DSpace Repository :: Browsing by Author "Lanas, Fernando"

Browsing by Author "Lanas, Fernando"

Now showing 1 - 4 of 4

Candidate Interventions for Integrating Hypertension and Cardiovascular-Kidney-Metabolic Care in Primary Health Settings: HEARTS 2.0 Phase 1
(2025) Rosende, Andres; Romero, Cesar; DiPette, Donald; Brettler, Jeffrey; Van der Stuyft, Patrick; Satheesh, Gautam; Perel, Pablo; Chapman, Niamh; Moran, Andrew; Schutte, Aletta; Sharman, James; Irazola, Vilma; Huffman, Mark; Campbell, Norm; Salam, Abdul; Lanas, Fernando; Coca, Antonio; Garcia, Sebastian; Ferreiro, Alejandro; Lopez, Patricio; Rico, Jorge; Ridley, Emily; Picone, Dean; Flood, David; Piñeiro, Daniel; Neira, Carolina; Rodriguez, Gonzalo; Wellmann, Irmgardt; Orias, Marcelo; Rivera, Marcela; Villatoro, Matías; Onuma, Oyere; Ramroop, Shaun; Khan, Taskeen; Valdes, Yamile; Kunz, Weimar; Plavnik, Frida; Zuniga, Eric; Grassani, Ana; Tajer, Carlos; Zaidel, Ezequiel; Marin, Marcos; Cyr-Philbert, Shana; Amorin, Ignacio; Diaz, Miguel; Bortolotto, Luiz; Avezum, Alvaro; Ribeiro, Antonio; Tobe, Sheldon; Aumala, Teresa; Angell, Sonia; Lavados, Pablo; Ouriques, Sheila; Munera, Ana; Jaffe, Marc; Prabhakaran, Dorairaj; Parati, Gianfranco; Zhang, Xin Hua; Rodgers, Anthony; Yusuf, Salim; Whelton, Paul; Ordunez, Pedro
Background: HEARTS in the Americas is the regional adaptation of the WHO Global HEARTS Initiative, aimed at helping countries enhance hypertension and cardiovascular disease (CVD) risk management in primary care settings. Its core implementation tool, the HEARTS Clinical Pathway, has been adopted by 28 countries. To improve the care of hypertension, diabetes, and chronic kidney disease (CKD), HEARTS 2.0 was developed as a three-phase process to integrate evidence-based interventions into a unified care pathway, ensuring consistency across fragmented guidelines. This paper focuses on Phase 1, highlighting targeted interventions to improve and update the HEARTS Clinical Pathway. Methods: First, the coordinating group defined the project's scope, objectives, principles, methodological framework, and tools. Second, international experts from different disciplines proposed interventions to enhance the HEARTS Clinical Pathway. Third, the coordinating group harmonized these proposals into unique interventions. Fourth, experts appraised the appropriateness of the proposed interventions on a 1-to-9 scale using the adapted RAND/UCLA Appropriateness Method. Finally, interventions with a median score above 6 were deemed appropriate and selected as candidates to enhance the HEARTS Clinical Pathway. Results: Building on the existing HEARTS Clinical Pathway, 45 unique interventions were selected, including community-based screening, early detection and management of risk factors, lower blood pressure thresholds for diagnosing hypertension in high-CVD-risk patients, reinforcement of single-pill combination therapy, inclusion of sodium-glucose cotransporter-2 inhibitors for patients with diabetes, CKD, or heart failure, expanded roles for non-physician health workers in team-based care, and strengthened clinical documentation, monitoring, and evaluation. Conclusion: HEARTS 2.0 Phase 1 identifies key interventions to integrate and improve hypertension and cardiovascular-kidney-metabolic care within primary care, enabling their seamless incorporation into a unified and effective clinical pathway. This process will inform an update to the HEARTS Clinical Pathway, optimizing resources, reducing care fragmentation, improving care delivery, and advancing health equity, thereby supporting global efforts to combat the leading causes of death and disability.
Characterization of microbial communities from gut microbiota of hypercholesterolemic and control subjects
(2022) Morales, Cristian; Rojas, Gabriel; Rebolledo, Camilo; Rojas, Marcelo; Arias, Raúl; Cuadros, Sara; Maracaja, Vinicius; Saavedra, Kathleen; Leal, Pamela; Lanas, Fernando; Salazar, Luis; Saavedra, Nicolas
Introduction: In recent years, several studies have evidenced the importance of the microbiome to host physiology as metabolism regulator, along with its potential role in triggering various diseases. In this study, we analyzed the gut microbiota in hypercholesterolemic (cases) and normocholesterolemic (controls) individuals to identify characteristic microbial signature for each condition. Methods: Stool samples were obtained from 57 adult volunteers (27 hypercholesterolemic and 30 controls). The taxonomic profiling of microbial communities was performed using high-throughput sequencing of 16S rRNA V3-V4 amplicons, followed by data analysis using Quantitative Insights Into Microbial Ecology 2 (QIIME2) and linear discriminant analysis (LDA) effect size (LEfSe). Results: Significant differences were observed in weight, height, body mass index (BMI) and serum levels of triglycerides, total cholesterol and low-density lipoprotein cholesterol (LDL-C) between the groups (p<0.05). LEfSe showed differentially abundant prokaryotic taxa (α=0.05, LDA score > 2.0) in the group of hypercholesterolemic individuals (Methanosphaera, Rothia, Chromatiales, Clostridiales, Bacillaceae and Coriobacteriaceae) and controls (Faecalibacterium, Victivallis and Selenomonas) at various taxonomic levels. In addition, through the application of Phylogenetic Investigation of Communities by Reconstruction of Unobserved States 2 (PICRUSt2), the predominance of pathways related to biosynthesis in hypercholesterolemic patients was established, compared to controls in which degradation pathways were predominant. Finally, in the analysis of co-occurrence networks, it was possible to identify associations between the microorganisms present in both studied groups. Conclusion: Our results point out to unique microbial signatures, which likely play a role on the cholesterol metabolism in the studied population.
Percutaneous or surgical revascularization in patients with severe left main coronary artery disease in Latin America: A GRADE clinical practice guideline
(2025) Lamelas, Pablo; Pompeu, Michel; Izcovich, Ariel; Bottaro, Federico; Tisi Baña, Matias; Sosa Liprandi, María Inés; Lanas, Fernando; Vilca Mejia, Omar Asdrúbal; Zuñiga Luna, Mauricio; Aubanel, Patricia; Munera, Ana; Contreras Reyes, Juan; Bagur, Rodrigo; Whitlock, Richard; Garcia Garcia, Héctor; Mamas Mamas; Cohen, Mauricio G.; Ricalde, Alejandro; Abizaid, Alexandre; Mendiz, Oscar; Araya, Mario; Costa, Ricardo; Santaera, Omar; Hidalgo, Pedro; Caldonazo, Tulio; Baranchuk, Adrian; Ragusa, Martin Alberto; SOLACI; SIAC
Background Severe left main coronary artery disease (LMD) poses a major treatment challenge in Latin America, where both percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are used. Methods This guideline was developed de novo using the GRADE approach. A multidisciplinary panel reviewed evidence from a systematic review of randomized trials comparing PCI and CABG, incorporating a comprehensive literature search of patient values and preferences and outcome utilities. Thresholds were assigned for each clinical outcome, from small to large effect. Results Five randomized trials enrolling 4612 patients were included. At 30 days, PCI resulted in a large reduction in major bleeding and a small reduction in strokes. At 5 years, PCI was associated with a small to moderate increase of spontaneous myocardial infarction and a moderate to large increase in repeat revascularization. No important differences in short- or long-term mortality were observed between PCI and CABG. The overall certainty of evidence was rated low. There was a notable variability in patient values and a close call on the balance of effects. Conclusions For patients in Latin America with severe left main coronary artery disease, the guideline panel suggests either PCI or CABG. This is a conditional recommendation, based on low certainty in the evidence (⨁⨁◯◯). It applies when both procedures are clinically and anatomically appropriate and can be performed at centers meeting acceptable standards. The decision should be made through a shared decision-making process involving the patient and the multidisciplinary care team.
Risk and impact of stroke across 38 countries and territories of the Americas from 1990 to 2021: a population-based trends analysis from the Global Burden of Disease Study 2021
(2025) Martinez, Ramón; Munoz Venturelli, Paula; Ordunez, Pero; Fregni, Felipe; Abanto, Carlos; Alet, Matias; Alvarez, Tony; Amaya, Pablo; Ameriso, Sebastian; Arauz, Antonio; Barboza, Miguel; Bayona, Hernán; Ortiz, Antonio; Calleja, Juan; Cano, Vanessa; Carbonera, Leonardo; Carrillo, Rodrigo; Corredor, Angel; De Souza, Ana; Jimenez, Claudio; Lanas, Fernando; Martins, Sheila; Navia, Víctor; Novarro, Nelson; Olavarría, Verónica V.; Ovbiagele, Bruce; Pachecho, Kevin; Pontes, Octavio; Pujol, Virginia; Rabinstein, Alejandro; Rosales, Julieta; Rosende, Andrés; Sampaio, Gisele; Saposnik, Gustavo; Sen, Souvik; Testai, Fernando; Urrutia, Victor; Anderson, Craig; Lavados, Pablo
Background: Despite substantial declines in burden over time, stroke remains a public health threat in the Americas. This study aimed to assess the current magnitude, trends, and disparities in the estimates of stroke burden by sex and age in the Americas from 1990 to 2021. Methods: Estimates from the Global Burden of Disease, Injuries and Risk Factors Study 2021 were used to analyze incidence, prevalence, mortality, years of life lost due to premature death, years lived with disabilities, and disability-adjusted life years (DALYs) caused by stroke and its major subtypes stratified by age, and sex in the Americas from 1990 to 2021. We used Joinpoint regression analysis to estimate the average annual percent change (AAPC) of stroke mortality and disease burden outcomes and assessed trends. Findings: In 2021, there were 1.1 million (95% uncertainty interval: 1.0-1.2) new cases, 12.9 million (12.3-13.7) prevalent cases, 0.5 million (0.5-0.6) deaths, and 11.4 million (10.6-12.1) DALYs due to stroke in the Americas. The absolute number of stroke burden outcomes increased from 1990 to 2021, but their corresponding age-standardized rates significantly declined. A deceleration in reduction rates of burden outcomes for all strokes and most stroke subtypes occurred over the last decade, with pronounced difference between sexes mainly in incidence among younger groups. From 2015 to 2021, trends in incidence rates from all stroke and stroke subtypes reversed to increase in most age groups, and strikingly, trends in mortality and DALY rates from ischemic stroke among younger populations reversed to upward with AAPC over 1.4%. A substantial number of countries contributed to these increasing trends. Interpretation: Regionally, the annual number of stroke cases and deaths significantly increased from 1990 to 2021, despite reductions in age-standardized rates. The declining pace in age-standardized stroke rates has decelerated in recent years, while trends in incidence, and ischemic stroke mortality and DALY among middle-aged adults and adults, reversed towards upward in the period 2015-2021. Further studies are needed to understand the determinants of this recent pattern and identify the most cost-effective interventions to stem this alarming trend. Funding: There was no funding source for this study.

Browsing by Author "Lanas, Fernando"

Results Per Page

Sort Options