Papers by Carlos Guijarro
Nefrología (English Edition)
Advances in Laboratory Medicine / Avances en Medicina de Laboratorio
Cardiovascular diseases (CVD) continue to be the main cause of death in our country. Adequate con... more Cardiovascular diseases (CVD) continue to be the main cause of death in our country. Adequate control of lipid metabolism disorders is a key challenge in cardiovascular prevention that is far from being achieved in real clinical practice. There is a great heterogeneity in the reports of lipid metabolism from Spanish clinical laboratories, which may contribute to its poor control. For this reason, a working group of the main scientific societies involved in the care of patients at vascular risk, has prepared this document with a consensus proposal on the determination of the basic lipid profile in cardiovascular prevention, recommendations for its realization and unification of criteria to incorporate the lipid control goals appropriate to the vascular risk of the patients in the laboratory reports.
Revista Clínica de Medicina de Familia
Las enfermedades cardiovasculares (ECV) siguen siendo la principal causa de muerte en nuestro paí... more Las enfermedades cardiovasculares (ECV) siguen siendo la principal causa de muerte en nuestro país. El control adecuado de las alteraciones del metabolismo lipídico es un reto clave en prevención cardiovascular que está lejos de alcanzarse en la práctica clínica real. Existe una gran heterogeneidad en los informes del metabolismo lipídico de los laboratorios clínicos españoles, lo que puede contribuir al mal control del mismo. Por ello, un grupo de trabajo de las principales sociedades científicas implicadas en la atención de los pacientes de riesgo vascular, hemos elaborado este documento con una propuesta básica de consenso sobre la determinación del perfil lipídico básico en prevención cardiovascular, recomendaciones para su realización y unificación de criterios para incorporar los objetivos de control lipídico adecuados al riesgo vascular de los pacientes en los informes de laboratorio. Palabras clave: consenso, panel de lípidos, enfermedades cardiovasculares, bioquímica, coles...
Revista Española de Quimioterapia, 2019
RESUMEN Objetivos Comunicar la actividad de telemedicina, desde su apertura, entre una consulta h... more RESUMEN Objetivos Comunicar la actividad de telemedicina, desde su apertura, entre una consulta hospitalaria de enfermedades infecciosas y un centro penitenciario. Material y métodos Estudio descriptivo de la teleconsulta de enfermedades infecciosas del Hospital Universitario Fundación Alcorcón con el centro penitenciario de Navalcarnero desde 2013 hasta 2017, que se lleva a cabo mediante videoconferencia. Se analizó motivo y número de consultas, diagnóstico de VIH, tratamiento antirretroviral (TAR), situación inmunovirológica, diagnóstico del virus de la hepatitis C (VHC) e intervención realizada por el experto en infecciosas. Resultados Se valoraron 75 pacientes en un total de 168 consultas (en el primer año 11 consultas y en el quinto 62). El índice de consultas sucesivas/nuevas fue de 1,24 y el 85% de los pacientes requirió menos de 1 año de seguimiento. El 84% de los pacientes no se trasladó al hospital. El 99% de los pacientes aceptó esta modalidad. El 96% era VIH positivo, el...
Pathogens
Current evidence suggests that a group of patients who had survived coronavirus disease, 2019 (CO... more Current evidence suggests that a group of patients who had survived coronavirus disease, 2019 (COVID-19) and developed post-COVID pain can exhibit altered nociceptive processing. The role of serological biomarkers and hospitalization treatments in post-COVID pain is unclear. This study aimed to investigate the association of serological biomarkers and treatments received during hospitalization with sensitization-associated symptoms in COVID-19 survivors with post-COVID pain. One hundred and eighty-three (n = 183) patients who had been hospitalized due to COVID-19 in one urban hospital of Madrid (Spain) during the first wave of the pandemic were assessed in a face-to-face interview 9.4 (SD 3.4) months after hospitalization. Levels of 19 serological biomarkers, hospitalization data, and treatments during hospitalization were obtained from hospital records. Sensitization-associated symptoms (Central Sensitization Inventory, CSI), sleep quality (Pittsburgh Sleep Quality Index, PSQI), pa...
Revista De Calidad Asistencial, Sep 1, 2016
BMC Cardiovascular Disorders, Oct 21, 2020
Background: An Advanced Care Planning (ACP) program of health decisions is the result of a proces... more Background: An Advanced Care Planning (ACP) program of health decisions is the result of a process of reflection and relationship-building between the patient, their relatives and health professionals. It is based on respect for patients' autonomy, involving them in making decisions about their disease in a way that is shared between the medical team, the patient and their relatives. Up until now, the efficacy of an ACP has not been measured in the existing literature, and therefore it is unknown if these programs reach their goal. The main objective of our study is to evaluate the efficacy of an ACP program for decision-making in patients with advanced heart failure (HF) in comparison to usual follow up and care. This objective will be evaluated by the Patient Activation Measure test, which measures the participation and self-management of the patient in decision-making. Secondary objectives: to evaluate the effect of the program on quality of life, to know if the patients wishes expressed through the ACP program are fulfilled, to measure the impact of the program on patients' caregivers, to determine the satisfaction of patients included in the program and to evaluate the effect on quality of death. Methods: Randomized multicentre clinical trial at four hospitals in Madrid. Once they are included in the study, patients' allocation to groups (control vs intervention) will be made by alternative sampling. ACP will be applied to the intervention group, whereas in the Control Group usual follow-up will be carried out in HF units. All patients will fulfil questionnaires and tests related to the objectives of the study again after a 12-month follow-up period in order to gauge the effect of ACP in patients with advanced HF. Discussion: The characteristics of patients with advanced HF make them a model for designing ACP programs, given the high prevalence of this disease, the progressive increase in its incidence and it's clinical characteristics. Until now, the efficacy of this type of program has not been measured, so this Clinical Trial can provide relevant data for future ACP projects. Trial registration ClinicalTrials.gov Identifier: NCT04424680. Registered 9 June 2020. Retrospectively registered, https :https:// clini caltr ials.gov/ct2/show/NCT04 42468 0?term=NCT04 42468 0&draw=2&rank=1.
Atherosclerosis, May 1, 1997
Lipid changes and reductions in the incidence of major canmary heart disease events in the Scandi... more Lipid changes and reductions in the incidence of major canmary heart disease events in the Scandinavian siimvastatia Survival Study (4s)
Circulation Research, Sep 7, 1998
Recent evidence suggests that apoptosis may be involved in the control of vascular smooth muscle ... more Recent evidence suggests that apoptosis may be involved in the control of vascular smooth muscle cell (VSMC) number in atherosclerotic lesions. 3-Hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors have been reported to induce apoptosis in a variety of tumor cell lines. To evaluate whether these agents also induce apoptosis of VSMCs, cultured rat VSMCs were treated with increasing doses of atorvastatin in the presence of FBS as a survival factor. The presence of apoptosis was evaluated by morphological criteria, annexin V binding, and DNA fragmentation and quantified as the proportion of hypodiploid cells by flow cytometry. Atorvastatin induced apoptosis in a dose-dependent manner, an effect also seen with simvastatin and lovastatin, but not with the hydrophilic drug pravastatin. The proapoptotic effect of statins was seen only when the inhibition of acetate incorporation into sterols was Ͼ95% and was fully reversed by mevalonate, farnesyl pyrophosphate, and geranylgeranyl pyrophosphate but not by isopentenyl adenosine, ubiquinone, or squalene, suggesting a role for prenylated proteins in the regulation of VSMC apoptosis. To further assess the role of protein prenylation, VSMCs were exposed to the prenyl transferase inhibitors perillic acid and manumycin A. Both agents induced VSMC apoptosis as evaluated by the above-mentioned criteria. Finally, VSMC treatment with lipophilic statins was associated with decreased prenylation of p21-Rho B, further supporting the role of protein prenylation inhibition in statin-induced VSMC apoptosis. The present data suggest that interference with protein prenylation by HMG-CoA reductase inhibitors or other agents may provide new strategies for the prevention of neointimal thickening.
Clínica E Investigación En Arteriosclerosis (english Edition), May 1, 2019
A group of experts convened by the Spanish Society of Arteriosclerosis (SEA) has been in charge o... more A group of experts convened by the Spanish Society of Arteriosclerosis (SEA) has been in charge of updating the SEA document on the indications of PCSK9 inhibitors (PCSK9i) in clinical practice that was published in 2016. This update is justified by the fact that the data from clinical trials carried out on a large scale with PCSK9i have shown that in addition to their high potency to lower atherogenic cholesterol, they reduce the risk of atherosclerotic cardiovascular disease, both in patients with stable disease, and with recent disease, and with a high degree of security. This update provides the recommendations and level of evidence for the prescription of iPCSK9 in patients with homozygous and heterozygous familial hypercholesterolemia, with atherosclerotic cardiovascular disease, and in primary prevention in patients with very high
Clinical Infectious Diseases, Aug 20, 2022
Background. This study was designed to evaluate if patients with high risk for severe coronavirus... more Background. This study was designed to evaluate if patients with high risk for severe coronavirus disease 2019 (COVID-19) would benefit from treatment with tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) followed by baricitinib in case of hypoxemia and systemic inflammation. Methods. PANCOVID is an open-label, double-randomized, phase 3 pragmatic clinical trial including adults with symptomatic COVID-19 with ≥2 comorbidities or aged ≥60 years and was conducted between 10 October 2020 and 23 September 2021. In the first randomization, patients received TDF/FTC or no TDF/FTC. In the second randomization, patients with room air oxygen saturation <95% and at least 1 increased inflammatory biomarker received baricitinib plus dexamethasone or dexamethasone alone. The primary endpoint was 28-day mortality. Main secondary endpoint was 28-day disease progression or critical care unit admission or mortality. The trial was stopped before reaching planned sample size due to the decrease in the number of cases and a mortality rate substantially lower than expected. Results. Of the 355 included participants, 97% were hospitalized at baseline. Overall, 28-day mortality was 3.1%. The 28-day mortality relative risk (RR) for participants treated with TDF/FTC was 1.76 (95% confidence interval [CI], .52-5.91; P = .379); it was 0.42 (95% CI, .11-1.59; P = .201) for those treated with baricitinib. The 28-day RR for the main secondary combined endpoint for participants treated with TDF/FTC was 0.95 (95% CI, .66-1.40; P = .774); it was 0.90 (95% CI, .61-1.33; P = .687) for those treated with baricitinib. Conclusions. Our results do not suggest a beneficial effect of TDF/FTC; nevertheless, they are compatible with the beneficial effect of baricitinib already established by other clinical trials.
Revista Clínica Española (English Edition), 2022
BACKGROUND AND AIMS There is no consensus regarding risk stratification tools for secondary preve... more BACKGROUND AND AIMS There is no consensus regarding risk stratification tools for secondary prevention in atherosclerotic cardiovascular disease. Our aim was to compare the discriminative performance of the Framingham, REGICOR, SCORE, and REACH risk functions and the Bohula-TIMI and SMART risk scores, as well as to assess the potential added value of other clinical variables for the prediction of recurrent events in patients with established vascular disease. METHODS A cohort of 269 patients with established vascular disease (52.8% coronary, 32% cerebrovascular, 15.2% PAD) was included. The survival functions of risk groups (low/medium/high) according to commonly used cutoff points for each function/score were compared, and hazard ratios for each were estimated using Cox regression. We calculated Δ Harrell's C statistic, cat-NRI, and cNRI after adding new predictors to a base model including age, sex, total cholesterol, current smoking status, hypertension, and diabetes. RESULTS After six years of follow-up (median 4.82 years), 61 events occurred (23%). High-risk groups had a higher risk of recurrent event: SMART (HR: 3.17 [1.55-6.5]), Framingham (HR: 3.08 [1.65-5.75]), REGICOR (HR: 2.71 [1.39-5.27]), SCORE (HR: 2.14 [1.01-4.5], REACH (HR: 5.74 [2.83-11.7]), B-TIMI (HR: 3.68 [0.88-15.3]). Polyvascular disease (three territories HR: 5.6 [2.2-14.25]), albuminuria (HR: 3.55 [2.06-6.11]), and heart failure (HR: 3.11 [1.34-7.25]) also increased risk. Discrimination (Harrell's C) was low but improved after adding albuminuria and polyvascular disease. Both variables also improved the performance of the base model (cNRI.326 [.036; .607]). CONCLUSIONS The Framingham, REGICOR, SCORE, and REACH functions and the B-TIMI and SMART scores showed low yet similar performance in secondary prevention. Albuminuria and polyvascular disease improved the predictive performance of major classical cardiovascular risk factors.
The Lancet Respiratory Medicine, 2021
Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on ... more Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre-including this research content-immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
REC: CardioClinics, 2021
The reduction of low-density lipoprotein cholesterol with lipid lowering therapy has demonstrated... more The reduction of low-density lipoprotein cholesterol with lipid lowering therapy has demonstrated to decrease the risk of developing cardiovascular complications during the follow-up in primary and secondary prevention. Unfortunately, a great number of patients do not achieve recommended targets. This is mainly due to an insufficient use of the lipidlowering therapy currently available. Although healthy life style changes are the basis of the treatment, in many cases this is not enough and it is necessary to add lipid lowering drugs to attain these targets. For these reasons, the current consensus document of the Spanish
Revista Española de Cardiología, 2019
Resumen El control actual de la concentracion de colesterol unido a lipoproteinas de baja densida... more Resumen El control actual de la concentracion de colesterol unido a lipoproteinas de baja densidad en el paciente con enfermedad cardiovascular ateroesclerotica es muy escaso y esto se asocia con un aumento del riesgo de que se presenten complicaciones cardiovasculares. Ademas, cuanto mas tarde se logren dichos objetivos, el riesgo sera mayor. Esto se debe principalmente a un uso insuficiente de las terapias hipolipemiantes actualmente disponibles. De hecho, con los tratamientos actuales (estatinas, ezetimiba e inhibidores de la proteina PCSK9), la mayoria de los pacientes en prevencion secundaria deberia lograr los objetivos de control del colesterol unido a lipoproteinas de baja densidad. Por estos motivos, en el presente documento promovido por la Sociedad Espanola de Cardiologia se proponen 3 algoritmos de abordaje sencillos y facilmente aplicables, que abarcan la mayoria de las situaciones clinicas que nos podemos encontrar en los pacientes con cardiopatia isquemica, con el doble objetivo de lograr controlar a la mayoria de los pacientes y hacerlo lo antes posible, ya que el beneficio en prevencion secundaria depende del riesgo y del tiempo.
Atherosclerosis, 2019
, p<0.001) and adherence (score <8): 54.1% vs 28.5% (p<0.001). They were more physically active (... more , p<0.001) and adherence (score <8): 54.1% vs 28.5% (p<0.001). They were more physically active (75.6% vs 56.3%, p<0.001), included more smokers (20.1% vs 17.2%, p<0.001) and less alcohol drinkers (62.7% vs 72.3%, p¼0.014). Overweight/obesity prevalence, waist circumference, blood pressure, total cholesterol, triglycerides were not different. The PLIC-CHIESA cohort showed lower HDL-C (58(13) vs 62(16) mg/dL, p<0.001) and higher LDL-C (131(31) vs 126(31) mg/dL, p¼0.037), glycaemia (98(15) vs 92(15) mg/dL, p<0.001), uric acid (8.2(12) vs 4.8(1.2) mg/dL), p<0.001). Compared to PLIC subjects, PLIC-CHIESA participants showed lower mean c-IMT (0.641(0.116) vs 0.703(0.167) mm, p<0.001), and reduced carotid atherosclerosis (23.4% vs 31.4%, p¼0.019) and CVD (9(2.5)% vs 27(7.6)% subjects) prevalences. Conclusions: The studies showed substantial differences concerning lifestyle features and cardiometabolic risk markers. In the PLIC-CHIESA cohort, lower sub-clinical atherosclerosis and CVD prevalence were found. Further insights into the determinants of such differences await the completion of PLIC-CHIESA enrollment.
Revista Clínica Española, 2022
Resumen Antecedentes y objetivos En la enfermedad cardiovascular ateroesclerotica no existe conse... more Resumen Antecedentes y objetivos En la enfermedad cardiovascular ateroesclerotica no existe consenso respecto a los instrumentos de estratificacion del riesgo en su prevencion secundaria. Nuestro objetivo consistia en comparar la capacidad discriminativa de las funciones de riesgo de Framingham, REGICOR, SCORE y REACH y las puntuaciones de riesgo Bohula-TIMI y SMART, asi como en evaluar el posible valor anadido de otras variables clinicas en cuanto a la prediccion de recurrencias en pacientes con enfermedad cardiovascular. Metodos Se analizo una cohorte de 269 pacientes con enfermedad cardiovascular establecida (52,8% coronaria, 32% cerebrovascular, 15,2% arteriopatia periferica). Se compararon las funciones de supervivencia de los grupos de riesgo (bajo/intermedio/alto) segun los valores de corte de uso habitual de cada funcion o puntuacion y se calcularon las razones de riesgos instantaneos (RRI) correspondientes a cada una mediante regresion de Cox. Se calculo el Δ C de Harrell, el cat-IRN y el cIRN despues de anadir nuevos factores predictivos a un modelo base que incluia edad, sexo, colesterol total, tabaquismo activo, hipertension arterial y diabetes. Resultados Al cabo de 6 anos de seguimiento (mediana de 4,82 anos) se habian producido 61 eventos (23%). Los grupos de riesgo alto tuvieron un mayor riesgo de recurrencia: SMART (RRI: 3,17 [1,55-6,5]), Framingham (RRI: 3,08 [1,65-5,75]), REGICOR (RRI: 2,71 [1,39-5,27]), SCORE (RRI: 2,14 [1,01-4,5], REACH (RRI: 5,74 [2,83-11,7]) y B-TIMI (RRI: 3,68 [0,88-15,3]). La enfermedad polivascular (3 territorios, RRI: 5,6 [2,2-14,25]), la albuminuria (RRI: 3,55 [2,06-6,11]) y la insuficiencia cardiaca (RRI: 3,11 [1,34-7,25]) tambien incrementaron el riesgo. La capacidad discriminativa (indice C de Harrell) fue baja, pero mejoro tras anadir la albuminuria y la enfermedad polivascular. Ambas variables tambien mejoraron el rendimiento del modelo base (cIRN: 0,326 [0,036; 0,607]). Conclusiones Las funciones de Framingham, REGICOR, SCORE y REACH y las puntuaciones B-TIMI y SMART mostraron un rendimiento bajo, aunque similar, en prevencion secundaria. La albuminuria y la enfermedad polivascular mejoraron el rendimiento predictivo de los principales factores de riesgo cardiovascular clasicos.
Clínica E Investigación En Arteriosclerosis (english Edition), May 1, 2022
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Papers by Carlos Guijarro