Evaluation of the efficacy and safety of text messages targeting adherence to cardiovascular medications in secondary prevention: the txt2heart Colombia randomised controlled trial (Preprint)

Background: Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of mortality in the world. Prevalence is estimated at around 100 million patients worldwide. There is evidence that antiplatelet agents and antihypertensive medication reduce the risk of new vascular events in this population, but treatment adherence is very low. Objective: We developed an intervention based on behavioral modification techniques delivered via mobile short message services (SMS) to increase the adherence to pharmacologic treatment on patients with prior history of ASCVD. Methods: We conducted a randomized controlled clinical trial for patients with a prior diagnosis of cardiovascular event such as acute myocardial infarction, unstable angina, cerebrovascular disease or peripheral artery disease in one centre in Colombia. Patients randomized to the intervention arm were assigned to receive SMS daily for the first 4 weeks, five SMS on week 5: three SMS per week from week 6, and one SMS from 8th week until 52nd week. Patients in the control arm received a monthly SMS reminding them of the next study appointment, requesting information about changes in phone number, thanking them for participating in the study and reminding them of the importance of the study. Primary endpoint was change in Low Density Lipoprotein-Cholesterol (LDL-C) and the secondary endpoints were change in thromboxane B2 levels, heart rate, systolic and diastolic blood pressure. Medication adherence was measured with the Medication Adherence Report Scale (MARS 5), mortality and new cardiac hospitalization were assessed at one year end point. A logistic regression analysis and bivariate testing was performed. Results: Nine hundred and thirty patients were randomized, 805 (87%) completed follow up, and were analyzed for the primary endpoint. There was no difference between arms in change of LDL-C at 12 months (P=.41). or for any of the secondary outcomes. No adverse events were reported. Conclusions: In our study we did not find evidence that a behavior modification intervention delivered by SMS improved LDL-C, blood pressure levels or adherence at 12 months. More research is needed to evaluate whether different SMS strategies including personalized messages and with different timing are effective; future studies should include mixed methods to understand better why, for whom and in which context (e.g. health system, social environment) SMS interventions work (or not) to improve adherence in patients with ASCVD. Clinical Trial: Clinicaltrial.gov NCT03098186. Date of registration: March 31st 201

Relationship between disease activity status or clinical response and patient-reported outcomes in patients with non-radiographic axial spondyloarthritis: 104-week results from the randomized controlled EMBARK study

Background We assessed the external validity of composite indices Ankylosing Spondylitis Disease Activity Score (ASDAS), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and Assessment in SpondyloArthritis international Society (ASAS) 40 response (ASAS40) by evaluating the correlations between the changes in some patient reported outcomes (PROs) for patients with non-radiographic axial spondyloarthritis (nr-axSpA) and the changes in the scores of the composite indices. Methods This was a post-hoc analysis of data from the EMBARK study in patients with nr-axSpA treated with etanercept. PROs were grouped according to ASDAS status (inactive [= 1.3 to = 2.1 to 3.5]), patient achievement of > 50% improvement in BASDAI (BASDAI50 responders), and > 40% improvement in ASAS (ASAS40 responders) at 104 weeks. Analyses were conducted on observed cases available at Week 104. Changes in PROs from Baseline to Week 104 were assessed using analysis of covariance with adjustment for baseline with linear contrast. Results Higher ASDAS disease activity at 104 weeks was associated with lower long-term improvement from baseline in PROs (e.g., total back pain [visual analog scale, cm (95% confidence interval): - 4.58 (- 4.95, - 4.21), - 3.86 (- 4.28, - 3.43), - 2.15 (- 2.68, - 1.61), and 1.30 (- 0.51, 3.12) for inactive, low, high, and very high ASDAS disease activity, respectively; Multidimensional Fatigue Inventory (MFI) general fatigue: - 4.77 (- 5.70, - 3.84), - 2.96 (- 4.04, - 1.87), - 1.00 (- 2.32, 0.31), and 2.14 (- 2.10, 6.38); all p < 0.001)]. BASDAI50 non-responders had less improvement in PROs from Baseline to Week 104 vs. responders (e.g., total back pain: - 1.61 (- 2.05, - 1.18) vs. -4.43 (- 4.69, - 4.18); MFI general fatigue: - 0.01 (- 1.12, 1.09) vs. -4.30 (- 4.98, - 3.62); all p < 0.001). ASAS40 non-responders also had less improvement in PROs from Baseline to Week 104 vs. responders (e.g., total back pain: - 1.91 (- 2.30, - 1.52) vs. -4.75 (- 5.05, - 4.46); MFI general fatigue: - 0.63 (- 1.56, 0.30) vs. -4.64 (- 5.37, - 3.91); all p < 0.001). Conclusion Composite indices are valid for monitoring treatment response and adequately reflect treatment-related changes experienced by patients with nr-axSpA.Pathophysiology and treatment of rheumatic disease

Better Health-Related Quality of Life and Work Capacity in Patients Achieving Inactive Disease and Clinical Response in Patients with Non-Radiographic Axial Spondyloarthritis

Pathophysiology and treatment of rheumatic disease

Vasculitis de grandes y medianos vasos. Características epidemiológicas, clínicas y paraclínicas

IP 2104-10-005-92Reumatologia. -- Vol. 12, no 2. -- (mar.-abr. 1997); p. 87-95.-- ISSN 01868969. -- Asociacion entre;Antonio Iglesias Gamarra. ... [et. al]. -- En: Revista Mexicanade Reumatologia. -- Vol. 10, no 4. --;anticuerpos contra el citoplasma de los neutrofilos (ANCA)y artritis reumatoide complicada con vasculitis /;(jul.-ago. 1994); p. 105-112. -- ISSN 01868969. -- Sindrome pulmon-riñon en lupus eritematoso sistemico.;Reporte de casos / Antonio Iglesias Gamarra. ... [et. al].--En: RevistaMexicana de Reumatologia. -- Vol.;Universidad Nacional de Colombia. -- Vol. 45, no 1. -- (1997);p. 16-20. -'- Enfermedad de buerger en el;Hospital San Juan de Dios / Antonio Iglesias Gamarra. ...[et.al]. -- En:Acta Medica Colombiana. -- Vol. 22,;no 3. -- (may.-jun. 1997); p. 125-131. -- Sindrome antifosfolipido cofactor / Antonio Iglesias Gamarra. ...;[et. al]. -- En: Acta Medica Colombiana. -- Vol. 22, no 4.--(jul.-ago. 1997); p. 188-198. -- Enfermedad de;Kawasaki y fenomeno de raynaud en un paciente de 15 años de edad/ AntonioIglesias Gamarra. ... [et. al]. --;En: Acta Medica Colombiana. -- Vol. 20, no 5. -- (sep.-oct. 1995); p. 241-244. -- Descripcion de un grupo de;pacientes con poliserositis como manifestacion temprana delupuseritematoso sistemico / Antonio Iglesias;Gamarra. ... [et. al]. -- En: Acta Medica Colombiana. -- Vol.22, no 2. --(mar.-abr. 1997); p. 78-84. --;Arteritis de takayasu en Colombia / Antonio Iglesias Gamarra.... [et. al]. -- En: Acta Medica Colombiana. --;Vol. 22, no 2. -- (mar.-abr. 1997); p. 85-92. -- Takayasuarteritis in Colombia / Antonio Iglesias Gamarra.;... [et. al]. -. En: International Journal of Cardiology.'-- Vol. 66. (1998); p. 73-79. -- Buerger's disease;at the San Juan de Dios Hospital, Santa fe de Bogotá, Colombia/Antonio Iglesias Gamarra. ... [et. al]. -- En;: International Journal of Cardiology. -- Vol. 66. (1998).--Vasculitis granulomatosa centrofacial: estudio;10, no 6. -- (nov.-dic. 1995); p. 185-194. -- ISSN 01868969. --Arterial fibrodysplasia causing occlusive;vascular disease simulating primary vasculitis / Antonio Iglesias Gamarra.... [et. al]. -- En: Revista de;Investigacion Clinica. -- Vol. 46, no 1. -- (ene.-feb. 1994);p.67-71. --ISSN 00348376. -- Un caso de lupus;asociado a mucinosis papulonodular / Antonio Iglesias Gamarra.... [et. al]. -- En: Revista de Investigacion;Clinica. -- Vol. 46, no 1. -- (ene.-feb. 1994); p. 63-66.'-- ISSN 00348376. -- Buerger's disease in the San;Juan de Dios hospital in Bogotá / Antonio Iglesias Gamarra. ...[et. al].'-- en: American College of;Rheumatology. -- Vol. 40, no 9. -- (Sep. 1997); p. 167. --Takayasu arteritis in Colombia / Antonio Iglesias;Gamarra. ... [et. al]. -- En: American College of Rheumatology.-- Vol. 40, no 9. -- (Sep. 1997); p. 169. --;Las Anexinas / Antonio Iglesias Gamarra. ... [et. al]. --En:Revista Colombiana de Reumatologia. -- Vol. 3,;no 1. -- (1996); p. 7-15. -- Asociacion de esclerosis sistemicay enfermedad de graves / Antonio Iglesias;Gamarra. ... [et. al]. -- En: Revista Colombiana de Reumatologia. -- Vol.3, no 1. -- (1996); p. 35-38. --;Criterios diagnosticos y clasificatorios de las enfermedades reumaticas /Antonio Iglesias Gamarra. ... [et.;al]. -- En: Revista Colombiana de Reumatologia. -- Vol. 4,no4.'-- (1997); p. 180-194. -- Vasculitis:;analisis de 12.683 protocolos de autopsia. Estudio de 34 casos/Antonio Iglesias Gamarra. ... [et. al]. --;En: Revista de la facultad de medicina Universidad Nacional deColombia. -- Vol. 44, no 2. -- (1996); p.;Revista Colombiana de Reumatologia. -- Vol. 5, no 1. -- (1998);p. 18-26.'-- Compromiso vascular en La;encefalitis herpetica / Antonio Iglesias Gamarra. ... [et.al].'-- en: Revista de la facultad de medicina;'-- Polyarticular sporothrix schenckii infection in an immunocompetent host: report f a case and review of the;literature / Antonio Iglesias Gamarra. ... [et. al]. -- En: Journal of clinical rheumatology. -- Vol. 2, no 4.; (Aug. 1996); p. 215-220. -- ISSN 1076-1608. -- Esclerosis sistemica progresiva sine escleroderma y;calcinosis universalis como manifestacion inicial / Antonio Iglesias Gamarra. ... [et. al]. -- En: Revista;Mexicana de Reumatologia. -- Vol. 9, no 3. -- (may.-jun. 1994);p. 129-137. -- ISSN 01868969. --;polineuropatia con compromiso de los cuatro miembros. Unaformade presentacion inusual de la panarteritis;75-80. -- Causas de muerte en lupus eritematoso sistemico:estudio de necropsias en 27 pacientes del Hospital;San Juan de Dios / Antonio Iglesias Gamarra. ... [et. al].--En: RevistaColombiana de Reumatologia. -- Vol.;4, no 3. -- (1997); p. 144-147. -- Sindrome de sjogren primario:Estudio prospectivo para conocer las;caracteristicas clinicas en nuestro medio / Antonio Iglesias Gamarra. ...[et. al]. -- En: Revista Colombiana;de Reumatologia. -- Vol. 4, no 3. -- (1997); p. 126-130. -'- anticuerpos contra citoplasma de neutrofilo;(ANCAs) en lupus eritematoso sistemico y artritis reumatoidea/Antonio Iglesias Gamarra. ... [et. al]. -- En:;nodosa / Antonio Iglesias Gamarra. ... [et. al]. -- En: RevistaMexicana de Reumatologia. -- Vol. 9, no 6. --;(nov.-dic. 1994); p. 199-205. -- ISSN 01868969. -- Linfomaangiocentrico de la linea media. Informe de tres;casos y revision de la literatura / Antonio Iglesias Gamarra.... [et al].'-- en: Revista Mexicana de;ARTICULO(S) EN REVISTA: Comment on transient osteoporosisof thehip / Antonio Iglesias Gamarra. ... [et.;al]. -- En: Journal of clinical rheumatology. -- Vol. 3, no 6.-- (Dic. 1997); p. 375-378. -- ISSN 10761608.;de seis casos y propuesta para su clasificacion / AntonioIglesias Gamarra. ... [et. al]. -- En: Biomedica. --;Vol. 14. -- (1994); p. 90-104. -- Analisis historico de las vasculitis, suclasificacion y propuesta para su;entendimiento / Antonio Iglesias Gamarra. ... [et. al]. --En:Biomedica.-- Vol. 13, no 1. -- (1993); p.;32-56. -- Surrogate markers of disease activity in patients withtakayasuarteritis a preliminary report from;the international network for the study of the systemic vasculitides (INSSYS) / Gary S. Hoffman, Alaa E. Ahmed;. -- En International Journal of Cardiology. -- Vol. 66, sup.1.'-- (1998); p. 191-194

Hyperinsulinemia is a predictor of new cardiovascular events in colombian patients with a first myocardial infarction

6 p.Background: Acute Myocardial Infarction (AMI) is one of the main causes of mortality and disability in Colombia. The factors associated to a new event in surviving subjects to a first AMI in our population have not yet been fully identified. Methods: Two hundred and ninety five surviving subjects to a first AMI (58.8±12.6 years) were included in a prospective cohort study between 2000 and 2006. Lipid profile, glycemia and plasma insulin levels were measured. Deaths of cardiovascular origin, a new AMI, unstable angina, heart failure, stroke, new myocardial revascularization or angioplasty were considered new cardiovascular events. Results: The study included 61 (20.6%) women and 234 (79.4%) men. The mean follow up time was 50± 30 months with a 38.9% incidence of new events. Fifty five patients (18.6%) were diabetic. Bi-varied analysis identified as risk factors for a new cardiovascular event the presence of: hypertension, anterior descending coronary artery stenosis, intrahospital cardiac failure, age over 55, low income, lack of education, Killip III–IV, heart rate over 76 bpm, pulse pressure over 80 mm Hg, total cholesterol over 200 mg/dl and insulin over 10 IU/ml. After logistic regression analysis, the log values of insulin remained as the only significant predictor for new cardiovascular events. Conclusions: Hyperinsulinism was the most important factor associated to the occurrence of new cardiovascular events in Colombian patients with AMI, which emphasizes the pivotal role of insulin resistance in the physiopathologic mechanisms of atherosclerosis, especially in undeveloped countries

Vasculitis de grandes y medianos vasos. Características epidemiológicas, clínicas y paraclínicas

IP 2104-10-005-92Reumatologia. -- Vol. 12, no 2. -- (mar.-abr. 1997); p. 87-95.-- ISSN 01868969. -- Asociacion entre;Antonio Iglesias Gamarra. ... [et. al]. -- En: Revista Mexicanade Reumatologia. -- Vol. 10, no 4. --;anticuerpos contra el citoplasma de los neutrofilos (ANCA)y artritis reumatoide complicada con vasculitis /;(jul.-ago. 1994); p. 105-112. -- ISSN 01868969. -- Sindrome pulmon-riñon en lupus eritematoso sistemico.;Reporte de casos / Antonio Iglesias Gamarra. ... [et. al].--En: RevistaMexicana de Reumatologia. -- Vol.;Universidad Nacional de Colombia. -- Vol. 45, no 1. -- (1997);p. 16-20. -'- Enfermedad de buerger en el;Hospital San Juan de Dios / Antonio Iglesias Gamarra. ...[et.al]. -- En:Acta Medica Colombiana. -- Vol. 22,;no 3. -- (may.-jun. 1997); p. 125-131. -- Sindrome antifosfolipido cofactor / Antonio Iglesias Gamarra. ...;[et. al]. -- En: Acta Medica Colombiana. -- Vol. 22, no 4.--(jul.-ago. 1997); p. 188-198. -- Enfermedad de;Kawasaki y fenomeno de raynaud en un paciente de 15 años de edad/ AntonioIglesias Gamarra. ... [et. al]. --;En: Acta Medica Colombiana. -- Vol. 20, no 5. -- (sep.-oct. 1995); p. 241-244. -- Descripcion de un grupo de;pacientes con poliserositis como manifestacion temprana delupuseritematoso sistemico / Antonio Iglesias;Gamarra. ... [et. al]. -- En: Acta Medica Colombiana. -- Vol.22, no 2. --(mar.-abr. 1997); p. 78-84. --;Arteritis de takayasu en Colombia / Antonio Iglesias Gamarra.... [et. al]. -- En: Acta Medica Colombiana. --;Vol. 22, no 2. -- (mar.-abr. 1997); p. 85-92. -- Takayasuarteritis in Colombia / Antonio Iglesias Gamarra.;... [et. al]. -. En: International Journal of Cardiology.'-- Vol. 66. (1998); p. 73-79. -- Buerger's disease;at the San Juan de Dios Hospital, Santa fe de Bogotá, Colombia/Antonio Iglesias Gamarra. ... [et. al]. -- En;: International Journal of Cardiology. -- Vol. 66. (1998).--Vasculitis granulomatosa centrofacial: estudio;10, no 6. -- (nov.-dic. 1995); p. 185-194. -- ISSN 01868969. --Arterial fibrodysplasia causing occlusive;vascular disease simulating primary vasculitis / Antonio Iglesias Gamarra.... [et. al]. -- En: Revista de;Investigacion Clinica. -- Vol. 46, no 1. -- (ene.-feb. 1994);p.67-71. --ISSN 00348376. -- Un caso de lupus;asociado a mucinosis papulonodular / Antonio Iglesias Gamarra.... [et. al]. -- En: Revista de Investigacion;Clinica. -- Vol. 46, no 1. -- (ene.-feb. 1994); p. 63-66.'-- ISSN 00348376. -- Buerger's disease in the San;Juan de Dios hospital in Bogotá / Antonio Iglesias Gamarra. ...[et. al].'-- en: American College of;Rheumatology. -- Vol. 40, no 9. -- (Sep. 1997); p. 167. --Takayasu arteritis in Colombia / Antonio Iglesias;Gamarra. ... [et. al]. -- En: American College of Rheumatology.-- Vol. 40, no 9. -- (Sep. 1997); p. 169. --;Las Anexinas / Antonio Iglesias Gamarra. ... [et. al]. --En:Revista Colombiana de Reumatologia. -- Vol. 3,;no 1. -- (1996); p. 7-15. -- Asociacion de esclerosis sistemicay enfermedad de graves / Antonio Iglesias;Gamarra. ... [et. al]. -- En: Revista Colombiana de Reumatologia. -- Vol.3, no 1. -- (1996); p. 35-38. --;Criterios diagnosticos y clasificatorios de las enfermedades reumaticas /Antonio Iglesias Gamarra. ... [et.;al]. -- En: Revista Colombiana de Reumatologia. -- Vol. 4,no4.'-- (1997); p. 180-194. -- Vasculitis:;analisis de 12.683 protocolos de autopsia. Estudio de 34 casos/Antonio Iglesias Gamarra. ... [et. al]. --;En: Revista de la facultad de medicina Universidad Nacional deColombia. -- Vol. 44, no 2. -- (1996); p.;Revista Colombiana de Reumatologia. -- Vol. 5, no 1. -- (1998);p. 18-26.'-- Compromiso vascular en La;encefalitis herpetica / Antonio Iglesias Gamarra. ... [et.al].'-- en: Revista de la facultad de medicina;'-- Polyarticular sporothrix schenckii infection in an immunocompetent host: report f a case and review of the;literature / Antonio Iglesias Gamarra. ... [et. al]. -- En: Journal of clinical rheumatology. -- Vol. 2, no 4.; (Aug. 1996); p. 215-220. -- ISSN 1076-1608. -- Esclerosis sistemica progresiva sine escleroderma y;calcinosis universalis como manifestacion inicial / Antonio Iglesias Gamarra. ... [et. al]. -- En: Revista;Mexicana de Reumatologia. -- Vol. 9, no 3. -- (may.-jun. 1994);p. 129-137. -- ISSN 01868969. --;polineuropatia con compromiso de los cuatro miembros. Unaformade presentacion inusual de la panarteritis;75-80. -- Causas de muerte en lupus eritematoso sistemico:estudio de necropsias en 27 pacientes del Hospital;San Juan de Dios / Antonio Iglesias Gamarra. ... [et. al].--En: RevistaColombiana de Reumatologia. -- Vol.;4, no 3. -- (1997); p. 144-147. -- Sindrome de sjogren primario:Estudio prospectivo para conocer las;caracteristicas clinicas en nuestro medio / Antonio Iglesias Gamarra. ...[et. al]. -- En: Revista Colombiana;de Reumatologia. -- Vol. 4, no 3. -- (1997); p. 126-130. -'- anticuerpos contra citoplasma de neutrofilo;(ANCAs) en lupus eritematoso sistemico y artritis reumatoidea/Antonio Iglesias Gamarra. ... [et. al]. -- En:;nodosa / Antonio Iglesias Gamarra. ... [et. al]. -- En: RevistaMexicana de Reumatologia. -- Vol. 9, no 6. --;(nov.-dic. 1994); p. 199-205. -- ISSN 01868969. -- Linfomaangiocentrico de la linea media. Informe de tres;casos y revision de la literatura / Antonio Iglesias Gamarra.... [et al].'-- en: Revista Mexicana de;ARTICULO(S) EN REVISTA: Comment on transient osteoporosisof thehip / Antonio Iglesias Gamarra. ... [et.;al]. -- En: Journal of clinical rheumatology. -- Vol. 3, no 6.-- (Dic. 1997); p. 375-378. -- ISSN 10761608.;de seis casos y propuesta para su clasificacion / AntonioIglesias Gamarra. ... [et. al]. -- En: Biomedica. --;Vol. 14. -- (1994); p. 90-104. -- Analisis historico de las vasculitis, suclasificacion y propuesta para su;entendimiento / Antonio Iglesias Gamarra. ... [et. al]. --En:Biomedica.-- Vol. 13, no 1. -- (1993); p.;32-56. -- Surrogate markers of disease activity in patients withtakayasuarteritis a preliminary report from;the international network for the study of the systemic vasculitides (INSSYS) / Gary S. Hoffman, Alaa E. Ahmed;. -- En International Journal of Cardiology. -- Vol. 66, sup.1.'-- (1998); p. 191-194