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González-Vela, C. González-Juanatey" "autores" => array:3 [ 0 => array:4 [ "nombre" => "M.A." "apellidos" => "González-Gay" "email" => array:1 [ 0 => "miguelaggay@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "C." "apellidos" => "González-Vela" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "C." "apellidos" => "González-Juanatey" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Reumatología, Hospital Universitario Marqués de Valdecilla, IFIMAV, Santander, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Sección de Dermatopatología, Servicio de Anatomía Patológica, Hospital Universitario Marqués de Valdecilla, IFIMAV, Santander, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Cardiología, Hospital Universitario Lucus Augusti, Lugo, Spain" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Psoriasis: una enfermedad cutánea relacionada con riesgo cardiovascular elevado" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Psoriasis is a chronic inflammatory skin disease that affects between 1% and 3% of the population, with the highest prevalence in the white population.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The authors of a study carried out in the United States estimated the prevalence of heart disease in patients with psoriasis to be 14.3%, somewhat higher than in the general population (11.3%).<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> This difference could be attributed to the higher incidence of metabolic syndrome and other traditional cardiovascular risk factors in these patients. However, the higher prevalence of heart disease in patients with psoriasis has been shown to be independent of body mass index, and in a recent study obesity was not an independent risk factor for acute myocardial infarction in this setting.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Psoriasis is now thought to be an independent risk factor for coronary artery disease and acute myocardial infarction.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The risk of developing ischemic heart disease and cerebrovascular disease has been reported to be higher in patients with moderate to severe psoriasis than in the general population.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a> Using the Framingham risk score, Kimball et al.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> estimated the 10-year risk of coronary heart disease and stroke in 1591 patients with moderate to severe psoriasis. In the patients with a PASI score between 10 and 20, the 10-year risk of coronary heart disease and stroke was 12.3% and 8.3%, respectively, and the corresponding figures in patients with a PASI score greater than 20 were 12.2% and 8.7%, respectively. While the level of risk did not differ greatly according to the PASI score, estimated cardiovascular risk was significantly higher in both groups of patients than in the general population, with a risk that was 28% greater risk for coronary heart disease and 11.8% greater for stroke. In another study the presence of psoriasis, even in mild forms but especially in severe cases, was found to be an independent risk factor for stroke.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The hypothesis that the severity of psoriasis is a significant factor in the development of cardiovascular disease is also supported by the evidence of a correlation between PASI scores and insulin secretion.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Insulin resistance is a hallmark of metabolic syndrome, and a statistically significant correlation has been observed in patients with psoriasis between PASI scores and serum levels of resistin (a cytokine known to be increased in insulin resistance).<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> The implications of these findings are that the more severe the psoriasis the higher the risk of cardiovascular complications and that a chronic inflammatory state is of pathogenic importance in the development of vascular disease in these patients.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Psoriatic arthritis (PsA) is a chronic inflammatory joint disease associated with psoriasis that affects 0.3% to 1% of the population.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> In 85% of patients with PsA, joint involvement is preceded by psoriatic skin lesions. Patients with PsA are usually seronegative for rheumatoid factor, a finding that can serve to differentiate between PsA and rheumatoid arthritis. PsA is currently classified as a rheumatic disease and included in the group of spondyloarthropathies.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> As in rheumatoid arthritis, which is the prototype of a chronic inflammatory disease associated with accelerated atherosclerosis and a high incidence of cardiovascular disease,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> higher mortality has been observed in PsA than in the general population primarily owing to the increased risk of cardiovascular disease in these patients.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> In a study that compared 3066 patients with PsA and a matched group of controls (1:4 ratio), Han et al.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> observed a higher prevalence of peripheral vascular disease, congestive heart failure, atherosclerosis, ischemic heart disease, and cerebrovascular disease in patients with PsA compared to the control group. The same authors also observed an increased incidence of the traditional cardiovascular risk factors, such as hypertension, diabetes mellitus, and dyslipidemia, in the patients with PsA.</p><p id="par0025" class="elsevierStylePara elsevierViewall">It has been observed that the high cardiovascular mortality in rheumatoid arthritis is due to the concurrence of traditional cardiovascular risk factors,<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> a chronic inflammatory state,<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> and certain genetic factors.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13,14</span></a> It is therefore conceivable that the same factors may be responsible for the high cardiovascular morbidity and mortality observed in patients with PsA.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Subclinical atherosclerosis—diagnosed on the basis of increased intima-media thickness in the common carotid artery—has also been reported in association with the following chronic inflammatory rheumatic diseases: ankylosing spondylitis<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> (a spondyloarthropathy like PsA), psoriasis without joint involvement,<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> and PsA.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17,18</span></a> Patients with all these diseases were found to have increased carotid artery intima-media thickness compared to control groups matched for age, sex, and traditional cardiovascular risk factors.</p><p id="par0035" class="elsevierStylePara elsevierViewall">This association may provide very significant prognostic information in patients with these chronic inflammatory diseases since, as previously noted, a direct correlation has been found between common carotid artery intima-media thickness and the development of cardiovascular complications in both the general population and in patients with rheumatoid arthritis.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">A correlation has also been reported in PsA between common carotid artery intima-media thickness and the presence of traditional risk factors for atherosclerosis.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> Two studies in the past decade in patients with PsA with no clinical evidence of cardiovascular disease and no traditional cardiovascular risk factors have confirmed the increased prevalence of subclinical atherosclerosis in this population. Subclinical disease was manifest by the presence of endothelial dysfunction, a condition that represents the initial phase in the development of atherosclerosis,<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> or by increased carotid intima-media thickness.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> However, no association has been observed between the severity of joint involvement in PsA and subclinical atherosclerosis<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20,21</span></a> or cardiovascular events.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> This lack of evidence would appear to be an indication that, in PsA, the severity of the patient's skin condition may be more predictive of the development of vascular disease than the joint involvement.</p><p id="par0045" class="elsevierStylePara elsevierViewall">In line with the studies showing a correlation between the severity of psoriasis and cardiovascular events,<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a> Gladman et al.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> found in patients with PsA that, in addition to known risk factors for atherosclerosis, the severity of skin involvement was predictive of cardiovascular disease.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The implication of the evidence discussed above is that chronic inflammation may play a key role in the accelerated development of atherosclerosis in patients with psoriasis and PsA. However, while chronic inflammation itself may be the key factor in the development of cardiovascular disease, we should not forget the additive effect in this process of traditional cardiovascular risk factors.</p><p id="par0055" class="elsevierStylePara elsevierViewall">In view of this evidence, clinicians treating patients with psoriasis and PsA should routinely take active steps to reduce cardiovascular risk in these patients, and the first step in this process should be to determine cardiovascular risk in every patient. Unfortunately, there are at present no guidelines dealing specifically with the management of cardiovascular risk in these patients. We should, therefore, envisage the future development of comprehensive cardiovascular risk charts specifically adapted to these diseases. Given the close correlation between the severity of skin disease and the development of cardiovascular events, these tables should take into account the clinical assessment of the patient's psoriasis and the treatments prescribed as well as the traditional risk factors.</p><p id="par0060" class="elsevierStylePara elsevierViewall">From the dermatological standpoint, a treatment aimed at reducing the severity of skin disease would also reduce the inflammatory burden. In these patients, it is also important to monitor known modifiable cardiovascular risk factors, such as obesity, hypertension, and dyslipidemia, and to check blood sugar levels regularly because of the increased risk of diabetes mellitus. Proper control of these factors may be of greater importance in patients with a long history of psoriasis or PsA in whom the presence of sustained chronic inflammation in conjunction with poor control of cardiovascular risk factors could lead to a higher atherogenic burden. In this regard, a direct correlation between the duration of PsA and the presence of an abnormally thick common carotid artery intima-media was detected in a recent study.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">If, once again, we take rheumatoid arthritis as a model for chronic inflammatory disease, we find that a consensus group of European experts has recommended stratifying cardiovascular risk in patients with rheumatoid arthritis using the Systematic Coronary Risk Evaluation (SCORE) risk charts.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> On the basis of the available evidence, the 2 key aspects of the management of cardiovascular risk in rheumatoid arthritis are the use of SCORE risk charts adapted to each population group and clinical assessment of disease severity. It is very possible that this approach could also prove useful for the management of cardiovascular risk in patients with psoriasis and PsA. However, its usefulness has not yet been demonstrated and no consensus has been reached on clinical guidelines relating to this important aspect of the management of these patients.</p><p id="par0070" class="elsevierStylePara elsevierViewall">In view of the higher incidence of dyslipidemia and hypertension in patients with psoriasis and PsA, treatment with statins and/or antihypertensive agents should be considered in accordance with the Spanish guidelines on the management of cardiovascular risk based on the SCORE risk chart, adapted to a southern European population, as a guide. The Third European Joint Task Force on cardiovascular prevention in clinical practice recommended the SCORE model as a tool for predicting cardiovascular risk. The model predicts cardiovascular mortality at 10 years on the basis of age, sex, systolic blood pressure, total cholesterol, and smoking status. In view of the geographical variability of cardiovascular risk in Europe, 2 SCORE models have been developed: 1 for high-risk and 1 for low-risk countries. The main difference between the SCORE risk function and the Framingham-DORICA model is that the SCORE chart estimates risk for all atherothrombotic cardiovascular manifestations, including stroke, heart failure, and peripheral arterial disease, and not just coronary heart disease. Moreover, several studies have suggested that the Framingham-DORICA tables tend to underestimate cardiovascular risk in Spain, especially in hypertensive patients with other cardiovascular risk factors; the SCORE risk charts are, therefore, the recommended instrument for use in this country.<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">24,25</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Given that the prevalence of cardiovascular disease in patients with psoriasis and PsA is high, cardiovascular risk should be assessed in these patients by identifying factors inherent in these chronic inflammatory diseases that have been shown to be associated with the development of accelerated atherogenesis and cardiovascular events. We would therefore consider the presence of a PASI > 10 to be a prognostic factor signaling the need for more rigorous management of the skin symptoms on the part of the dermatologist.</p><p id="par0080" class="elsevierStylePara elsevierViewall">As a first step, clinicians who assess patients with psoriasis or PsA should also define a primary cardiovascular risk prevention strategy, based initially on making general recommendations to the patient regarding lifestyle, such as the need for regular moderate physical activity, a heart healthy diet, weight and blood pressure control, as well as tobacco cessation when appropriate. Furthermore, in accordance with the SCORE guidelines, treatment with statins and/or antihypertensive drugs should be initiated in patients with high cardiovascular risk (SCORE<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>5%).</p><p id="par0085" class="elsevierStylePara elsevierViewall">In summary, the risk of cardiovascular morbidity and mortality is higher in patients with psoriasis and PsA than in the population in general. The presence of severe psoriasis is a significant predictor of cardiovascular risk in these patients. In addition to treating the cutaneous manifestations in patients with psoriasis and the rheumatic process in patients with PsA, clinicians must also monitor and appropriately manage the traditional risk factors for atherogenesis.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicts of Interest</span><p id="par0090" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:6 [ 0 => array:2 [ "identificador" => "xres96156" "titulo" => "Abstract" ] 1 => array:2 [ "identificador" => "xpalclavsec83317" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres96157" "titulo" => "Resumen" ] 3 => array:2 [ "identificador" => "xpalclavsec83318" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of Interest" ] 5 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2011-06-07" "fechaAceptado" => "2012-01-15" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec83317" "palabras" => array:5 [ 0 => "Psoriasis" 1 => "Psoriatic arthritis" 2 => "Cardiovascular disease" 3 => "Atherosclerosis" 4 => "Clinical management" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec83318" "palabras" => array:5 [ 0 => "Psoriasis" 1 => "Artritis psoriásica" 2 => "Enfermedad cardiovascular" 3 => "Aterosclerosis" 4 => "Manejo clínico" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Psoriasis and psoriatic arthritis are associated with increased risk of cardiovascular events and cardiovascular mortality. Alongside classic risk factors for atherosclerosis, the severity of psoriatic skin disease also influences cardiovascular risk in these patients. In both cases, endothelial dysfunction and increased intima-media thickness in the carotid artery are indicators of subclinical cardiovascular disease. Active treatment of the psoriasis and management of traditional cardiovascular risk factors are essential in order to reduce cardiovascular morbidity in these patients. Clinical practice guidelines on the management of cardiovascular risk will define a new integrated approach to the care of patients with psoriasis and psoriatic arthritis.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La psoriasis y la artritis psoriásica se asocian con un mayor riesgo de eventos cardiovasculares y de mortalidad cardiovascular. Además de los factores clásicos de aterosclerosis, la gravedad de la afección cutánea influye en el aumento del riesgo cardiovascular en estos pacientes. En ambos procesos se observa la presencia de disfunción endotelial y un grosor aumentado de la íntima-media de la arteria carótida, como expresión de enfermedad cardiovascular subclínica. El tratamiento activo de la enfermedad y el manejo de los factores de riesgo cardiovascular clásicos son fundamentales para disminuir la morbilidad cardiovascular en estos pacientes. El establecimiento de guías clínicas para el manejo del riesgo cardiovascular abrirá, en el futuro, un nuevo abordaje clínico integral del paciente con psoriasis y la artritis psoriásica.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: González-Gay MA, González-Vela C, González-Juanatey C. Psoriasis: una enfermedad cutánea relacionada con riesgo cardiovascular elevado. 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año/Mes | Html | Total | |
---|---|---|---|
2024 Noviembre | 14 | 11 | 25 |
2024 Octubre | 99 | 43 | 142 |
2024 Septiembre | 95 | 23 | 118 |
2024 Agosto | 96 | 66 | 162 |
2024 Julio | 76 | 22 | 98 |
2024 Junio | 83 | 30 | 113 |
2024 Mayo | 67 | 30 | 97 |
2024 Abril | 64 | 35 | 99 |
2024 Marzo | 73 | 31 | 104 |
2024 Febrero | 53 | 33 | 86 |
2024 Enero | 48 | 33 | 81 |
2023 Diciembre | 51 | 20 | 71 |
2023 Noviembre | 67 | 33 | 100 |
2023 Octubre | 66 | 29 | 95 |
2023 Septiembre | 62 | 31 | 93 |
2023 Agosto | 34 | 15 | 49 |
2023 Julio | 49 | 32 | 81 |
2023 Junio | 49 | 18 | 67 |
2023 Mayo | 45 | 28 | 73 |
2023 Abril | 55 | 33 | 88 |
2023 Marzo | 53 | 26 | 79 |
2023 Febrero | 35 | 28 | 63 |
2023 Enero | 33 | 28 | 61 |
2022 Diciembre | 61 | 47 | 108 |
2022 Noviembre | 45 | 28 | 73 |
2022 Octubre | 52 | 39 | 91 |
2022 Septiembre | 32 | 36 | 68 |
2022 Agosto | 32 | 56 | 88 |
2022 Julio | 29 | 49 | 78 |
2022 Junio | 31 | 39 | 70 |
2022 Mayo | 44 | 45 | 89 |
2022 Abril | 40 | 59 | 99 |
2022 Marzo | 50 | 64 | 114 |
2022 Febrero | 34 | 30 | 64 |
2022 Enero | 31 | 61 | 92 |
2021 Diciembre | 34 | 46 | 80 |
2021 Noviembre | 33 | 51 | 84 |
2021 Octubre | 34 | 52 | 86 |
2021 Septiembre | 28 | 42 | 70 |
2021 Agosto | 32 | 41 | 73 |
2021 Julio | 19 | 28 | 47 |
2021 Junio | 25 | 37 | 62 |
2021 Mayo | 44 | 35 | 79 |
2021 Abril | 83 | 53 | 136 |
2021 Marzo | 64 | 45 | 109 |
2021 Febrero | 41 | 27 | 68 |
2021 Enero | 55 | 34 | 89 |
2020 Diciembre | 41 | 21 | 62 |
2020 Noviembre | 25 | 22 | 47 |
2020 Octubre | 26 | 16 | 42 |
2020 Septiembre | 22 | 29 | 51 |
2020 Agosto | 37 | 28 | 65 |
2020 Julio | 27 | 12 | 39 |
2020 Junio | 32 | 30 | 62 |
2020 Mayo | 20 | 21 | 41 |
2020 Abril | 31 | 19 | 50 |
2020 Marzo | 24 | 17 | 41 |
2020 Febrero | 3 | 1 | 4 |
2019 Diciembre | 2 | 2 | 4 |
2019 Septiembre | 5 | 0 | 5 |
2019 Junio | 3 | 2 | 5 |
2019 Mayo | 1 | 6 | 7 |
2019 Abril | 0 | 1 | 1 |
2019 Marzo | 2 | 8 | 10 |
2019 Enero | 1 | 0 | 1 |
2018 Diciembre | 3 | 0 | 3 |
2018 Octubre | 3 | 0 | 3 |
2018 Septiembre | 4 | 0 | 4 |
2018 Marzo | 1 | 0 | 1 |
2018 Febrero | 25 | 8 | 33 |
2018 Enero | 35 | 6 | 41 |
2017 Diciembre | 25 | 8 | 33 |
2017 Noviembre | 14 | 10 | 24 |
2017 Octubre | 29 | 5 | 34 |
2017 Septiembre | 25 | 6 | 31 |
2017 Agosto | 34 | 12 | 46 |
2017 Julio | 20 | 5 | 25 |
2017 Junio | 38 | 13 | 51 |
2017 Mayo | 27 | 6 | 33 |
2017 Abril | 19 | 5 | 24 |
2017 Marzo | 20 | 7 | 27 |
2017 Febrero | 12 | 8 | 20 |
2017 Enero | 15 | 13 | 28 |
2016 Diciembre | 29 | 8 | 37 |
2016 Noviembre | 39 | 7 | 46 |
2016 Octubre | 36 | 10 | 46 |
2016 Septiembre | 36 | 10 | 46 |
2016 Agosto | 46 | 14 | 60 |
2016 Julio | 49 | 24 | 73 |
2016 Junio | 9 | 0 | 9 |
2016 Mayo | 7 | 17 | 24 |
2016 Abril | 14 | 4 | 18 |
2016 Marzo | 13 | 0 | 13 |
2016 Febrero | 11 | 7 | 18 |
2016 Enero | 12 | 6 | 18 |
2015 Diciembre | 8 | 0 | 8 |
2015 Noviembre | 16 | 6 | 22 |
2015 Octubre | 18 | 2 | 20 |
2015 Septiembre | 7 | 0 | 7 |
2015 Agosto | 11 | 1 | 12 |
2015 Julio | 49 | 6 | 55 |
2015 Junio | 55 | 8 | 63 |
2015 Mayo | 69 | 18 | 87 |
2015 Abril | 76 | 14 | 90 |
2015 Marzo | 46 | 12 | 58 |
2015 Febrero | 62 | 7 | 69 |
2015 Enero | 40 | 9 | 49 |
2014 Diciembre | 59 | 13 | 72 |
2014 Noviembre | 43 | 11 | 54 |
2014 Octubre | 58 | 16 | 74 |
2014 Septiembre | 45 | 13 | 58 |
2014 Agosto | 16 | 3 | 19 |
2014 Julio | 15 | 8 | 23 |
2014 Junio | 33 | 6 | 39 |
2014 Mayo | 32 | 3 | 35 |
2014 Abril | 27 | 11 | 38 |
2014 Marzo | 19 | 11 | 30 |
2014 Febrero | 24 | 11 | 35 |
2014 Enero | 31 | 7 | 38 |
2013 Diciembre | 32 | 7 | 39 |
2013 Noviembre | 30 | 16 | 46 |
2013 Octubre | 18 | 11 | 29 |
2013 Septiembre | 7 | 13 | 20 |
2013 Agosto | 13 | 15 | 28 |
2013 Julio | 15 | 21 | 36 |
2013 Junio | 12 | 25 | 37 |
2013 Mayo | 14 | 15 | 29 |
2013 Abril | 28 | 18 | 46 |
2013 Marzo | 22 | 20 | 42 |
2013 Febrero | 22 | 8 | 30 |
2013 Enero | 28 | 9 | 37 |
2012 Diciembre | 21 | 6 | 27 |
2012 Noviembre | 2 | 6 | 8 |
2012 Octubre | 3 | 21 | 24 |
2012 Septiembre | 0 | 13 | 13 |