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Search Results: 1 - 10 of 404095 matches for " Mónica Acevedo "
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Non-traditional risk factors for Atherosclerosis
Acevedo,Mónica; Tagle,Rodrigo; Simpfendorfer,Conrad;
Revista médica de Chile , 2001, DOI: 10.4067/S0034-98872001001000016
Abstract: during the last 10 years, several "non-traditional" risk markers for atherosclerosis have been identified. among them, new markers of lipoprotein metabolism (ie lipoprotein [ a]), endothelial dysfunction (ie homocysteine), hemostasis (ie fibrinogen) and inflammation (ie c-reactive protein) have been linked to an excessive risk of cardiovascular disease. these factors should help the clinician to better identify individuals at risk of premature atherosclerotic disease and/or improve the predictive value of established risk factors for atherosclerosis. finally, these factors are expected to improve the knowledge in the pathophysiology of cardiovascular diseases, and perhaps to impact future therapeutic decisions. in this review article, we will analyze the markers in which there are at least some evidence to support their acceptance as "non-traditional risk factors" for atherosclerotic disease (rev méd chile 2001; 129: 1212-21)
Las preguntas que el clínico debe hacerse en un paciente hipertenso al sospechar una Hipertensión Secundaria
Rodrigo Tagle V,Mónica Acevedo B
Revista Chilena de Cardiología , 2009,
Abstract:
Non-traditional risk factors for Atherosclerosis Factores de riesgo no-tradicionales en la aterosclerosis
Mónica Acevedo,Rodrigo Tagle,Conrad Simpfendorfer
Revista médica de Chile , 2001,
Abstract: During the last 10 years, several "non-traditional" risk markers for atherosclerosis have been identified. Among them, new markers of lipoprotein metabolism (ie lipoprotein [ a]), endothelial dysfunction (ie homocysteine), hemostasis (ie fibrinogen) and inflammation (ie C-reactive protein) have been linked to an excessive risk of cardiovascular disease. These factors should help the clinician to better identify individuals at risk of premature atherosclerotic disease and/or improve the predictive value of established risk factors for atherosclerosis. Finally, these factors are expected to improve the knowledge in the pathophysiology of cardiovascular diseases, and perhaps to impact future therapeutic decisions. In this review article, we will analyze the markers in which there are at least some evidence to support their acceptance as "non-traditional risk factors" for atherosclerotic disease (Rev Méd Chile 2001; 129: 1212-21) Durante los últimos 10 a os se han identificado varios marcadores de riesgo "no-tradicionales" para la aterosclerosis. Entre ellos, se ha relacionado con un riesgo excesivo de enfermedad cardiovascular a nuevos marcadores del metabolismo de lipoproteínas (ej: lipoproteína [a]), disfunción endotelial (ej: homocisteína), hemostasis (ej: fibrinógeno) e inflamación (ej: proteína C-reactiva). Estos factores deberían ayudar al clínico a identificar mejor los individuos con riesgo de una enfermedad aterosclerótica prematura y/o mejorar el valor predictivo de los factores de riesgo de aterosclerosis ya conocidos. Finalmente, se espera que estos factores aumenten el conocimiento de la fisiopatología y el diagnóstico de las enfermedades cardiovasculares y, tal vez, tengan impacto en futuras decisiones terapéuticas. En este artículo de revisión se analizan aquellos marcadores sobre los cuales existen algunas evidencias que apoyen su aceptación como "factores no-tradicionales de riesgo" para la enfermedad aterosclerótica
Patient Adherence to a Cardiovascular Rehabilitation Program: What Factors Are Involved?  [PDF]
María José Bustamante, Giovanna Valentino, Verónica Kr?mer, Marcela Adasme, Dominique Guidi, Camila Ibara, Cinthia Casasbellas, Lorena Orellana, Marcelo Fernández, Carlos Navarrete, Mónica Acevedo
International Journal of Clinical Medicine (IJCM) , 2015, DOI: 10.4236/ijcm.2015.69081
Abstract: Background: Phase II cardiac rehabilitation (CR) is a class IA indication in patients suffering a cardiovascular event (CV). Current guidelines suggest 36 exercise sessions over a period of 3 months. The main aim of this study was to analyze the rate of adherence to a cardiac rehabilitation program and the factors influencing it. Methods: This was a cross-sectional study in 421 secondary prevention patients, who assisted to a Phase-II-CR program between 2007 and 2014. At baseline and program end, patients completed a 6-minute walk test and the Short-Form 36 Health Survey (SF-36). Vital signs and anthropometric measurements were also collected. Adherence was quantified as the percentage of individuals who attended all 36 sessions of the program. Factors considered for affecting adherence included: cardiovascular risk factors (RFs), type of health insurance (public or private), aerobic capacity, and SF-36 score parameters. Results: Adherence to Phase-II-CR was 33%, with no significant differences between men and women. The regression model fully adjusted for age, sex, RFs, type of health insurance and SF-36 score, showed that a SF-36 score <50 on physical health (odds ratio (OR): 11.47; 3.99 - 32.99; p < 0.0001) and smoking (OR: 4.41; 1.25 - 15.62; p = 0.02) were strong predictors for non-adherence. A trend for better adherence was observed in subjects older than 50 years compared to those aged between 17 and 50 years (37% versus 23%, respectively; p = 0.05). No significant differences were observed in adherence according to RFs clustering. Conclusions: Adherence to Phase-II-CR is low in our population. Patient-related factors, such as SF-36 score and smoking, were the best determinants of Phase-II-CR adherence. Health system-related factors did not influence adherence in this population. Prospective studies are warranted to determine all the factors which may influence adherence to Phase-II-CR programs.
El Gabro Rancho Lata: Magmatismo mesozoico off-axis de la cuenca marginal Rocas Verdes en los Andes Fueguinos de Argentina
González-Guillot, Mauricio;Acevedo, Rogelio;Escayola, Mónica;
Revista mexicana de ciencias geológicas , 2010,
Abstract: the rocas verdes marginal basin originated during an extensional tectonic event in the late jurassic-early cretaceous, which finally led to the break-up of the gondwana supercontinent. it is composed of mafic tholeiitic rocks with mid-ocean ridge basalt (morb) affinity, exposed at the southernmost tip of south america. magmatism occurred at spreading centers and was coeval with a calc-alkaline volcanic arc built on continental crust to the pacific side of the basin. mafic dykes that also intrude continental crust on both sides of the marginal basin are related to the initial stages of basin development. in this contribution we present new field, petrographic, geochemical and microchemical data from gabbroic stocks and sills (the rancho lata gabbro, grl) emplaced in the northern flank of the southern tip of the marginal basin. the rocks exhibitphaneritic (gabbros) and subvolcanic (dolerites) textures. the grl experienced greenschistfacies metamorphism and mylonitic deformation. chemical and mineralogical composition of grl suggest that dolerites and gabbros could derive from a common parental magma, by crystal fractionation, where dolerites represent more differentiated liquids and gabbros the cumulus fraction. the grl has tholeiitic affinity, moderate enrichment in lile and lree compared with normal (n)-morb and chondrite, respectively, and high lree/hree ratios similar to those of enriched (e)-morbs. on the basis of mineralogical and chemical composition, metamorphism and ductile deformation, the grl is correlationed to other mafic dykes flanking the ophiolites reported in literature, and to the ophiolites itself from the least evolved part of the marginal basin. therefore, the grl most probably generated during the initial stages of basin development in an enriched upper mantle. the nb-ta-ti troughs seen on normalized trace element diagrams indicate contribution of subduction components to the source.
Razón cintura estatura como predictor de riesgo cardiometabólico en ni os y adolescentes Waist-Height ratio as a predictor if cardio-metabolic risk in children
Pilar Arnaiz,Mónica Acevedo,Carlos Díaz,Rodrigo Bancalari
Revista Chilena de Cardiología , 2010,
Abstract: En ni os, la obesidad general y visceral se asocian con mayor riesgo cardiometabólico. El aumento en la prevalencia del síndrome metabólico (SM) en ni os y adolescentes empeora el riesgo cardiovascular. Necesitamos contar con nuevos marcadores que permitan predecir el SM en ni os. Objetivo: Comparar índice de masa corporal (zIMC) con razón cintura estatura (RCE) como pre-dictores de SM en ni os chilenos. Método: Estudio transversal en 618 escolares, edad 10.8± 1.9 a os, 51.6% mujeres, 190 eutróficos, 174 sobrepeso, 254 obesos, estrato socioeconómico medio y medio bajo, área urbana de Santiago. Determinamos peso, talla, circunferencia de cintura, presión arterial, perfil lipídico y glicemia. Diagnóstico de SM basado en la presencia de > 3 criterios de Cook. El SM se modeló en función de RCE y z score IMC , con modelos de regresión logística. Se usaron curvas ROC para comparar RCE y zIMC como predictores de SM. Punto de corte según índice de YOUDEN. Resultados: La prevalencia de SM fue 15.37 %. Promedio de z IMC + 1.22± 0.90 y de RCE 0.52±0.07. Punto de corte óptimo para SM: RCE 0.55 (sensibilidad 72%, especificidad 70%)yzIMC: 1.76 (sensibilidad 71%, especificidad 74%). Conclusión: RCE y zIMC predicen igualmente el riesgo cardiometabólico en ni os y adolescentes. Dada la mayor facilidad de calcular RCE, la transforma en mejor herramienta definiendo riesgo en este grupo. El punto de corte > 0.55 sería buen predictor de SM en ni os y adolescentes. Background: Among children both general and visceral obesity are associated with increased cardio-metabolic risk. The increasing prevalence of the metabolic syndrome (MS) in children and adolescents increases cardiovascular risk. Studies of new clinical markers which can easily and accurately predict MS in children and adolescents are needed. Aim: To compare zBMI and waist to height ratio (WHR) as predictors of MS in Chilean children. Method: We performed a crossectional study of 618 schoolchildren, age 11 ± 2 years, 52 % females, 190 eutrophic, 174 overweight, 254 obese, from middle and low social economic strata from the Santiago urban área. We determined weight, height, waist circumference, blood pressure and fasting lipids and glycemia. MS diagnosis was based on the presence of > 3 Cook criteria. MS was modeled in function of WHR and z score BMI, through logistic regression models. ROC curves were used to compare zBMI and WHR as predictors of MS. The cutoff point by YOUDEN índex was used. Results: The prevalence of MS was 15%. Mean zBMI was +1.22 ± 0.90 and WHR 0.52 ± 0.07. Cutoff point for MS were: WHR 0,55 (
Strain y Strain rate auricular izquierdo evaluado por speckle tracking está relacionado a PCR ultrasensible en adolescentes obesos Speckle tracking derived left atrial strain and strain rate are related to high sensitive C reactive protein in obese adolescents
Luigi Gabrielli,Pilar Arnaiz,Mónica Acevedo,Andrés Enriquez
Revista Chilena de Cardiología , 2011,
Abstract: Introducción: La obesidad y el síndrome metabólico están asociados a un tama o auricular izquierdo (AI) aumentado y mayor riesgo cardiovascular. El strain y strain rate longitudinal determinado por speckle tracking son herramientas novedosas en la evaluación de la función AI. Objetivo: evaluar el strain y strain rate AI en adolescentes obesos y su relación con biomarcadores de riesgo cardiovascular. Métodos: se incluyeron adolescentes consecutivos con un z-índice de masa corporal (z-IMC) > 1 en ritmo sinusal sin otra comorbilidad y un grupo control pareado por edad y sexo. Se registraron las características clínicas y ecocardiográficas con evaluación del strain AI: onda s (LASs), onda a (LASa) y strain rate AI: onda s (LASRs), onda a (LASRa) por speckle tracking. Se midió adiponectina y PCR ultrasensible. Se utilizó t-Student, chi-cuadrado y correlación de Pearson. Resultados: Se incluyeron 15 sujetos por grupo de edad promedio de 13 a os, 47% hombres sin diferencia entre ambos grupos. Los pacientes con sobrepeso presentaron significativamente mayores niveles de PCR us respecto del grupo control, 0,5 ± 0,1 mg/L vs 1,4 ± 0,3, p = 0,04 y menores de LASs (44 ± 1,8 vs 32 ± 1,1%;p<0,01), LASa ( -1,7 ± 0,3 vs -0,7 ± 0,3 1/s; p<0,01), LASRs ( 1,7 ± 0,07 vs 1,3 ± 0,03%; p<0,01), LASRa (-1,8 ± 0,1 vs -1,2 ± 0,08 1/s;p<0,01). En el grupo con sobrepeso se encontró una correlación negativa significativa entre LASs, LASRs y PCR ultrasensible (R: -0,62; p < 0,01 y R: -0,58: p = 0,02 respectivamente). Conclusiones: El strain y strain rate AI se encuentran reducidos en adolescentes obesos y estos parámetros de función AI se correlacionan con un estado inflamatorio aumentado. La importancia clínica de estos hallazgos requieren mayor investigación. Background: Obesity is an emerging problem in children worldwide and a well-known risk factor for atrial fibrillation (AF) in adulthood. There is some evidence that functional and structural changes responsible for the development of AF may arise early in life. Left atrial (LA) strain and strain rate, assessed by speckle tracking, are indices of LA function and correlate with the development of AF. Objective: To evaluate LA strain and strain rate in obese adolescents and their correlation with plasma levels of high sensitive C reactive protein (hs-CRP) and adiponec-tin, two markers of cardiovascular risk. Methods: Fifteen obese adolescents, age 13 ± 0.2 yr, body mass index (BMI)-z-score 1.9 ± 0.16 and 15 lean controls were recruited. All patients underwent transtho-racic echocardiography with evaluation of LA strain and strain
La atorvastatina no modifica el incremento agudo de los niveles de p-selectina y fibrinógeno inducido con esfuerzo físico máximo Atovastatin does not modify the acutely increased levels of P-selectin and fibrinogen induced by maximal physical exercise
Dante Lindefjeld,Mónica Acevedo,Gastón Chamorro,Diego Mezzano
Revista Chilena de Cardiología , 2010,
Abstract: Introducción: Las estatinas han demostrado disminuir los eventos cardiovasculares en sujetos con y sin enfermedad aterosclerótica establecida. Se ha demostrado, que sus efectos benéficos no sólo dependen de la reducción del colesterol, sino que también podrían ser secundarios a otros efectos de las estatinas, como su efectos de reducción de inflamación y/ o trombogénesis entre otros. Sin embargo, no existen trabajos que demuestren que las estatinas sean capaces de frenarla activación de la cascada de inflamación y/o trombogénesis. Objetivos: Determinar el efecto de la administración oral de atorvastatina por 7 días sobre los niveles plasmáticos de proteína C- reactiva ultrasensible (PCR us), fibrinógeno y P-selectina, pre y post prueba de esfuerzo máximo inmediato y a las 24 horas de su ejecución. Métodos: Ensayo clínico en 50 hombres sanos (18 a 50 a os), randomizado atorvastatina 80 mg/día - placebo por 7 días, doble ciego. Muestras tomadas en sangre para PCRus, fibrinógeno y P-selectina, perfil lipídico, creatin kinasa y transaminasas hepáticas, pre y post test de esfuerzo, y a las 24 horas. Los resultados para datos continuos se expresan como medias ± desviación estándar, test de student para muestras independientes, ANOVA para muestras repetidas. Programa estadístico SPSS 14.0. Resultados: Un grupo de 44 sujetos completaron el estudio: atorvastatina 80 mg (n=24) o placebo (n=20). En el grupo atorvastatina, después de una semana de tratamiento, los niveles de LDLc disminuyeron en 38% (LDL basal: 97 ± 27 mg/dL vs LDL post: 62 ± 31 mg/dL, p < 0.001). Sin embargo, no se observaron cambios en ese mismo período en los niveles de PCRus, fibrinógeno y P-selectina con respecto a placebo. Los niveles de fibrinógeno se elevaron 8% entre la etapa pre y post ejercicio inmediato (341 ± 56 mg/dL vs 368 ± 65 mg/dL, p<0.001), retornando a los niveles básales a las 24 horas; no hubo diferencias entre atorvastatina - placebo. Los niveles de P-selectina aumentaron 9.5% entre la etapa pre y post ejercicio inmediato (25 ± 1.5 ng/dL vs 28 ±1.7 ng/dL, p = 0.01), retornando a los niveles basales a las 24 horas; no hubo diferencias entre atorvastatina - placebo. El ejercicio no indujo elevación de PCRus. Los niveles plasmáticos de CKtotal se elevaron significativamente en ambos grupos post ejercicio (Atorvastatina 43% aumento, p = 0.004 versus nivel basal y placebo 12% aumento, p = 0.005 versus nivel basal). Sin embargo, no se encontró diferencias estadísticamente significativas entre el grupo atorvastatina versus placebo. Conclusiones: La administración de atorvastatina ora
Hipertensión arterial en la mujer adulta Hypertension in women
Rodrigo Tagle V,Mónica Acevedo,Gloria Valdés
Revista médica de Chile , 2013,
Abstract: The present review examines the types of hypertension that women may suffer throughout life, their physiopathological characteristics and management. In early life, the currently used low-dose oral contraceptives seldom cause hypertension. Pregnancy provokes preeclampsia, its main medical complication, secondary to inadequate transformation of the spiral arteries and the subsequent multisystem endothelial damage caused by deportation of placental factors and microparticles. Hypertension in preeclampsia is an epiphenomenon which needs to be controlled at levels that reduce maternal risk without impairing placental perfusion. The hemodynamic changes of pregnancy may unmask a hypertensive phenotype, may exacerbate a chronic hypertension, or may complicate hypertension secondary to lupus, renovascular lesions, and pheochromocytoma. On the other hand a primary aldosteronism may benefit from the effect of progesterone and present as a postpartum hypertension. A hypertensive pregnancy, especially preeclampsia, represents a risk for cardiac, vascular and renal disease in later life. Menopause may mimic a pheochromocytoma, and is associated to endothelial dysfunction and salt-sensitivity. Among women, non-pharmacological treatment should be forcefully advocated, except for sodium restriction during pregnancy. The blockade of the renin-angiotensin system should be avoided in women at risk of pregnancy; betablockers could be used with precautions during pregnancy; diuretics, ACE inhibitors and angiotensin receptor antagonists should not be used during breast feeding. Collateral effects of antihypertensives, such as hyponatremia, cough and edema are more common in women. Thus, hypertension in women should be managed according to the different life stages.
Marcadores de aterosclerosis temprana y síndrome metabólico en ni os Early markers for atherosclerosis and metabolic syndrome in children
Salesa Barja,Mónica Acevedo,Pilar Arnaiz,Ximena Berríos
Revista médica de Chile , 2009,
Abstract: Background: The high prevalence of obesity in children favors the appearance of metabolic syndrome (MS), increasing their cardiovascular risk. Aim: To evaluate components of MSin children and to comtate them with surrogate markers of atherosclerosis and subclinical inflammation. Material and methods: We studied 209 children aged 11.5 ± 2 years (50% girls, 30% prepuberal). Fifty percent had normal weight, 18% were overweight, 29% were obese and 3% were undernourished. A fasting blood sample was obtained to measure lipid levels, glucose, insulin, adiponectin and ultrasensitive C-reactive protein (usCRP). Subclinical atherosclerosis was evaluated using flow mediated dilatation of brachial artery (FMD) and carotid intima-media thicknes (IMT). For diagnosis of MS we adapted Cook's criteria. Results: Five percent of all children and 18% ofthose with overweight had MS. Children with more components had significantly higher fasting insulin and Homeostasis Model Assessment (HOMA) values. Clustering of MS components was also associated to higher values of usCRP and non significantly to lower adiponectin levels. We did not find differences in FMD. In obese children there was a tendency towards a higher IMT with clustering of MS components, although not significant. Conclusions: Children with overweight presented a higher risk of a clusteríng of MS components, which was also associated with insulin resistance and increase in ultrasensitive C reactive protein.
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