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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Cardiovascular diseases &#40;CVDs&#41;&#44; including coronary heart disease and cerebrovascular disease are the leading cause of mortality and disability in the world&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> In Spain&#44; CVDs continue to be the leading cause of death&#44; followed by tumors and COVID-19 even during the height of the pandemic&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> As the underlying pathological process in most CVDs&#44; arteriosclerosis is a gradual process that occurs over decades&#46; The main associated risk factors are widely known&#46; Among them&#44; dyslipidaemia is a well-known risk factor whose control has proven to reduce Cardiovascular morbimortality&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a> While there is a large therapeutic armamentarium for dyslipidaemia the level of control over lipid abnormalities is clearly suboptimal&#44; particularly in patients with a &#40;very&#41; high cardiovascular risk&#44; where reducing absolute risk is crucial&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#8211;8</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">An update of ESC Guidelines on Cardiovascular Disease Prevention in Clinical Practice was recently published&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> These guidelines are supported by the major Spanish scientific societies involved in cardiovascular disease&#44; including the CEIPV &#40;Comit&#233; Espa&#241;ol Interdisciplinario de Prevenci&#243;n Vascular&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#8211;13</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Therapeutic targets have been established and widely accepted for lipid-lowering therapies&#46; However&#44; the reference values provided on laboratory biochemistry reports continue to be based on the distribution of values in the general population&#59; unfortunately&#44; the &#34;desirable&#34; values according to the level of cardiovascular risk of the patient all-too-often not provided&#46; In spite of the SEA &#40;Spanish Society of Arteriosclerosis&#41; and 2018 SEC &#40;Spanish Society of Cardiology&#41; recommendations&#44;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;15</span></a> lipid values largely exceeding &#34;desirable&#34; values in terms of cardiovascular prevention<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> are often reported as &#34;normal&#34;&#44; whereas &#34;desirable&#34; values are reported as &#34;abnormally low&#34;&#46; This information may be misleading and result in therapeutic abstention in patients with &#34;normal&#34; values&#44; and dose reduction in patients with &#34;abnormally low&#34; values&#46; This is the reason by which a task force of experts from the main scientific societies involved in the prevention and treatment of CVDs For this reason&#44; a working group of the main scientific societies involved in the care of patients at vascular risk have prepared this document with a basic consensus proposal on the determination of the basic lipid profile in cardiovascular prevention&#44; recommendations for its implementation and unification of criteria to incorporate the objectives of lipid control appropriate to the vascular risk of the patients in the laboratory reports&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17&#44;18</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Pre-analytical considerations</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">How&#44; when&#44; and in which cases should lipid profile testing be ordered&#63;</span><p id="par0020" class="elsevierStylePara elsevierViewall">Lipid profile is necessary to <span class="elsevierStyleBold">assess the risk</span> of developing a cardiovascular disease in apparently-healthy subjects and in high-risk clinical conditions&#44; including candidates for cardiovascular surgery patients s&#46; Lipid profile is also required to <span class="elsevierStyleBold">assess the therapeutic effectiveness</span> of and adherence to lipid-lowering treatments&#46; It is essential in the prevention of CVDs&#44; especially in subjects with a high cardiovascular risk or having relatives with a high cardiovascular risk&#46; Likewise&#44; it is part of the global assessment of other disorders causing secondary dyslipidaemias&#46; Our Task Force deems those recent recommendations from the Spanish Society of Cardiology&#44;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> recently translated&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> and supported by the Spanish Committee of Vascular Prevention&#44;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> provide appropriate reference values &#40;<a class="elsevierStyleCrossRefs" href="#tbl0005">Table 1A and 1B</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Factors influencing lipid profile determination</span><p id="par0025" class="elsevierStylePara elsevierViewall">Laboratory parameters may be influenced by multiple factors&#46; Thus&#44; samples should be collected when the patient is in a &#34;stable metabolic status&#34;&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a><elsevierMultimedia ident="tbl0030"></elsevierMultimedia></p><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Lifestyle and pathophysiological status of the patient</span><p id="par0030" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">a&#41;</span><p id="par0035" class="elsevierStylePara elsevierViewall">The patient should maintain regular habits in the two previous weeks prior to the blood test&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">b&#41;</span><p id="par0040" class="elsevierStylePara elsevierViewall">The patient should not do strenuous exercise before a blood test&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">c&#41;</span><p id="par0045" class="elsevierStylePara elsevierViewall">The patient should remain in sitting position 15&#160;min before the blood test&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">d&#41;</span><p id="par0050" class="elsevierStylePara elsevierViewall">Phlebotomy should be standarised&#58; Venous blood should be drawn with the patient in sitting position &#40;levels of TC and LDL cholesterol may be lower in supine position&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">e&#41;</span><p id="par0055" class="elsevierStylePara elsevierViewall">Exclude secondary dyslipidaemias and dyslipidaemias related to drug therapy &#40;Supplementary material Annex 1&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#44;21</span></a></p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">f&#41;</span><p id="par0060" class="elsevierStylePara elsevierViewall">In case of an acute inflammatory process&#44; phlebotomy should be performed at least 2&#8211;4 weeks after the process&#44; since the process may cause a decrease in total cholesterol&#44; LDL cholesterol&#44; and HDL cholesterol&#44; and an increase in triglycerides&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">22&#8211;25</span></a></p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">g&#41;</span><p id="par0065" class="elsevierStylePara elsevierViewall">g&#41; In case of acute coronary syndrome &#40;or other acute ischemic atherosclerotic event&#41;&#44; lipid profile should be obtained within the first 24&#160;h&#46;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">26&#8211;28</span></a> If it is performed &#62; 24&#160;h after the acute process&#44; levels of total cholesterol and LDL cholesterol may be reduced with respect to the values normally found in the patient&#44; a phenomenon that should be taken into account in clinical decision-making&#46; In patients that have never undergone a lipid profile test&#44; Lp&#40;a&#41; testing is recommended&#46; Although Lp&#40;a&#41; values may increase in acute processes&#44; variation is modest&#44;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">29&#44;30</span></a> which enables the detection of patients with significantly elevated Lp&#40;a&#41; in early stages&#46;</p></li></ul></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Is it necessary that lipid profile is tested in fasting conditions&#63;</span><p id="par0070" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">&#8226;</span><p id="par0075" class="elsevierStylePara elsevierViewall">Most lipid parameters offer little variation regardless of the patient being in fasting conditions or not<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> &#40;Annex&#46; Suplemmentary material&#46; Table 2&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">&#8226;</span><p id="par0080" class="elsevierStylePara elsevierViewall">The main clinical guidelines <span class="elsevierStyleUnderline">do not require fasting lipid profile</span>&#44; at least for an initial cardiovascular risk assessment or for diagnosis of isolated hypercholesterolemia&#44; i&#46;e&#46; familial hypercholesterolemia or elevated Lp&#40;a&#41; in the absence of increased triglycerides&#46; Non-fasting lipid values may better predict the risk for ASCVD&#44; since they provide a more accurate insight into the postprandial status of the patient and the influence of residual risk&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a></p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">&#8226;</span><p id="par0085" class="elsevierStylePara elsevierViewall">Triglyceride concentration is the only parameter that changes substantially after food intake&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a> Given that the Friedewald&#8217;s formula is significantly inaccurate in patients with Tg&#62;150&#160;mg&#47;dL&#44; it is recommended that LDL cholesterol is calculated using Martin&#47;Hopkins formula<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a> &#40;Annex&#46; Supplementary material Table 3&#41; or that Non-HDL cholesterol is calculated instead in these patients&#46;</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">&#8226;</span><p id="par0090" class="elsevierStylePara elsevierViewall">Fasting is recommended if Tg &#8805;4&#46;5&#160;mmol&#47;L &#40;&#8805;398&#160;mg&#47;dL&#41; prior to the initiation of a drug therapy that can cause severe hypertriglyceridaemia &#40;i&#46;e&#46; isotretinoin&#41; and in genetically predisposed subjects with a history of hypertriglyceridaemic pancreatitis&#46; Fasting is also advised when the laboratory request includes additional laboratory tests that require that samples are collected in fasting conditions&#44; or when morning samples are required &#40;i&#46;e&#46; fasting glucose or parameters affected by circadian rhythm&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">&#8226;</span><p id="par0095" class="elsevierStylePara elsevierViewall">Fasting and non-fasting lipid profile should be considered as complementary rather than as mutually exclusive&#46;</p></li><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">&#8226;</span><p id="par0100" class="elsevierStylePara elsevierViewall">Cholesterol and triglycerides are generally tested using enzymatic methods&#44; which determinations having a variability &#60; 10&#37; &#40;Annex&#46; Supplementary material <a class="elsevierStyleCrossRef" href="#tbl0015">Table 2</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> However&#44; within-subject variability and variability resulting from sample collection conditions &#40;&#8776;20 &#37; for triglycerides and &#8776;10 &#37; for HDL cholesterol and LDL cholesterol&#41;&#44; make it necessary that lipid profile testing is repeated in primary prevention patients without a clear indication for immediate initiation of a lipid-lowering therapy&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a></p></li></ul><elsevierMultimedia ident="tbl0035"></elsevierMultimedia></p></span></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Analytical considerations</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Should the analytical method be reported&#63;</span><p id="par0105" class="elsevierStylePara elsevierViewall">Lipid profile determination should always be performed using the same methods&#44; and a change in the testing method should always be reported&#46; It is necessary that physicians are aware of the laboratory method used in lipid profile testing&#44; since interferences or misinterpretations may occur&#46;<elsevierMultimedia ident="tbl0040"></elsevierMultimedia></p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods for the determination of LDL cholesterol</span><p id="par0110" class="elsevierStylePara elsevierViewall">The method of reference for testing LDL cholesterol involves separating lipoproteins by density-gradient ultracentrifugation&#44; a time-consuming method that is only available in specialized laboratories&#46; For this reason&#44; LDL cholesterol is often estimated by measuring total cholesterol and triglycerides &#40;using enzymatic methods&#41;&#44; and by direct HDL cholesterol determination&#46; Friedewald&#8217;s is the most frequently used formula&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">Friedewald&#8217;s formula for the estimation of LDL cholesterol &#40;in mg&#47;dL&#41;<elsevierMultimedia ident="eq0005"></elsevierMultimedia></p><p id="par0120" class="elsevierStylePara elsevierViewall">Friedewald&#8217;s formula assumes the absence of chylomicrons and a specific of cholesterol&#47;Tg ratio in VLDL &#40;1&#47;5&#160;in mg&#47;dL&#59; 1&#47;2&#46;2 in mmol&#47;L&#41;&#46; In VLDL&#44; the Tg&#47; cholesterol ratio progressively increases as hypertriglyceridaemia exacerbates&#59; therefore&#44; in patients with hypertriglyceridaemia&#44; the formula overestimates VLDL cholesterol and thus underestimates LDL cholesterol&#46; The formula has an acceptable accuracy when Tg concentration is &#60; 200&#160;mg&#47;dL and it should not be used if Tg&#160;&#62;&#160;400&#160;mg&#47;dL &#40;Recommendation 4&#41;&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">The Martin-Hopkins formula replaces number 5 in the Friedewald&#8217;s formula &#40;c-VLDL&#160;&#61;&#160;Tg&#47;5&#41; with divisors that vary according to the levels of Tg and non-HDL cholesterol of the patient &#40;Annex&#46; Supplementary material Table&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a> The Martin-Hopkins formula is more accurate than Friedewald&#39;s when Tg&#160;&#62;&#160;150&#160;mg&#47;dL&#44; LDL cholesterol &#60;100&#160;mg&#47;dL&#44; and especially when &#60;70&#160;mg&#47;dL&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">The Sampson formula is more complex and provides similar results to those of Martin-Hopkins for patients with Tg&#160;&#60;&#160;400&#160;mg&#47;dL&#46; As a result&#44; the former is less frequently used&#46; In patients with Tg&#160;&#62;&#160;400&#160;mg&#47;dL&#44; the use of formulas for the estimation of LDL cholesterol is not recommended&#44; due to their poor reliability&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Ultracentrifugation&#44; the classical reference method for LDL cholesterol determination&#44; is labour intensive one and is only used in very specialized laboratories&#46; There is a direct&#44; accurate&#44; and widely available measurement method&#46; The use of this marker is recommended if Tg&#160;&#62;&#160;400&#160;mg&#47;dL or LDL&#160;&#60;&#160;70&#160;mg&#47;dL&#44; when LDL cholesterol determination methods are more inaccurate&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">When a direct method cannot be used to determine LDL cholesterol&#44; the use of non-HDL cholesterol as a marker of &#34;atherogenic&#34; cholesterol is recommended&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a> Determination of apolipoprotein B can also be used &#40;Apo B&#41;&#46; Non-HDL cholesterol does not require Tg determination nor is it influenced by fasting&#46; Moreover&#44; it strongly correlates with levels of Apo B&#46;<elsevierMultimedia ident="tbl0045"></elsevierMultimedia></p><p id="par0145" class="elsevierStylePara elsevierViewall">In patients with significantly elevated Lp&#40;a&#41; concentrations&#44; LDL cholesterol estimation should be corrected using the following formula&#58; <elsevierMultimedia ident="eq0010"></elsevierMultimedia><elsevierMultimedia ident="eq0015"></elsevierMultimedia></p><p id="par0150" class="elsevierStylePara elsevierViewall">Potential Lp&#40;a&#41; elevation should be especially considered in Sub Saharan patients&#44; patients with the nephrotic syndrome&#44; on peritoneal dialysis&#44; or with a poor decrease of LDL cholesterol after having received a lipid-lowering therapy&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Post-analytical considerations</span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Markers of &#34;normality&#34; and alerts</span><p id="par0155" class="elsevierStylePara elsevierViewall">The clinical laboratory plays a crucial role in the assessment of cardiovascular risk in patients with dyslipidaemia&#46; It is essential that specific reference values are established for the pediatric population&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Desirable values should be provided in terms of cardiovascular risk and prevention on lipid profile reports&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#8211;16</span></a><a class="elsevierStyleCrossRef" href="#tbl0015">Table 2</a> shows the desirable values for the main lipid parameters established for adults by the European Society of Cardiology&#44; Arteriosclerosis and the Spanish Society of Laboratory Medicine &#40;2019&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17&#44;18&#44;36</span></a></p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0165" class="elsevierStylePara elsevierViewall">Critical values should be flagged and reported as such to the requesting physician&#44; as shown in <a class="elsevierStyleCrossRef" href="#tbl0020">Table 3</a>&#46;<elsevierMultimedia ident="tbl0050"></elsevierMultimedia></p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">What parameters should a basic lipid profile include&#63;</span><p id="par0170" class="elsevierStylePara elsevierViewall">The basic lipid profile should include the determination of total cholesterol&#44; HDL cholesterol&#44; triglycerides&#44; non-HDL cholesterol&#44; and LDL cholesterol<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;36&#8211;39</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0175" class="elsevierStylePara elsevierViewall">The Consensus Statements of the European Society of Arteriosclerosis and the European Society of Laboratory Medicine also recommend the estimation of remnant particles&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#8211;17</span></a> Elevated lipoprotein &#40;a&#41; confers an increased vascular risk&#46; Therefore&#44; it is recommended that it is measured at least once in life&#44; since levels are substantially determined by genetic factors&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#8211;17</span></a></p><p id="par0180" class="elsevierStylePara elsevierViewall">In patients with Tg&#160;&#62;&#160;400&#160;mg&#47;dL&#44; direct determination of LCL cholesterol is recommended in order to obtain more reliable values&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">40</span></a> If available&#44; Apo B is a marker of special interest&#44; since it is the best marker of the number of atherogenic lipoproteins&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a> When direct determination of LDL cholesterol or Apo B is not available&#44; non-HDL cholesterol can be used as an approximation&#46;<elsevierMultimedia ident="tbl0055"></elsevierMultimedia></p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">What is non-HDL cholesterol tested for&#63;</span><p id="par0185" class="elsevierStylePara elsevierViewall">The estimation of non-HDL cholesterol involves a simple calculation &#40;total cholesterol - HDL cholesterol&#41; that reflects the cholesterol of atherogenic lipoproteins&#46; Non-HDL cholesterol strongly correlates with Apo B concentrations&#46; Also&#44; it is the parameter of reference in the vascular risk assessment formulas SCORE2 &#40;Systematic Coronary Risk Evaluation&#41; and SCOREOP &#40;Systematic Coronary Risk Evaluation old people&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;42&#44;43</span></a> An additional advantage of this parameter is that it is not influenced by fasting&#46; Moreover&#44; it can be determined in patients with Tg&#160;&#62;&#160;400&#160;mg&#47;dL or be useful as a guideline in laboratories where direct LDL or Apo B determination is not available&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">44</span></a></p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">When should Apolipoprotein B used&#63;</span><p id="par0190" class="elsevierStylePara elsevierViewall">Apo B is an excellent predictor of cardiovascular events&#44; since this apoprotein is found in the main atherogenic lipoproteins&#44; namely&#58; LDL&#44; lipoprotein &#40;a&#41;&#44; VLDL and IDL&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">41&#8211;45</span></a> Testing Apo B is equivalent to measuring the amount of atherogenic lipoproteins&#44; since each one contains a single molecule of Apo B&#46; Apo B values are not affected by fasting&#46; The amount of lipoparticles can also be measured by MRI &#40;magnetic resonance imaging&#41;&#46; However&#44; this technique is not available in routine clinical practice&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">46</span></a></p><p id="par0195" class="elsevierStylePara elsevierViewall">Apo B is especially relevant in patients with elevated triglycerides&#44; diabetes mellitus&#44; obesity&#44; metabolic syndrome&#44; or very low LDL cholesterol&#46; In these cases&#44; measurement or estimation of LDL cholesterol may be inaccurate and not consider the atherogenic component of other lipoproteins&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">Apo B test is rarely included in standard lipid profiles or ASCVD risk assessment tests&#46; Monogenic disorders such as familial hypercholesterolemia &#40;FH&#41; can be easily recognized using a standard panel of lipids&#46; In these cases&#44; measuring Apo B is not necessary &#40;Annex&#46; Supplementary material Table 4&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">47</span></a> On another note&#44; Apo B concentration helps classify severe dyslipidaemias&#44; such as combined familial hyperlipidaemia and familial dysbetalipoproteinemia<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">48</span></a> &#40;Annex&#46; Supplementary material Figure&#41;&#46;<elsevierMultimedia ident="tbl0060"></elsevierMultimedia></p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">When should lipoprotein &#40;a&#41; be determined&#63;</span><p id="par0205" class="elsevierStylePara elsevierViewall">Testing Lp&#40;a&#41; is recommended at least once in life to estimate vascular risk&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;49&#8211;52</span></a> This determination is especially relevant in patients with early-onset cardiovascular disease&#44; familial hypercholesterolemia&#44; poor response to statin therapy&#44; aortic stenosis&#44; or recurrent ischemic events&#44; and in relatives to patients with elevated Lp&#40;a&#41;&#46; The cardiovascular risk of patients with very elevated Lp&#40;a&#41; &#40;&#62;180&#160;mg&#47;dL&#47;&#62;430&#160;nmol&#47;L&#41; is similar to that of patients with heterozygous familial hypercholesterolemia&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">53&#44;54</span></a> One of the challenges of Lp&#40;a&#41; determination is the variability of results across the different detection techniques&#46; Another disadvantage is the unavailability of a direct equivalence between values reported in mg&#47;dL and in nmol&#47;L&#44; according to the different apoprotein &#40;a&#41; isoforms&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">Lp&#40;a&#41; should only be measured once in life&#44; given that it is substantially determined by genetics and there are no specific drug therapies available as yet&#46; Exceptions to this rule include transition to menopause&#44; pregnancy&#44; use of oral contraceptives&#44; chronic kidney disease&#47; nephrotic syndrome&#44; or when a specific treatment is used to reduce Lp&#40;a&#41; or modulate the recommended therapeutic options&#44; such as PCSK9 inhibitors&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">55</span></a><elsevierMultimedia ident="tbl0065"></elsevierMultimedia></p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Should inflammation be assessed in patients with arteriosclerosis&#63;</span><p id="par0215" class="elsevierStylePara elsevierViewall">Chronic inflammatory processes are associated with an increased cardiovascular risk&#44; regardless of the risk attributable to conventional risk factors&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">56</span></a> High-sensitivity C-reactive protein is the analytical parameter most frequently used as a maker of low-intensity inflammation&#46; It has a high variability&#44; and there is no defined consensus on the values that should be considered &#8216;elevated&#8217; for the estimation for vascular risk assessment&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a></p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Innovations in the diagnosis of dyslipidaemias&#58; parameters for an e-consultation</span><p id="par0220" class="elsevierStylePara elsevierViewall">For an e-consultation to be rapid and effective&#44; the basic parameters to be included for the diagnosis of dyslipidaemias are shown in <a class="elsevierStyleCrossRef" href="#tbl0025">Table 4</a>&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia></span></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Funding</span><p id="par0225" class="elsevierStylePara elsevierViewall">This study did not receive any funds&#46;</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Competing interests</span><p id="par0230" class="elsevierStylePara elsevierViewall">None&#46;</p></span></span>"
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            3 => "Biochemistry"
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            1 => "CEIPV"
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            3 => "CKD"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Cardiovascular diseases &#40;CVD&#41; continue to be the main cause of death in our country&#46; Adequate control of lipid metabolism disorders is a key challenge in cardiovascular prevention that is far from being achieved in real clinical practice&#46; There is a great heterogeneity in the reports of lipid metabolism from Spanish clinical laboratories&#44; which may contribute to its poor control&#46; For this reason&#44; a working group of the main scientific societies involved in the care of patients at vascular risk&#44; has prepared this document with a consensus proposal on the determination of the basic lipid profile in cardiovascular prevention&#44; recommendations for its realization and unification of criteria to incorporate the lipid control goals appropriate to the vascular risk of the patients in the laboratory reports&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Las enfermedades cardiovasculares &#40;ECV&#41; siguen siendo la principal causa de muerte en nuestro pa&#237;s&#46; El control adecuado de las alteraciones del metabolismo lip&#237;dico es un reto clave en prevenci&#243;n cardiovascular que est&#225; lejos de alcanzarse en la pr&#225;ctica cl&#237;nica real&#46; Existe una gran heterogeneidad en los informes del metabolismo lip&#237;dico de los laboratorios cl&#237;nicos espa&#241;oles&#44; lo que puede contribuir al mal control del mismo&#46; Por ello&#44; un grupo de trabajo de las principales sociedades cient&#237;ficas implicadas en la atenci&#243;n de los pacientes de riesgo vascular hemos elaborado este documento con una propuesta b&#225;sica de consenso sobre la determinaci&#243;n del perfil lip&#237;dico b&#225;sico en prevenci&#243;n cardiovascular&#44; recomendaciones para su realizaci&#243;n y unificaci&#243;n de criterios para incorporar los objetivos de control lip&#237;dico adecuados al riesgo vascular de los pacientes en los informes de laboratorio&#46;</p></span>"
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                  \t\t\t\t">1&#41; Routine vascular risk assessment is recommended in patients presenting a major cardiovascular risk factor &#40;i&#46;e&#46; familial history of early CVD&#44; familial hypercholesterolemia&#44; or factors such as tobacco use&#44; arterial hypertension&#44; Diabetes mellitus&#44; Hyperlipemia&#44; chronic renal disease&#44; obesity or comorbidities that increase the risk for CVD&#41;&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#41; Consider routine or opportunistic assessment of CVR in men 40 years and women &#62; 50 years or postmenopausal women of the general population without CV risk factors&#46;&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">3&#41; Consider follow-up assessment at 5 years &#40;or earlier if the risk is close to therapeutic thresholds&#41; in all subjects who have undergone screening for CVD risk during an opportunistic screening&#46;&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">4&#41; Routine CVR assessment is not recommended in men &#60; 40 years and women &#60; 50 years without known CVR factors&#46;&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_colgroup " colspan="1" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-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">Monitoring of therapeutic efficacy and adherence to lipid lowering treatment</span>&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">1&#41; Before lipid-lowering therapy is initiated perform 2 determinations within a 1&#8722;2 week interval&#44; except in case of cardiovascular event and in patient with very high risk with indication for immediate treatment&#46;&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">2&#41; Once lipid-lowering treatment has been initiated&#44; repeat laboratory analysis&#46;&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="elsevierStyleHsp" style=""></span>a&#46; After an acute atherosclerotic vascular event&#44; at 4&#8722;6 weeks&#46;&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="elsevierStyleHsp" style=""></span>b&#46; In patients who are stable in cardiovascular terms&#44; at 8&#160;&#177;&#160;4 weeks until targets are achieved&#46;&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">3&#41; Once the patient has reached the optimal lipid target&#44; the lipids should be measured on a yearly basis&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Lipid determination for assessing cardiovascular risk&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a></p>"
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      2 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 1B"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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            "identificador" => "at0015"
            "detalle" => "Table 1"
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          "leyenda" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">CVD&#58; cardiovascular disease&#59; CVR&#58; cardiovascular risk&#58; LDL-c&#58; cholesterol associated to low density lipoproteins&#59; Apo B&#58; apolipoprotein B&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><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">&#8226; In cases of very high CVR&#44; a 50&#37; reduction of the baseline value is recommended&#44; along with and a target LDL chol&#160;&#60;&#160;1&#46;4&#160;mmol&#47;L &#40;&#60;55&#160;mg&#47;dL&#41;&#44; non-HDL ch&#46;&#160;&#60;&#160;85&#160;mg&#47;dl and ApoB &#60;65&#160;mg&#47;dL&#46;&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">&#8226; In case of high CVR&#44; a 50&#37; reduction of the baseline value is recommended&#44; along with a target LDL chol&#160;&#60;&#160;1&#46;8&#160;mmol&#47;L &#40;&#60;70&#160;mg&#47;dL&#41;&#44; non-HDL ch&#46;&#160;&#60;&#160;100&#160;mg&#47;dl and ApoB &#60;80&#160;mg&#47;dL&#46;&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">&#8226; In case of moderate CVR&#44; a target LDL chol&#160;&#60;&#160;2&#46;6&#160;mmol&#47;L &#40;&#60;100&#160;mg&#47;dL&#41;&#44; non-HDL ch&#46;&#160;&#60;&#160;131&#160;mg&#47;dL and ApoB &#60;100&#160;mg&#47;dL is recommended&#46;&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">&#8226; In case of low CVR&#44; consider a target LDL&#160;&#60;&#160;3&#46;0&#160;mmol&#47;L &#40;&#60;116&#160;mg&#47;dl&#41;&#46;&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">Suspect for familial hypercholesterolemia</span> in patients who developed arteriosclerotic cardiovascular disease before 55 years &#40;men&#41; or 60 years of age &#40;women&#41;&#59; subjects with a relative who had early CVD&#59; subjects with relatives with tendon xamtomata&#59; patients with very elevated LDL chol&#46; &#40;adults &#62;5&#160;mmol&#47;L &#91;190&#160;mg&#47;dL&#93;&#59; children &#62;4&#160;mmol&#47;L &#91;150&#160;mg&#47;dL&#93;&#41; and first-degree relatives with familial hypercholesterolemia&#46;&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">In children&#44; perform testing from 5 years of age or younger&#44; upon suspicion for homozygous familial hypercholesterolemia &#40;HFHo&#41;&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Lipid targets according to cardiovascular risk&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p>"
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      3 => array:8 [
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        "etiqueta" => "Table 2"
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            "identificador" => "at0020"
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          "leyenda" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">CVR&#58; Cardiovascular Risk&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><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">Parameter&nbsp;\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">Desirable Value in Adults&nbsp;\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" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Total cholesterol&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">&#60;200 mg&#47;dl &#40;5&#46;17&#160;mmol&#47;l&#41;&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">HDL cholesterol&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">&#62;50&#160;mg&#47;dl women &#40;&#62;1&#46;29&#160;mmol&#47;l&#41;&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">&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">&#62; 40&#160;mg&#47;dl men &#40;1&#46;03&#160;mmol&#47;l&#41;&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">Non-HDL cholesterol&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">Recommended values based on cardiovascular risk&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">&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"><span class="elsevierStyleHsp" style=""></span>&#8226; Secondary prevention and very-high CVR&#160;&#60;&#160;85&#160;mg&#47;dl &#40;&#60;2&#46;2&#160;mmol&#47;l&#41;&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">&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"><span class="elsevierStyleHsp" style=""></span>&#8226; High CVR&#160;&#60;&#160;100&#160;mg&#47;dl&#59; &#40;&#60;2&#46;6&#160;mmol&#47;l&#41;&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">&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"><span class="elsevierStyleHsp" style=""></span>&#8226; Moderate CVR&#160;&#60;&#160;100&#160;mg&#47;dl &#40;&#60;2&#46;6&#160;mmol&#47;l&#41;&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">LDL cholesterol&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">Recommended values based on CVR&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">&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"><span class="elsevierStyleHsp" style=""></span>&#8226; Secondary prevention and very-high CVR&#160;&#60;&#160;55&#160;mg&#47;dL &#40;&#60;1&#46;4&#160;mmol&#47;l&#41;&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">&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"><span class="elsevierStyleHsp" style=""></span>&#8226; High CVR&#160;&#60;&#160;70&#160;mg&#47;dL &#40;&#60;1&#46;8&#160;mmol&#47;l&#41;&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">&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"><span class="elsevierStyleHsp" style=""></span>&#8226; Moderate CVR&#160;&#60;&#160;100&#160;mg&#47;dl &#40;&#60;2&#46;6&#160;mmol&#47;l&#41;&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">&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"><span class="elsevierStyleHsp" style=""></span>&#8226; Low CVR&#160;&#60;&#160;116&#160;mg&#47;dL &#40;&#60;3&#160;mmol&#47;L&#41;&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 rowgroup " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Triglycerides</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">Fasting TG&#160;&#60;&#160;150&#160;mg&#47;dl &#40;&#60;1&#46;69&#160;mmol&#47;l&#41;&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">&#40;Non-fasting TG&#160;&#60;&#160;175&#160;mg&#47;dl&#41; &#40;&#60;1&#46;97&#160;mmol&#47;l&#41;&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">Apolipoprotein B&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">Recommended values based on CVR&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">&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"><span class="elsevierStyleHsp" style=""></span>&#8226; Secondary prevention and very-high CVR&#160;&#60;65&#160;mg&#47;dl &#40;1&#44;27 umol&#47;L&#41;&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">&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"><span class="elsevierStyleHsp" style=""></span>&#8226; High CVR&#160;&#60;80&#160;mg&#47;dl&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">&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"><span class="elsevierStyleHsp" style=""></span>&#8226; Moderate CVR&#160;&#60;&#160;100&#160;mg&#47;dL &#40;&#60;3&#46;4&#160;mmol&#47;l&#41;&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">Lipoprotein &#40;a&#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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;50 mg&#47;dL &#40;&#60;105 nmol&#47;l&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3395606.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Desirable lipid values in adults&#44; according to the European Societies of Arteriosclerosis and Laboratory Medicine&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17&#44;18&#44;36</span></a></p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "tbl0020"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0025"
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        "tabla" => array:3 [
          "leyenda" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">LDL&#58; low density lipoprotein&#59; Apo&#58; apolipoprotein&#59; Tg&#58; triglycerides&#59; CV&#58; cardiovascular&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><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">Parameter&nbsp;\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">Critical value&nbsp;\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">&nbsp;\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">Serum Total Cholesterol&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">310&#160;mg&#47;dL&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">Patient of High vascular risk&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">Triglycerides&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">&#62;880&#160;mg&#47;dL&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">Severe hypertriglyceridaemia with risk of acute pancreatitis&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">Adult LDL cholesterol&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">&#62;190 mg&#47;dL&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">Consider heterozygous familial hypercholesterolemia&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">Adult LDL cholesterol&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">&#62;500 mg&#47;dL&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">Consider homozygous familial hypercholesterolemia&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">Atherogenic lipid triad&#58;&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">If&#58; Tg&#160;&#62;&#160;150&#160;mg&#47;dL and HDL&#160;&#60;&#160;30&#160;mg&#47;dL&#44; LDL&#47;Apo B&#160;&#60;&#160;1&#46;3 or Tg&#47;HDL &#62; 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lipid triad suggestive of atherogenic dyslipidemia with a very high vascular risk&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">Lipoprotein &#40;a&#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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#62;120 mg&#47;dL &#40;260&#160;nmol&#47;L&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&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">Very high CV risk of atherosclerotic cardiovascular disease and aortic valve stenosis&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">Apolipoprotein A 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">&#60; 10 mg&#47;dL&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">Consider Hypoalphalipoproteinemia&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">Apolipoprotein B&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">&#60;10&#160;mg&#47;dL&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">Consider hypo betalipoproteinemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3395601.png"
              ]
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          ]
          "notaPie" => array:1 [
            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Estimation based on EAS &#47;EFLM Consensus Document&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Recommended alerts of the information system&#47;laboratory report&#46;</p>"
        ]
      ]
      5 => array:8 [
        "identificador" => "tbl0025"
        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0030"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">BMI&#58; body mass index&#59; LDL&#58; low density lipoprotein&#59; HDL&#58; high density lipoprotein&#59; WHO&#58; World Health Organization&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><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">1&#46; Age&#44; sex&#44; BMI&#44; waist circumference of the patient&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">2&#46; Short summary of familial and personal medical history&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">3&#46; Risk factors&#58; tobacco use&#44; alcohol use &#40;quantified&#41;&#44;&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">4&#46; Short summary of the lipid history and previous lipid-lowering treatments&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">5&#46; Full outline of patient treatment&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">6&#46; Possible side effects of lipid-lowering therapy&#46;&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">7&#46; Current basic lipid profile&#46; Total cholesterol&#44; LDL cholesterol&#44; HDL cholesterol&#44; Non-HDL cholesterol&#44; Triglycerides&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">8&#46; Active problem&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">9&#46; Availability of personal or familial genetic studies&#46;&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">10&#46; In case familial hypercholesterolemia is suspected&#44; &#8212; Dutch lipid clinic network score &#40;DLCN&#41; &#47;WHO<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">47</span></a>&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">11&#46; On case of suspicion of hypertriglyceridemia&#58; Moulin score for the diagnosis of familial quilomicronemia<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">57</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab3395611.png"
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          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Reference data required for assessing cardiovascular risks in an e-consultation&#46;</p>"
        ]
      ]
      6 => array:5 [
        "identificador" => "upi0005"
        "tipo" => "MULTIMEDIAECOMPONENTE"
        "mostrarFloat" => false
        "mostrarDisplay" => true
        "Ecomponente" => array:2 [
          "fichero" => "mmc1.pdf"
          "ficheroTamanyo" => 798741
        ]
      ]
      7 => array:5 [
        "identificador" => "eq0005"
        "tipo" => "MULTIMEDIAFORMULA"
        "mostrarFloat" => false
        "mostrarDisplay" => true
        "Formula" => array:1 [
          "Quimica" => "<span class="elsevierStyleItalic">LDL</span> cholesterol&#160;&#61;&#160;Total cholesterol&#160;&#8722;&#160;<span class="elsevierStyleItalic">HDL</span> cholesterol&#160;&#8722;&#160;triglycerides&#47;5"
        ]
      ]
      8 => array:5 [
        "identificador" => "eq0010"
        "tipo" => "MULTIMEDIAFORMULA"
        "mostrarFloat" => false
        "mostrarDisplay" => true
        "Formula" => array:1 [
          "Quimica" => "LDL cholesterol corrected for Lp&#40;a&#41; &#40;mg&#47;dL&#41;&#160;&#61;&#160;LDL cholesterol &#40;mg&#47;dL&#41;&#160;&#8722;&#160;&#91;Lp&#40;a&#41; &#40;mg&#47;dL&#41;&#160;&#215;&#160;0&#46;30&#93;"
        ]
      ]
      9 => array:5 [
        "identificador" => "eq0015"
        "tipo" => "MULTIMEDIAFORMULA"
        "mostrarFloat" => false
        "mostrarDisplay" => true
        "Formula" => array:1 [
          "Quimica" => "LDL cholesterol corrected for Lp&#40;a&#41; &#40;nmol&#47;L&#41;&#160;&#61;&#160;LDL cholesterol &#40;nmol&#47;L&#41;&#160;&#8722;&#160;&#91;Lp&#40;a&#41; &#40;mg&#47;dL&#41;&#160;&#215;&#160;0&#46;0078&#93;"
        ]
      ]
      10 => array:5 [
        "identificador" => "tbl0030"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => false
        "mostrarDisplay" => true
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><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">Recommendation 1&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">Testing lipid profile is not recommended in a context of non-cardiovascular acute inflammatory process&#46; Lipid profile should be determined during the first 24&#160;h after an acute arteriosclerotic ischemic event&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab3395608.png"
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                  \t\t\t\t" class=""><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">Recommendation 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fasting is not required for lipid profile evaluation as an initial cardiovascular risk assessment&#46; If levels of triglycerides exceed Tg&#160;&#8805;&#160;4&#46;5&#160;mmol&#47;L &#40;&#8805;398&#160;mg&#47;dL&#41;&#44; a second determination is recommended in fasting conditions for confirmation of results&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3395609.png"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><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">Recommendation 3&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">Reporting the laboratory technique or a change of units is essential for a correct interpretation of laboratory results&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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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">Recommendation 4&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">The Friedewald formula is accurate in most patients with LDL cholesterol &#62; 100&#160;mg&#47;dl and Tg&#160;&#60;&#160;150&#160;mg&#47;dL&#46; The modified Martin-Hopkins formula is superior for the estimation of LDL cholesterol&#44; especially in patients with low LDL-c concentrations &#60;70&#160;mg&#47;dL&#44; Tg concentrations 150&#8722;400&#160;mg&#47;dL&#44; and in non-fasting conditions&#46; Direct LDL cholesterol assays should be used to determine LDL cholesterol if Tg&#160;&#8805;&#160;400&#160;mg&#47;dL&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><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
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                  \t\t\t\t">Recommendation 5&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">On laboratory reports&#44; the reference values for lipid parameters should always be referred to the cardiovascular risk of the patient&#44; rather than to normal reference values for the general population&#46; The use of asterisks marking values outside the population normality range is discouraged&#46; The use of flagging systems is recommended for extreme lipid concentrations suggestive of severe dyslipidaemias&#46; Specific values should be established for the pediatric population&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab3395610.png"
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                  \t\t\t\t" class=""><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
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                  \t\t\t\t">Recommendation 6&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">The basic lipid profile should include the determination of total cholesterol&#44; HDL cholesterol&#44; triglycerides&#44; non-HDL cholesterol&#44; and LDL cholesterol estimation&#46; In patients with mild&#47;moderate hypertriglyceridaemia&#44; testing non-HDL cholesterol and Apo B is recommended for assessing residual cardiovascular risk&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab3395613.png"
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                  <table border="0" frame="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">Recommendation 7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">Testing Apo B is recommended for assessing vascular risk&#59; classify dyslipidaemias and characterize particle size&#46; It is also preferable to non-HDL cholesterol testing in patients with mild-to-moderate hypertriglyceridaemia &#40;175&#8722;880&#160;mg&#47;dL&#41;&#44; diabetes&#44; obesity&#44; metabolic syndrome&#44; or very low LDL cholesterol &#40;&#60;70&#160;mg&#47;dL&#41;&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab3395603.png"
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        "identificador" => "tbl0065"
        "tipo" => "MULTIMEDIATABLA"
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        "mostrarDisplay" => true
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          "tablatextoimagen" => array:1 [
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                  <table border="0" frame="\n
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                  \t\t\t\t" class=""><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">Recommendation 8&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
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                  \t\t\t\t">Lp&#40;a&#41; should be determined only once in life&#44; except when its levels may be affected by significant changes&#44; as the development of nephrotic syndrome or the use of a therapy to reduce Lp&#40;a&#41;&#46; The most appropriate units of measurement are nmol&#47;L&#46; &#40;Annex&#46; Supplementary Material Comment&#41;&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:57 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "titulo" => "GBD 2017 Causes of Death Collaborators Global&#44; regional&#44; and national age-sex-specific mortality for 282 causes of death in 195 countries and territories&#44; 1980&#8211;2017&#58; a systematic analysis for the Global Burden of Disease Study 2017"
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(18)32203-7"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet Lond Engl"
                        "fecha" => "2018"
                        "volumen" => "392"
                        "numero" => "10159"
                        "paginaInicial" => "1736"
                        "paginaFinal" => "1788"
                      ]
                    ]
                  ]
                ]
              ]
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            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "INE Defunciones por causas &#40;lista reducida&#41; por sexo y grupos de edad &#40;7947&#41;&#46; INE&#46; &#91;Accessed 16 February 2022&#93;&#46; Available at&#58; <a target="_blank" href="https://www.ine.es/jaxiT3/Datos.htm?t=7947#!tabs-tabla">https&#58;&#47;&#47;www&#46;ine&#46;es&#47;jaxiT3&#47;Datos&#46;htm&#63;t&#61;7947&#35;&#33;tabs-tabla</a>&#46;"
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Low-density lipoproteins cause atherosclerotic cardiovascular disease&#58; pathophysiological&#44; genetic&#44; and therapeutic insights&#58; a consensus statement from the European Atherosclerosis Society Consensus Panel"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Bor&#233;n"
                            1 => "M&#46;J&#46; Chapman"
                            2 => "R&#46;M&#46; Krauss"
                            3 => "C&#46;J&#46; Packard"
                            4 => "J&#46;F&#46; Bentzon"
                            5 => "C&#46;J&#46; Binder"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehz962"
                      "Revista" => array:7 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2020"
                        "volumen" => "41"
                        "paginaInicial" => "2313"
                        "paginaFinal" => "2330"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32052833"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S154855951730188X"
                          "estado" => "S300"
                          "issn" => "15485595"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dislipidemias&#58; un reto pendiente en prevenci&#243;n cardiovascular&#46; Documento de consenso CEIPC&#47;SEA"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;&#193;&#46; Royo Bordonada"
                            1 => "J&#46;M&#46; Lobos Bejarano"
                            2 => "J&#46; Mill&#225;n N&#250;&#241;ez-Cort&#233;s"
                            3 => "F&#46; Villar &#193;lvarez"
                            4 => "C&#46; Brotons Cuixart"
                            5 => "M&#46; Camafort Babkowski"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.medcli.2011.02.008"
                      "Revista" => array:5 [
                        "tituloSerie" => "Med Cl&#237;nica"
                        "fecha" => "2011"
                        "volumen" => "137"
                        "paginaInicial" => "30&#46;e1"
                        "paginaFinal" => "30&#46;e13"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Management of dyslipidaemia in patients with coronary heart disease&#58; results from the ESC-EORP EUROASPIRE V survey in 27 countries"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46; De Backer"
                            1 => "P&#46; Jankowski"
                            2 => "K&#46; Kotseva"
                            3 => "E&#46; Mirrakhimov"
                            4 => "&#381;&#46; Reiner"
                            5 => "L&#46; Ryd&#233;n"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.atherosclerosis.2019.03.014"
                      "Revista" => array:6 [
                        "tituloSerie" => "Atherosclerosis"
                        "fecha" => "2019"
                        "volumen" => "285"
                        "paginaInicial" => "135"
                        "paginaFinal" => "146"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31054483"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "EU-wide cross- sectional observational study of lipid-modifying therapy use in secondary and primary care&#58; the DA VINCI study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46;K&#46; Ray"
                            1 => "B&#46; Molemans"
                            2 => "W&#46;M&#46; Schoonen"
                            3 => "P&#46; Giovas"
                            4 => "S&#46; Bray"
                            5 => "G&#46; Kiru"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurjpc/zwaa047"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Prev Cardiol"
                        "fecha" => "2021"
                        "volumen" => "28"
                        "paginaInicial" => "1279"
                        "paginaFinal" => "1289"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33580789"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence and characteristics of lipid abnormalities in patients treated with statins in primary and secondary prevention in Spain&#46; DYSIS-Spain Study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46;R&#46; Gonz&#225;lez-Juanatey"
                            1 => "J&#46; Mill&#225;n"
                            2 => "E&#46; Alegr&#237;a"
                            3 => "C&#46; Guijarro"
                            4 => "J&#46;V&#46; Lozano"
                            5 => "G&#46;C&#46; Vitale"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.recesp.2010.10.030"
                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Esp Cardiol Engl Ed"
                        "fecha" => "2011"
                        "volumen" => "64"
                        "paginaInicial" => "286"
                        "paginaFinal" => "294"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Determining when to add nonstatin therapy&#58; a quantitative approach"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46;G&#46; Robinson"
                            1 => "R&#46; Huijgen"
                            2 => "K&#46; Ray"
                            3 => "J&#46; Persons"
                            4 => "J&#46;J&#46;P&#46; Kastelein"
                            5 => "M&#46;J&#46; Pencina"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2016.09.928"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2016"
                        "volumen" => "68"
                        "paginaInicial" => "2412"
                        "paginaFinal" => "2421"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27908345"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "2021 ESC Guidelines on cardiovascular disease prevention in clinical practice&#58; developed by the Task Force for cardiovascular disease prevention in clinical practice with representatives of the European Society of Cardiology and 12 medical societies With the special contribution of the European Association of Preventive Cardiology &#40;EAPC&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F&#46;L&#46;J&#46; Visseren"
                            1 => "F&#46; Mach"
                            2 => "Y&#46;M&#46; Smulders"
                            3 => "D&#46; Carballo"
                            4 => "K&#46;C&#46; Koskinas"
                            5 => "M&#46; B&#228;ck"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehab484"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2021"
                        "volumen" => "42"
                        "paginaInicial" => "3227"
                        "paginaFinal" => "3337"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34458905"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
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        "texto" => "<p id="par0235" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Committee of Lipids and Vascular Diseases of the Spanish Society of Laboratory Medicine and Task Force for Cardiac Rehabilitation of the Spanish Society of Cardiology</span></p><p id="par0240" class="elsevierStylePara elsevierViewall">Nuria Amig&#243; Grau&#46; Biosfer Teslab&#44; IISPV&#44; CIBERDEM&#44; Universidad Rovira i Virgili&#44; Tarragona&#44; Espa&#241;a&#46;</p><p id="par0245" class="elsevierStylePara elsevierViewall">Pilar Calmarza Calmarza&#46; Departamento de Bioqu&#237;mica&#46;Hospital Universitario Miguel Servet&#46; Zaragoza&#44; Espa&#241;a&#46;</p><p id="par0250" class="elsevierStylePara elsevierViewall">Silvia Cam&#242;s Anguila&#46; Servicio de Bioqu&#237;mica Cl&#237;nica&#44; Hospital Hospital Universitari de Girona Josep Trueta&#46;</p><p id="par0255" class="elsevierStylePara elsevierViewall">Beatriz Cand&#225;s Estebanez&#46; Laboratorio Cl&#237;nico&#46; Hospital de Barcelona&#46;</p><p id="par0260" class="elsevierStylePara elsevierViewall">Mar&#237;a Jos&#233; Castro Castro&#46; Laboratorio Cl&#237;nico Hospital Universitario de Bellvitge&#44; Barcelona&#44; Espa&#241;a&#46;</p><p id="par0265" class="elsevierStylePara elsevierViewall">Carla Fern&#225;ndez Prendes&#46; Laboratorio de Bioqu&#237;mica Hospital Universitario Germans Trias i Pujol&#44; Barcelona&#44; Espa&#241;a&#46;</p><p id="par0270" class="elsevierStylePara elsevierViewall">Irene Gonz&#225;lez Mart&#237;nez&#46; Servicio de an&#225;lisis cl&#237;nicos&#46; Hospital 12 de Octubre&#46; Espa&#241;a&#46;</p><p id="par0275" class="elsevierStylePara elsevierViewall">Mar&#237;a Mart&#237;n Palencia&#46; Hospital Universitario de Burgos&#46; Espa&#241;a</p><p id="par0280" class="elsevierStylePara elsevierViewall">Carlos Romero Rom&#225;n&#46; Laboratory of Clinical Biochemistry&#46; Hospital de Albacete&#44; Espa&#241;a&#46;</p><p id="par0285" class="elsevierStylePara elsevierViewall">Jos&#233; Puzo Foncillas&#46; Laboratorio Hospital General San Jorge&#44; Huesca&#44; Espa&#241;a&#46;</p><p id="par0290" class="elsevierStylePara elsevierViewall">Almudena Castro Conde&#46; Unidad de Rehabilitaci&#243;n Cardiaca&#46; Servicio de Cardiolog&#237;a&#46; Hospital Universitario La Paz&#46; Madrid&#44; Espa&#241;a&#46;</p><p id="par0295" class="elsevierStylePara elsevierViewall">Rosa Fern&#225;ndez Olmo&#46; Servicio Cardiolog&#237;a Hospital Universitario de Ja&#233;n&#44; Espa&#241;a&#46;</p>"
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