Cardiovascular morbidity–mortality associated to ankle-brachial index in the general population

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Lahoz, M. Barrionuevo, T. García-Fernández, I. Vicente, M.F. García-Iglesias, J.M. Mostaza" "autores" => array:6 [ 0 => array:4 [ "nombre" => "C." "apellidos" => "Lahoz" "email" => array:1 [ 0 => "carlos.lahoz@salud.madrid.org" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "¿" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "M." "apellidos" => "Barrionuevo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "T." "apellidos" => "García-Fernández" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "I." "apellidos" => "Vicente" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 4 => array:3 [ "nombre" => "M.F." "apellidos" => "García-Iglesias" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "J.M." "apellidos" => "Mostaza" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Unidad de Lípidos y Riesgo Cardiovascular, Hospital Carlos III, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Centro de Salud Fuencarral, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Centro de Salud Monóvar, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Morbimortalidad cardiovascular asociada al índice tobillo-brazo en la población general" ] ] "textoCompleto" => "<elsevierMultimedia ident="tb0005"></elsevierMultimedia>BackgroundThe ankle brachial index (ABI) is a simple and very useful test for diagnosing peripheral arterial disease (PAD). A low ABI (when the ratio of the systolic blood pressure in the legs to that in the arms is <0.9) represents a diagnosis of PAD with high sensitivity and specificity,<a class="elsevierStyleCrossRef" href="#bib0005">1</a> despite the majority of patients having no clinical symptoms.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> The ABI also indicates generalized arteriosclerosis given that it is associated with a high prevalence of atherosclerotic vascular disease in other vascular beds. Moreover, ABI is useful for predicting the risk of future cardiovascular events.<a class="elsevierStyleCrossRef" href="#bib0015">3</a> Thus, a strong and consistent association has been described between a low ABI and the incidence of coronary and cerebrovascular disease in various cohorts studies.<a class="elsevierStyleCrossRefs" href="#bib0020">4–6</a> Moreover, a number of authors have reported an association between the presence of an ABI>1.4 or an incompressible ABI with a increased risk of cardiovascular events and death.<a class="elsevierStyleCrossRefs" href="#bib0020">4,5</a>In our community, an association has been described between a low ABI and an increased incidence of cardiovascular events and with increased mortality in patients with high cardiovascular risk. Thus, in patients with acute coronary syndrome (ACS)<a class="elsevierStyleCrossRefs" href="#bib0035">7,8</a> or with stable cardiovascular disease,<a class="elsevierStyleCrossRef" href="#bib0045">9</a> a low ABI is associated with increased mortality. It has also been reported that patients who have had an acute ischemic stroke and a low ABI have a greater recurrence of stroke and a higher number of cardiovascular events.<a class="elsevierStyleCrossRef" href="#bib0050">10</a> Lastly, in participants with permanent atrial fibrillation in anticoagulant therapy, a low ABI predicts higher mortality.<a class="elsevierStyleCrossRef" href="#bib0055">11</a> However, there is no study in Spain that has analyzed the potential association between a low ABI and a poorer cardiovascular prognosis in the general population.The aim of this study was to investigate the association between a low ABI and the incidence of death due to cardiovascular causes in a population treated at a health center, after a mean follow-up of 4 years.Materials and methodThis was a prospective descriptive observational study performed in a primary care setting. Between 2003 and 2004, 1361 volunteers between the ages of 60 and 79 years and with no known PAD were recruited at the Fuencarral Health Center (Madrid) to participate in a study whose aim was to assess the risk factors associated with a low ABI.<a class="elsevierStyleCrossRef" href="#bib0060">12</a> A review of the participants’ medical history was conducted, with special attention given to the cardiovascular risk factors and the medication the patients were taking. The participants underwent a physical examination to determine height, weight, abdominal circumference, blood pressure and ABI. In addition, fasting blood tests were performed to determine glucose, creatinine, total cholesterol, HDL-cholesterol and triglyceride levels using enzymatic methods. LDL-cholesterol levels were calculated using the Friedewald formula.In 2008, all participants were contacted by telephone. Of the 1361 participants who attended the first visit, 71 (5.2%) had died, 61(4.4%) could not be located and the remainder (90.3%) were contacted. They were asked about any cardiovascular problems that might have occurred since the first visit. Medical reports were requested from all those who reported having some cardiovascular problem and these reports were checked against the medical history from the health center or reference hospital. The deaths were confirmed in the national death index of the Ministry of Health, Social Services and Equality. All subjects who could not be located were also sought in the national death index.The primary outcome variable was cardiovascular death. Cardiovascular death was considered, according to the REACH registry,<a class="elsevierStyleCrossRef" href="#bib0065">13</a> as that resulting from a fatal stroke, a fatal acute myocardial infarction (AMI), any sudden death unless some other cause was demonstrated, death after vascular surgery or vascular procedure, death attributed to heart failure, death after bowel or limb infarction or any other death that could not be categorically attributed to a nonvascular cause. The secondary objectives were nonfatal AMI, nonfatal stroke, cardiovascular events and total mortality. AMI was defined as the presence of high levels of biochemical markers (troponin or CPK-MB) and one of the following criteria: ischemic symptoms, electrocardiogram abnormalities (pathological Q waves, changes in the ST-segment) or surgery on the coronary arteries. Stroke was defined as any cerebral circulatory disorder that caused a transient impairment of >24h or definitive impairment of the functioning of one or several parts of the brain. Major cardiovascular event was defined as the inclusion of nonfatal AMI, nonfatal stroke or cardiovascular death.The measurement of the ABI was performed with a bidirectional portable Doppler with an 8-MHz probe (Hadeco; Kawasaki, Japan) and a calibrated mercury sphygmomanometer. With the patient supine, the systolic blood pressure was measured in both brachial arteries in each upper limb and in the posterior tibial and pedal arteries of both legs. The highest value achieved in each of the legs was divided by the highest value measured in the arms, thereby obtaining an ABI for each of the legs. The definitive ABI was the lower of these 2 values. An ABI low was considered low when less than 0.9 and high when greater then 1.4 or incompressible when a peripheral pulse persisted despite raising the cuff pressure to 250mm Hg).Patients whose blood pressure was ≥140/90mm Hg or who were already on treatment with antihypertensive drugs were considered hypertensive. Patients with LDL-cholesterol levels ≥100mg/dl or in treatment with hypolipidemic drugs were considered hypercholesterolemic. Smokers were defined as any patient who had consumed tobacco in the past month. The diagnosis of diabetes was established when the baseline glycemia level was ≥126mg/dl on 2 occasions or when the patient was on therapy with oral antidiabetic agents or insulin. HDL-cholesterol levels were considered low when they were <50mg/dL in females or <40mg/dL in males; triglycerides levels were high when ≥150mg/dL. We defined the presence of atherogenic dyslipidemia in a patient when both a low HDL-cholesterol level and a high triglyceride level were present. The glomerular filtration rate (GFR) was calculated using the abbreviated formula of the Modification of Diet in Renal Disease<a class="elsevierStyleCrossRef" href="#bib0070">14</a>; patients were considered to have chronic renal failure their glomerular filtration rate was less than 60ml/min/1.73m2. For the definition of metabolic syndrome, we used the NCEP-ATP III criteria.<a class="elsevierStyleCrossRef" href="#bib0075">15</a>Statistical analysisAll statistical analyses were performed with the SPSS® statistical package (version 18.0). The quantitative variables are expressed as means (standard deviation) and the qualitative as percentages. To check the normal distribution of the variables, we performed a Kolmogorov–mirnov test. Comparisons between quantitative variables were performed using Student's t-test. Comparisons between qualitative variables were performed using the χ2 test. To study the association between clinical events and low or high ABI, we conducted a stepwise logistic regression analysis. We used the outcome variables (cardiovascular mortality, cardiovascular event, nonfatal stroke, nonfatal AMI, total mortality) as the dependent variables. For the independent variables, we used low or high ABI and other variables that, in the univariate analysis, had p-values <0.10 or that were considered clinically relevant (sex, age, smoking, high blood pressure, diabetes mellitus, hypercholesterolemia, atherogenic dyslipidemia, cardiovascular disease, metabolic syndrome, hypotensive therapy, lipid-lowering therapy, hypoglycemic therapy and antiplatelet therapy). We considered the differences to be statistically significant when the p-value was less than 0.05.All participants gave their informed consent. The study was approved by the Clinical Research Ethics Committee of the Hospital Carlos III of Madrid.ResultsThe characteristics of the 1300 patients assessed are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. The mean age was approximately 70 years, and almost two thirds of the study participants were women. Previously established cardiovascular disease was identified in only 9.1% of the patients. Approximately 16% had diabetes mellitus. Close to 1 in every 2 participants was taking some hypotensive drug. The mean ABI was 1.08±4.3 (mean±SD). A total of 66 participants (5.0%) had an ABI <0.9, 32 (2.4%) had an ABI≥1.4 or incompressible ABI and the rest (92.6%) had normal ABIs. The mean time between the baseline visit and the follow-up call was 49.8±7.2 months.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>When comparing the baseline characteristics of the 1300 contacted participants with those of the 61 not found, the only difference was that the latter were significantly younger (mean age, 68.0±5.2 years (ata not shown).<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the clinical–biological characteristics of the population divided according to baseline ABI. Participants who had a reduced ABI were older, had a greater proportion of men, had a greater calculated cardiovascular risk, had a greater prevalence of high blood pressure, diabetes mellitus, atherogenic dyslipidemia, established cardiovascular disease and metabolic syndrome than patients who had a normal ABI. In addition, the former received hypotensive, lipid-lowering, hypoglycemic and antiplatelet therapy more often than the patients who had a normal ABI. Participants with high or incompressible ABI were more frequently male, younger, had a greater prevalence of diabetes and cardiovascular disease and used hypoglycemic and antiplatelet drugs more frequently than the participants who had a normal ABI.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>During the follow-up period, there were 13 deaths due to cardiovascular causes and 49 major cardiovascular events. There was 10 (0.8%) deaths due to cardiovascular causes in the group with normal ABI, 3 (4.5%) in the group with reduced ABI and none in the group with high or incompressible ABI (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). The risk of cardiovascular death was significantly greater in the participants with reduced ABI (relative risk (RR) 5.67, 95% confidence interval (95% CI) 1.52–21.12, p=0.010) compared with those with normal ABI, even after adjusting for the risk factors, comorbidity and use of drugs (RR 6.83; 95% CI 1.36–34.3, p=0.020). Also, the risk of cardiovascular events was greater in the participants with reduced ABI when compared with the participants with normal ABI, both with the raw (RR 3.35, 95% CI 1.44–7.80, p=0.005) and adjusted (RR 2.42, 95% CI 0.99–5.91, p=0.051) data (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). There were no significant differences between the two groups in terms of the incidence of stroke, nonfatal AMI or all-cause mortality when comparing the variables separately.<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>Compared with the participants with ABI≥1.4 or incompressible ABI, only 1 participant (3.4%) had a cardiovascular event, and there were no significant differences in any of the study variables with respect to subjects with normal ABI (data not shown).DiscussionIn our study, a low ABI was associated with the main risk cardiovascular factors, with the presence of cardiovascular disease and with a greater risk of cardiovascular death and future cardiovascular events, in contrast to a high or incompressible ABI.The prevalence of low ABI in our study was lower than that of other U.S. and Northern Europe series, which is probably due to the lower atherosclerotic burden of Mediterranean populations. When comparing the prevalence obtained in this study (5%) with that of other national series in the general population (4.9%<a class="elsevierStyleCrossRef" href="#bib0080">16</a> and 7.6%<a class="elsevierStyleCrossRef" href="#bib0085">17</a>), we observed a slight difference that could be attributed to the lower age in those studies in comparison to our study. The lower prevalence of PAD in our series can also be attributed to the greater number of women in our population and to a possible selection bias, given that the participants signed up voluntarily for the ABI measurement. It is possible, therefore, that healthier individuals participated in this study.The risk factors associated with PAD, diagnosed with a low ABI, are the same as those for ischemic heart disease and ischemic stroke because they have a common cause, arteriosclerosis, affecting various vascular beds.<a class="elsevierStyleCrossRefs" href="#bib0090">18,19</a> In our study, the participants with a low ABI were older and had a significantly greater prevalence of high blood pressure, diabetes mellitus and atherogenic dyslipidemia. There was also a greater prevalence of smokers, although this was not statistically significant, which was probably due to the low rate of smokers in our population. With regard to hypercholesterolemia, its high prevalence in the control group (71%) prevented the difference with the low ABI group (79%) from being statistically significant. The factors associated with high or incompressible ABI have been less studied. In our study, a greater age, the male gender and diabetes were the factors associated with a high or incompressible ABI. These same factors, as well as high blood pressure and obesity, were described by Alzamora et al. in a population from Barcelona.<a class="elsevierStyleCrossRef" href="#bib0100">20</a> Subjects with low or high ABI were associated with an increased prevalence of vascular disease, a finding described in several population-based cohorts.<a class="elsevierStyleCrossRef" href="#bib0015">3</a>Numerous studies have demonstrated than a low ABI is associated with an increased risk of myocardial infarction, stroke and death from cardiovascular causes, regardless of risk factors or the presence of established cardiovascular disease.<a class="elsevierStyleCrossRefs" href="#bib0020">4–6</a> In a meta-analysis with 16 cohorts and approximately 50,000 participants, a low ABI multiplied cardiovascular mortality by 4 in men and by 3 in women at 10 years, compared with participants with a normal ABI.<a class="elsevierStyleCrossRef" href="#bib0105">21</a> In our study, the presence of an ABI<0.9 was associated with a significantly higher cardiovascular mortality after 4 years of follow-up, even after adjusting for risk factors and comorbidity. Furthermore, a low ABI was associated with a greater incidence of cardiovascular events, which, after statistical adjustment, reached statistical significance (p=0.051). It is worth noting that the total mortality and cardiovascular rates in our study were slightly below those of the Community of Madrid for patients 70 years of age and much lower than those of other Anglo-Saxon series.<a class="elsevierStyleCrossRefs" href="#bib0025">5,6</a> We attribute the differences with the international series to the relatively low cardiovascular risk of the Spanish population, with the corresponding lower rate of cardiovascular events. As for the differences with the data from the Community of Madrid, we believe that these are due to the possible selection bias mentioned earlier. However, the participants with a low ABI in our series were patients with high cardiovascular risk with an annual cardiovascular mortality of 1.1% and an annual rate of cardiovascular events of 2.5%.In Spain, there are no prospective studies that have evaluated the predictive role of ABI in the general population. There have been several studies performed with very high-risk patients, mainly in the hospital setting. In 2 studies with 1-year follow-ups, patients with acute coronary syndrome and a low ABI had a greater total and cardiovascular mortality than those who had a normal ABI.<a class="elsevierStyleCrossRefs" href="#bib0035">7,8</a> In patients with an acute ischemic stroke, an ABI<0.9 was associated with a significantly higher recurrence of stroke and an increased incidence of cardiovascular events after 18 months of follow-up.<a class="elsevierStyleCrossRef" href="#bib0050">10</a> Moreover, in patients older than 65 years with established cardiovascular disease followed-up by the internal medicine department, an ABI<0.9 was associated with increased cardiovascular morbidity and mortality after a 1-year follow-up.<a class="elsevierStyleCrossRef" href="#bib0045">9</a> Lastly, there is only one study performed in primary care in which 232 patients with diabetes were followed-up for 7.7 years, which reported greater cardiovascular morbidity and mortality in patients with a low ABI.<a class="elsevierStyleCrossRef" href="#bib0110">22</a>An ABI>1.4 or an incompressible ABI has been associated with a greater risk of cardiovascular mortality in various cohort studies.<a class="elsevierStyleCrossRefs" href="#bib0020">4,5,21</a> However, in our study there was no such association. In this group, there were 3 deaths, none from vascular causes, and only one cardiovascular event occurred during the follow-up. This lack of association could be due in part to the low proportion of participants with high or incompressible ABI (2.4%) in our population and to the significantly lower age of these participants, who were 5 years younger than the participants with normal ABI.We believe that our results have an important clinical relevance since they confirm that the determination of the ABI, which is a simple, inexpensive and reproducible test performed in the primary care setting, selects a subgroup of the general population with a high risk of experiencing a cardiovascular event. This finding would oblige us to perform an intensive treatment of modifiable cardiovascular risk factors in these patients.The limitations of this study include the possibility of a participant selection bias due to the fact that they volunteered for the study and that some of the participants might have experienced a cardiovascular event during follow-up that they did not report to the interviewer or that the event was oligosymptomatic and they did not contact their primary care physician or reference hospital. It is also possible that some of the 61 participants lost during follow-up might have presented a nonfatal cardiovascular event. None of these limitations affect the primary endpoint of the study, cardiovascular mortality, because all subjects who could not be contacted were sought in the national death index, ruling out their death.In conclusion, the presence of a low ABI in a general population followed up in a health center is associated with increased cardiovascular mortality and cardiovascular events. By contrast, a high or incompressible ABI is not associated in our population with an increased cardiovascular risk.Conflict of interestThe authors declare no conflicts of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:2 [ "identificador" => "xres307805" "titulo" => array:5 [ 0 => "Abstract" 1 => "Background and objectives" 2 => "Patients and methods" 3 => "Results" 4 => "Conclusions" ] ] 1 => array:2 [ "identificador" => "xpalclavsec290885" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres307806" "titulo" => array:5 [ 0 => "Resumen" 1 => "Antecedentes y objetivos" 2 => "Pacientes y métodos" 3 => "Resultados" 4 => "Conclusiones" ] ] 3 => array:2 [ "identificador" => "xpalclavsec290886" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0015" "titulo" => "Background" ] 5 => array:2 [ "identificador" => "sec0020" "titulo" => "Materials and method" ] 6 => array:2 [ "identificador" => "sec0025" "titulo" => "Statistical analysis" ] 7 => array:2 [ "identificador" => "sec0030" "titulo" => "Results" ] 8 => array:2 [ "identificador" => "sec0035" "titulo" => "Discussion" ] 9 => array:2 [ "identificador" => "sec0040" "titulo" => "Conflict of interest" ] 10 => array:2 [ "identificador" => "xack73621" "titulo" => "Acknowledgments" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2013-06-17" "fechaAceptado" => "2013-08-17" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec290885" "palabras" => array:3 [ 0 => "Ankle-brachial index" 1 => "Peripheral arterial disease" 2 => "Coronary disease" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec290886" "palabras" => array:3 [ 0 => "Índice tobillo-brazo" 1 => "Enfermedad arterial periférica" 2 => "Enfermedad coronaria" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "Background and objectivesAbnormal ankle-brachial index (ABI) is associated with a high risk of cardiovascular disease. This study has aimed to investigate the association between low ABI and risk of cardiovascular death in a general population attended in a primary care center. Patients and methodsA total of 1361 volunteers aged between 60 and 79 years without any evidence of peripheral artery disease who attended a primary care center participated in the study. They underwent a complete physical examination, together with standard blood tests and ABI was determined. The participants were contacted by telephone 4 years later and asked about any cardiovascular problems for that period. Causes of death and hospitalization were confirmed in the medical records in the primary care center and/or hospital. ResultsInformation was obtained about the clinical evolution of 1300 participants (mean age 69.9 years, 38.2% men). Mean follow-up was 49.8 months. There were 13 cardiovascular death and 49 major cardiovascular events. Low ABI (<0.9) was associated with a significant higher risk of cardiovascular death (adjusted relative risk 6.83; 95% confidence interval 1.36–34.30, P=0.020), and with a higher risk of major cardiovascular events (adjusted relative risk 2.42; 95% confidence interval 0.99–5.91, P=0.051). High or uncompressible ABI was not associated with higher cardiovascular risk. ConclusionsA low ABI was associated with higher risk of cardiovascular death in the general population followed up in a primary care center." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "Antecedentes y objetivosUn índice tobillo-brazo (ITB) anormal se asocia con un elevado riesgo de enfermedad cardiovascular. El objetivo del estudio fue investigar la asociación entre un ITB bajo con el riesgo de muerte de causa cardiovascular en una población atendida en un centro de salud. Pacientes y métodosParticiparon 1.361 voluntarios de entre 60 y 79 años sin enfermedad arterial periférica conocida, reclutados en una consulta de atención primaria. Se les hizo una historia clínica, una exploración física, un análisis de sangre y se les determinó el ITB. Cuatro años después se contactó con ellos y se les interrogó sobre problemas cardiovasculares acaecidos durante ese periodo. Las causas de los ingresos o de las muertes se confirmaron en las historias clínicas del centro de salud y/o del hospital de zona. ResultadosSe consiguió información sobre la evolución clínica de 1.300 participantes (edad media 69,6 años; un 38,2% eran varones). El seguimiento medio fue de 49,8 meses. Hubo 13 muertes de causa cardiovascular y 49 eventos cardiovasculares mayores. Un ITB bajo basal (<0,9) se asoció con un significativo mayor riesgo de muerte cardiovascular (riesgo relativo ajustado 6,83; intervalo de confianza 95%: 1,36-34,30; p=0,020), así como con un mayor riesgo de eventos cardiovasculares (riesgo relativo ajustado 2,42; intervalo de confianza 95%: 0,99-5,91; p=0,051). El ITB alto (>1,4) o incompresible no se asoció con un mayor riesgo cardiovascular. ConclusionesEn población general seguida en un centro de salud, un ITB bajo se asocia con un mayor riesgo de muerte cardiovascular." ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Lahoz C, Barrionuevo M, García-Fernández T, Vicente I, García-Iglesias MF, Mostaza JM. Morbimortalidad cardiovascular asociada al índice tobillo-brazo en la población general. Rev Clin Esp. 2014;214:1–7." ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "Abbreviations: ABI, ankle-brachial index; SCORE, Systematic Coronary Risk Evaluation (likelihood of death at 10 years due to myocardial infarction or stroke, expressed as a percentage); SD, standard deviation." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \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" style="border-bottom: 2px solid black">n=1300 \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><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">Age, years [mean (SD)] \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">69.6 (5.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Men, % \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">BMI, kg/m2[mean (SD)] \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">29.1 (4.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">ABI [mean (SD)] \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.08 (0.16) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">SCORE, % [mean (SD)] \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.2 (2.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Risk factors</td></tr><tr title="table-row"><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">Hypertension (%) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Diabetes mellitus (%) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Hypercholesterolemia (%) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">71.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Atherogenic dyslipidemia (%) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Smokers (%) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Comorbidity</td></tr><tr title="table-row"><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">Cardiovascular disease (%) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Metabolic syndrome (%) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">33.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Chronic renal failure (%) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Treatment</td></tr><tr title="table-row"><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">Hypotensive (%) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Lipid-lowering (%) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Hypoglycemic (%) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Antiplatelet (%) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab455047.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Population characteristics." ] ] 1 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "Abbreviations: ABI, ankle-brachial index; BMI, body mass index; CRF, chronic renal failure; p, differences with respect to normal ABI participants.All data are expressed as percentages, unless stated otherwise." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \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" style="border-bottom: 2px solid black">Normal ABI (n=1202) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \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" style="border-bottom: 2px solid black">ABI<0.90 (n=66) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \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" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \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" style="border-bottom: 2px solid black">ABI≥1.4 (n=32) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \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" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><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">Age, years [mean (SD)] \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">69.5 (5.2) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">71.2 (5.5) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.012 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">64.6 (11.2) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.029 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Men \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36.9 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50.0 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.032 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">62.5 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.003 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">BMI, kg/m2[mean (SD)] \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">29.1 (4.3) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">29.3 (4.4) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.715 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28.1 (4.7) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.236 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">ABI [mean (SD)] \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.08 (0.09) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.76 (0.11) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.74 (0.34) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="6" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="6" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Risk factors</td></tr><tr title="table-row"><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">Hypertension \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">48.8 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">72.7 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">46.9 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.827 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Diabetes \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14.6 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">33.3 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">31.3 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.009 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Hypercholesterolemia \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">71.3 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">79.7 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.148 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">56.3 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.064 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Atherogenic dyslipidemia \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.2 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16.4 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.025 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12.5 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.678 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Smoker \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10.2 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16.7 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.098 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12.5 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.677 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="6" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="6" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Comorbidity</td></tr><tr title="table-row"><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">Cardiovascular disease \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.6 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">31.8 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18.8 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.020 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Metabolic syndrome \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35.0 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">52.5 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.006 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">34.4 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.944 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">CRF \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35.9 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38.6 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.713 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26.3 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.390 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="6" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Treatment</td></tr><tr title="table-row"><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">Hypotensive \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">44.5 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">68.2 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40.6 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.663 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Lipid-lowering \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20.3 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">34.8 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.005 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.4 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.127 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Hypoglycemic \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.3 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28.7 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28.1 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Antiplatelet \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.6 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27.3 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21.9 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.021 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab455048.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Population characteristics according to ankle-brachial index." ] ] 2 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "Abbreviations: ABI, ankle-brachial index; AMI, acute myocardial infarction; CI, confidence interval; RR, relative risk." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \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" style="border-bottom: 2px solid black">Normal ABI (n=1202) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \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" style="border-bottom: 2px solid black">ABI<0.90 (n=66) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \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" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cardiovascular mortality</td></tr><tr title="table-row"><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">n (%) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 (0.8%) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (4.5%) \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="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Raw RR (95% CI) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.67 (1.52–21.12) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.010 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Adjusted RR (95% CI) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.83 (1.36–34.3) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.020 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cardiovascular event</td></tr><tr title="table-row"><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">n (%) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">41 (3.4%) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (10.0%) \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="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Raw RR (95% CI) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.35 (1.44–7.80) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.005 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Adjusted RR (95% CI) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.42 (0.99–5.91) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.051 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Nonfatal AMI</td></tr><tr title="table-row"><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">n (%) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 (1.0%) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (3.3%) \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="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Raw RR (95% CI) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.51 (0.76–16.23) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.107 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Adjusted RR (95% CI) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.58 (0.30–8.33) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.585 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Nonfatal stroke</td></tr><tr title="table-row"><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">n (%) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20 (1.7%) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (3.3%) \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="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Raw RR (95% CI) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.96 (0.44–8.58) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.372 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Adjusted RR (95% CI) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.33 (0.26–6.75) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.727 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Total mortality</td></tr><tr title="table-row"><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">n (%) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">62 (5.2%) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (9.1%) \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="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Raw RR (95% CI) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.83 (0.76–4.42) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.174 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Adjusted RR (95% CI) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.85 (0.74–4.66) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.187 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab455046.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Number, incidence and relative risk of cardiovascular events according to the presence of a low or normal ABI." ] ] 3 => array:5 [ "identificador" => "tb0005" "tipo" => "MULTIMEDIATEXTO" "mostrarFloat" => false "mostrarDisplay" => true "texto" => array:1 [ "textoCompleto" => "What we know?The ratio of the systolic blood pressures of the leg and arm (ankle brachial index, ABI), when low (<0.9), establishes that a patient has peripheral arterial disease. Patients with an increased vascular risk and an ABI<0.9 often present atherosclerotic lesions in other arteries (coronary, carotid) and have an increased risk of experiencing new cardiovascular events and death. We do not know whether patients with low vascular risk but with an ABI<0.9 also have increased cardiovascular morbidity and mortality.What this article provides?In 1300 volunteers aged 60–79 years, the finding of an ABI<0.9 was associated, after more than 4 years, with a mortality and cardiovascular disease risk approximately 7 times and 2.5 times greater, respectively, than in subjects with a normal ABI.The Editors" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:22 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The measurement of atherosclerotic peripheral arterial disease in epidemiological surveys" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "F.G. 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Cardiovascular morbidity–mortality associated to ankle-brachial index in the general population

Morbimortalidad cardiovascular asociada al índice tobillo-brazo en la población general

C. Lahoza,

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carlos.lahoz@salud.madrid.org

Corresponding author.

, M. Barrionuevob, T. García-Fernándezb, I. Vicentec, M.F. García-Iglesiasa, J.M. Mostazaa

a Unidad de Lípidos y Riesgo Cardiovascular, Hospital Carlos III, Madrid, Spain

b Centro de Salud Fuencarral, Madrid, Spain

c Centro de Salud Monóvar, Madrid, Spain

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            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Morbimortalidad cardiovascular asociada al &#237;ndice tobillo-brazo en la poblaci&#243;n general"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="tb0005"></elsevierMultimedia></p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Background</span><p id="par0030" class="elsevierStylePara elsevierViewall">The ankle brachial index &#40;ABI&#41; is a simple and very useful test for diagnosing peripheral arterial disease &#40;PAD&#41;&#46; A low ABI &#40;when the ratio of the systolic blood pressure in the legs to that in the arms is &#60;0&#46;9&#41; represents a diagnosis of PAD with high sensitivity and specificity&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> despite the majority of patients having no clinical symptoms&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The ABI also indicates generalized arteriosclerosis given that it is associated with a high prevalence of atherosclerotic vascular disease in other vascular beds&#46; Moreover&#44; ABI is useful for predicting the risk of future cardiovascular events&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Thus&#44; a strong and consistent association has been described between a low ABI and the incidence of coronary and cerebrovascular disease in various cohorts studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#8211;6</span></a> Moreover&#44; a number of authors have reported an association between the presence of an ABI<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>1&#46;4 or an incompressible ABI with a increased risk of cardiovascular events and death&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">In our community&#44; an association has been described between a low ABI and an increased incidence of cardiovascular events and with increased mortality in patients with high cardiovascular risk&#46; Thus&#44; in patients with acute coronary syndrome &#40;ACS&#41;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;8</span></a> or with stable cardiovascular disease&#44;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> a low ABI is associated with increased mortality&#46; It has also been reported that patients who have had an acute ischemic stroke and a low ABI have a greater recurrence of stroke and a higher number of cardiovascular events&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Lastly&#44; in participants with permanent atrial fibrillation in anticoagulant therapy&#44; a low ABI predicts higher mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> However&#44; there is no study in Spain that has analyzed the potential association between a low ABI and a poorer cardiovascular prognosis in the general population&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The aim of this study was to investigate the association between a low ABI and the incidence of death due to cardiovascular causes in a population treated at a health center&#44; after a mean follow-up of 4 years&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Materials and method</span><p id="par0045" class="elsevierStylePara elsevierViewall">This was a prospective descriptive observational study performed in a primary care setting&#46; Between 2003 and 2004&#44; 1361 volunteers between the ages of 60 and 79 years and with no known PAD were recruited at the Fuencarral Health Center &#40;Madrid&#41; to participate in a study whose aim was to assess the risk factors associated with a low ABI&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> A review of the participants&#8217; medical history was conducted&#44; with special attention given to the cardiovascular risk factors and the medication the patients were taking&#46; The participants underwent a physical examination to determine height&#44; weight&#44; abdominal circumference&#44; blood pressure and ABI&#46; In addition&#44; fasting blood tests were performed to determine glucose&#44; creatinine&#44; total cholesterol&#44; HDL-cholesterol and triglyceride levels using enzymatic methods&#46; LDL-cholesterol levels were calculated using the Friedewald formula&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">In 2008&#44; all participants were contacted by telephone&#46; Of the 1361 participants who attended the first visit&#44; 71 &#40;5&#46;2&#37;&#41; had died&#44; 61&#40;4&#46;4&#37;&#41; could not be located and the remainder &#40;90&#46;3&#37;&#41; were contacted&#46; They were asked about any cardiovascular problems that might have occurred since the first visit&#46; Medical reports were requested from all those who reported having some cardiovascular problem and these reports were checked against the medical history from the health center or reference hospital&#46; The deaths were confirmed in the national death index of the Ministry of Health&#44; Social Services and Equality&#46; All subjects who could not be located were also sought in the national death index&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The primary outcome variable was cardiovascular death&#46; Cardiovascular death was considered&#44; according to the REACH registry&#44;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> as that resulting from a fatal stroke&#44; a fatal acute myocardial infarction &#40;AMI&#41;&#44; any sudden death unless some other cause was demonstrated&#44; death after vascular surgery or vascular procedure&#44; death attributed to heart failure&#44; death after bowel or limb infarction or any other death that could not be categorically attributed to a nonvascular cause&#46; The secondary objectives were nonfatal AMI&#44; nonfatal stroke&#44; cardiovascular events and total mortality&#46; AMI was defined as the presence of high levels of biochemical markers &#40;troponin or CPK-MB&#41; and one of the following criteria&#58; ischemic symptoms&#44; electrocardiogram abnormalities &#40;pathological Q waves&#44; changes in the ST-segment&#41; or surgery on the coronary arteries&#46; Stroke was defined as any cerebral circulatory disorder that caused a transient impairment of &#62;24<span class="elsevierStyleHsp" style=""></span>h or definitive impairment of the functioning of one or several parts of the brain&#46; Major cardiovascular event was defined as the inclusion of nonfatal AMI&#44; nonfatal stroke or cardiovascular death&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The measurement of the ABI was performed with a bidirectional portable Doppler with an 8-MHz probe &#40;Hadeco&#59; Kawasaki&#44; Japan&#41; and a calibrated mercury sphygmomanometer&#46; With the patient supine&#44; the systolic blood pressure was measured in both brachial arteries in each upper limb and in the posterior tibial and pedal arteries of both legs&#46; The highest value achieved in each of the legs was divided by the highest value measured in the arms&#44; thereby obtaining an ABI for each of the legs&#46; The definitive ABI was the lower of these 2 values&#46; An ABI low was considered low when less than 0&#46;9 and high when greater then 1&#46;4 or incompressible when a peripheral pulse persisted despite raising the cuff pressure to 250<span class="elsevierStyleHsp" style=""></span>mm Hg&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Patients whose blood pressure was &#8805;140&#47;90<span class="elsevierStyleHsp" style=""></span>mm Hg or who were already on treatment with antihypertensive drugs were considered hypertensive&#46; Patients with LDL-cholesterol levels &#8805;100<span class="elsevierStyleHsp" style=""></span>mg&#47;dl or in treatment with hypolipidemic drugs were considered hypercholesterolemic&#46; Smokers were defined as any patient who had consumed tobacco in the past month&#46; The diagnosis of diabetes was established when the baseline glycemia level was &#8805;126<span class="elsevierStyleHsp" style=""></span>mg&#47;dl on 2 occasions or when the patient was on therapy with oral antidiabetic agents or insulin&#46; HDL-cholesterol levels were considered low when they were &#60;50<span class="elsevierStyleHsp" style=""></span>mg&#47;dL in females or &#60;40<span class="elsevierStyleHsp" style=""></span>mg&#47;dL in males&#59; triglycerides levels were high when &#8805;150<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#46; We defined the presence of atherogenic dyslipidemia in a patient when both a low HDL-cholesterol level and a high triglyceride level were present&#46; The glomerular filtration rate &#40;GFR&#41; was calculated using the abbreviated formula of the Modification of Diet in Renal Disease<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a>&#59; patients were considered to have chronic renal failure their glomerular filtration rate was less than 60<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#46; For the definition of metabolic syndrome&#44; we used the NCEP-ATP III criteria&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Statistical analysis</span><p id="par0070" class="elsevierStylePara elsevierViewall">All statistical analyses were performed with the SPSS<span class="elsevierStyleSup">&#174;</span> statistical package &#40;version 18&#46;0&#41;&#46; The quantitative variables are expressed as means &#40;standard deviation&#41; and the qualitative as percentages&#46; To check the normal distribution of the variables&#44; we performed a Kolmogorov&#8211;mirnov test&#46; Comparisons between quantitative variables were performed using Student&#39;s <span class="elsevierStyleItalic">t</span>-test&#46; Comparisons between qualitative variables were performed using the <span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup">2</span> test&#46; To study the association between clinical events and low or high ABI&#44; we conducted a stepwise logistic regression analysis&#46; We used the outcome variables &#40;cardiovascular mortality&#44; cardiovascular event&#44; nonfatal stroke&#44; nonfatal AMI&#44; total mortality&#41; as the dependent variables&#46; For the independent variables&#44; we used low or high ABI and other variables that&#44; in the univariate analysis&#44; had <span class="elsevierStyleItalic">p</span>-values &#60;0&#46;10 or that were considered clinically relevant &#40;sex&#44; age&#44; smoking&#44; high blood pressure&#44; diabetes mellitus&#44; hypercholesterolemia&#44; atherogenic dyslipidemia&#44; cardiovascular disease&#44; metabolic syndrome&#44; hypotensive therapy&#44; lipid-lowering therapy&#44; hypoglycemic therapy and antiplatelet therapy&#41;&#46; We considered the differences to be statistically significant when the <span class="elsevierStyleItalic">p</span>-value was less than 0&#46;05&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">All participants gave their informed consent&#46; The study was approved by the Clinical Research Ethics Committee of the Hospital Carlos III of Madrid&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><p id="par0080" class="elsevierStylePara elsevierViewall">The characteristics of the 1300 patients assessed are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; The mean age was approximately 70 years&#44; and almost two thirds of the study participants were women&#46; Previously established cardiovascular disease was identified in only 9&#46;1&#37; of the patients&#46; Approximately 16&#37; had diabetes mellitus&#46; Close to 1 in every 2 participants was taking some hypotensive drug&#46; The mean ABI was 1&#46;08<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;3 &#40;mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41;&#46; A total of 66 participants &#40;5&#46;0&#37;&#41; had an ABI &#60;0&#46;9&#44; 32 &#40;2&#46;4&#37;&#41; had an ABI<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>1&#46;4 or incompressible ABI and the rest &#40;92&#46;6&#37;&#41; had normal ABIs&#46; The mean time between the baseline visit and the follow-up call was 49&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;2 months&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">When comparing the baseline characteristics of the 1300 contacted participants with those of the 61 not found&#44; the only difference was that the latter were significantly younger &#40;mean age&#44; 68&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;2 years &#40;ata not shown&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the clinical&#8211;biological characteristics of the population divided according to baseline ABI&#46; Participants who had a reduced ABI were older&#44; had a greater proportion of men&#44; had a greater calculated cardiovascular risk&#44; had a greater prevalence of high blood pressure&#44; diabetes mellitus&#44; atherogenic dyslipidemia&#44; established cardiovascular disease and metabolic syndrome than patients who had a normal ABI&#46; In addition&#44; the former received hypotensive&#44; lipid-lowering&#44; hypoglycemic and antiplatelet therapy more often than the patients who had a normal ABI&#46; Participants with high or incompressible ABI were more frequently male&#44; younger&#44; had a greater prevalence of diabetes and cardiovascular disease and used hypoglycemic and antiplatelet drugs more frequently than the participants who had a normal ABI&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">During the follow-up period&#44; there were 13 deaths due to cardiovascular causes and 49 major cardiovascular events&#46; There was 10 &#40;0&#46;8&#37;&#41; deaths due to cardiovascular causes in the group with normal ABI&#44; 3 &#40;4&#46;5&#37;&#41; in the group with reduced ABI and none in the group with high or incompressible ABI &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; The risk of cardiovascular death was significantly greater in the participants with reduced ABI &#40;relative risk &#40;RR&#41; 5&#46;67&#44; 95&#37; confidence interval &#40;95&#37; CI&#41; 1&#46;52&#8211;21&#46;12&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;010&#41; compared with those with normal ABI&#44; even after adjusting for the risk factors&#44; comorbidity and use of drugs &#40;RR 6&#46;83&#59; 95&#37; CI 1&#46;36&#8211;34&#46;3&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;020&#41;&#46; Also&#44; the risk of cardiovascular events was greater in the participants with reduced ABI when compared with the participants with normal ABI&#44; both with the raw &#40;RR 3&#46;35&#44; 95&#37; CI 1&#46;44&#8211;7&#46;80&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;005&#41; and adjusted &#40;RR 2&#46;42&#44; 95&#37; CI 0&#46;99&#8211;5&#46;91&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;051&#41; data &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; There were no significant differences between the two groups in terms of the incidence of stroke&#44; nonfatal AMI or all-cause mortality when comparing the variables separately&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">Compared with the participants with ABI<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>1&#46;4 or incompressible ABI&#44; only 1 participant &#40;3&#46;4&#37;&#41; had a cardiovascular event&#44; and there were no significant differences in any of the study variables with respect to subjects with normal ABI &#40;data not shown&#41;&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discussion</span><p id="par0105" class="elsevierStylePara elsevierViewall">In our study&#44; a low ABI was associated with the main risk cardiovascular factors&#44; with the presence of cardiovascular disease and with a greater risk of cardiovascular death and future cardiovascular events&#44; in contrast to a high or incompressible ABI&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">The prevalence of low ABI in our study was lower than that of other U&#46;S&#46; and Northern Europe series&#44; which is probably due to the lower atherosclerotic burden of Mediterranean populations&#46; When comparing the prevalence obtained in this study &#40;5&#37;&#41; with that of other national series in the general population &#40;4&#46;9&#37;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> and 7&#46;6&#37;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a>&#41;&#44; we observed a slight difference that could be attributed to the lower age in those studies in comparison to our study&#46; The lower prevalence of PAD in our series can also be attributed to the greater number of women in our population and to a possible selection bias&#44; given that the participants signed up voluntarily for the ABI measurement&#46; It is possible&#44; therefore&#44; that healthier individuals participated in this study&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">The risk factors associated with PAD&#44; diagnosed with a low ABI&#44; are the same as those for ischemic heart disease and ischemic stroke because they have a common cause&#44; arteriosclerosis&#44; affecting various vascular beds&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18&#44;19</span></a> In our study&#44; the participants with a low ABI were older and had a significantly greater prevalence of high blood pressure&#44; diabetes mellitus and atherogenic dyslipidemia&#46; There was also a greater prevalence of smokers&#44; although this was not statistically significant&#44; which was probably due to the low rate of smokers in our population&#46; With regard to hypercholesterolemia&#44; its high prevalence in the control group &#40;71&#37;&#41; prevented the difference with the low ABI group &#40;79&#37;&#41; from being statistically significant&#46; The factors associated with high or incompressible ABI have been less studied&#46; In our study&#44; a greater age&#44; the male gender and diabetes were the factors associated with a high or incompressible ABI&#46; These same factors&#44; as well as high blood pressure and obesity&#44; were described by Alzamora et al&#46; in a population from Barcelona&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> Subjects with low or high ABI were associated with an increased prevalence of vascular disease&#44; a finding described in several population-based cohorts&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">Numerous studies have demonstrated than a low ABI is associated with an increased risk of myocardial infarction&#44; stroke and death from cardiovascular causes&#44; regardless of risk factors or the presence of established cardiovascular disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#8211;6</span></a> In a meta-analysis with 16 cohorts and approximately 50&#44;000 participants&#44; a low ABI multiplied cardiovascular mortality by 4 in men and by 3 in women at 10 years&#44; compared with participants with a normal ABI&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> In our study&#44; the presence of an ABI<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;9 was associated with a significantly higher cardiovascular mortality after 4 years of follow-up&#44; even after adjusting for risk factors and comorbidity&#46; Furthermore&#44; a low ABI was associated with a greater incidence of cardiovascular events&#44; which&#44; after statistical adjustment&#44; reached statistical significance &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;051&#41;&#46; It is worth noting that the total mortality and cardiovascular rates in our study were slightly below those of the Community of Madrid for patients 70 years of age and much lower than those of other Anglo-Saxon series&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a> We attribute the differences with the international series to the relatively low cardiovascular risk of the Spanish population&#44; with the corresponding lower rate of cardiovascular events&#46; As for the differences with the data from the Community of Madrid&#44; we believe that these are due to the possible selection bias mentioned earlier&#46; However&#44; the participants with a low ABI in our series were patients with high cardiovascular risk with an annual cardiovascular mortality of 1&#46;1&#37; and an annual rate of cardiovascular events of 2&#46;5&#37;&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">In Spain&#44; there are no prospective studies that have evaluated the predictive role of ABI in the general population&#46; There have been several studies performed with very high-risk patients&#44; mainly in the hospital setting&#46; In 2 studies with 1-year follow-ups&#44; patients with acute coronary syndrome and a low ABI had a greater total and cardiovascular mortality than those who had a normal ABI&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;8</span></a> In patients with an acute ischemic stroke&#44; an ABI<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;9 was associated with a significantly higher recurrence of stroke and an increased incidence of cardiovascular events after 18 months of follow-up&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Moreover&#44; in patients older than 65 years with established cardiovascular disease followed-up by the internal medicine department&#44; an ABI<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;9 was associated with increased cardiovascular morbidity and mortality after a 1-year follow-up&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Lastly&#44; there is only one study performed in primary care in which 232 patients with diabetes were followed-up for 7&#46;7 years&#44; which reported greater cardiovascular morbidity and mortality in patients with a low ABI&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">An ABI<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>1&#46;4 or an incompressible ABI has been associated with a greater risk of cardiovascular mortality in various cohort studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5&#44;21</span></a> However&#44; in our study there was no such association&#46; In this group&#44; there were 3 deaths&#44; none from vascular causes&#44; and only one cardiovascular event occurred during the follow-up&#46; This lack of association could be due in part to the low proportion of participants with high or incompressible ABI &#40;2&#46;4&#37;&#41; in our population and to the significantly lower age of these participants&#44; who were 5 years younger than the participants with normal ABI&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">We believe that our results have an important clinical relevance since they confirm that the determination of the ABI&#44; which is a simple&#44; inexpensive and reproducible test performed in the primary care setting&#44; selects a subgroup of the general population with a high risk of experiencing a cardiovascular event&#46; This finding would oblige us to perform an intensive treatment of modifiable cardiovascular risk factors in these patients&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">The limitations of this study include the possibility of a participant selection bias due to the fact that they volunteered for the study and that some of the participants might have experienced a cardiovascular event during follow-up that they did not report to the interviewer or that the event was oligosymptomatic and they did not contact their primary care physician or reference hospital&#46; It is also possible that some of the 61 participants lost during follow-up might have presented a nonfatal cardiovascular event&#46; None of these limitations affect the primary endpoint of the study&#44; cardiovascular mortality&#44; because all subjects who could not be contacted were sought in the national death index&#44; ruling out their death&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">In conclusion&#44; the presence of a low ABI in a general population followed up in a health center is associated with increased cardiovascular mortality and cardiovascular events&#46; By contrast&#44; a high or incompressible ABI is not associated in our population with an increased cardiovascular risk&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflict of interest</span><p id="par0150" class="elsevierStylePara elsevierViewall">The authors declare no conflicts of interest&#46;</p></span></span>"
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    "fechaRecibido" => "2013-06-17"
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      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Background and objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Abnormal ankle-brachial index &#40;ABI&#41; is associated with a high risk of cardiovascular disease&#46; This study has aimed to investigate the association between low ABI and risk of cardiovascular death in a general population attended in a primary care center&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0015">Patients and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A total of 1361 volunteers aged between 60 and 79 years without any evidence of peripheral artery disease who attended a primary care center participated in the study&#46; They underwent a complete physical examination&#44; together with standard blood tests and ABI was determined&#46; The participants were contacted by telephone 4 years later and asked about any cardiovascular problems for that period&#46; Causes of death and hospitalization were confirmed in the medical records in the primary care center and&#47;or hospital&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Information was obtained about the clinical evolution of 1300 participants &#40;mean age 69&#46;9 years&#44; 38&#46;2&#37; men&#41;&#46; Mean follow-up was 49&#46;8 months&#46; There were 13 cardiovascular death and 49 major cardiovascular events&#46; Low ABI &#40;&#60;0&#46;9&#41; was associated with a significant higher risk of cardiovascular death &#40;adjusted relative risk 6&#46;83&#59; 95&#37; confidence interval 1&#46;36&#8211;34&#46;30&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;020&#41;&#44; and with a higher risk of major cardiovascular events &#40;adjusted relative risk 2&#46;42&#59; 95&#37; confidence interval 0&#46;99&#8211;5&#46;91&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;051&#41;&#46; High or uncompressible ABI was not associated with higher cardiovascular risk&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A low ABI was associated with higher risk of cardiovascular death in the general population followed up in a primary care center&#46;</p>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes y objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Un &#237;ndice tobillo-brazo &#40;ITB&#41; anormal se asocia con un elevado riesgo de enfermedad cardiovascular&#46; El objetivo del estudio fue investigar la asociaci&#243;n entre un ITB bajo con el riesgo de muerte de causa cardiovascular en una poblaci&#243;n atendida en un centro de salud&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0040">Pacientes y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Participaron 1&#46;361 voluntarios de entre 60 y 79 a&#241;os sin enfermedad arterial perif&#233;rica conocida&#44; reclutados en una consulta de atenci&#243;n primaria&#46; Se les hizo una historia cl&#237;nica&#44; una exploraci&#243;n f&#237;sica&#44; un an&#225;lisis de sangre y se les determin&#243; el ITB&#46; Cuatro a&#241;os despu&#233;s se contact&#243; con ellos y se les interrog&#243; sobre problemas cardiovasculares acaecidos durante ese periodo&#46; Las causas de los ingresos o de las muertes se confirmaron en las historias cl&#237;nicas del centro de salud y&#47;o del hospital de zona&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se consigui&#243; informaci&#243;n sobre la evoluci&#243;n cl&#237;nica de 1&#46;300 participantes &#40;edad media 69&#44;6 a&#241;os&#59; un 38&#44;2&#37; eran varones&#41;&#46; El seguimiento medio fue de 49&#44;8 meses&#46; Hubo 13 muertes de causa cardiovascular y 49 eventos cardiovasculares mayores&#46; Un ITB bajo basal &#40;&#60;0&#44;9&#41; se asoci&#243; con un significativo mayor riesgo de muerte cardiovascular &#40;riesgo relativo ajustado 6&#44;83&#59; intervalo de confianza 95&#37;&#58; 1&#44;36-34&#44;30&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;020&#41;&#44; as&#237; como con un mayor riesgo de eventos cardiovasculares &#40;riesgo relativo ajustado 2&#44;42&#59; intervalo de confianza 95&#37;&#58; 0&#44;99-5&#44;91&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;051&#41;&#46; El ITB alto &#40;&#62;1&#44;4&#41; o incompresible no se asoci&#243; con un mayor riesgo cardiovascular&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">En poblaci&#243;n general seguida en un centro de salud&#44; un ITB bajo se asocia con un mayor riesgo de muerte cardiovascular&#46;</p>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Lahoz C&#44; Barrionuevo M&#44; Garc&#237;a-Fern&#225;ndez T&#44; Vicente I&#44; Garc&#237;a-Iglesias MF&#44; Mostaza JM&#46; Morbimortalidad cardiovascular asociada al &#237;ndice tobillo-brazo en la poblaci&#243;n general&#46; Rev Clin Esp&#46; 2014&#59;214&#58;1&#8211;7&#46;</p>"
      ]
    ]
    "multimedia" => array:4 [
      0 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; ABI&#44; ankle-brachial index&#59; SCORE&#44; Systematic Coronary Risk Evaluation &#40;likelihood of death at 10 years due to myocardial infarction or stroke&#44; expressed as a percentage&#41;&#59; SD&#44; standard deviation&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1300&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><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"><span class="elsevierStyleItalic">Age&#44; years &#91;mean &#40;SD&#41;&#93;</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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">69&#46;6 &#40;5&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Men&#44; &#37;</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="char" valign="\n
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                  \t\t\t\t">38&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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"><span class="elsevierStyleItalic">BMI&#44; kg&#47;m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">&#91;mean &#40;SD&#41;&#93;</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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&#46;1 &#40;4&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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"><span class="elsevierStyleItalic">ABI &#91;mean &#40;SD&#41;&#93;</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="char" valign="\n
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                  \t\t\t\t">1&#46;08 &#40;0&#46;16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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"><span class="elsevierStyleItalic">SCORE&#44; &#37; &#91;mean &#40;SD&#41;&#93;</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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;2 &#40;2&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Risk factors</span></td></tr><tr title="table-row"><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"><span class="elsevierStyleHsp" style=""></span>Hypertension &#40;&#37;&#41;&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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"><span class="elsevierStyleHsp" style=""></span>Diabetes mellitus &#40;&#37;&#41;&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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"><span class="elsevierStyleHsp" style=""></span>Hypercholesterolemia &#40;&#37;&#41;&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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"><span class="elsevierStyleHsp" style=""></span>Atherogenic dyslipidemia &#40;&#37;&#41;&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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"><span class="elsevierStyleHsp" style=""></span>Smokers &#40;&#37;&#41;&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Comorbidity</span></td></tr><tr title="table-row"><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"><span class="elsevierStyleHsp" style=""></span>Cardiovascular disease &#40;&#37;&#41;&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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"><span class="elsevierStyleHsp" style=""></span>Metabolic syndrome &#40;&#37;&#41;&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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"><span class="elsevierStyleHsp" style=""></span>Chronic renal failure &#40;&#37;&#41;&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Treatment</span></td></tr><tr title="table-row"><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"><span class="elsevierStyleHsp" style=""></span>Hypotensive &#40;&#37;&#41;&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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"><span class="elsevierStyleHsp" style=""></span>Lipid-lowering &#40;&#37;&#41;&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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"><span class="elsevierStyleHsp" style=""></span>Hypoglycemic &#40;&#37;&#41;&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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"><span class="elsevierStyleHsp" style=""></span>Antiplatelet &#40;&#37;&#41;&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Population characteristics&#46;</p>"
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      1 => array:7 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; ABI&#44; ankle-brachial index&#59; BMI&#44; body mass index&#59; CRF&#44; chronic renal failure&#59; <span class="elsevierStyleItalic">p</span>&#44; differences with respect to normal ABI participants&#46;</p><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">All data are expressed as percentages&#44; unless stated otherwise&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \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" style="border-bottom: 2px solid black">Normal ABI &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1202&#41;&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" style="border-bottom: 2px solid black">ABI<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;90 &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>66&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \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" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \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" style="border-bottom: 2px solid black">ABI<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>1&#46;4 &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>32&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \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" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><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"><span class="elsevierStyleItalic">Age&#44; years &#91;mean &#40;SD&#41;&#93;</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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">69&#46;5 &#40;5&#46;2&#41;&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71&#46;2 &#40;5&#46;5&#41;&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;012&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64&#46;6 &#40;11&#46;2&#41;&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;029&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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"><span class="elsevierStyleItalic">Men</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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&#46;0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;032&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62&#46;5&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="char" valign="\n
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                  \t\t\t\t">0&#46;003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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"><span class="elsevierStyleItalic">BMI&#44; kg&#47;m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">&#91;mean &#40;SD&#41;&#93;</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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&#46;1 &#40;4&#46;3&#41;&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&#46;3 &#40;4&#46;4&#41;&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;715&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&#46;1 &#40;4&#46;7&#41;&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;236&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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"><span class="elsevierStyleItalic">ABI &#91;mean &#40;SD&#41;&#93;</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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;08 &#40;0&#46;09&#41;&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;76 &#40;0&#46;11&#41;&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;74 &#40;0&#46;34&#41;&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Risk factors</span></td></tr><tr title="table-row"><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"><span class="elsevierStyleHsp" style=""></span>Hypertension&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48&#46;8&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;827&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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"><span class="elsevierStyleHsp" style=""></span>Diabetes&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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"><span class="elsevierStyleHsp" style=""></span>Hypercholesterolemia&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">79&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;148&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;064&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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"><span class="elsevierStyleHsp" style=""></span>Atherogenic dyslipidemia&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;2&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;025&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="char" valign="\n
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                  \t\t\t\t">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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;678&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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"><span class="elsevierStyleHsp" style=""></span>Smoker&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;2&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;098&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;677&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Comorbidity</span></td></tr><tr title="table-row"><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"><span class="elsevierStyleHsp" style=""></span>Cardiovascular disease&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&#46;8&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&#46;8&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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"><span class="elsevierStyleHsp" style=""></span>Metabolic syndrome&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="char" valign="\n
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                  """
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                  \t\t\t\t">0&#46;005&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Adjusted RR &#40;95&#37; CI&#41;&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
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                  """
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        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Number&#44; incidence and relative risk of cardiovascular events according to the presence of a low or normal ABI&#46;</p>"
        ]
      ]
      3 => array:5 [
        "identificador" => "tb0005"
        "tipo" => "MULTIMEDIATEXTO"
        "mostrarFloat" => false
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        "texto" => array:1 [
          "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">What we know&#63;</span><p id="par0010" class="elsevierStylePara elsevierViewall">The ratio of the systolic blood pressures of the leg and arm &#40;ankle brachial index&#44; ABI&#41;&#44; when low &#40;&#60;0&#46;9&#41;&#44; establishes that a patient has peripheral arterial disease&#46; Patients with an increased vascular risk and an ABI<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;9 often present atherosclerotic lesions in other arteries &#40;coronary&#44; carotid&#41; and have an increased risk of experiencing new cardiovascular events and death&#46; We do not know whether patients with low vascular risk but with an ABI<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;9 also have increased cardiovascular morbidity and mortality&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">What this article provides&#63;</span><p id="par0015" class="elsevierStylePara elsevierViewall">In 1300 volunteers aged 60&#8211;79 years&#44; the finding of an ABI<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;9 was associated&#44; after more than 4 years&#44; with a mortality and cardiovascular disease risk approximately 7 times and 2&#46;5 times greater&#44; respectively&#44; than in subjects with a normal ABI&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The Editors</p></span></span>"
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                    0 => array:2 [
                      "titulo" => "The measurement of atherosclerotic peripheral arterial disease in epidemiological surveys"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "F&#46;G&#46; Fowkes"
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                    0 => array:1 [
                      "Revista" => array:6 [
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                        "volumen" => "17"
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                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3042648"
                            "web" => "Medline"
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              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Peripheral arterial disease detection&#44; awareness&#44; and treatment in primary care"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46;T&#46; Hirsch"
                            1 => "M&#46;H&#46; Criqui"
                            2 => "D&#46; Treat-Jacobson"
                            3 => "J&#46;G&#46; Regensteiner"
                            4 => "M&#46;A&#46; Creager"
                            5 => "J&#46;W&#46; Olin"
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                        "paginaInicial" => "1317"
                        "paginaFinal" => "1324"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11560536"
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                0 => array:2 [
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                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "V&#46; Aboyans"
                            1 => "M&#46;H&#46; Criqui"
                            2 => "P&#46; Abraham"
                            3 => "M&#46;A&#46; Allison"
                            4 => "M&#46;A&#46; Creager"
                            5 => "C&#46; Diehm"
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                    ]
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                    0 => array:2 [
                      "doi" => "10.1161/CIR.0b013e318276fbcb"
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                        "tituloSerie" => "Circulation"
                        "fecha" => "2012"
                        "volumen" => "126"
                        "paginaInicial" => "2890"
                        "paginaFinal" => "2909"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23159553"
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              "etiqueta" => "4"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The ankle-brachial index and incident cardiovascular events in the MESA &#40;multi-ethnic study of atherosclerosis&#41;"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;H&#46; Criqui"
                            1 => "R&#46;L&#46; McClelland"
                            2 => "M&#46;M&#46; McDermott"
                            3 => "M&#46;A&#46; Allison"
                            4 => "R&#46;S&#46; Blumenthal"
                            5 => "V&#46; Aboyans"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2010.04.060"
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                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2010"
                        "volumen" => "56"
                        "paginaInicial" => "1506"
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                    0 => array:2 [
                      "titulo" => "Asymptomatic peripheral arterial disease in type 2 diabetes patients&#58; a 10-year follow-up study of the utility of the ankle brachial index as a prognostic marker of cardiovascular disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Bund&#243;"
                            1 => "L&#46; Mu&#241;oz"
                            2 => "C&#46; P&#233;rez"
                            3 => "J&#46;J&#46; Montero"
                            4 => "N&#46; Montell&#224;"
                            5 => "P&#46; Toran"
                          ]
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                      ]
                    ]
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                    0 => array:2 [
                      "doi" => "10.1016/j.avsg.2010.06.001"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Vasc Surg"
                        "fecha" => "2010"
                        "volumen" => "24"
                        "paginaInicial" => "985"
                        "paginaFinal" => "993"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21035692"
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Article information

ISSN: 22548874
Original language: English

DOI:10.1016/j.rceng.2013.10.003

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2023 March	3	3	6
2018 February	5	0	5
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