LÓPEZ FLECHER, MAVEL ESTEFANÍA

Preferred name
LÓPEZ FLECHER, MAVEL ESTEFANÍA
Official Name
Lopez-Flecher, Mavel
Main Affiliation
Scopus Author ID
59704126300

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    The positive impact of the Life's Essential 8 in the prevention of incident heart failure
    (Oxford University Press (OUP), 2025-02-08)
    LOPEZ JARAMILLO, JOSÉ PATRICIO  
    ;
    LOPEZ FLECHER, MAVEL ESTEFANIA  
    ;
    Jose P Lopez-Lopez
    Heart failure (HF) prevalence is increasing rapidly, particularly in middle- and low-income countries, contributing to considerable treatment costs and weakening their health systems.1 Individually, cardiovascular risk factors are associated with a higher risk of developing HF. For example, the NHANES I study reported that smoking is an independent risk factor for incident HF, apart from coronary artery disease (population attributable fraction = 17%).2 A recent meta-analysis showed that hypertension is associated with a 71% increase in the risk of HF and that a 20 mmHg increase in systolic blood pressure is associated with a 28% increase in HF risk.3 Similarly, a pooled analysis of 61 prospective studies on blood pressure and mortality from HF reported a hazard ratio (HR) of 0.53 [95% confidence interval (CI): 0.48–0.59] for a 20 mmHg lower systolic blood pressure.4 However, few studies have examined the combination and the effect of the trajectory, the burden of lifestyles, and the control of risk factors in large observational studies.
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    Self-Reported Prevalence of Chronic Non-Communicable Diseases Concerning Socioeconomic and Educational Factors: Analysis of the PURE-Ecuador Cohort
    (Ubiquity Press, Ltd., 2025-03-13)
    FELIX GALLEGOS, CAMILO EDGAR VINICIO  
    ;
    LOPEZ FLECHER, MAVEL ESTEFANIA  
    ;
    Michelle Vega
    ;
    Katherine Andrango
    ;
    Selena Andrango
    Background: The changing epidemiological landscape, marked by the increasing prominence of Non-Communicable Chronic Diseases (NCDs), underscores the need for studies that identify and analyze these conditions and their associated risk factors. This secondary analysis aims to describe the association between socioeconomic and educational characteristics and the prevalence of self-reported NCDs among participants in the PURE-Ecuador cohort in urban and rural populations of the Metropolitan District of Quito (MDQ), Ecuador. Methods: This secondary analysis is part of the Prospective Urban Rural Epidemiological (PURE) study. Data were collected from February to December 2018, including 2028 participants aged 35 to 70 years from different urban and rural areas of the MDQ. Data collection utilized standardized questionnaires administered in face-to-face interviews. Pearson’s chi-square tests and multivariate logistic regression were used to assess associations. Results: The self-reported prevalence of hypertension was 16.2%, rising to 32.7% in individuals over 60 years old. The prevalence of diabetes mellitus was 6.7%, coronary heart disease 1.3%, stroke 1.6%, heart failure 1.3%, COPD 0.4%, asthma 1.3%, and cancer 1.9%. Multimorbidity affected 5.9% of participants, with the highest rates in obese and older individuals (≥60 years). Adherence to medications was high for hypertension and diabetes mellitus but varied substantially between communities. Conclusions: The secondary analysis revealed significant disparities in the prevalence and management of NCDs in MDQ. The prevalence of self-reported NCDs in Quito, Ecuador, is significantly associated with age and body mass index (BMI). Older individuals, particularly those over 60 years, and obese participants demonstrated higher rates of NCDs and multimorbidity. While socioeconomic factors such as education and income showed some associations with NCD prevalence, these were less pronounced after adjusting for other variables. These findings highlight the importance of age-specific and obesity-focused interventions in addressing the burden of NCDs in this population.
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    Spironolactone versus placebo in patients undergoing maintenance dialysis - ACHIEVE: an international, parallel-group, randomised controlled trial
    (Elsevier BV, 2025-08)
    Michael Walsh
    ;
    David Collister
    ;
    Martin Gallagher
    ;
    Patrick B Mark
    ;
    Janak R de Zoysa
    Background: Patients undergoing maintenance dialysis for kidney failure are at substantial risk of cardiovascular morbidity and mortality. We aimed to establish if spironolactone reduces heart failure and cardiovascular deaths in these patients. Methods: ACHIEVE was an international, parallel-group, randomised controlled trial done in 143 dialysis programmes in 12 countries. Patients were aged 45 years or older, or aged 18 years or older with a history of diabetes, and were receiving maintenance dialysis for kidney failure for at least 3 months at the time of recruitment. Patients who were able to tolerate and adhere to spironolactone 25 mg daily orally during an open-label run-in were randomly assigned (1:1) to continue spironolactone or matching placebo, using a central computerised block randomisation system (block sizes of 4) stratified by centre. Participants, health-care providers, and those assessing outcomes were masked to group assignment. The primary outcome was a composite of cardiovascular mortality or hospitalisation for heart failure analysed as time-to-event in all randomly assigned participants. The trial was registered at ClinicalTrials.gov, NCT03020303. Findings: After a planned interim analysis of 75% of the expected primary outcome events, the external safety and efficacy monitoring committee recommended the trial be stopped early for futility. From Sept 19, 2017, to Oct 31, 2024, 3689 patients were screened for inclusion, 3565 of whom were enrolled in the open-label run-in phase, and 2538 were randomly assigned to spironolactone (n=1260) or placebo (n=1278). 931 (36·7%) participants were female and 1607 (63·3%) were male. Median follow-up was 1·8 years (IQR 0·85–3·35). The composite primary outcome occurred in 258 participants (10·46 events per 100 patient-years) in the spironolactone group and in 276 participants (11·33 per 100 patient-years) in the placebo group (hazard ratio [HR] 0·92 [95% CI 0·78–1·09]; p=0·35). Death from any cause was similar between groups (HR 0·95 [0·83–1·09]) as was hospitalisation for any cause (HR 0·96 [0·87–1·06]). Interpretation: Among patients receiving maintenance dialysis, spironolactone 25 mg daily orally did not reduce the composite outcome of cardiovascular mortality and hospitalisation due to heart failure compared with placebo. This trial did not identify a benefit of initiating spironolactone in patients receiving maintenance dialysis. Future research should consider alternatives to steroidal mineralocorticoid receptor antagonism to reduce cardiovascular morbidity and mortality in patients receiving maintenance haemodialysis. Funding: The Canadian Institutes of Health Research, The Medical Research Future Fund, The Health Research Council, The British Heart Foundation, Population Health Research Institute/Hamilton Health Sciences Research Institute, St Joseph's Healthcare Hamilton Division of Nephrology, Accelerating Clinical Trials Consortium, Can-SOLVE CKD Network, and the Dalhousie Department of Medicine.