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            "entidad" => "Servicio de Cardiolog&#237;a&#44; Hospital Marqu&#233;s de Valdecilla&#44; Santander&#44; Cantabria&#44; Spain"
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          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Percentage of LDL goal achievement according to type of lipid-lowering treatment &#40;24 months&#41;&#46; &#42;For 16 patients&#44; treatment was not recorded or they did not receive any lipid-lowering treatment&#46; &#40;B&#41; Percentage of LDL target achievement according to type of lipid-lowering treatment &#40;end of follow-up&#41;&#46; &#42;For 7 patients&#44; treatment was not recorded or they did not receive any lipid-lowering treatment&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Cardiovascular disease &#40;CVD&#41; is the most common cause of mortality in Europe and coronary artery disease &#40;CAD&#41; is the main cause of death in the Spanish population<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46; The evidence provided by clinical trials and Mendelian randomization genetic studies have established that low-density lipoprotein cholesterol &#40;LDL&#41; plays a causal role in the development of atherosclerotic disease<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Statin treatment has substantially modified the natural history of CVD<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#8211;5</span></a>&#46; The reduction in plasma LDL levels is accompanied by a regression of atheroma plaque when it reaches concentrations below 70 mg&#47;dl<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&#46; With new lipid-lowering treatments such as ezetimibe and proprotein convertase subtilisin&#47;kexin type 9 inhibitors &#40;PCSK9i&#41;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#8211;6</span></a>&#44; the concept of &#8220;high-intensity lipid-lowering therapy&#8221; has gained importance in reaching the LDL goals recommended by the European Society of Cardiology&#47;European Atherosclerosis Society &#40;ESC&#47;EAS&#41;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;8</span></a>&#46; The 2016 edition recommended that patients with established CVD reach an LDL &#60; 70 mg&#47;dl and a decrease of 50&#37; from the baseline figure<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>&#46; In the 2019 update<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>&#44; the LDL goal was reduced to &#60;55 mg&#47;dl and it even proposed considering an LDL goal &#60;40 mg&#47;dl for patients with recurrent events despite optimal lipid-lowering treatment&#46; However&#44; large epidemiological studies have shown a suboptimal degree of lipid control in patients with very high cardiovascular risk despite a high use of lipid-lowering drugs&#59; just one-third of subjects evaluated reached LDL levels &#60;70 mg&#47;dl<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;10</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Based on these considerations&#44; this study aims to a&#41; verify the degree of achievement of the lipid goal according to the 2016 and 2019 ESC&#47;EAS guidelines during long-term follow-up on a large cohort of patients with ACS in real-world clinical practice conditions&#59; b&#41; analyze the epidemiological characteristics&#44; cardiovascular risk factors &#40;CVRF&#41;&#44; lipid profile&#44; and treatment indicated to these patients&#59; and c&#41; evaluate recurrent ACS throughout follow-up and its relationship with lipid goals&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Patients and methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">A retrospective&#44; single-center&#44; non-interventional cohort study was conducted that included patients admitted due to ACS to a Coronary Care Unit &#40;CCU&#41; of the Marqu&#233;s de Valdecilla University Hospital of Santander &#40;Cantabria&#41;&#46; All patients with a diagnosis of ACS &#40;ST-elevation myocardial infarction &#40;STEMI&#41;&#44; non-ST elevation myocardial infarction &#40;NSTEMI&#41;&#44; or unstable angina &#40;UA&#41; with a need for revascularization&#41; on the CCU discharge summary from January 1&#44; 2012 to December 31&#44; 2015 were selected&#46; Patients were identified through the electronic database of the hospital&#8217;s Hospitalization and Clinical Documentation Department&#46; The CCU is a reference center for the entire population of the autonomous community of Cantabria &#40;582&#44;905 residents&#41;&#46; At 24 months&#44; the patients&#8217; medical records were reviewed&#46; Clinical data and the results of the most recent lipid profile closest to the end of the study period &#40;March 2022&#41; were gathered&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Variables and imaging studies analyzed</span><p id="par0025" class="elsevierStylePara elsevierViewall">Demographic&#44; physical examination&#44; and imaging study variables were gathered from the electronic medical record&#46; The following epidemiological variables were analyzed&#58; age&#44; sex&#44; tobacco use&#44; family history of early ischemic heart disease &#40;IHD&#41;&#44; personal medical history of IHD&#44; and other comorbidities &#40;hypertension &#40;HT&#41;&#44; type 2 diabetes mellitus &#40;T2DM&#41;&#44; chronic kidney disease &#40;CKD&#41;&#44; hyperuricemia&#44; cerebrovascular accident &#40;CVA&#41;&#44; peripheral arterial disease &#40;PAD&#41;&#44; lung disease&#44; and liver disease&#41;&#46; The main outcome and imaging test variables analyzed included type of ACS&#44; single-vessel or multivessel involvement on the coronary angiogram &#40;CA&#41;&#44; and whether percutaneous transluminal coronary angioplasty &#40;PTCA&#41; was performed&#46; The type of lipid-lowering treatment&#44; doses&#44; and changes in lipid-lowering treatment throughout follow-up were gathered&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Laboratory tests</span><p id="par0030" class="elsevierStylePara elsevierViewall">A fasting blood sample was drawn in the first 24 h following the ACS&#46; The routine biochemical profile included a basic lipid profile&#58; total cholesterol &#40;TC&#41;&#44; triglycerides &#40;TG&#41;&#44; high-density lipoprotein cholesterol &#40;HDL&#41;&#44; and LDL calculated using the Friedewald formula&#46; Lipid parameters were measured according to current recommendations<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Follow-up on the cohort</span><p id="par0035" class="elsevierStylePara elsevierViewall">Two time points were analyzed during follow-up on patients with ACS in order to evaluate the degree to which LDL goals were achieved&#44; pursuant to the 2016 and 2019 ESC&#47;EAS guidelines&#46; The first analysis was conducted 24 months after the ACS and a second evaluation was performed during the period from March 2021 to March 2022 &#40;total follow-up of seven to ten years&#41;&#46; In both&#44; the basic lipid profile closest to the established dates was collected&#44; as well as active lipid-lowering treatment at that time&#44; mortality&#44; and its cause&#46; In addition&#44; ACS recurrence throughout follow-up and the percentage of patients who achieved the lipid goals were analyzed&#46; The study was approved by the Ethics Committee of Cantabria &#40;number&#58; 2018&#46;271&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Statistical analysis</span><p id="par0040" class="elsevierStylePara elsevierViewall">Quantitative variables are expressed as mean &#177; SD or median &#40;IQR&#41; according to the data&#8217;s distribution&#46; Qualitative variables are expressed as number and percentage&#46; Groups were compared using the Student&#8217;s t test or Mann&#8211;Whitney U test according to the data&#8217;s distribution&#46; The chi-square test or Fisher&#8217;s exact test were used to compare qualitative variables&#46; The incidence of ACS recurrence was expressed as cumulative incidence per 100 patient-years&#46; Data analysis was conducted using the SPSS 28&#46;0 statistical package &#40;Armonk&#44; NY&#58; IBM Corp&#46;&#41;&#46; For all calculations&#44; a two-tailed <span class="elsevierStyleItalic">p</span> value &#60;0&#46;05 was considered significant&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><p id="par0045" class="elsevierStylePara elsevierViewall">A total of 826 patients with ACS were included in the study&#58; 449 &#40;55&#37;&#41; with single-vessel involvement and 377 &#40;45&#37;&#41; with multivessel involvement&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the baseline epidemiological characteristics of the total cohort and the cohort classified based on coronary vessel involvement&#46; Only 17 patients were lost to follow-up&#46; Of the patients who had a follow-up lipid profile performed&#44; treatment was not recorded in the medical record of 16 of them at 24 months and seven of them at the end of follow-up&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Evolution of the lipid profile and its relationship to angiographic involvement</span><p id="par0050" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the lipid profile variables at the time of the event&#44; at 24 months&#44; and at the end of follow-up for the total sample and according to coronary vessel involvement&#46; The percentage of LDL reduction was 33&#46;2&#37; at 24 months of the ACS and 39&#46;1&#37; at the end of follow-up&#46; In patients with single-vessel disease&#44; LDL levels declined by 30&#37; at two years from the ACS and by 38&#46;9&#37; at the end of follow-up&#46; The respective LDL percentage reductions in subjects with multivessel coronary involvement were 33&#46;9&#37; and 40&#46;9&#37;&#46; No significant differences were found in mean LDL levels at 24 months or at the end of follow-up&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Type of lipid-lowering treatment at admission&#44; at discharge&#44; and during the follow-up period</span><p id="par0055" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> shows the type of lipid-lowering treatment used in the different periods analyzed&#46; It is notable that despite suboptimal achievement of goals&#44; the statin treatment dose was increased in just 19&#46;7&#37;&#46; What&#8217;s more&#44; in a higher percentage of patients&#44; 29&#46;7&#37;&#44; the statin dose was reduced or it was withdrawn&#44; with the main cause documented being liver profile abnormalities&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Degree to which lipid goals were met</span><p id="par0060" class="elsevierStylePara elsevierViewall">At 24 months from the ACS&#44; the degree of LDL goal achievement was suboptimal &#40;LDL &#60;70 mg&#47;dl&#58; 207 patients&#44; &#8722;33&#46;6&#37;&#59; LDL &#60;55 mg&#47;dl&#58; 56 patients&#44; &#8722;9&#46;3&#37;&#41;&#46; The same was true at the end of follow-up &#40;LDL &#60;70 mg&#47;dl&#58; 341 patients&#44; &#8722;9&#46;3&#37;&#59; LDL &#60;55 mg&#47;dl&#58; 132 patients&#44; &#8722;21&#46;1&#37;&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a> &#40;A and B&#41; shows the degree of LDL goal achievement at 24 months from the ACS and at the end of follow-up based on the lipid-lowering therapy received by the patients&#46; <a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a> &#40;A and B&#41; shows these data according to coronary vessel involvement&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">ACS recurrence and mortality</span><p id="par0070" class="elsevierStylePara elsevierViewall">During follow-up&#44; 179 patients had a recurrent event &#40;22&#46;1&#37;&#41; It occurred during the first two years in 118 patients &#40;14&#46;6&#37;&#41; and after the second year in 95 patients&#46; The recurrent ACS occurred in 31 patients within the first six months&#44; in 37 patients between six and 12 months&#44; and in 50 patients in the second year&#46; The percentage of patients who had a recurrent event who achieved LDL targets at two years was&#58; LDL &#60;70 mg&#47;dl&#59; 29&#46;4&#37; vs&#46; 35&#46;3&#37; &#40;<span class="elsevierStyleItalic">p</span> &#61; 0&#46;34&#41; and LDL&#60;55 mg&#47;dl&#59; 7&#46;1&#37; vs&#46; 10&#46;1&#37; &#40;<span class="elsevierStyleItalic">p</span> &#61; 0&#46;49&#41;&#44; respectively&#46; At the end of follow-up&#44; these data were&#58; LDL &#60;70 mg&#47;dl&#59; 56&#46;9&#46;3&#37; vs&#46; 53&#46;8&#37; &#40;<span class="elsevierStyleItalic">p</span> &#61; 0&#46;59&#41; and LDL &#60;55 mg&#47;dl 24&#46;6&#37; vs&#46; 20&#46;3&#37; &#40;<span class="elsevierStyleItalic">p</span> &#61; 0&#46;34&#41;&#46; Of the patients who had already had a second event in the first 24 months&#44; 34 of them had at least a third ACS&#46; It is notable that of them&#44; only two patients reached an LDL &#60;55 mg&#47;dl and none of them reached an LDL &#60;40 mg&#47;dl at the end of follow-up&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Regarding mortality&#44; 22&#46;2&#37; of patients &#40;n &#61; 183&#41; died during follow-up&#44; 7&#46;6&#37; &#40;n &#61; 63&#41; in the first 24 months&#46; The main cause of death was a recurrent cardiovascular event &#40;34&#46;1&#37;&#41;&#44; followed by neoplastic disease &#40;30&#46;2&#37;&#41;&#46; Patients who had a recurrent ACS had greater mortality than patients who did not &#40;26&#46;8&#37; vs&#46; 20&#46;8&#37;&#44; <span class="elsevierStyleItalic">p</span> &#61; 0&#46;006&#41;&#46; No significant differences were found in mortality &#40;20&#37; vs&#46; 24&#46;7&#37;&#59; <span class="elsevierStyleItalic">p</span> &#61; 0&#46;13&#41; or recurrence &#40;10&#46;9&#37; vs&#46; 11&#46;2&#37;&#59; <span class="elsevierStyleItalic">p</span> &#61; 0&#46;096&#41; according to single-vessel or multivessel involvement&#44; respectively&#46;</p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Discussion</span><p id="par0080" class="elsevierStylePara elsevierViewall">The results of this work show that the degree of LDL goal achievement in a large group of patients with ACS is suboptimal&#44; especially in regard to the 2019 ESC&#47;EAS guidelines recommendations&#44; and in spite of the fact that a high percentage of patients received high-intensity statins&#46; These data are in accordance with the latest results from large European studies&#44; although the follow-up period was shorter in those studies<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;10</span></a>&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">The mean age of this cohort is lower than that of the 622 patients with CAD included in the DA VINCI study &#40;62 vs&#46; 67 years&#41;&#46; Male sex was predominant in both &#40;79&#37; vs&#46; 76&#37;&#41;&#46; The prevalence of active tobacco use was higher in this study &#40;48&#37; vs&#46; 12&#37;&#41;&#44; but the percentage of patients with hypertension &#40;52&#37; vs&#46; 73&#37;&#41;&#44; DM2 &#40;19&#37; vs&#46; 38&#37;&#41;&#44; and CKD &#40;4&#37; vs&#46; 7&#37;&#41; was lower&#46; In patients in the DA VINCI study in secondary prevention&#44; the overall degree of lipid goal achievement was 39&#37; and was somewhat higher among those with CAD &#40;44&#37;&#41;&#46; In this work&#44; LDL &#60;70 mg&#47;dl at 24 months of an ACS was observed in 33&#46;6&#37; of patients&#46; Although the ESC&#47;EAS guidelines had not been published at the time of inclusion&#44; only 9&#46;3&#37; met the goal of LDL &#60;55 mg&#47;dl at 24 months of an ACS&#46; It is notable that LDL &#60;55 mg&#47;dl was only found in one out of every five patients with an ACS after seven to ten years of follow-up&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">The EUROASPIRE V registry included a total of 7824 patients with ACS followed-up on for six months&#46; Thirty-two percent reached an LDL &#60;70 mg&#47;dl&#44; a figure which rose to 49&#37; in the subanalysis of the Spanish population&#46; Approximately half received high-intensity statins at six months&#46; A reduction or suspension of treatment was recorded in 20&#46;8&#37; and an intensification in 11&#46;7&#37;&#46; In this cohort&#44; a change in lipid-lowering treatment was made in nearly one out of every three patients&#46; The percentage of patients who had an increase in the statin dose was lower &#40;6&#46;7&#37; vs&#46; 11&#46;7&#37;&#41;&#44; as was the percentage in whom the dose was reduced or the drug was suspended &#40;10&#37; vs&#46; 20&#46;8&#37;&#41;&#46; The causes for interrupting treatment in the EUROASPIRE V registry were intolerance to the treatment &#40;15&#46;8&#37;&#41; and the clinician&#8217;s decision &#40;36&#46;8&#37;&#41;&#46; In this study&#44; the percentage of withdrawal due to intolerance was lower &#40;4&#37;&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">In the DA VINCI study&#44; 35&#37; of patients reached the lipid goal and most received moderate-intensity statins&#46; Compared to the cohort in this study&#44; nearly 70&#37; received high-intensity statins at 24 months from the event and only one out of every four subjects had LDL levels below 70 mg&#47;dl&#46; However&#44; a change was observed in lipid-lowering treatment during the years of follow-up&#46; At the end of the study&#44; one out of every two patients was receiving a combined lipid-lowering therapy&#59; despite this&#44; the degree of achievement of the LDL &#60;55 mg&#47;dl goal was low &#40;14&#37;&#41;&#46; There are multiple reasons for this&#44; predominant among which are treatment inertia and lack of adherence<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>&#46; The use of PCSK9i has become widespread after the publication of the FOURIER and ODYSSEY-OUTCOMES studies<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a>&#46; However&#44; only six patients received this treatment at the end of follow-up&#44; which could in part be related to the conditions for its use that are funded according to the current therapeutic positioning report&#44; although there could possibly have been other causes<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#44;14</span></a>&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Data on ACS recurrence are similar to what has been published&#44; with a percentage of recurrence in the first year of around 8&#37;&#8211;20&#37;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a>&#46; In addition&#44; comparing the long-term recurrence figures in this study to those from a study conducted in patients with ACS followed-up on for eight years&#44; the results are similar&#44; with a recurrence of around 21&#46;7&#37;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a>&#46; It should be noted that 66&#37; of patients presented with a recurrence of ACS in the first two years following the initial event&#44; which highlights the relevance of attempting to achieve LDL cholesterol goals as soon as possible&#46; In fact&#44; in patients with an ACS and a later recurrent event&#44; the percentage which achieved LDL &#60;55 mg&#47;dl is even lower than in those without recurrence&#44; both at two years and at the end of follow-up&#44; despite having very high cardiovascular risk&#46; This is significantly associated with greater mortality&#44; as has been observed in previous studies&#44; but no significant differences were found in this work regarding recurrence or mortality based on coronary vessel involvement&#44; although the frequency of the combined event &#40;recurrence and&#47;or mortality&#41; was greater in patients with multivessel involvement<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a>&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Methodological considerations and limitations</span><p id="par0105" class="elsevierStylePara elsevierViewall">The patients were studied in a single center&#46; Therefore&#44; the results may not be able to be extrapolated to other countries or geographical settings&#46; However&#44; the number of patients included is large&#46; In addition&#44; the autonomous community where this work was conducted has a centralized CCU&#46; The lipid goal was defined according to the ESC&#47;EAS guidelines in force at each moment during the study&#46; Data were analyzed in the context of real-world clinical practice&#44; which entails the limitations inherent to variability in clinical practice&#46; Lastly&#44; the reason for changing or withdrawing lipid-lowering medication was obtained from the medical records&#44; with the inherent limitations of this method&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conclusions</span><p id="par0110" class="elsevierStylePara elsevierViewall">The degree to which long-term LDL goals were reached in a cohort of patients with ACS was suboptimal&#44; despite the fact that a high percentage of cases received high-intensity lipid-lowering treatment&#46; Although changes have been observed over a long period of time in the intensification of lipid-lowering treatment&#44; with an increase in the use of combinations of statins and ezetimibe&#44; the LDL target &#60;55 mg&#47;dl was only achieved in the long-term in one out of every five patients with ACS&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Funding</span><p id="par0115" class="elsevierStylePara elsevierViewall">This research received no specific grands from agencies in the public or commercial sectors or from non-profit entities&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Conflicts of interest</span><p id="par0120" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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          "identificador" => "sec0035"
          "titulo" => "Results"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Evolution of the lipid profile and its relationship to angiographic involvement"
            ]
            1 => array:2 [
              "identificador" => "sec0045"
              "titulo" => "Type of lipid-lowering treatment at admission&#44; at discharge&#44; and during the follow-up period"
            ]
            2 => array:2 [
              "identificador" => "sec0050"
              "titulo" => "Degree to which lipid goals were met"
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            3 => array:2 [
              "identificador" => "sec0055"
              "titulo" => "ACS recurrence and mortality"
            ]
          ]
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          "titulo" => "Discussion"
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          "titulo" => "Methodological considerations and limitations"
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          "titulo" => "Conclusions"
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          "titulo" => "Funding"
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          "titulo" => "Conflicts of interest"
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        12 => array:1 [
          "titulo" => "References"
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      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2022-12-05"
    "fechaAceptado" => "2023-02-04"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1630401"
          "palabras" => array:4 [
            0 => "Acute coronary syndrome"
            1 => "Dyslipidemia"
            2 => "LDL cholesterol"
            3 => "ESC&#47;EAS dyslipidemia guidelines"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1630400"
          "palabras" => array:4 [
            0 => "S&#237;ndrome coronario agudo"
            1 => "Dislipemia"
            2 => "LDL-colesterol"
            3 => "Gu&#237;as de dislipemia ESCEAS"
          ]
        ]
      ]
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    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction and objectives</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">According to the recent European epidemiological studies&#44; the degree of lipid control in patients with very high vascular risk is suboptimal&#46; This study analyzes the epidemiological characteristics&#44; cardiovascular risk factors&#44; lipid profile&#44; recurrence&#44; and degree of achievement of long-term lipid targets&#44; according to the ESC&#47;EAS Guidelines&#44; in a cohort of patients with acute coronary syndrome &#40;ACS&#41; in a real-world clinical practice setting&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">This work is a retrospective cohort study of patients diagnosed with ACS admitted to the Coronary Unit of a tertiary hospital from January 1&#44; 2012 to December 31&#44; 2015 and followed-up on until March 2022&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">A total of 826 patients were studied&#46; During the follow-up period&#44; greater prescribing of combined lipid-lowering therapy was observed&#44; mainly high- and moderate-intensity statins and ezetimibe&#46; At 24 months after the ACS&#44; 33&#46;6&#37; of living patients had LDL levels &#60;70 mg&#47;dl and 9&#46;3&#37; had LDL levels &#60;55 mg&#47;dl&#46; At the end of the follow-up &#40;101 &#91;88&#8211;111&#93; months&#41;&#44; the corresponding figures were 54&#46;5&#37; and 21&#46;1&#37;&#46; Some 22&#46;1&#37; of patients had a recurrent coronary event and only 24&#46;6&#37; achieved an LDL level &#60;55 mg&#47;dl&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Achievement of the LDL targets recommended by the ESC&#47;EAS guidelines is suboptimal in patients with ACS&#44; both at two years and in the long-term &#40;7&#8211;10 years&#41;&#44; especially in patients with recurrent ACS&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction and objectives"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
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            "identificador" => "abst0015"
            "titulo" => "Results"
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      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n y objetivos</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Seg&#250;n los recientes estudios epidemiol&#243;gicos europeos&#44; el grado de control lip&#237;dico de los pacientes de muy alto riesgo vascular es sub&#243;ptimo&#46; En este estudio se han analizado las caracter&#237;sticas epidemiol&#243;gicas&#44; los factores de riesgo cardiovascular&#44; el perfil lip&#237;dico&#44; la recurrencia y el grado de consecuci&#243;n de los objetivos lip&#237;dicos a largo plazo&#44; seg&#250;n las Gu&#237;as ESC&#47;EAS&#44; en una cohorte de pacientes con s&#237;ndrome coronario agudo &#40;SCA&#41;&#44; en condiciones de pr&#225;ctica cl&#237;nica real&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Estudio de cohorte retrospectivo de los pacientes con diagn&#243;stico de SCA ingresados en la unidad coronaria de un hospital de tercer nivel&#44; entre el 1 de enero de 2012 y el 31 de diciembre de 2015&#44; y seguidos hasta marzo de 2022&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Se estudiaron 826 pacientes&#46; Durante el periodo de seguimiento se observ&#243; una mayor prescripci&#243;n de terapia hipolipemiante combinada&#44; principalmente estatinas de alta y moderada intensidad y ezetimibe&#46; A los 24 meses del SCA&#44; un 33&#44;6&#37; de los pacientes vivos ten&#237;an un LDL &#60; 70 mg&#47;dl y en un 9&#44;3&#37; los niveles eran &#60; 55 mg&#47;dl&#46; Al final del seguimiento &#40;101 &#91;88&#8211;111&#93; meses&#41;&#44; las correspondientes cifras eran del 54&#44;5 y 21&#44;1&#37;&#46; Un 22&#44;1&#37; de los pacientes presentaron un evento coronario recurrente&#44; y solamente un 24&#44;6&#37; de ellos alcanzaron un nivel de LDL &#60; 55 mg&#47;dl&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">El cumplimiento de los objetivos recomendados por las Gu&#237;as ESC&#47;EAS en pacientes con SCA&#44; es sub&#243;ptimo&#44; tanto a los 2 a&#241;os como a largo plazo &#40;7-10 a&#241;os&#41; desde el evento&#44; y en especial en los pacientes con SCA recurrente&#46;</p></span>"
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            "identificador" => "abst0030"
            "titulo" => "M&#233;todos"
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            "identificador" => "abst0035"
            "titulo" => "Resultados"
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            "identificador" => "abst0040"
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        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
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        "figura" => array:1 [
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        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Lipid-lowering treatment in patients with ACS&#46;</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">&#42;PCSK9i&#58; proprotein convertase subtilisin&#47;kexin type 9 inhibitors&#46;</p> <p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">&#8220;<span class="elsevierStyleItalic">Ezetimibe combination refers to the use of high- &#40;n &#61; 70&#41;&#44; moderate- &#40;n &#61; 13&#41;&#44; or low-intensity &#40;n &#61; 1&#41; statins and ezetimibe at 24 months</span>&#46;&#8221;</p> <p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">&#8220;<span class="elsevierStyleItalic">Ezetimibe combination refers to the use of high- &#40;n &#61; 235&#41;&#44; moderate- &#40;n &#61; 47&#41;&#44; or low-intensity &#40;n &#61; 3&#41; statins and ezetimibe at the end of follow-up&#46;</span>&#8221;</p>"
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          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Percentage of LDL goal achievement according to type of lipid-lowering treatment &#40;24 months&#41;&#46; &#42;For 16 patients&#44; treatment was not recorded or they did not receive any lipid-lowering treatment&#46; &#40;B&#41; Percentage of LDL target achievement according to type of lipid-lowering treatment &#40;end of follow-up&#41;&#46; &#42;For 7 patients&#44; treatment was not recorded or they did not receive any lipid-lowering treatment&#46;</p>"
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      ]
      2 => array:8 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
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          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Percentage of LDL target achievement according to type of lipid-lowering treatment and coronary tree involvement &#40;24 months&#41;&#46; &#40;B&#41; Percentage of LDL target achievement according to type of lipid-lowering treatment and coronary tree involvement &#40;end of follow-up&#41;&#46;</p>"
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          "leyenda" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">SBP&#58; systolic blood pressure&#59; DBP&#58; diastolic blood pressure&#59; BMI&#58; body mass index&#59; HT&#58; hypertension&#59; AMI&#58; acute myocardial infarction&#59; ACS&#58; acute coronary syndrome&#59; CVA&#58; cerebrovascular accident&#59; m&#58; mean&#59; SD&#58; standard deviation&#46;</p>"
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                  \t\t\t\t"><span class="elsevierStyleBold">Heart rate &#40;bpm&#41;</span>&#44; <span class="elsevierStyleItalic">m &#177; SD</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;72&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">BMI &#40;kg&#47;m<span class="elsevierStyleSup">2</span>&#41;</span>&#44; <span class="elsevierStyleItalic">m &#177; SD</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Active tobacco use</span>&#44; <span class="elsevierStyleItalic">n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">HT</span>&#44; <span class="elsevierStyleItalic">n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Dyslipidemia</span>&#44; <span class="elsevierStyleItalic">n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">375 &#40;45&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;0&#46;0001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Type 2 diabetes mellitus</span>&#44; <span class="elsevierStyleItalic">n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">HbA1c &#40;&#37;&#41;</span><span class="elsevierStyleItalic">&#44; m &#177; SD</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Hyperuricemia</span>&#44; <span class="elsevierStyleItalic">n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Chronic kidney disease</span>&#44; <span class="elsevierStyleItalic">n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Lung disease</span>&#44; <span class="elsevierStyleItalic">n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">87 &#40;10&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Liver disease</span>&#44; <span class="elsevierStyleItalic">n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">23 &#40;5&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Family history of early AMI</span>&#44; <span class="elsevierStyleItalic">n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Prior CVD</span><span class="elsevierStyleItalic">&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">172 &#40;20&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">80 &#40;17&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8226; <span class="elsevierStyleBold">Peripheral arterial disease</span>&#44; <span class="elsevierStyleItalic">n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">46 &#40;5&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">15 &#40;3&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">31 &#40;8&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">&#8226; <span class="elsevierStyleBold">ACS</span>&#44; <span class="elsevierStyleItalic">n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">123 &#40;14&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">63 &#40;16&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#46;18&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">&#8226; <span class="elsevierStyleBold">CVA</span>&#44; <span class="elsevierStyleItalic">n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">13 &#40;3&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;93&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; <span class="elsevierStyleBold">Ischemic CVA</span>&#44; <span class="elsevierStyleItalic">n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;2&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">11 &#40;2&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Single-vessel&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Multivessel&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Event</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Total cholesterol</span>&#44; <span class="elsevierStyleItalic">m &#177; SD</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">193&#46;5 &#177; 46&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">193 &#177; 45&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">193&#46;2 &#177; 42&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">LDL</span>&#44; <span class="elsevierStyleItalic">m &#177; SD</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">121&#46;8 &#177; 40&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">121&#46;7 &#177; 40&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">123&#46;1 &#177; 38&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">HDL</span>&#44; <span class="elsevierStyleItalic">m &#177; SD</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45&#46;8 &#177; 12&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45&#46;8 &#177; 13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&#46;7 &#177; 12&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Triglycerides</span>&#44; <span class="elsevierStyleItalic">m &#177; SD</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">130&#46;5 &#177; 147&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">130&#46;5 &#177; 147&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">120&#46;2 &#177; 74&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;08&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Non-HDL cholesterol</span>&#44; <span class="elsevierStyleItalic">m &#177; SD</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">147&#46;4 &#177; 46&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">146&#46;9 &#177; 42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">148&#46;1 &#177; 50&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24 months</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Total cholesterol</span>&#44; <span class="elsevierStyleItalic">m &#177; SD</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">150&#46;6 &#177; 33&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">151&#46;1 &#177; 34&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">150&#46;2 &#177; 32&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">LDL</span>&#44; <span class="elsevierStyleItalic">m &#177; SD</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">81&#46;4 &#177; 25&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">81&#46;5 &#177; 26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">81&#46;4 &#177; 25&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">HDL</span>&#44; <span class="elsevierStyleItalic">m &#177; SD</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&#46;6 &#177; 12&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45&#46;04 &#177; 11&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&#46;2 &#177; 12&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Triglycerides</span>&#44; <span class="elsevierStyleItalic">m &#177; SD</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">121&#46;2 &#177; 72&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">122&#46;4 &#177; 79&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">119&#46;9 &#177; 63&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Non-HDL cholesterol</span>&#44; <span class="elsevierStyleItalic">m &#177; SD</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">106 &#177; 31&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">106&#46;3 &#177; 33&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">105&#46;6 &#177; 29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;78&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="5" align="left" valign="\n
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                  \t\t\t\t">End of follow-up &#40;2021&#8211;2022&#41;</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">142&#46;7 &#177; 36&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">143&#46;5 &#177; 38&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">141&#46;8 &#177; 33&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">LDL</span>&#44; <span class="elsevierStyleItalic">m &#177; SD</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">74&#46;1 &#177; 30&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">75&#46;2 &#177; 33&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">72&#46;8 &#177; 27&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">HDL</span>&#44; <span class="elsevierStyleItalic">m &#177; SD</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">44&#46;3 &#177; 11&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">44&#46;6 &#177; 12&#46;44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">44 &#177; 11&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Triglycerides</span>&#44; <span class="elsevierStyleItalic">m &#177; SD</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">128&#46;2 &#177; 72&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">125&#46;4 &#177; 67&#46;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">131&#46;8 &#177; 79&#46;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;34&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Non-HDL cholesterol</span>&#44; <span class="elsevierStyleItalic">m &#177; SD</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">98&#46;4 &#177; 33&#46;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">98&#46;9 &#177; 36&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">97&#46;7 &#177; 30&#46;4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;69&nbsp;\t\t\t\t\t\t\n
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                  """
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        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Lipid profile according to coronary vessel involvement in progress monitoring&#46;</p>"
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      "titulo" => "References"
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        0 => array:2 [
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                    0 => array:2 [
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                  "host" => array:1 [
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                0 => array:2 [
                  "contribucion" => array:1 [
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                      "titulo" => "Gu&#237;a ESC&#47;EAS 2016 sobre el tratamiento de las dislipemias Grupo de Trabajo de la Sociedad Europea de Cardiolog&#237;a &#40;ESC&#41; y la European Atherosclerosis Society &#40;EAS&#41; sobre el Tratamiento de las Dislipemias"
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                          "etal" => true
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                            2 => "Guy De Backer"
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                    0 => array:2 [
                      "doi" => "10.1016/j.rec.2017.01.001"
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                        "volumen" => "70"
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                0 => array:2 [
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                      "titulo" => "Gu&#237;a ESC&#47;EAS 2019 sobre el tratamiento de las dislipemias&#58; modificaci&#243;n de los l&#237;pidos para reducir el riesgo cardiovascular"
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                        0 => array:2 [
                          "etal" => true
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                            1 => "Colin Baigent"
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                            3 => "C&#46; Konstantinos Koskinas"
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                  "host" => array:1 [
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Original article
Achievement of long-term lipid targets in a cohort of patients with acute coronary syndrome in real-world clinical practice
Grado de consecución de los objetivos lipídicos a largo plazo en una cohorte de pacientes con síndrome coronario agudo en práctica clínica real
C. Baldeón Condea,
Corresponding author
cristina.baldeon@scsalud.es

Corresponding author.
, N. Royuela Martínezb, C. García Ibarbiaa,d,e, A.R. Guerra Ruizc, I. Olavarri Miguelb,e, M. Cobo Belausteguib,e, B. Alio Lavínc,e, F.J. González Vilchezb,e, J.M. de la Torre Hernándezb,d,e, J.L. Hernández Hernándeza,d,e
a Unidad de Lípidos y Riesgo Vascular, Servicio de Medicina Interna, Hospital Marqués de Valdecilla, Santander, Cantabria, Spain
b Servicio de Cardiología, Hospital Marqués de Valdecilla, Santander, Cantabria, Spain
c Servicio de Análisis Clínicos, Hospital Marqués de Valdecilla, Santander, Cantabria, Spain
d Departamento de Medicina y Psiquiatría, Universidad de Cantabria, Santander, Cantabria, Spain
e Instituto de Investigación Valdecilla (IDIVAL), Santander, Cantabria, Spain

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