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Article ; Online: [No title information]

Carmena, Rafael

Clinica e investigacion en arteriosclerosis : publicacion oficial de la Sociedad Espanola de Arteriosclerosis

2022

Title translation	Germán Camejo (1936-2021).
Language	Spanish
Publishing date	2022-05-16
Publishing country	Spain
Document type	Journal Article
ISSN	1578-1879
ISSN (online)	1578-1879
DOI	10.1016/j.arteri.2022.03.001
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Arteriosclerosis and other diseases in heads of government and its consequences for the population.

Carmena, Rafael

Clinica e investigacion en arteriosclerosis : publicacion oficial de la Sociedad Espanola de Arteriosclerosis

2021 Volume 33, Issue 5, Page(s) 267–271

Abstract: Heads of government with cerebrovascular arteriosclerosis and other diseases in key historical moments have led to decisions that have marked the destiny of countries not always in a beneficial direction. Severe diseases in political leaders in power ... ...

Title translation	Arteriosclerosis y otras enfermedades en líderes políticos y sus consecuencias para la población.
Abstract	Heads of government with cerebrovascular arteriosclerosis and other diseases in key historical moments have led to decisions that have marked the destiny of countries not always in a beneficial direction. Severe diseases in political leaders in power have often been hidden from citizens with the collaboration of personal physicians. The confidentiality of the patient-doctor relationship in special political circumstances should be reexamined and subjected to debate. Legal provisions to ensure total transparency of medical information about the health of heads of government should be implemented. Transparency ensures the trust of citizens.
MeSH term(s)	Arteriosclerosis ; Government ; Humans ; Physicians
Language	Spanish
Publishing date	2021-06-04
Publishing country	Spain
Document type	Journal Article
ISSN	1578-1879
ISSN (online)	1578-1879
DOI	10.1016/j.arteri.2021.04.001
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Article ; Online: Present and future of drug therapy in hypertension: an overview.

Redon, Josep / Carmena, Rafael

Blood pressure

2024 Volume 33, Issue 1, Page(s) 2320401

Abstract: Purpose: ...

Abstract	Purpose:
MeSH term(s)	Humans ; Hypertension/drug therapy ; Antihypertensive Agents/therapeutic use ; Blood Pressure
Chemical Substances	Antihypertensive Agents
Language	English
Publishing date	2024-03-06
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	1170048-8
ISSN	1651-1999 ; 1651-2480 ; 0803-7051 ; 0803-8023
ISSN (online)	1651-1999 ; 1651-2480
ISSN	0803-7051 ; 0803-8023
DOI	10.1080/08037051.2024.2320401
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Zs.A 3843: Show issues

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Article ; Online: Cardiovascular prevention in diabetes mellitus. Is it appropriate to speak of moderate or intermediate risk?

Martínez-Hervás, Sergio / Real, José T / Carmena, Rafael / Ascaso, Juan F

Clinica e investigacion en arteriosclerosis : publicacion oficial de la Sociedad Espanola de Arteriosclerosis

2023 Volume 36, Issue 2, Page(s) 80–85

Abstract: Diabetes, especially type 2, is considered a risk situation for atherosclerotic cardiovascular disease (ASCVD). Subjects with diabetes type 2 have a mortality rate due to ASCVD 3 times higher than that found in the general population, attributed to ... ...

Title translation	Prevención cardiovascular en la diabetes mellitus. ¿Es adecuado hablar de riesgo moderado o intermedio?
Abstract	Diabetes, especially type 2, is considered a risk situation for atherosclerotic cardiovascular disease (ASCVD). Subjects with diabetes type 2 have a mortality rate due to ASCVD 3 times higher than that found in the general population, attributed to hyperglycemia and the frequent association of other cardiovascular risk factors, such as atherogenic dyslipidemia. Numerous scientific societies have established a risk classification for ASCVD in diabetes based on 3 degrees (moderate, high and very high). The objectives of dyslipidemia control are clearly defined and accepted, and vary depending on the previously established cardiovascular risk. In moderate or intermediate risk, the guidelines propose a less intensive intervention, maintaining LDL-C levels<100mg/dL and NO-HDL-C levels<130mg/dL, and waiting 10 years until reaching the high-risk category to initiate more intensive treatment. However, during the decade of follow-up recommended in the guidelines, cholesterol deposition in the arterial wall increases, facilitating the development of an unstable and inflammatory atheromatous plaque, and the development of ASCVD. Alternatively, diabetes could be considered from the outset to be a high-risk situation and the goal should be LDL-C<70mg/dL. Furthermore, maintaining LDL-C levels<70mg/dL contributes to reducing and stabilizing atheromatous plaque, avoiding or reducing mortality episodes due to ASCVD during those years of diabetes evolution. Should we maintain the proposed objectives in subjects with diabetes and moderate risk for a decade until reaching the high cardiovascular risk phase or, on the contrary, should we adopt a more intensive stance from the beginning seeking to reduce cardiovascular risk in the majority of patients with diabetes? Is it better to wait or prevent with effective therapeutic measures from the first moment?
MeSH term(s)	Humans ; Cholesterol, LDL ; Risk Factors ; Plaque, Atherosclerotic ; Diabetes Mellitus, Type 2/complications ; Diabetes Mellitus, Type 2/drug therapy ; Atherosclerosis/etiology ; Atherosclerosis/prevention & control ; Atherosclerosis/drug therapy ; Dyslipidemias/epidemiology ; Cardiovascular Diseases/prevention & control ; Cardiovascular Diseases/complications ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use
Chemical Substances	Cholesterol, LDL ; Hydroxymethylglutaryl-CoA Reductase Inhibitors
Language	Spanish
Publishing date	2023-11-18
Publishing country	Spain
Document type	Journal Article
ISSN	1578-1879
ISSN (online)	1578-1879
DOI	10.1016/j.arteri.2023.10.003
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Article ; Online: Diabetogenic Action of Statins: Mechanisms.

Carmena, Rafael / Betteridge, D John

Current atherosclerosis reports

2019 Volume 21, Issue 6, Page(s) 23

Abstract: Purpose of review: Observational studies and meta-analyses of randomized clinical trials data have revealed a 10-12% increased risk of new-onset diabetes (NOD) associated with statin therapy; the risk is increased with intensive treatment regimens and ... ...

Abstract	Purpose of review: Observational studies and meta-analyses of randomized clinical trials data have revealed a 10-12% increased risk of new-onset diabetes (NOD) associated with statin therapy; the risk is increased with intensive treatment regimens and in people with features of the metabolic syndrome or prediabetes. The purpose of this review is to provide an updated summary of what is known about the potential mechanisms for the diabetogenic effect of statins. Recent findings: Hydroxyl methyl glutaryl coenzyme A reductase (HMGCoAR) is the target of statin therapy and the activity of this key enzyme in cholesterol synthesis is reduced by statins in a partial and reversible way. Mendelian randomization studies suggest that the effect of statins on glucose homeostasis reflect reduced activity of HMGCoAR. In vitro and in vivo data indicate that statins reduce synthesis of mevalonate pathway products and increase cholesterol loading, leading to impaired β-cell function and decreased insulin sensitivity and insulin release. While this effect has been thought to be a drug class effect, recent insights suggest that pravastatin and pitavastatin could exhibit neutral effects on glycaemic parameters in patients with and without diabetes mellitus. The mechanisms by which statins might lead to the development of NOD are unclear. The inhibition of HMGCoAR activity by statins appears to be a key mechanism. It is difficult to offer a comprehensive view regarding the diabetogenic effect of statins because our understanding of the most widely recognized potential mechanisms, i.e. underlying statin-induced reduction of insulin sensitivity and/or insulin secretion, is still far from complete. The existence of this dual mechanism is supported by the results of a study in a large group of non-diabetic men, showing that a 46% higher risk of NOD in statin users compared to non-users was accompanied by a significant 12% reduction in insulin secretion and a 24.3% increase in insulin resistance. Although statin therapy is associated with a modest increase in the risk of NOD (about one per thousand patient-years), patients should be reassured that the benefits of statins in preventing cardiovascular disease (CVD) events far outweigh the potential risk from elevation in plasma glucose.
MeSH term(s)	Aged ; Animals ; Blood Glucose/drug effects ; Cardiovascular Diseases/prevention & control ; Cholesterol/metabolism ; Diabetes Mellitus, Type 2/chemically induced ; Diabetes Mellitus, Type 2/epidemiology ; Humans ; Hydroxymethylglutaryl CoA Reductases/metabolism ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/adverse effects ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use ; Incidence ; Insulin/metabolism ; Male ; Metabolic Syndrome/chemically induced ; Mice ; Middle Aged ; Pravastatin/therapeutic use ; Quinolines/therapeutic use ; Risk Factors
Chemical Substances	Blood Glucose ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Insulin ; Quinolines ; Cholesterol (97C5T2UQ7J) ; Hydroxymethylglutaryl CoA Reductases (EC 1.1.1.-) ; Pravastatin (KXO2KT9N0G) ; pitavastatin (M5681Q5F9P)
Language	English
Publishing date	2019-04-30
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2057369-8
ISSN	1534-6242 ; 1523-3804
ISSN (online)	1534-6242
ISSN	1523-3804
DOI	10.1007/s11883-019-0780-z
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Zs.A 5534: Show issues

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Article ; Online: Chronic kidney disease as a cardiovascular risk factor.

Carmena, Rafael / Ascaso, Juan F / Redon, Josep

Journal of hypertension

2020 Volume 38, Issue 11, Page(s) 2110–2121

Abstract: Chronic kidney disease (CKD) is a public health threat with impact in cardiovascular risk. All forms of cardiovascular disease and mortality are more common in CKD. Treatment of cardiovascular risk factors, hypertension, dyslipidemia and diabetes is ... ...

Abstract	: Chronic kidney disease (CKD) is a public health threat with impact in cardiovascular risk. All forms of cardiovascular disease and mortality are more common in CKD. Treatment of cardiovascular risk factors, hypertension, dyslipidemia and diabetes is essential for cardiovascular and kidney protection. CKD is a marker of high or very high cardiovascular risk and its presence require early treatment and specific goals. Lifestyle is a pivotal factor, stopping smoking, reducing weight in the overweight or obese, starting regular physical exercise and healthy dietary pattern are recommended. Office BP should be lowered towards 130/80 mmHg or even lower if tolerated with sodium restriction and single pill combination, including angiotensin system blocker. Out-of-office BP monitoring, mainly 24-h assessment, is recommended. Diabetes requires treatment from the moment of diagnosis, but prediabetes benefits with lifestyle changes and metformin in patients stage 2 and 3a. iSGLT2 and GLP-1RA are initially recommended in T2D patients with high or very high cardiovascular risk. Concerning dyslipidemia, for patients in stage 4, LDL-C 55 mg/dl or less (1.4 mmol/l) and an LDL-C reduction of 50% or less from baseline is recommended. In stage 3, LDL-C goal is 70 mg/dl or less (1.8 mmol/l) and an LDL-C. reduction of at least 50% from baseline. Statins are the lipid-lowering therapy of choice with or without ezetimibe. Higher doses of statins are required as GFR declines. Available evidence suggests that combined PCSK9 inhibitors with maximally tolerated dose of statins may have an emerging role in treatment of dyslipidemia in CKD patients.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Diabetes Mellitus ; Dyslipidemias ; Female ; Heart Disease Risk Factors ; Humans ; Hypertension ; Life Style ; Male ; Middle Aged ; Renal Insufficiency, Chronic/epidemiology
Language	English
Publishing date	2020-07-10
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	605532-1
ISSN	1473-5598 ; 0263-6352 ; 0952-1178
ISSN (online)	1473-5598
ISSN	0263-6352 ; 0952-1178
DOI	10.1097/HJH.0000000000002506
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Zs.A 1885: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MO 614: Show issues

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Article ; Online: The diabetogenic action of statins - mechanisms and clinical implications.

Betteridge, D John / Carmena, Rafael

Nature reviews. Endocrinology

2016 Volume 12, Issue 2, Page(s) 99–110

Abstract: Treatment with statins has transformed primary and secondary prevention of cardiovascular disease (CVD), including thrombotic stroke. Evidence-based data demonstrate the benefits and safety of statin therapy and help to guide clinicians in the management ...

Abstract	Treatment with statins has transformed primary and secondary prevention of cardiovascular disease (CVD), including thrombotic stroke. Evidence-based data demonstrate the benefits and safety of statin therapy and help to guide clinicians in the management of populations at high risk of CVD. Nevertheless, clinical trials, meta-analyses and observational studies highlight a 10-12% increase in new-onset diabetes mellitus (NODM) among patients receiving statins. The risk further increases with intensive therapy and among individuals with known risk factors for NODM. Mechanisms underpinning this effect are not yet fully understood; however, Mendelian randomization studies suggest that they are related to lowered activity of HMG-CoA reductase, the target of statin therapy. In vitro research indicates that statins potentially impair β-cell function and decrease insulin sensitivity but how these findings relate to patients is unknown. In the clinic, statins should be prescribed on the basis of CVD risk and individual patient characteristics. In addition, diet and lifestyle interventions should be emphasized to help mitigate the risk of NODM. Individuals who develop NODM while taking statins do not exhibit increased microvascular disease, which is reassuring. In diabetes mellitus of long duration, the effect of statins on glycaemic control is small and unlikely to be clinically important.
MeSH term(s)	Animals ; Cardiovascular Diseases/drug therapy ; Diabetes Mellitus, Type 2/chemically induced ; Diabetes Mellitus, Type 2/genetics ; Diabetes Mellitus, Type 2/prevention & control ; Feeding Behavior ; Humans ; Hydroxymethylglutaryl CoA Reductases/genetics ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/adverse effects ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/pharmacology ; In Vitro Techniques ; Insulin Resistance ; Insulin-Secreting Cells/drug effects ; Mendelian Randomization Analysis ; Risk Factors ; Risk Reduction Behavior ; Secondary Prevention
Chemical Substances	Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Hydroxymethylglutaryl CoA Reductases (EC 1.1.1.-)
Language	English
Publishing date	2016-02
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2489381-X
ISSN	1759-5037 ; 1759-5029
ISSN (online)	1759-5037
ISSN	1759-5029
DOI	10.1038/nrendo.2015.194
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Zs.A 6336: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 2021: Bestellungen von Artikeln über das Online-Bestellformular ab Jg. 2022: Lesesaal (EG)
Zs.MG 93: Show issues

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Article ; Online: Importancia de la dislipidemia en la enfermedad cardiovascular: un punto de vista.

Ascaso, Juan F / Carmena, Rafael

Clinica e investigacion en arteriosclerosis : publicacion oficial de la Sociedad Espanola de Arteriosclerosis

2015 Volume 27, Issue 6, Page(s) 301–308

Abstract: The authors present their view on the prevention of cardiovascular diseases, accepting the European ESC/EAS guidelines. They consider that the aim of the lipid control, based on LDL-C goals, is essential for the prevention and treatment of cardiovascular ...

Title translation	Importance of dyslipidaemia in cardiovascular disease: a point of view.
Abstract	The authors present their view on the prevention of cardiovascular diseases, accepting the European ESC/EAS guidelines. They consider that the aim of the lipid control, based on LDL-C goals, is essential for the prevention and treatment of cardiovascular diseases. In subjects with metabolic syndrome (mainly, abdominal obesity, pre-diabetes and diabetes), the primary objective should be apoB or Non-HDL-C, which are better associated with cardiovascular risk. The treatment must be lifestyle changes and control of other risk factors. After calculating cardiovascular risk, statins are the first therapeutic step, with the strength and dose needed to achieve LDL-C goals. If targets are not achieved, ezetimibe or resins should be added. A new group of potent cholesterol-lowering agents, the PCSK-9 monoclonal antibodies, have recently been approved in Spain. Subjects at very high cardiovascular risk that have achieved LDL-C goals, or other objectives (apoB, Non-HDL-C), other drugs (fibrates, omega-3) capable of modifying triglycerides and HDL-C could be added, if necessary. Treatment to reduce cardiovascular risk and prevent cardiovascular disease has proven effective in all populations and at all age groups. Subjects older than 80years should be individually assessed, taking into consideration possible comorbidities.
MeSH term(s)	Aged, 80 and over ; Anticholesteremic Agents/administration & dosage ; Anticholesteremic Agents/therapeutic use ; Cardiovascular Diseases/etiology ; Cardiovascular Diseases/prevention & control ; Cholesterol, LDL/blood ; Dyslipidemias/complications ; Dyslipidemias/therapy ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/administration & dosage ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use ; Life Style ; Lipids/blood ; Metabolic Syndrome/complications ; Metabolic Syndrome/therapy ; Practice Guidelines as Topic ; Risk Factors
Chemical Substances	Anticholesteremic Agents ; Cholesterol, LDL ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Lipids
Language	Spanish
Publishing date	2015-11
Publishing country	Spain
Document type	Journal Article
ISSN	1578-1879
ISSN (online)	1578-1879
DOI	10.1016/j.arteri.2015.07.002
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Article ; Online: Type 2 diabetes, dyslipidemia, and vascular risk: rationale and evidence for correcting the lipid imbalance.

Carmena, Rafael

American heart journal

2005 Volume 150, Issue 5, Page(s) 859–870

Abstract: Type 2 diabetes is an important cardiovascular risk factor. A significant component of the risk associated with type 2 diabetes is thought to be because of its characteristic lipid "triad" profile of raised small dense low-density lipoprotein levels, ... ...

Abstract	Type 2 diabetes is an important cardiovascular risk factor. A significant component of the risk associated with type 2 diabetes is thought to be because of its characteristic lipid "triad" profile of raised small dense low-density lipoprotein levels, lowered high-density lipoprotein, and elevated triglycerides (TGs). Trials of statins and fibrates have included substantial numbers of patients with diabetes and indicate that lipid lowering reduces cardiovascular event rates in these patients. However, statins alone do not always address all the lipid abnormalities of diabetes. Fibrates, which have low affinity for peroxisome proliferator-activated receptor alpha (PPARalpha), improve most aspects of the atherogenic dyslipidemia of diabetes. Chronic elevations of free fatty acids (FFA) induce insulin resistance and contribute to the lipid triad of diabetes. Therefore, reducing their levels is likely to ameliorate insulin resistance and improve the lipid triad of diabetes. PPARs are intimately involved in the regulation of FFA: PPARalpha modulation increases FFA catabolism and PPARgamma agonism (eg, by thiazolidinediones) increases TG lipolysis, FFA transport, conversion of FFA to TGs, and safe storage of FFA. Integrating potent PPARalpha and PPARgamma activity may deliver greater improvement of the diabetic dyslipidemic profile and its attendant risks than selective PPAR activation.
MeSH term(s)	Cardiovascular Diseases/etiology ; Cardiovascular Diseases/metabolism ; Diabetes Mellitus, Type 2/complications ; Diabetes Mellitus, Type 2/drug therapy ; Diabetes Mellitus, Type 2/metabolism ; Diabetes Mellitus, Type 2/physiopathology ; Dyslipidemias/complications ; Dyslipidemias/metabolism ; Dyslipidemias/physiopathology ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use ; Lipid Metabolism ; Lipoproteins/metabolism ; PPAR alpha/agonists ; Risk Factors
Chemical Substances	Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Lipoproteins ; PPAR alpha
Language	English
Publishing date	2005-11
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	80026-0
ISSN	1097-6744 ; 0002-8703
ISSN (online)	1097-6744
ISSN	0002-8703
DOI	10.1016/j.ahj.2005.04.027
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Ui IV Zs.15: Show issues

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Book: La medicina pre-técnica en la antigua Grecia

Carmena, Rafael

2009

MeSH term(s)	History of Medicine ; History, Ancient
Keywords	Greece
Language	Spanish
Size	40 p.
Publisher	Real Academia de Medicina y Cirugía de Murcia
Publishing place	Murcia Spain
Document type	Book
Database	Catalogue of the US National Library of Medicine (NLM)

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