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Castro Conde A, Marzal Martín D, Campuzano Ruiz R, Fernández Olmo MR, Morillas Ariño C, Gómez Doblas JJ, Gorriz Teruel JL, Mazón Ramos P, García-Moll Marimon X, Soler Romeo MJ, León Jiménez D, Arrarte Esteban V, Obaya Rebollar JC, Escobar Cervantes C, Gorgojo Martínez JJ. Comprehensive Cardiovascular and Renal Protection in Patients with Type 2 Diabetes. J Clin Med 2023; 12:3925. [PMID: 37373620 PMCID: PMC10299569 DOI: 10.3390/jcm12123925] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 05/19/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023] Open
Abstract
Type 2 diabetes (T2DM) is one of the main public health care problems worldwide. It is associated with a marked increased risk of developing atherosclerotic vascular disease, heart failure, chronic kidney disease and death. It is essential to act during the early phases of the disease, through the intensification of lifestyle changes and the prescription of those drugs that have been shown to reduce these complications, with the aim not only of achieving an adequate metabolic control, but also a comprehensive vascular risk control. In this consensus document, developed by the different specialists that treat these patients (endocrinologists, primary care physicians, internists, nephrologists and cardiologists), a more appropriate approach in the management of patients with T2DM or its complications is provided. A particular focus is given to the global control of cardiovascular risk factors, the inclusion of weight within the therapeutic objectives, the education of patients, the deprescription of those drugs without cardiovascular benefit, and the inclusion of GLP-1 receptor agonists and SGLT2 inhibitors as cardiovascular protective drugs, at the same level as statins, acetylsalicylic acid, or renin angiotensin system inhibitors.
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Affiliation(s)
| | | | | | | | | | | | | | - Pilar Mazón Ramos
- Cardiology Department, Complejo Hospitalario Universitario Santiago de Compostela, 15706 A Coruña, Spain;
| | | | | | - David León Jiménez
- Internal Medicine Department, University Hospital Virgen del Rocío, 41013 Sevilla, Spain;
| | | | | | | | - Juan J. Gorgojo Martínez
- Department of Endocrinology and Nutrition, University Hospital Fundación Alcorcón, 28922 Madrid, Spain;
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Moreno Obregón F, Espino Montoro A, Marín Martín J, León Jiménez D. Cetoacidosis diabética grave, fracaso renal agudo y deshidratación por canagliflozina en paciente con diabetes mellitus tipo 2: presentación clínica atípica. Aten Primaria 2019; 51:664-666. [PMID: 31326123 PMCID: PMC6930940 DOI: 10.1016/j.aprim.2019.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 04/04/2019] [Accepted: 04/22/2019] [Indexed: 01/06/2023] Open
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Pareja-Obregón Prieto A, Rufo Muñoz M, León Jiménez D. Massive cerebral hematoma with electrocardiographic abnormalities. Emergencias 2019; 30:443. [PMID: 30638356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
| | - Miguel Rufo Muñoz
- Servicio de Cuidados Críticos y Urgencias, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - David León Jiménez
- Servicio de Cuidados Críticos y Urgencias, Hospital Universitario Virgen del Rocío, Sevilla, España
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Affiliation(s)
- David León Jiménez
- Vascular Risk Unit, Internal Medicine Department, Virgen Rocio University Hospital, Sevilla 41013, Spain.
| | | | - José Pablo Miramontes González
- Internal Medicine Department, Clinic University Hospital, Valladolid, IBSAL: Instituto de investigaciones biomédicas de Salamanca, Spain
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Miramontes-González JP, Usategui-Martín R, Pérez de Isla L, Alonso R, Muñiz-Grijalvo O, Díaz-Díaz JL, Zambón D, Jiménez FF, Martín-Vallejo J, Rodríguez Gude AE, Jiménez DL, Padro T, González-Sarmiento R, Mata P. VEGFR2 and OPG genes modify the risk of subclinical coronary atherosclerosis in patients with familial hypercholesterolemia. Atherosclerosis 2019; 285:17-22. [PMID: 30991288 DOI: 10.1016/j.atherosclerosis.2019.03.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 03/18/2019] [Accepted: 03/29/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND AIMS Heterozygous familial hypercholesterolemia (FH) is a genetic disorder characterized by high levels of low-density lipoprotein cholesterol (LDL-C). The magnitude of atherosclerotic cardiovascular disease (ASCVD) risk in FH patients is highly variable, and this can result from genetic factors. The aim of our study was to characterize whether polymorphisms in VEGFR2 and OPG genes could influence the expression of ASCVD in FH patients. METHODS We studied 318 FH patients from the SAFEHEART registry, without clinical diagnosis of ASCVD. A coronary tomographic angiography (CTA) was performed to determine and evaluate the presence of coronary stenosis and coronary artery calcium, as measured by coronary calcium score (CCS). Genotyping of OPG rs2073618 and VEGFR2 rs2071559 polymorphisms was performed using TaqMan 5'-exonuclease allelic discrimination assays. RESULTS Homozygous GG genotype and G allele of VEGFR2 rs2071559 polymorphism were associated with decreased risk of developing coronary artery stenosis. In the analysis of OPG rs2073618 and VEGFR2 rs2071559 polymorphisms, according to the presence of coronary artery calcium, we found significant differences in both polymorphisms. Homozygous GG genotype and G allele of VEGFR2 rs2071559 polymorphism were associated with decreased risk of accumulation of coronary artery calcium measured by CCS in CTA. Moreover, being a carrier of the GG genotype and G allele of the OPG rs2073618 polymorphism increased the risk of the presence of coronary artery calcium measured by CCS in CTA. CONCLUSIONS Polymorphisms in VEGFR2 and OPG genes modify the risk of ASCVD in FH patients.
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Affiliation(s)
- José Pablo Miramontes-González
- Unidad de Lípidos, Medicina Interna Hospital Universitario de Salamanca, Spain; Instituto de Investigación Biomédica de Salamanca, IBSAL, Spain; Unidad de Medicina Molecular, Departamento de Medicina, Universidad de Salamanca, Salamanca, Spain.
| | - Ricardo Usategui-Martín
- Instituto de Investigación Biomédica de Salamanca, IBSAL, Spain; Unidad de Medicina Molecular, Departamento de Medicina, Universidad de Salamanca, Salamanca, Spain
| | - Leopoldo Pérez de Isla
- Cardiology Departament, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain; Fundación Hipercolesterolemia Familiar, Madrid, Spain
| | - Rodrigo Alonso
- Fundación Hipercolesterolemia Familiar, Madrid, Spain; Nutrition Departament, Clínica Las Condes, Santiago de Chile, Chile
| | | | | | - Daniel Zambón
- Lipids Clinic, Department of Endocrinology, Hospital Clinic, (IDIBAPS) Institut d'Investigacions Biomèdiques August Pi i Sunyer University of Barcelona, Barcelona, Spain
| | - Francisco Fuentes Jiménez
- Lipids and Atherosclerosis Unit, IMIBIC/Hospital Universitario Reina Sofía/Universidad de Cordoba, Spain; CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Javier Martín-Vallejo
- Instituto de Investigación Biomédica de Salamanca, IBSAL, Spain; Unidad de Medicina Molecular, Departamento de Medicina, Universidad de Salamanca, Salamanca, Spain
| | - Ana Elisa Rodríguez Gude
- Unidad de Lípidos, Medicina Interna Hospital Universitario de Salamanca, Spain; Unidad de Medicina Molecular, Departamento de Medicina, Universidad de Salamanca, Salamanca, Spain
| | - David León Jiménez
- Medicina Interna, Hospital Universitario Virgen Macarena de Sevilla, Sevilla, Spain
| | - Teresa Padro
- Instituto Catalán Ciencias Cardiovasculares, IIB-Sant Pau, Barcelona, Spain
| | - Rogelio González-Sarmiento
- Instituto de Investigación Biomédica de Salamanca, IBSAL, Spain; Unidad de Medicina Molecular, Departamento de Medicina, Universidad de Salamanca, Salamanca, Spain
| | - Pedro Mata
- Fundación Hipercolesterolemia Familiar, Madrid, Spain.
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León Jiménez D, López Chozas JM, Espino Montoro A, Rico Corral MÁ, Castilla Guerra L, Miramontes González JP. Could renin-angiotensin-aldosterone system activation explain the amputations associated with canagliflozin? The nitric oxide hypothesis. Diabetes Res Clin Pract 2019; 148:10-13. [PMID: 30583037 DOI: 10.1016/j.diabres.2018.12.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 11/21/2018] [Accepted: 12/17/2018] [Indexed: 12/12/2022]
Affiliation(s)
- David León Jiménez
- Unidad Riesgo Vascular, Medicina Interna, Hospital Universitario Virgen Macarena, Seville, Spain.
| | - José Manuel López Chozas
- Unidad Gestión Clínica Medicina Interna, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Antonio Espino Montoro
- Unidad Gestión Clínica Medicina Interna, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Miguel Ángel Rico Corral
- Unidad Riesgo Vascular, Medicina Interna, Hospital Universitario Virgen Macarena, Seville, Spain.
| | - Luis Castilla Guerra
- Unidad Riesgo Vascular, Medicina Interna, Hospital Universitario Virgen Macarena, Seville, Spain
| | - José Pablo Miramontes González
- Medicina Interna, Instituto de Investigación Biomédica de Salamanca (IBSAL), Hospital Universitario de Salamanca, Salamanca, Spain.
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León Jiménez D, Moreno Obregón F, Miramontes González JP. In response to Yaribeygi et al. "Sodium-glucose cotransporter 2 inhibitors and inflammation in chronic kidney disease: Possible molecular pathways". J Cell Physiol 2019; 234:9906-9907. [PMID: 30697745 DOI: 10.1002/jcp.28235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 01/22/2019] [Indexed: 11/06/2022]
Affiliation(s)
- David León Jiménez
- Medicina Interna. Hospital Universitario Virgen Rocío de Sevilla, Sevilla, Spain
| | | | - José Pablo Miramontes González
- Medicina Interna, Instituto de Investigación Biomédica de Salamanca (IBSAL), Hospital Universitario de Salamanca, Salamanca, Spain
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Moreno Obregón F, León Jiménez D, Pedregal González M. Clinical interview and mobile phone. Med Clin (Barc) 2019; 152:e7-e8. [PMID: 29887171 DOI: 10.1016/j.medcli.2018.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 04/24/2018] [Accepted: 04/26/2018] [Indexed: 11/16/2022]
Affiliation(s)
| | - David León Jiménez
- Unidad de Riesgo Vascular, Medicina Interna, Hospital Universitario Virgen Macarena, Sevilla, España
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León Jiménez D, Cherney DZI, Bjornstad P, Castilla-Guerra L, Miramontes González JP. Antihyperglycemic agents as novel natriuretic therapies in diabetic kidney disease. Am J Physiol Renal Physiol 2018; 315:F1406-F1415. [PMID: 30066584 DOI: 10.1152/ajprenal.00384.2017] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
While sodium-glucose cotransporter-2 (SGLT2) inhibitors have been used for the routine management of type 2 diabetes for several years, it is perhaps their natriuretic effects that are most important clinically. This natriuresis activates tubuloglomerular feedback, resulting in reduced glomerular hypertension and proteinuria, leading to renal protective effects in the EMPA-REG OUTCOME and CANVAS Program trials. In the cardiovascular system, it is likely that plasma volume contraction due to natriuresis in response to SGLT2 inhibition is at least in part responsible for the reduction in the risk of heart failure observed in these trials. We compare this mechanism of action with other antidiabetics. Importantly, other diuretic classes, including thiazide and loop diuretics, have not resulted in such robust clinical benefits in patients with type 2 diabetes, possibly because these older agents do not influence intraglomerular pressure directly. In contrast, SGLT2 inhibitors do have important physiological similarities with carbonic anhydrase inhibitors, which also act proximally, and have been shown to activate tubuloglomerular feedback.
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Affiliation(s)
- David León Jiménez
- Vascular Risk Unit, Internal Medicine Clinical Management Unit, Hospital Universitario Virgen Macarena , Seville , Spain
| | - David Z I Cherney
- Department of Medicine, Division of Nephrology. Toronto General Hospital, University of Toronto , Toronto , Ontario, Canada
| | - Petter Bjornstad
- Department of Pediatrics, Division of Endocrinology and Department of Medicine, Division of Renal Diseases and Hypertension, University of Colorado , Aurora, Colorado
| | - Luis Castilla-Guerra
- Vascular Risk Unit, Internal Medicine Clinical Management Unit, Hospital Universitario Virgen Macarena , Seville , Spain
| | - José Pablo Miramontes González
- Service of Internal Medicine, Institute of Biomedical Research of Salamanca (IBSAL), Hospital Universitario de Salamanca , Salamanca , Spain
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León Jiménez D, Pérez Temprano R, Ruiz Hueso R, Lopéz Chozas JM, Miramontes González JP. Reply to ‘Effects of sodium-glucose cotransporter 2 inhibitors on urinary excretion of intact and total angiotensinogen in patients with type 2 diabetes’ by Yoshimoto et al.. J Investig Med 2018; 66:e4. [DOI: 10.1136/jim-2017-000569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2017] [Indexed: 11/04/2022]
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León Jiménez D, Gómez Huelgas R, Miramontes González JP. The mechanism of action of sodium-glucose co-transporter 2 inhibitors is similar to carbonic anhydrase inhibitors. Eur J Heart Fail 2017; 20:409. [PMID: 29171186 DOI: 10.1002/ejhf.1068] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 10/03/2017] [Accepted: 10/03/2017] [Indexed: 11/07/2022] Open
Affiliation(s)
- David León Jiménez
- Medicina Interna, Hospital Universitario Virgen Macarena de Sevilla, Sevilla, Spain
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Pareja-Obregón Prieto A, Moreno Obregón F, León Jiménez D, Pérez Temprano R. [Digoxin: Does it have a rest at weekends?]. Aten Primaria 2017; 50:257-258. [PMID: 28869049 PMCID: PMC6837007 DOI: 10.1016/j.aprim.2017.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 05/15/2017] [Indexed: 11/17/2022] Open
Affiliation(s)
| | | | - David León Jiménez
- Medicina Interna, Hospital Universitario Virgen Macarena, Sevilla, España.
| | - Ramón Pérez Temprano
- Unidad de Gestión Clínica de Medicina Interna, Hospital Universitario Virgen Macarena, Sevilla, España
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León Jiménez D, Castilla Guerra L, López Chozas JM, Miramontes González JP. Update concept of the dual blocking of the renin-angiotensin-aldosteron system. A new therapeutic option? Med Clin (Barc) 2017; 150:33-38. [PMID: 28668172 DOI: 10.1016/j.medcli.2017.05.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 05/26/2017] [Accepted: 05/29/2017] [Indexed: 12/18/2022]
Affiliation(s)
- David León Jiménez
- Unidad de Gestión Clínica de Medicina Interna, Hospital Universitario Virgen Macarena, Sevilla, España.
| | - Luis Castilla Guerra
- Unidad de Riesgo Vascular, Hospital Universitario Virgen Macarena, Sevilla, España
| | - José Manuel López Chozas
- Unidad de Gestión Clínica de Medicina Interna, Hospital Universitario Virgen Rocío, Sevilla, España
| | - José Pablo Miramontes González
- Servicio de Medicina Interna, Instituto de Investigación Biomédica de Salamanca (IBSAL), Hospital Universitario de Salamanca, Salamanca, España
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