DMARDs) following anti-TNF-alpha therapy [6, 7]. However, carotid ultrasound studies in patients with RA undergoing anti-TNF-alpha therapy have
"Giant R wave" electrocardiogram pattern during exercise treadmill test: A case report
Ana Testa-Fernández, Ramón Rios-Vazquez, Juan Sieira-Rodríguez-Moret, Raúl Franco-Gutierrez, Carlos Pe?a-Gil, Ruth Pérez-Fernández, Victor Puebla-Rojo, Margarita Regueiro-Abel, Carlos Gonzalez-Juanatey
Journal of Medical Case Reports , 2011, DOI: 10.1186/1752-1947-5-304
Abstract: We describe a case of a 51-year-old Caucasian man with an unusual ischemic response during the exercise treadmill test: a "giant R wave" electrocardiogram pattern as a manifestation of hyperacute ischemia that resolved with sublingual nitroglycerin. Coronary catheterization showed a severe stenosis in a proximal dominant circumflex coronary artery. We hypothesize that, in this case, the "giant R wave" pattern was related to severe hyperacute ischemia due to coronary spasm superimposed on the atherosclerotic lesion, which probably caused complete occlusion of the artery. The patient was successfully treated with coronary percutaneous revascularization.This is a dramatic and rare ischemic response during the exercise treadmill test, in which, a rapid administration of nitroglycerin can prevent life-threatening events.A typical ischemic response during an exercise treadmill test (ETT) is ST-segment depression. ST-segment elevation is present in only about 3.5% of patients who undergo this test [1] and is more specific for indicating the site of the culprit lesion [2,3]. The "giant R wave syndrome" was first described by Prinzmetal et al. [4] in the context of variant angina, and it is characterized by the appearance of a giant R wave, loss of the S wave, and merging of the QRS complex with the ST segment, causing a monophasic QRS-ST complex in leads facing the ischemic territory. This pattern may be rarely observed following coronary artery occlusion in acute myocardial infarction (MI), following variant angina during an ETT (or spontaneously at rest), and after percutaneous transluminal coronary angioplasty or experimental coronary artery ligation [5]. We report a case of a patient who developed the giant R wave syndrome during an ETT.A 51-year-old Caucasian man with the cardiovascular risk factors of hypertension and smoking was admitted to our hospital because of chest pain and syncope during exercise. He had experienced intermittent chest pain for one week prior to
Correlation between endothelial function and carotid atherosclerosis in rheumatoid arthritis patients with long-standing disease
Carlos González-Juanatey, Javier Llorca, Miguel A González-Gay
Arthritis Research & Therapy , 2011, DOI: 10.1186/ar3382
Abstract: One hundred eighteen patients who fulfilled the 1987 American College of Rheumatology classification criteria for RA, had no history of CV disease and had at least one year of follow-up after disease diagnosis were randomly selected. Brachial and carotid ultrasonography were performed to determine FMD and carotid IMT, respectively.Carotid IMT values were higher and FMD percentages derived by performing ultrasonography were lower in individuals with a long duration from the time of disease diagnosis. Patients with a disease duration ≤ 7 years had significantly lower carotid IMT (mean ± SD) 0.69 ± 0.17 mm than those with long disease duration (0.81 ± 0.12 mm in patients with ≥ 20 years of follow-up). Also, patients with a long disease duration had severe endothelial dysfunction (FMD 4.0 ± 4.0% in patients with disease duration from 14.5 to 19.7 years) compared with those with shorter disease duration (FMD 7.4 ± 3.8% in patients with disease duration ≤ 7 years). Linear regression analysis revealed that carotid IMT was unrelated to FMD in the whole sample of 118 patients. However, carotid IMT was negatively associated with FMD when the time from disease diagnosis ranged from 7.5 to 19.7 years (P = 0.02).In patients with RA without CV disease, endothelial dysfunction and carotid IMT increased with the duration of RA. The association between FMD and carotid IMT values was observed only in patients with long disease duration.Rheumatoid arthritis (RA) is a chronic inflammatory disease associated with increased incidence of cardiovascular (CV) mortality [1,2]. This is the result of accelerated atherosclerosis [3]. Because of the high incidence of CV events observed in patients with RA, an important step forward might be to identify high-risk individuals who would benefit from active therapy to prevent clinical disease. In this regard, several noninvasive imaging techniques offer clinicians a unique opportunity to study the relationship of surrogate markers to the development
Implication of new atherosclerotic carotid plaques in the cardiovascular outcome of patients with rheumatoid arthritis
Miguel A González-Gay, Carlos González-Juanatey
Arthritis Research & Therapy , 2012, DOI: 10.1186/ar3733
Abstract: Rheumatoid arthritis (RA) is a disease associated with accelerated atherosclerosis and increased risk of cardiovascular (CV) events. In this issue of Arthritis Research & Therapy, Zampeli and colleagues [1] longitudinally assessed the association with new carotid artery plaques in a series of non-diabetic patients with RA. Besides highlighting the expected influence of age and traditional CV risk factors, the authors highlighted the potential influence of corticosteroid use as an independent risk factor for new plaque formation in the follow-up of these patients [1]. This interesting study raises a series of points that deserve to be addressed.First, the importance of early detection of atherosclerosis in RA before the development of CV complications. In this regard, the detection of endothelial dysfunction by brachial ultrasonography and the presence of abnormally increased carotid artery intima-media thickness (IMT) and carotid plaques by carotid ultrasound constitute a major breakthrough as they allow the presence of subclinical atherosclerosis in patients with RA to be identified [2]. In this respect, a recent study confirmed a correlation between the presence of endothelial dysfunction (considered an early step in the atherogenesis process) and morphological data showing abnormally increased carotid IMT in RA patients with a disease duration of longer than 7 years [3]. However, carotid ultrasound is technically easier to perform than flow-mediated endothelium-dependent brachial ultrasound and, in the hands of trained professionals, is a technique with low interobserver variability. Furthermore, as observed in low- and intermediate-risk groups of non-rheumatic individuals [4], both carotid IMT and the presence of carotid plaques have proven to be good predictors of CV events in patients with RA [5,6].Second, in their study, Zampeli and colleagues [1] focused specifically on carotid plaques. With respect to this, carotid plaques constitute the best expression of
Inflammation, endothelial function and atherosclerosis in rheumatoid arthritis
Miguel A González-Gay, Carlos González-Juanatey
Arthritis Research & Therapy , 2012, DOI: 10.1186/ar3891
Abstract: Endothelial dysfunction is an early step in the atherogenesis process of rheumatoid arthritis (RA). In the previous issue of Arthritis Research & Therapy, Sandoo and colleagues [1] reported a cross-sectional study performed on 99 unselected patients with RA to determine the presence of microvascular and macrovascular endothelial function in parallel with disease activity, individual cardiovascular (CV) disease risk factors, and global CV disease. The authors also longitudinally studied 23 patients who had RA and who started on anti-tumor necrosis factor-alpha (anti-TNFα) therapy [1]. In the cross-sectional study, markers of RA-related inflammation were not associated with microvascular or macrovascular endothelium-dependent function, and global CV disease risk inversely correlated with microvascular endothelium dependent function. In the longitudinal study, only microvascular endothelium-dependent function showed an improvement following 2 weeks of anti-TNFα treatment in comparison with baseline, but no association between change in endothelial function and change in inflammatory markers was evident. Considering these results, the authors concluded that classic CV disease risk may influence endothelial function more than disease-related markers of inflammation in RA. They stated that classic CV disease risk factors and anti-TNFα medication have different effects on microvascular and macrovascular endothelial function [1].This interesting study raises a series of points that deserve to be addressed. First, endothelial dysfunction in RA is the result of a complex effect mediated by classic CV risk factors, genetic predisposition, chronic inflammation, pro-oxidative stress, a prothrombotic status, and metabolic abnormalities (such as insulin resistance or dyslipidemia) that to a greater or lesser extent may influence the development of this systemic pathological state [2]. The results reported by Sandoo and colleagues suggest that systemic markers of inflammation - ery
Perspectivas Alternativas de Investigación en Contabilidad: Una Revisión
Carlos Larrinaga Gonzalez
Revista de Contabilidad : Spanish Accounting Review , 1999,
Abstract: A pesar de que gran parte de la investigación en contabilidad se realiza sobre premisas funcionalistas, en los últimos a os han aparecido formas alternativas de estudiar la contabilidad, con distintos fundamentos: estudios interpretativos, perspectiva crítica y estudios de la relación entre la contabilidad y el poder. Mediante la revisión de las creencias que subyacen en la investigación de cada escuela, este trabajo tiene el propósito de sostener la oportunidad de emprender estudios sobre la base de presuposiciones alternativas al funcionalismo. El trabajo concluye: (a) respaldando la validez de las perspectivas alternativas de investigación; y (b) demostrando la riqueza que aportan diferentes planteamientos científicos. Although mainstream accounting research is accomplished under functionalist assumptions, alternative schools of accounting research have emerged in the last few years. They proceed from different foundations: interpretative studies, critical perspective and studies of the relationship between accounting and power. Through the revision of the beliefs that pervade each research approach, the aim o/ this paper is to sustain the opportunity of undertaking studies based on assumptions alternative to functionalism. In conclusion, this exposition (a) supports the validity of the alternative perspectives on accounting research; and (b) demonstrates that different scientific positions provide enlightenment.
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