Achievement of long-term lipid targets in a cohort of patients with acute coronary syndrome in real-world clinical practice

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En 16 pacientes no estaba recogido su tratamiento o no recibían ningún hipolipemiante. B) Porcentaje de consecución de objetivo de LDL según el tipo de tratamiento hipolipemiante (fin de seguimiento). En 7 pacientes no estaba recogido su tratamiento o no recibían ningún hipolipemiante." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "C. Baldeón Conde, N. Royuela Martínez, C. García Ibarbia, A.R. Guerra Ruiz, I. Olavarri Miguel, M. Cobo Belaustegui, B. Alio Lavín, F.J. González Vilchez, J.M. de la Torre Hernández, J.L. Hernández Hernández" "autores" => array:10 [ 0 => array:2 [ "nombre" => "C." "apellidos" => "Baldeón Conde" ] 1 => array:2 [ "nombre" => "N." "apellidos" => "Royuela Martínez" ] 2 => array:2 [ "nombre" => "C." "apellidos" => "García Ibarbia" ] 3 => array:2 [ "nombre" => "A.R." "apellidos" => "Guerra Ruiz" ] 4 => array:2 [ "nombre" => "I." "apellidos" => "Olavarri Miguel" ] 5 => array:2 [ "nombre" => "M." 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"apellidos" => "González Vilchez" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "e" "identificador" => "aff0025" ] ] ] 8 => array:3 [ "nombre" => "J.M." "apellidos" => "de la Torre Hernández" "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] 2 => array:2 [ "etiqueta" => "e" "identificador" => "aff0025" ] ] ] 9 => array:3 [ "nombre" => "J.L." "apellidos" => "Hernández Hernández" "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] 2 => array:2 [ "etiqueta" => "e" "identificador" => "aff0025" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Unidad de Lípidos y Riesgo Vascular, Servicio de Medicina Interna, Hospital Marqués de Valdecilla, Santander, Cantabria, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Cardiología, Hospital Marqués de Valdecilla, Santander, Cantabria, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Análisis Clínicos, Hospital Marqués de Valdecilla, Santander, Cantabria, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Departamento de Medicina y Psiquiatría, Universidad de Cantabria, Santander, Cantabria, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Instituto de Investigación Valdecilla (IDIVAL), Santander, Cantabria, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Grado de consecución de los objetivos lipídicos a largo plazo en una cohorte de pacientes con síndrome coronario agudo en práctica clínica real" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 4175 "Ancho" => 3093 "Tamanyo" => 797792 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0040" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "(A) Percentage of LDL goal achievement according to type of lipid-lowering treatment (24 months). *For 16 patients, treatment was not recorded or they did not receive any lipid-lowering treatment. (B) Percentage of LDL target achievement according to type of lipid-lowering treatment (end of follow-up). *For 7 patients, treatment was not recorded or they did not receive any lipid-lowering treatment." ] ] ] "textoCompleto" => "IntroductionCardiovascular disease (CVD) is the most common cause of mortality in Europe and coronary artery disease (CAD) is the main cause of death in the Spanish population<a class="elsevierStyleCrossRef" href="#bib0005">1</a>. The evidence provided by clinical trials and Mendelian randomization genetic studies have established that low-density lipoprotein cholesterol (LDL) plays a causal role in the development of atherosclerotic disease<a class="elsevierStyleCrossRef" href="#bib0010">2</a>.Statin treatment has substantially modified the natural history of CVD<a class="elsevierStyleCrossRefs" href="#bib0015">3–5</a>. The reduction in plasma LDL levels is accompanied by a regression of atheroma plaque when it reaches concentrations below 70 mg/dl<a class="elsevierStyleCrossRef" href="#bib0030">6</a>. With new lipid-lowering treatments such as ezetimibe and proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i)<a class="elsevierStyleCrossRefs" href="#bib0020">4–6</a>, the concept of “high-intensity lipid-lowering therapy” has gained importance in reaching the LDL goals recommended by the European Society of Cardiology/European Atherosclerosis Society (ESC/EAS)<a class="elsevierStyleCrossRefs" href="#bib0035">7,8</a>. The 2016 edition recommended that patients with established CVD reach an LDL < 70 mg/dl and a decrease of 50% from the baseline figure<a class="elsevierStyleCrossRef" href="#bib0035">7</a>. In the 2019 update<a class="elsevierStyleCrossRef" href="#bib0040">8</a>, the LDL goal was reduced to <55 mg/dl and it even proposed considering an LDL goal <40 mg/dl for patients with recurrent events despite optimal lipid-lowering treatment. However, large epidemiological studies have shown a suboptimal degree of lipid control in patients with very high cardiovascular risk despite a high use of lipid-lowering drugs; just one-third of subjects evaluated reached LDL levels <70 mg/dl<a class="elsevierStyleCrossRefs" href="#bib0045">9,10</a>.Based on these considerations, this study aims to a) verify the degree of achievement of the lipid goal according to the 2016 and 2019 ESC/EAS guidelines during long-term follow-up on a large cohort of patients with ACS in real-world clinical practice conditions; b) analyze the epidemiological characteristics, cardiovascular risk factors (CVRF), lipid profile, and treatment indicated to these patients; and c) evaluate recurrent ACS throughout follow-up and its relationship with lipid goals.Patients and methodsA retrospective, single-center, non-interventional cohort study was conducted that included patients admitted due to ACS to a Coronary Care Unit (CCU) of the Marqués de Valdecilla University Hospital of Santander (Cantabria). All patients with a diagnosis of ACS (ST-elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI), or unstable angina (UA) with a need for revascularization) on the CCU discharge summary from January 1, 2012 to December 31, 2015 were selected. Patients were identified through the electronic database of the hospital’s Hospitalization and Clinical Documentation Department. The CCU is a reference center for the entire population of the autonomous community of Cantabria (582,905 residents). At 24 months, the patients’ medical records were reviewed. Clinical data and the results of the most recent lipid profile closest to the end of the study period (March 2022) were gathered.Variables and imaging studies analyzedDemographic, physical examination, and imaging study variables were gathered from the electronic medical record. The following epidemiological variables were analyzed: age, sex, tobacco use, family history of early ischemic heart disease (IHD), personal medical history of IHD, and other comorbidities (hypertension (HT), type 2 diabetes mellitus (T2DM), chronic kidney disease (CKD), hyperuricemia, cerebrovascular accident (CVA), peripheral arterial disease (PAD), lung disease, and liver disease). The main outcome and imaging test variables analyzed included type of ACS, single-vessel or multivessel involvement on the coronary angiogram (CA), and whether percutaneous transluminal coronary angioplasty (PTCA) was performed. The type of lipid-lowering treatment, doses, and changes in lipid-lowering treatment throughout follow-up were gathered.Laboratory testsA fasting blood sample was drawn in the first 24 h following the ACS. The routine biochemical profile included a basic lipid profile: total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL), and LDL calculated using the Friedewald formula. Lipid parameters were measured according to current recommendations<a class="elsevierStyleCrossRef" href="#bib0055">11</a>.Follow-up on the cohortTwo time points were analyzed during follow-up on patients with ACS in order to evaluate the degree to which LDL goals were achieved, pursuant to the 2016 and 2019 ESC/EAS guidelines. The first analysis was conducted 24 months after the ACS and a second evaluation was performed during the period from March 2021 to March 2022 (total follow-up of seven to ten years). In both, the basic lipid profile closest to the established dates was collected, as well as active lipid-lowering treatment at that time, mortality, and its cause. In addition, ACS recurrence throughout follow-up and the percentage of patients who achieved the lipid goals were analyzed. The study was approved by the Ethics Committee of Cantabria (number: 2018.271).Statistical analysisQuantitative variables are expressed as mean ± SD or median (IQR) according to the data’s distribution. Qualitative variables are expressed as number and percentage. Groups were compared using the Student’s t test or Mann–Whitney U test according to the data’s distribution. The chi-square test or Fisher’s exact test were used to compare qualitative variables. The incidence of ACS recurrence was expressed as cumulative incidence per 100 patient-years. Data analysis was conducted using the SPSS 28.0 statistical package (Armonk, NY: IBM Corp.). For all calculations, a two-tailed p value <0.05 was considered significant.ResultsA total of 826 patients with ACS were included in the study: 449 (55%) with single-vessel involvement and 377 (45%) with multivessel involvement. <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the baseline epidemiological characteristics of the total cohort and the cohort classified based on coronary vessel involvement. Only 17 patients were lost to follow-up. Of the patients who had a follow-up lipid profile performed, treatment was not recorded in the medical record of 16 of them at 24 months and seven of them at the end of follow-up.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Evolution of the lipid profile and its relationship to angiographic involvement<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the lipid profile variables at the time of the event, at 24 months, and at the end of follow-up for the total sample and according to coronary vessel involvement. The percentage of LDL reduction was 33.2% at 24 months of the ACS and 39.1% at the end of follow-up. In patients with single-vessel disease, LDL levels declined by 30% at two years from the ACS and by 38.9% at the end of follow-up. The respective LDL percentage reductions in subjects with multivessel coronary involvement were 33.9% and 40.9%. No significant differences were found in mean LDL levels at 24 months or at the end of follow-up.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Type of lipid-lowering treatment at admission, at discharge, and during the follow-up period<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> shows the type of lipid-lowering treatment used in the different periods analyzed. It is notable that despite suboptimal achievement of goals, the statin treatment dose was increased in just 19.7%. What’s more, in a higher percentage of patients, 29.7%, the statin dose was reduced or it was withdrawn, with the main cause documented being liver profile abnormalities.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>Degree to which lipid goals were metAt 24 months from the ACS, the degree of LDL goal achievement was suboptimal (LDL <70 mg/dl: 207 patients, −33.6%; LDL <55 mg/dl: 56 patients, −9.3%). The same was true at the end of follow-up (LDL <70 mg/dl: 341 patients, −9.3%; LDL <55 mg/dl: 132 patients, −21.1%).<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a> (A and B) shows the degree of LDL goal achievement at 24 months from the ACS and at the end of follow-up based on the lipid-lowering therapy received by the patients. <a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a> (A and B) shows these data according to coronary vessel involvement.<elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia>ACS recurrence and mortalityDuring follow-up, 179 patients had a recurrent event (22.1%) It occurred during the first two years in 118 patients (14.6%) and after the second year in 95 patients. The recurrent ACS occurred in 31 patients within the first six months, in 37 patients between six and 12 months, and in 50 patients in the second year. The percentage of patients who had a recurrent event who achieved LDL targets at two years was: LDL <70 mg/dl; 29.4% vs. 35.3% (p = 0.34) and LDL<55 mg/dl; 7.1% vs. 10.1% (p = 0.49), respectively. At the end of follow-up, these data were: LDL <70 mg/dl; 56.9.3% vs. 53.8% (p = 0.59) and LDL <55 mg/dl 24.6% vs. 20.3% (p = 0.34). Of the patients who had already had a second event in the first 24 months, 34 of them had at least a third ACS. It is notable that of them, only two patients reached an LDL <55 mg/dl and none of them reached an LDL <40 mg/dl at the end of follow-up.Regarding mortality, 22.2% of patients (n = 183) died during follow-up, 7.6% (n = 63) in the first 24 months. The main cause of death was a recurrent cardiovascular event (34.1%), followed by neoplastic disease (30.2%). Patients who had a recurrent ACS had greater mortality than patients who did not (26.8% vs. 20.8%, p = 0.006). No significant differences were found in mortality (20% vs. 24.7%; p = 0.13) or recurrence (10.9% vs. 11.2%; p = 0.096) according to single-vessel or multivessel involvement, respectively.DiscussionThe results of this work show that the degree of LDL goal achievement in a large group of patients with ACS is suboptimal, especially in regard to the 2019 ESC/EAS guidelines recommendations, and in spite of the fact that a high percentage of patients received high-intensity statins. These data are in accordance with the latest results from large European studies, although the follow-up period was shorter in those studies<a class="elsevierStyleCrossRefs" href="#bib0045">9,10</a>.The mean age of this cohort is lower than that of the 622 patients with CAD included in the DA VINCI study (62 vs. 67 years). Male sex was predominant in both (79% vs. 76%). The prevalence of active tobacco use was higher in this study (48% vs. 12%), but the percentage of patients with hypertension (52% vs. 73%), DM2 (19% vs. 38%), and CKD (4% vs. 7%) was lower. In patients in the DA VINCI study in secondary prevention, the overall degree of lipid goal achievement was 39% and was somewhat higher among those with CAD (44%). In this work, LDL <70 mg/dl at 24 months of an ACS was observed in 33.6% of patients. Although the ESC/EAS guidelines had not been published at the time of inclusion, only 9.3% met the goal of LDL <55 mg/dl at 24 months of an ACS. It is notable that LDL <55 mg/dl was only found in one out of every five patients with an ACS after seven to ten years of follow-up.The EUROASPIRE V registry included a total of 7824 patients with ACS followed-up on for six months. Thirty-two percent reached an LDL <70 mg/dl, a figure which rose to 49% in the subanalysis of the Spanish population. Approximately half received high-intensity statins at six months. A reduction or suspension of treatment was recorded in 20.8% and an intensification in 11.7%. In this cohort, a change in lipid-lowering treatment was made in nearly one out of every three patients. The percentage of patients who had an increase in the statin dose was lower (6.7% vs. 11.7%), as was the percentage in whom the dose was reduced or the drug was suspended (10% vs. 20.8%). The causes for interrupting treatment in the EUROASPIRE V registry were intolerance to the treatment (15.8%) and the clinician’s decision (36.8%). In this study, the percentage of withdrawal due to intolerance was lower (4%).In the DA VINCI study, 35% of patients reached the lipid goal and most received moderate-intensity statins. Compared to the cohort in this study, nearly 70% received high-intensity statins at 24 months from the event and only one out of every four subjects had LDL levels below 70 mg/dl. However, a change was observed in lipid-lowering treatment during the years of follow-up. At the end of the study, one out of every two patients was receiving a combined lipid-lowering therapy; despite this, the degree of achievement of the LDL <55 mg/dl goal was low (14%). There are multiple reasons for this, predominant among which are treatment inertia and lack of adherence<a class="elsevierStyleCrossRef" href="#bib0060">12</a>. The use of PCSK9i has become widespread after the publication of the FOURIER and ODYSSEY-OUTCOMES studies<a class="elsevierStyleCrossRefs" href="#bib0025">5,6</a>. However, only six patients received this treatment at the end of follow-up, which could in part be related to the conditions for its use that are funded according to the current therapeutic positioning report, although there could possibly have been other causes<a class="elsevierStyleCrossRefs" href="#bib0065">13,14</a>.Data on ACS recurrence are similar to what has been published, with a percentage of recurrence in the first year of around 8%–20%<a class="elsevierStyleCrossRef" href="#bib0075">15</a>. In addition, comparing the long-term recurrence figures in this study to those from a study conducted in patients with ACS followed-up on for eight years, the results are similar, with a recurrence of around 21.7%<a class="elsevierStyleCrossRef" href="#bib0080">16</a>. It should be noted that 66% of patients presented with a recurrence of ACS in the first two years following the initial event, which highlights the relevance of attempting to achieve LDL cholesterol goals as soon as possible. In fact, in patients with an ACS and a later recurrent event, the percentage which achieved LDL <55 mg/dl is even lower than in those without recurrence, both at two years and at the end of follow-up, despite having very high cardiovascular risk. This is significantly associated with greater mortality, as has been observed in previous studies, but no significant differences were found in this work regarding recurrence or mortality based on coronary vessel involvement, although the frequency of the combined event (recurrence and/or mortality) was greater in patients with multivessel involvement<a class="elsevierStyleCrossRef" href="#bib0085">17</a>.Methodological considerations and limitationsThe patients were studied in a single center. Therefore, the results may not be able to be extrapolated to other countries or geographical settings. However, the number of patients included is large. In addition, the autonomous community where this work was conducted has a centralized CCU. The lipid goal was defined according to the ESC/EAS guidelines in force at each moment during the study. Data were analyzed in the context of real-world clinical practice, which entails the limitations inherent to variability in clinical practice. Lastly, the reason for changing or withdrawing lipid-lowering medication was obtained from the medical records, with the inherent limitations of this method.ConclusionsThe degree to which long-term LDL goals were reached in a cohort of patients with ACS was suboptimal, despite the fact that a high percentage of cases received high-intensity lipid-lowering treatment. Although changes have been observed over a long period of time in the intensification of lipid-lowering treatment, with an increase in the use of combinations of statins and ezetimibe, the LDL target <55 mg/dl was only achieved in the long-term in one out of every five patients with ACS.FundingThis research received no specific grands from agencies in the public or commercial sectors or from non-profit entities.Conflicts of interestThe authors declare that they have no conflicts of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres1881021" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction and objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1630401" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1881022" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción y objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1630400" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Patients and methods" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Variables and imaging studies analyzed" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Laboratory tests" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Follow-up on the cohort" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Statistical analysis" ] ] ] 6 => array:3 [ "identificador" => "sec0035" "titulo" => "Results" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0040" "titulo" => "Evolution of the lipid profile and its relationship to angiographic involvement" ] 1 => array:2 [ "identificador" => "sec0045" "titulo" => "Type of lipid-lowering treatment at admission, at discharge, and during the follow-up period" ] 2 => array:2 [ "identificador" => "sec0050" "titulo" => "Degree to which lipid goals were met" ] 3 => array:2 [ "identificador" => "sec0055" "titulo" => "ACS recurrence and mortality" ] ] ] 7 => array:2 [ "identificador" => "sec0060" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0065" "titulo" => "Methodological considerations and limitations" ] 9 => array:2 [ "identificador" => "sec0070" "titulo" => "Conclusions" ] 10 => array:2 [ "identificador" => "sec0075" "titulo" => "Funding" ] 11 => array:2 [ "identificador" => "sec0080" "titulo" => "Conflicts of interest" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2022-12-05" "fechaAceptado" => "2023-02-04" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1630401" "palabras" => array:4 [ 0 => "Acute coronary syndrome" 1 => "Dyslipidemia" 2 => "LDL cholesterol" 3 => "ESC/EAS dyslipidemia guidelines" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1630400" "palabras" => array:4 [ 0 => "Síndrome coronario agudo" 1 => "Dislipemia" 2 => "LDL-colesterol" 3 => "Guías de dislipemia ESCEAS" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "Introduction and objectivesAccording to the recent European epidemiological studies, the degree of lipid control in patients with very high vascular risk is suboptimal. This study analyzes the epidemiological characteristics, cardiovascular risk factors, lipid profile, recurrence, and degree of achievement of long-term lipid targets, according to the ESC/EAS Guidelines, in a cohort of patients with acute coronary syndrome (ACS) in a real-world clinical practice setting. MethodsThis work is a retrospective cohort study of patients diagnosed with ACS admitted to the Coronary Unit of a tertiary hospital from January 1, 2012 to December 31, 2015 and followed-up on until March 2022. ResultsA total of 826 patients were studied. During the follow-up period, greater prescribing of combined lipid-lowering therapy was observed, mainly high- and moderate-intensity statins and ezetimibe. At 24 months after the ACS, 33.6% of living patients had LDL levels <70 mg/dl and 9.3% had LDL levels <55 mg/dl. At the end of the follow-up (101 [88–111] months), the corresponding figures were 54.5% and 21.1%. Some 22.1% of patients had a recurrent coronary event and only 24.6% achieved an LDL level <55 mg/dl. ConclusionsAchievement of the LDL targets recommended by the ESC/EAS guidelines is suboptimal in patients with ACS, both at two years and in the long-term (7–10 years), especially in patients with recurrent ACS." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction and objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "Introducción y objetivosSegún los recientes estudios epidemiológicos europeos, el grado de control lipídico de los pacientes de muy alto riesgo vascular es subóptimo. En este estudio se han analizado las características epidemiológicas, los factores de riesgo cardiovascular, el perfil lipídico, la recurrencia y el grado de consecución de los objetivos lipídicos a largo plazo, según las Guías ESC/EAS, en una cohorte de pacientes con síndrome coronario agudo (SCA), en condiciones de práctica clínica real. MétodosEstudio de cohorte retrospectivo de los pacientes con diagnóstico de SCA ingresados en la unidad coronaria de un hospital de tercer nivel, entre el 1 de enero de 2012 y el 31 de diciembre de 2015, y seguidos hasta marzo de 2022. ResultadosSe estudiaron 826 pacientes. Durante el periodo de seguimiento se observó una mayor prescripción de terapia hipolipemiante combinada, principalmente estatinas de alta y moderada intensidad y ezetimibe. A los 24 meses del SCA, un 33,6% de los pacientes vivos tenían un LDL < 70 mg/dl y en un 9,3% los niveles eran < 55 mg/dl. Al final del seguimiento (101 [88–111] meses), las correspondientes cifras eran del 54,5 y 21,1%. Un 22,1% de los pacientes presentaron un evento coronario recurrente, y solamente un 24,6% de ellos alcanzaron un nivel de LDL < 55 mg/dl. ConclusionesEl cumplimiento de los objetivos recomendados por las Guías ESC/EAS en pacientes con SCA, es subóptimo, tanto a los 2 años como a largo plazo (7-10 años) desde el evento, y en especial en los pacientes con SCA recurrente." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción y objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "multimedia" => array:5 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1535 "Ancho" => 2925 "Tamanyo" => 220663 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0035" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Lipid-lowering treatment in patients with ACS. *PCSK9i: proprotein convertase subtilisin/kexin type 9 inhibitors. “Ezetimibe combination refers to the use of high- (n = 70), moderate- (n = 13), or low-intensity (n = 1) statins and ezetimibe at 24 months.” “Ezetimibe combination refers to the use of high- (n = 235), moderate- (n = 47), or low-intensity (n = 3) statins and ezetimibe at the end of follow-up.”" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 4175 "Ancho" => 3093 "Tamanyo" => 797792 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0040" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "(A) Percentage of LDL goal achievement according to type of lipid-lowering treatment (24 months). *For 16 patients, treatment was not recorded or they did not receive any lipid-lowering treatment. (B) Percentage of LDL target achievement according to type of lipid-lowering treatment (end of follow-up). *For 7 patients, treatment was not recorded or they did not receive any lipid-lowering treatment." ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 4167 "Ancho" => 2339 "Tamanyo" => 761843 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0045" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "(A) Percentage of LDL target achievement according to type of lipid-lowering treatment and coronary tree involvement (24 months). (B) Percentage of LDL target achievement according to type of lipid-lowering treatment and coronary tree involvement (end of follow-up)." ] ] 3 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0050" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "SBP: systolic blood pressure; DBP: diastolic blood pressure; BMI: body mass index; HT: hypertension; AMI: acute myocardial infarction; ACS: acute coronary syndrome; CVA: cerebrovascular accident; m: mean; SD: standard deviation." "tablatextoimagen" => array:1 [ 0 => array:1 [ "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"><th 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" scope="col" style="border-bottom: 2px solid black">Variable \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th 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" scope="col" style="border-bottom: 2px solid black">Total \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th 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" scope="col" style="border-bottom: 2px solid black">Single-vessel \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th 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" scope="col" style="border-bottom: 2px solid black">Multivessel \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th 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" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sex (male), 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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">656 (79.4) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">351 (78.2) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">305 (80.9) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.33 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age (years), m ± 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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">61.64 ± 12.7 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">60.5 ± 13.2 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">63 ± 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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.0005 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SBP (mmHg), m ± 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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">135.1 ± 29.5 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">135.3 ± 29.1 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">134.9 ± 34.9 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.89 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">DBP (mmHg), m ± 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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">78.7 ± 17.5 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">78.5 ± 17.7 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">79 ± 17.3 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.66 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Heart rate (bpm), m ± 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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">72.3 ± 17.2 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">72.1 ± 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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">72.5 ± 17.8 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.72 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BMI (kg/m2), m ± 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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28.2 ± 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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28.2 ± 3.8 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28.3 ± 2.2 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.79 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Active tobacco use, 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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">396 (47.9) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">220 (49) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">176 (46.7) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.51 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HT, 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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">429 (51.9) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">222 (49.4) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">207 (54.9) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.12 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dyslipidemia, 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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">375 (45.4) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">177 (39.4) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">198 (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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Type 2 diabetes mellitus, 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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">154 (18.6) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">72 (16) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">82 (21.8) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.0036 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HbA1c (%), m ± 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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.3 ± 1.6 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.3 ± 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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.2 ± 1.4 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.69 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hyperuricemia, 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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35 (4.2) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 (3.6) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19 (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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.29 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Chronic kidney disease, 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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35 (4.2) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17 (3.8) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 (4.8) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.48 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lung disease, 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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">87 (10.5) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">47 (10.5) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40 (10.6) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.95 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Liver disease, 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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">41 (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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23 (5.1) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 (4.8) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.82 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Family history of early AMI, 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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">116 (14) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">64 (14.3) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">52 (13.8) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.85 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Prior CVD, 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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">172 (20.8) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">80 (17.8) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">92 (24.4) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.02 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Peripheral arterial disease, 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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">46 (5.6) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 (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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">31 (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="left" 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-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• ACS, 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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">123 (14.9) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">60 (13.4) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">63 (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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.18 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• CVA, 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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28 (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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 (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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13 (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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.93 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Ischemic CVA, 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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23 (2.8) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 (2.7) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 (2.9) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.83 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] ] "descripcion" => array:1 [ "en" => "Baseline epidemiological characteristics of patients with ACS according to coronary vessel involvement." ] ] 4 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0055" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "HDL: high-density lipoprotein cholesterol; LDL: low-density lipoprotein cholesterol; m: mean; SD: standard deviation." "tablatextoimagen" => array:1 [ 0 => array:1 [ "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"><th 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" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th 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" scope="col" style="border-bottom: 2px solid black">Total \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th 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" scope="col" style="border-bottom: 2px solid black">Single-vessel \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th 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" scope="col" style="border-bottom: 2px solid black">Multivessel \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th 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" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Event</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Total cholesterol, m ± 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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">193.5 ± 46.3 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">193 ± 45.6 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">193.2 ± 42.1 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.85 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">LDL, m ± 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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">121.8 ± 40.4 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">121.7 ± 40.1 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">123.1 ± 38.7 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.31 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HDL, m ± 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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45.8 ± 12.9 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45.8 ± 13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">46.7 ± 12.4 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Triglycerides, m ± 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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">130.5 ± 147.5 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">130.5 ± 147.5 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">120.2 ± 74.7 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.08 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Non-HDL cholesterol, m ± 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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">147.4 ± 46.1 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">146.9 ± 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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">148.1 ± 50.6 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.73 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24 months</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Total cholesterol, m ± 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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">150.6 ± 33.7 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">151.1 ± 34.7 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">150.2 ± 32.6 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.74 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">LDL, m ± 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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">81.4 ± 25.9 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">81.5 ± 26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">81.4 ± 25.9 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.96 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HDL, m ± 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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">44.6 ± 12.1 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45.04 ± 11.7 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">44.2 ± 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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.23 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Triglycerides, m ± 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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">121.2 ± 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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">122.4 ± 79.4 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">119.9 ± 63.7 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.81 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Non-HDL cholesterol, m ± 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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">106 ± 31.5 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">106.3 ± 33.5 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">105.6 ± 29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.78 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">End of follow-up (2021–2022)</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Total cholesterol, m ± 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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">142.7 ± 36.1 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">143.5 ± 38.1 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">141.8 ± 33.5 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.56 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">LDL, m ± 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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">74.1 ± 30.9 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">75.2 ± 33.4 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">72.8 ± 27.5 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.35 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HDL, m ± 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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">44.3 ± 11.9 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">44.6 ± 12.44 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">44 ± 11.3 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.64 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Triglycerides, m ± 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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">128.2 ± 72.9 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">125.4 ± 67.1 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">131.8 ± 79.8 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.34 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Non-HDL cholesterol, m ± 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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">98.4 ± 33.8 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">98.9 ± 36.3 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">97.7 ± 30.4 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.69 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] ] "descripcion" => array:1 [ "en" => "Lipid profile according to coronary vessel involvement in progress monitoring." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:17 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Instituto Nacional de Estadística. Estadística de defunciones según la causa de muerte [Accessed 30 November 2022] Available from: <a target="_blank" href="http://www.ine.es">http://www.ine.es</a>." ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Low-density lipoproteins cause atherosclerotic cardiovascular disease. Evidence from genetic, epidemiologic, and clinical studies. A consensus statement from the European Atherosclerosis Society Consensus Panel" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Ference" 1 => "H. Ginsberg" 2 => "I. Graham" 3 => "K.R. Kausik" 4 => "C. Packard" 5 => "E. 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Achievement of long-term lipid targets in a cohort of patients with acute coronary syndrome in real-world clinical practice

Grado de consecución de los objetivos lipídicos a largo plazo en una cohorte de pacientes con síndrome coronario agudo en práctica clínica real

C. Baldeón Condea,

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cristina.baldeon@scsalud.es

Corresponding author.

, N. Royuela Martínezb, C. García Ibarbiaa,d,e, A.R. Guerra Ruizc, I. Olavarri Miguelb,e, M. Cobo Belausteguib,e, B. Alio Lavínc,e, F.J. González Vilchezb,e, J.M. de la Torre Hernándezb,d,e, J.L. Hernández Hernándeza,d,e

a Unidad de Lípidos y Riesgo Vascular, Servicio de Medicina Interna, Hospital Marqués de Valdecilla, Santander, Cantabria, Spain

b Servicio de Cardiología, Hospital Marqués de Valdecilla, Santander, Cantabria, Spain

c Servicio de Análisis Clínicos, Hospital Marqués de Valdecilla, Santander, Cantabria, Spain

d Departamento de Medicina y Psiquiatría, Universidad de Cantabria, Santander, Cantabria, Spain

e Instituto de Investigación Valdecilla (IDIVAL), Santander, Cantabria, Spain

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The reduction in plasma LDL levels is accompanied by a regression of atheroma plaque when it reaches concentrations below 70 mg&#47;dl<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&#46; With new lipid-lowering treatments such as ezetimibe and proprotein convertase subtilisin&#47;kexin type 9 inhibitors &#40;PCSK9i&#41;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#8211;6</span></a>&#44; the concept of &#8220;high-intensity lipid-lowering therapy&#8221; has gained importance in reaching the LDL goals recommended by the European Society of Cardiology&#47;European Atherosclerosis Society &#40;ESC&#47;EAS&#41;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;8</span></a>&#46; The 2016 edition recommended that patients with established CVD reach an LDL &#60; 70 mg&#47;dl and a decrease of 50&#37; from the baseline figure<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>&#46; In the 2019 update<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>&#44; the LDL goal was reduced to &#60;55 mg&#47;dl and it even proposed considering an LDL goal &#60;40 mg&#47;dl for patients with recurrent events despite optimal lipid-lowering treatment&#46; However&#44; large epidemiological studies have shown a suboptimal degree of lipid control in patients with very high cardiovascular risk despite a high use of lipid-lowering drugs&#59; just one-third of subjects evaluated reached LDL levels &#60;70 mg&#47;dl<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;10</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Based on these considerations&#44; this study aims to a&#41; verify the degree of achievement of the lipid goal according to the 2016 and 2019 ESC&#47;EAS guidelines during long-term follow-up on a large cohort of patients with ACS in real-world clinical practice conditions&#59; b&#41; analyze the epidemiological characteristics&#44; cardiovascular risk factors &#40;CVRF&#41;&#44; lipid profile&#44; and treatment indicated to these patients&#59; and c&#41; evaluate recurrent ACS throughout follow-up and its relationship with lipid goals&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Patients and methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">A retrospective&#44; single-center&#44; non-interventional cohort study was conducted that included patients admitted due to ACS to a Coronary Care Unit &#40;CCU&#41; of the Marqu&#233;s de Valdecilla University Hospital of Santander &#40;Cantabria&#41;&#46; All patients with a diagnosis of ACS &#40;ST-elevation myocardial infarction &#40;STEMI&#41;&#44; non-ST elevation myocardial infarction &#40;NSTEMI&#41;&#44; or unstable angina &#40;UA&#41; with a need for revascularization&#41; on the CCU discharge summary from January 1&#44; 2012 to December 31&#44; 2015 were selected&#46; Patients were identified through the electronic database of the hospital&#8217;s Hospitalization and Clinical Documentation Department&#46; The CCU is a reference center for the entire population of the autonomous community of Cantabria &#40;582&#44;905 residents&#41;&#46; At 24 months&#44; the patients&#8217; medical records were reviewed&#46; Clinical data and the results of the most recent lipid profile closest to the end of the study period &#40;March 2022&#41; were gathered&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Variables and imaging studies analyzed</span><p id="par0025" class="elsevierStylePara elsevierViewall">Demographic&#44; physical examination&#44; and imaging study variables were gathered from the electronic medical record&#46; The following epidemiological variables were analyzed&#58; age&#44; sex&#44; tobacco use&#44; family history of early ischemic heart disease &#40;IHD&#41;&#44; personal medical history of IHD&#44; and other comorbidities &#40;hypertension &#40;HT&#41;&#44; type 2 diabetes mellitus &#40;T2DM&#41;&#44; chronic kidney disease &#40;CKD&#41;&#44; hyperuricemia&#44; cerebrovascular accident &#40;CVA&#41;&#44; peripheral arterial disease &#40;PAD&#41;&#44; lung disease&#44; and liver disease&#41;&#46; The main outcome and imaging test variables analyzed included type of ACS&#44; single-vessel or multivessel involvement on the coronary angiogram &#40;CA&#41;&#44; and whether percutaneous transluminal coronary angioplasty &#40;PTCA&#41; was performed&#46; The type of lipid-lowering treatment&#44; doses&#44; and changes in lipid-lowering treatment throughout follow-up were gathered&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Laboratory tests</span><p id="par0030" class="elsevierStylePara elsevierViewall">A fasting blood sample was drawn in the first 24 h following the ACS&#46; The routine biochemical profile included a basic lipid profile&#58; total cholesterol &#40;TC&#41;&#44; triglycerides &#40;TG&#41;&#44; high-density lipoprotein cholesterol &#40;HDL&#41;&#44; and LDL calculated using the Friedewald formula&#46; Lipid parameters were measured according to current recommendations<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Follow-up on the cohort</span><p id="par0035" class="elsevierStylePara elsevierViewall">Two time points were analyzed during follow-up on patients with ACS in order to evaluate the degree to which LDL goals were achieved&#44; pursuant to the 2016 and 2019 ESC&#47;EAS guidelines&#46; The first analysis was conducted 24 months after the ACS and a second evaluation was performed during the period from March 2021 to March 2022 &#40;total follow-up of seven to ten years&#41;&#46; In both&#44; the basic lipid profile closest to the established dates was collected&#44; as well as active lipid-lowering treatment at that time&#44; mortality&#44; and its cause&#46; In addition&#44; ACS recurrence throughout follow-up and the percentage of patients who achieved the lipid goals were analyzed&#46; The study was approved by the Ethics Committee of Cantabria &#40;number&#58; 2018&#46;271&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Statistical analysis</span><p id="par0040" class="elsevierStylePara elsevierViewall">Quantitative variables are expressed as mean &#177; SD or median &#40;IQR&#41; according to the data&#8217;s distribution&#46; Qualitative variables are expressed as number and percentage&#46; Groups were compared using the Student&#8217;s t test or Mann&#8211;Whitney U test according to the data&#8217;s distribution&#46; The chi-square test or Fisher&#8217;s exact test were used to compare qualitative variables&#46; The incidence of ACS recurrence was expressed as cumulative incidence per 100 patient-years&#46; Data analysis was conducted using the SPSS 28&#46;0 statistical package &#40;Armonk&#44; NY&#58; IBM Corp&#46;&#41;&#46; For all calculations&#44; a two-tailed <span class="elsevierStyleItalic">p</span> value &#60;0&#46;05 was considered significant&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><p id="par0045" class="elsevierStylePara elsevierViewall">A total of 826 patients with ACS were included in the study&#58; 449 &#40;55&#37;&#41; with single-vessel involvement and 377 &#40;45&#37;&#41; with multivessel involvement&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the baseline epidemiological characteristics of the total cohort and the cohort classified based on coronary vessel involvement&#46; Only 17 patients were lost to follow-up&#46; Of the patients who had a follow-up lipid profile performed&#44; treatment was not recorded in the medical record of 16 of them at 24 months and seven of them at the end of follow-up&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Evolution of the lipid profile and its relationship to angiographic involvement</span><p id="par0050" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the lipid profile variables at the time of the event&#44; at 24 months&#44; and at the end of follow-up for the total sample and according to coronary vessel involvement&#46; The percentage of LDL reduction was 33&#46;2&#37; at 24 months of the ACS and 39&#46;1&#37; at the end of follow-up&#46; In patients with single-vessel disease&#44; LDL levels declined by 30&#37; at two years from the ACS and by 38&#46;9&#37; at the end of follow-up&#46; The respective LDL percentage reductions in subjects with multivessel coronary involvement were 33&#46;9&#37; and 40&#46;9&#37;&#46; No significant differences were found in mean LDL levels at 24 months or at the end of follow-up&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Type of lipid-lowering treatment at admission&#44; at discharge&#44; and during the follow-up period</span><p id="par0055" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> shows the type of lipid-lowering treatment used in the different periods analyzed&#46; It is notable that despite suboptimal achievement of goals&#44; the statin treatment dose was increased in just 19&#46;7&#37;&#46; What&#8217;s more&#44; in a higher percentage of patients&#44; 29&#46;7&#37;&#44; the statin dose was reduced or it was withdrawn&#44; with the main cause documented being liver profile abnormalities&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Degree to which lipid goals were met</span><p id="par0060" class="elsevierStylePara elsevierViewall">At 24 months from the ACS&#44; the degree of LDL goal achievement was suboptimal &#40;LDL &#60;70 mg&#47;dl&#58; 207 patients&#44; &#8722;33&#46;6&#37;&#59; LDL &#60;55 mg&#47;dl&#58; 56 patients&#44; &#8722;9&#46;3&#37;&#41;&#46; The same was true at the end of follow-up &#40;LDL &#60;70 mg&#47;dl&#58; 341 patients&#44; &#8722;9&#46;3&#37;&#59; LDL &#60;55 mg&#47;dl&#58; 132 patients&#44; &#8722;21&#46;1&#37;&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a> &#40;A and B&#41; shows the degree of LDL goal achievement at 24 months from the ACS and at the end of follow-up based on the lipid-lowering therapy received by the patients&#46; <a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a> &#40;A and B&#41; shows these data according to coronary vessel involvement&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">ACS recurrence and mortality</span><p id="par0070" class="elsevierStylePara elsevierViewall">During follow-up&#44; 179 patients had a recurrent event &#40;22&#46;1&#37;&#41; It occurred during the first two years in 118 patients &#40;14&#46;6&#37;&#41; and after the second year in 95 patients&#46; The recurrent ACS occurred in 31 patients within the first six months&#44; in 37 patients between six and 12 months&#44; and in 50 patients in the second year&#46; The percentage of patients who had a recurrent event who achieved LDL targets at two years was&#58; LDL &#60;70 mg&#47;dl&#59; 29&#46;4&#37; vs&#46; 35&#46;3&#37; &#40;<span class="elsevierStyleItalic">p</span> &#61; 0&#46;34&#41; and LDL&#60;55 mg&#47;dl&#59; 7&#46;1&#37; vs&#46; 10&#46;1&#37; &#40;<span class="elsevierStyleItalic">p</span> &#61; 0&#46;49&#41;&#44; respectively&#46; At the end of follow-up&#44; these data were&#58; LDL &#60;70 mg&#47;dl&#59; 56&#46;9&#46;3&#37; vs&#46; 53&#46;8&#37; &#40;<span class="elsevierStyleItalic">p</span> &#61; 0&#46;59&#41; and LDL &#60;55 mg&#47;dl 24&#46;6&#37; vs&#46; 20&#46;3&#37; &#40;<span class="elsevierStyleItalic">p</span> &#61; 0&#46;34&#41;&#46; Of the patients who had already had a second event in the first 24 months&#44; 34 of them had at least a third ACS&#46; It is notable that of them&#44; only two patients reached an LDL &#60;55 mg&#47;dl and none of them reached an LDL &#60;40 mg&#47;dl at the end of follow-up&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Regarding mortality&#44; 22&#46;2&#37; of patients &#40;n &#61; 183&#41; died during follow-up&#44; 7&#46;6&#37; &#40;n &#61; 63&#41; in the first 24 months&#46; The main cause of death was a recurrent cardiovascular event &#40;34&#46;1&#37;&#41;&#44; followed by neoplastic disease &#40;30&#46;2&#37;&#41;&#46; Patients who had a recurrent ACS had greater mortality than patients who did not &#40;26&#46;8&#37; vs&#46; 20&#46;8&#37;&#44; <span class="elsevierStyleItalic">p</span> &#61; 0&#46;006&#41;&#46; No significant differences were found in mortality &#40;20&#37; vs&#46; 24&#46;7&#37;&#59; <span class="elsevierStyleItalic">p</span> &#61; 0&#46;13&#41; or recurrence &#40;10&#46;9&#37; vs&#46; 11&#46;2&#37;&#59; <span class="elsevierStyleItalic">p</span> &#61; 0&#46;096&#41; according to single-vessel or multivessel involvement&#44; respectively&#46;</p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Discussion</span><p id="par0080" class="elsevierStylePara elsevierViewall">The results of this work show that the degree of LDL goal achievement in a large group of patients with ACS is suboptimal&#44; especially in regard to the 2019 ESC&#47;EAS guidelines recommendations&#44; and in spite of the fact that a high percentage of patients received high-intensity statins&#46; These data are in accordance with the latest results from large European studies&#44; although the follow-up period was shorter in those studies<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;10</span></a>&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">The mean age of this cohort is lower than that of the 622 patients with CAD included in the DA VINCI study &#40;62 vs&#46; 67 years&#41;&#46; Male sex was predominant in both &#40;79&#37; vs&#46; 76&#37;&#41;&#46; The prevalence of active tobacco use was higher in this study &#40;48&#37; vs&#46; 12&#37;&#41;&#44; but the percentage of patients with hypertension &#40;52&#37; vs&#46; 73&#37;&#41;&#44; DM2 &#40;19&#37; vs&#46; 38&#37;&#41;&#44; and CKD &#40;4&#37; vs&#46; 7&#37;&#41; was lower&#46; In patients in the DA VINCI study in secondary prevention&#44; the overall degree of lipid goal achievement was 39&#37; and was somewhat higher among those with CAD &#40;44&#37;&#41;&#46; In this work&#44; LDL &#60;70 mg&#47;dl at 24 months of an ACS was observed in 33&#46;6&#37; of patients&#46; Although the ESC&#47;EAS guidelines had not been published at the time of inclusion&#44; only 9&#46;3&#37; met the goal of LDL &#60;55 mg&#47;dl at 24 months of an ACS&#46; It is notable that LDL &#60;55 mg&#47;dl was only found in one out of every five patients with an ACS after seven to ten years of follow-up&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">The EUROASPIRE V registry included a total of 7824 patients with ACS followed-up on for six months&#46; Thirty-two percent reached an LDL &#60;70 mg&#47;dl&#44; a figure which rose to 49&#37; in the subanalysis of the Spanish population&#46; Approximately half received high-intensity statins at six months&#46; A reduction or suspension of treatment was recorded in 20&#46;8&#37; and an intensification in 11&#46;7&#37;&#46; In this cohort&#44; a change in lipid-lowering treatment was made in nearly one out of every three patients&#46; The percentage of patients who had an increase in the statin dose was lower &#40;6&#46;7&#37; vs&#46; 11&#46;7&#37;&#41;&#44; as was the percentage in whom the dose was reduced or the drug was suspended &#40;10&#37; vs&#46; 20&#46;8&#37;&#41;&#46; The causes for interrupting treatment in the EUROASPIRE V registry were intolerance to the treatment &#40;15&#46;8&#37;&#41; and the clinician&#8217;s decision &#40;36&#46;8&#37;&#41;&#46; In this study&#44; the percentage of withdrawal due to intolerance was lower &#40;4&#37;&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">In the DA VINCI study&#44; 35&#37; of patients reached the lipid goal and most received moderate-intensity statins&#46; Compared to the cohort in this study&#44; nearly 70&#37; received high-intensity statins at 24 months from the event and only one out of every four subjects had LDL levels below 70 mg&#47;dl&#46; However&#44; a change was observed in lipid-lowering treatment during the years of follow-up&#46; At the end of the study&#44; one out of every two patients was receiving a combined lipid-lowering therapy&#59; despite this&#44; the degree of achievement of the LDL &#60;55 mg&#47;dl goal was low &#40;14&#37;&#41;&#46; There are multiple reasons for this&#44; predominant among which are treatment inertia and lack of adherence<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>&#46; The use of PCSK9i has become widespread after the publication of the FOURIER and ODYSSEY-OUTCOMES studies<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a>&#46; However&#44; only six patients received this treatment at the end of follow-up&#44; which could in part be related to the conditions for its use that are funded according to the current therapeutic positioning report&#44; although there could possibly have been other causes<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#44;14</span></a>&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Data on ACS recurrence are similar to what has been published&#44; with a percentage of recurrence in the first year of around 8&#37;&#8211;20&#37;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a>&#46; In addition&#44; comparing the long-term recurrence figures in this study to those from a study conducted in patients with ACS followed-up on for eight years&#44; the results are similar&#44; with a recurrence of around 21&#46;7&#37;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a>&#46; It should be noted that 66&#37; of patients presented with a recurrence of ACS in the first two years following the initial event&#44; which highlights the relevance of attempting to achieve LDL cholesterol goals as soon as possible&#46; In fact&#44; in patients with an ACS and a later recurrent event&#44; the percentage which achieved LDL &#60;55 mg&#47;dl is even lower than in those without recurrence&#44; both at two years and at the end of follow-up&#44; despite having very high cardiovascular risk&#46; This is significantly associated with greater mortality&#44; as has been observed in previous studies&#44; but no significant differences were found in this work regarding recurrence or mortality based on coronary vessel involvement&#44; although the frequency of the combined event &#40;recurrence and&#47;or mortality&#41; was greater in patients with multivessel involvement<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a>&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Methodological considerations and limitations</span><p id="par0105" class="elsevierStylePara elsevierViewall">The patients were studied in a single center&#46; Therefore&#44; the results may not be able to be extrapolated to other countries or geographical settings&#46; However&#44; the number of patients included is large&#46; In addition&#44; the autonomous community where this work was conducted has a centralized CCU&#46; The lipid goal was defined according to the ESC&#47;EAS guidelines in force at each moment during the study&#46; Data were analyzed in the context of real-world clinical practice&#44; which entails the limitations inherent to variability in clinical practice&#46; Lastly&#44; the reason for changing or withdrawing lipid-lowering medication was obtained from the medical records&#44; with the inherent limitations of this method&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conclusions</span><p id="par0110" class="elsevierStylePara elsevierViewall">The degree to which long-term LDL goals were reached in a cohort of patients with ACS was suboptimal&#44; despite the fact that a high percentage of cases received high-intensity lipid-lowering treatment&#46; Although changes have been observed over a long period of time in the intensification of lipid-lowering treatment&#44; with an increase in the use of combinations of statins and ezetimibe&#44; the LDL target &#60;55 mg&#47;dl was only achieved in the long-term in one out of every five patients with ACS&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Funding</span><p id="par0115" class="elsevierStylePara elsevierViewall">This research received no specific grands from agencies in the public or commercial sectors or from non-profit entities&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Conflicts of interest</span><p id="par0120" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction and objectives</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">According to the recent European epidemiological studies&#44; the degree of lipid control in patients with very high vascular risk is suboptimal&#46; This study analyzes the epidemiological characteristics&#44; cardiovascular risk factors&#44; lipid profile&#44; recurrence&#44; and degree of achievement of long-term lipid targets&#44; according to the ESC&#47;EAS Guidelines&#44; in a cohort of patients with acute coronary syndrome &#40;ACS&#41; in a real-world clinical practice setting&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">This work is a retrospective cohort study of patients diagnosed with ACS admitted to the Coronary Unit of a tertiary hospital from January 1&#44; 2012 to December 31&#44; 2015 and followed-up on until March 2022&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">A total of 826 patients were studied&#46; During the follow-up period&#44; greater prescribing of combined lipid-lowering therapy was observed&#44; mainly high- and moderate-intensity statins and ezetimibe&#46; At 24 months after the ACS&#44; 33&#46;6&#37; of living patients had LDL levels &#60;70 mg&#47;dl and 9&#46;3&#37; had LDL levels &#60;55 mg&#47;dl&#46; At the end of the follow-up &#40;101 &#91;88&#8211;111&#93; months&#41;&#44; the corresponding figures were 54&#46;5&#37; and 21&#46;1&#37;&#46; Some 22&#46;1&#37; of patients had a recurrent coronary event and only 24&#46;6&#37; achieved an LDL level &#60;55 mg&#47;dl&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Achievement of the LDL targets recommended by the ESC&#47;EAS guidelines is suboptimal in patients with ACS&#44; both at two years and in the long-term &#40;7&#8211;10 years&#41;&#44; especially in patients with recurrent ACS&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction and objectives"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
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            "identificador" => "abst0015"
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n y objetivos</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Seg&#250;n los recientes estudios epidemiol&#243;gicos europeos&#44; el grado de control lip&#237;dico de los pacientes de muy alto riesgo vascular es sub&#243;ptimo&#46; En este estudio se han analizado las caracter&#237;sticas epidemiol&#243;gicas&#44; los factores de riesgo cardiovascular&#44; el perfil lip&#237;dico&#44; la recurrencia y el grado de consecuci&#243;n de los objetivos lip&#237;dicos a largo plazo&#44; seg&#250;n las Gu&#237;as ESC&#47;EAS&#44; en una cohorte de pacientes con s&#237;ndrome coronario agudo &#40;SCA&#41;&#44; en condiciones de pr&#225;ctica cl&#237;nica real&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Estudio de cohorte retrospectivo de los pacientes con diagn&#243;stico de SCA ingresados en la unidad coronaria de un hospital de tercer nivel&#44; entre el 1 de enero de 2012 y el 31 de diciembre de 2015&#44; y seguidos hasta marzo de 2022&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Se estudiaron 826 pacientes&#46; Durante el periodo de seguimiento se observ&#243; una mayor prescripci&#243;n de terapia hipolipemiante combinada&#44; principalmente estatinas de alta y moderada intensidad y ezetimibe&#46; A los 24 meses del SCA&#44; un 33&#44;6&#37; de los pacientes vivos ten&#237;an un LDL &#60; 70 mg&#47;dl y en un 9&#44;3&#37; los niveles eran &#60; 55 mg&#47;dl&#46; Al final del seguimiento &#40;101 &#91;88&#8211;111&#93; meses&#41;&#44; las correspondientes cifras eran del 54&#44;5 y 21&#44;1&#37;&#46; Un 22&#44;1&#37; de los pacientes presentaron un evento coronario recurrente&#44; y solamente un 24&#44;6&#37; de ellos alcanzaron un nivel de LDL &#60; 55 mg&#47;dl&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">El cumplimiento de los objetivos recomendados por las Gu&#237;as ESC&#47;EAS en pacientes con SCA&#44; es sub&#243;ptimo&#44; tanto a los 2 a&#241;os como a largo plazo &#40;7-10 a&#241;os&#41; desde el evento&#44; y en especial en los pacientes con SCA recurrente&#46;</p></span>"
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            "identificador" => "abst0035"
            "titulo" => "Resultados"
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            "identificador" => "abst0040"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Lipid-lowering treatment in patients with ACS&#46;</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">&#42;PCSK9i&#58; proprotein convertase subtilisin&#47;kexin type 9 inhibitors&#46;</p> <p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">&#8220;<span class="elsevierStyleItalic">Ezetimibe combination refers to the use of high- &#40;n &#61; 70&#41;&#44; moderate- &#40;n &#61; 13&#41;&#44; or low-intensity &#40;n &#61; 1&#41; statins and ezetimibe at 24 months</span>&#46;&#8221;</p> <p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">&#8220;<span class="elsevierStyleItalic">Ezetimibe combination refers to the use of high- &#40;n &#61; 235&#41;&#44; moderate- &#40;n &#61; 47&#41;&#44; or low-intensity &#40;n &#61; 3&#41; statins and ezetimibe at the end of follow-up&#46;</span>&#8221;</p>"
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        "figura" => array:1 [
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          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Percentage of LDL goal achievement according to type of lipid-lowering treatment &#40;24 months&#41;&#46; &#42;For 16 patients&#44; treatment was not recorded or they did not receive any lipid-lowering treatment&#46; &#40;B&#41; Percentage of LDL target achievement according to type of lipid-lowering treatment &#40;end of follow-up&#41;&#46; &#42;For 7 patients&#44; treatment was not recorded or they did not receive any lipid-lowering treatment&#46;</p>"
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      2 => array:8 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
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        "detalles" => array:1 [
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            "identificador" => "at0045"
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          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Percentage of LDL target achievement according to type of lipid-lowering treatment and coronary tree involvement &#40;24 months&#41;&#46; &#40;B&#41; Percentage of LDL target achievement according to type of lipid-lowering treatment and coronary tree involvement &#40;end of follow-up&#41;&#46;</p>"
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          "leyenda" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">SBP&#58; systolic blood pressure&#59; DBP&#58; diastolic blood pressure&#59; BMI&#58; body mass index&#59; HT&#58; hypertension&#59; AMI&#58; acute myocardial infarction&#59; ACS&#58; acute coronary syndrome&#59; CVA&#58; cerebrovascular accident&#59; m&#58; mean&#59; SD&#58; standard deviation&#46;</p>"
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                  \t\t\t\t">28&#46;3 &#177; 2&#46;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Active tobacco use</span>&#44; <span class="elsevierStyleItalic">n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Dyslipidemia</span>&#44; <span class="elsevierStyleItalic">n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;0&#46;0001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Type 2 diabetes mellitus</span>&#44; <span class="elsevierStyleItalic">n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">HbA1c &#40;&#37;&#41;</span><span class="elsevierStyleItalic">&#44; m &#177; SD</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Hyperuricemia</span>&#44; <span class="elsevierStyleItalic">n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Chronic kidney disease</span>&#44; <span class="elsevierStyleItalic">n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Lung disease</span>&#44; <span class="elsevierStyleItalic">n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Family history of early AMI</span>&#44; <span class="elsevierStyleItalic">n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Prior CVD</span><span class="elsevierStyleItalic">&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8226; <span class="elsevierStyleBold">Peripheral arterial disease</span>&#44; <span class="elsevierStyleItalic">n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">31 &#40;8&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8226; <span class="elsevierStyleBold">ACS</span>&#44; <span class="elsevierStyleItalic">n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8226; <span class="elsevierStyleBold">CVA</span>&#44; <span class="elsevierStyleItalic">n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28 &#40;3&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">13 &#40;3&#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="left" valign="\n
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                  \t\t\t\t">0&#46;93&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; <span class="elsevierStyleBold">Ischemic CVA</span>&#44; <span class="elsevierStyleItalic">n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;2&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">11 &#40;2&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#46;83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Single-vessel&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Multivessel&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Event</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Total cholesterol</span>&#44; <span class="elsevierStyleItalic">m &#177; SD</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">193&#46;5 &#177; 46&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">193 &#177; 45&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">193&#46;2 &#177; 42&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">LDL</span>&#44; <span class="elsevierStyleItalic">m &#177; SD</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">121&#46;8 &#177; 40&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">121&#46;7 &#177; 40&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">123&#46;1 &#177; 38&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">HDL</span>&#44; <span class="elsevierStyleItalic">m &#177; SD</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45&#46;8 &#177; 12&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45&#46;8 &#177; 13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&#46;7 &#177; 12&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Triglycerides</span>&#44; <span class="elsevierStyleItalic">m &#177; SD</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">130&#46;5 &#177; 147&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">130&#46;5 &#177; 147&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">120&#46;2 &#177; 74&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;08&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Non-HDL cholesterol</span>&#44; <span class="elsevierStyleItalic">m &#177; SD</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">147&#46;4 &#177; 46&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">146&#46;9 &#177; 42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">148&#46;1 &#177; 50&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24 months</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Total cholesterol</span>&#44; <span class="elsevierStyleItalic">m &#177; SD</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">150&#46;6 &#177; 33&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">151&#46;1 &#177; 34&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">150&#46;2 &#177; 32&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">LDL</span>&#44; <span class="elsevierStyleItalic">m &#177; SD</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">81&#46;4 &#177; 25&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">81&#46;5 &#177; 26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">81&#46;4 &#177; 25&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">HDL</span>&#44; <span class="elsevierStyleItalic">m &#177; SD</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&#46;6 &#177; 12&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45&#46;04 &#177; 11&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&#46;2 &#177; 12&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Triglycerides</span>&#44; <span class="elsevierStyleItalic">m &#177; SD</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">121&#46;2 &#177; 72&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">122&#46;4 &#177; 79&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">119&#46;9 &#177; 63&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Non-HDL cholesterol</span>&#44; <span class="elsevierStyleItalic">m &#177; SD</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">106 &#177; 31&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">106&#46;3 &#177; 33&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">105&#46;6 &#177; 29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;78&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">End of follow-up &#40;2021&#8211;2022&#41;</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Total cholesterol<span class="elsevierStyleItalic">&#44; m &#177; SD</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">142&#46;7 &#177; 36&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">143&#46;5 &#177; 38&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">141&#46;8 &#177; 33&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">LDL</span>&#44; <span class="elsevierStyleItalic">m &#177; SD</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">74&#46;1 &#177; 30&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">75&#46;2 &#177; 33&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">72&#46;8 &#177; 27&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">HDL</span>&#44; <span class="elsevierStyleItalic">m &#177; SD</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">44&#46;3 &#177; 11&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">44&#46;6 &#177; 12&#46;44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">44 &#177; 11&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Triglycerides</span>&#44; <span class="elsevierStyleItalic">m &#177; SD</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">128&#46;2 &#177; 72&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">125&#46;4 &#177; 67&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">131&#46;8 &#177; 79&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#46;34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Non-HDL cholesterol</span>&#44; <span class="elsevierStyleItalic">m &#177; SD</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">98&#46;4 &#177; 33&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">98&#46;9 &#177; 36&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">97&#46;7 &#177; 30&#46;4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;69&nbsp;\t\t\t\t\t\t\n
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                  """
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Lipid profile according to coronary vessel involvement in progress monitoring&#46;</p>"
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                      "titulo" => "Gu&#237;a ESC&#47;EAS 2016 sobre el tratamiento de las dislipemias Grupo de Trabajo de la Sociedad Europea de Cardiolog&#237;a &#40;ESC&#41; y la European Atherosclerosis Society &#40;EAS&#41; sobre el Tratamiento de las Dislipemias"
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Article information

ISSN: 22548874
Original language: English

DOI:10.1016/j.rceng.2023.02.011

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