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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">Actualmente existen varias escalas de riesgo de enfermedad cardiovascular &#40;ECV&#41;&#44; pero la mayor&#237;a se han desarrollado bas&#225;ndose en poblaciones de mediana edad con poca representaci&#243;n de personas de m&#225;s de 70 a&#241;os<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">1&#44;2</span></a>&#46; Adem&#225;s&#44; las escalas existentes tienen varias limitaciones para su uso en ancianos&#44; ya que no suelen tener en cuenta el efecto del tratamiento de los factores de riesgo cardiovascular &#40;FRCV&#41;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">3</span></a> o de la fragilidad&#44; que son determinantes importantes de la ECV en los adultos mayores&#46; Por consiguiente&#44; pueden calcular err&#243;neamente el riesgo real de ECV en este grupo de poblaci&#243;n<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">4&#44;5</span></a>&#46; Por ejemplo&#44; la escala europea SCORE est&#225; pensada principalmente para personas de mediana edad&#44; recomend&#225;ndose su uso principalmente para las personas de 40 a 65 a&#241;os<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">1</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Adem&#225;s&#44; estudios observacionales en ancianos han mostrado que la estimaci&#243;n del riesgo en personas mayores de 70 a&#241;os es problem&#225;tica porque la capacidad predictiva de los FRCV disminuye con la edad&#46; El estudio Leiden 85-plus mostr&#243; que la funci&#243;n de riesgo de Framingham no es &#250;til en las personas de m&#225;s de 70 a&#241;os por su bajo poder de discriminaci&#243;n<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">6</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">En varios estudios se ha comunicado que la asociaci&#243;n entre hipertensi&#243;n arterial y mortalidad se aten&#250;a en los ancianos&#44; por lo que la edad podr&#237;a hacer que la hipertensi&#243;n fuera un mal determinante del riesgo de ECV en este grupo etario<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">7&#8211;10</span></a>&#46; Por otro lado&#44; las medidas de la fragilidad y de la funcionalidad pueden llegar a identificar mejor a los ancianos con riesgo de consecuencias adversas de la hipertensi&#243;n&#44; habi&#233;ndose se&#241;alado que la presi&#243;n arterial sist&#243;lica &#40;PAS&#41; se asocia con un aumento del riesgo de mortalidad en las personas mayores con una velocidad de marcha reducida<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">11</span></a>&#46; Adem&#225;s&#44; los efectos de algunos FRCV cl&#225;sicos como el colesterol total &#40;CT&#41; se tornan nebulosos o incluso se invierten con la edad avanzada<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">12</span></a>&#46; Por ello&#44; es deseable una valoraci&#243;n m&#225;s adecuada del riesgo de ECV en las personas de edad avanzada y muy avanzada para abordar y optimizar la prevenci&#243;n y el tratamiento&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">El objetivo de este estudio fue determinar los principales factores predictivos del riesgo total de ECV en la poblaci&#243;n de edad avanzada en Espa&#241;a y desarrollar tablas espec&#237;ficas del riesgo de ECV para este grupo de edad&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">M&#233;todos</span><p id="par0025" class="elsevierStylePara elsevierViewall">El estudio EPICARDIAN es un estudio poblacional&#44; de cohortes&#44; multic&#233;ntrico en personas de 65 a&#241;os o m&#225;s al inicio&#44; de 3 regiones geogr&#225;ficas de Espa&#241;a&#58; la ciudad de Madrid&#44; el municipio de Ar&#233;valo &#40;provincia de &#193;vila&#41; y el municipio de Begonte &#40;provincia de Lugo&#41;&#46; El dise&#241;o y los m&#233;todos del estudio ya se han publicado en otros art&#237;culos<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">13&#44;14</span></a>&#46; En resumen&#44; un total de 3&#46;729 personas mayores de 64 a&#241;os participaron en la examen cl&#237;nico basal&#46; De ellos&#44; 255 &#40;6&#44;8&#37;&#41; presentaban ECV cl&#237;nica manifiesta en ese momento&#46; Solo se incluyeron en los an&#225;lisis las personas sin ECV en el examen basal&#46; As&#237; pues&#44; la cohorte inicial estaba formada por 3&#46;474 sujetos &#40;1&#46;462 varones y 2&#46;012 mujeres&#41;&#46; Se sigui&#243; a todos los participantes hasta la aparici&#243;n de un primer episodio de ECV&#44; el fallecimiento o hasta completar 10 a&#241;os de seguimiento&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">En el examen basal se midieron las siguientes variables&#44; que fueron incluidas en la funci&#243;n de riesgo&#58; la edad&#44; el sexo&#44; la PAS&#44; el tabaquismo&#44; el CT&#44; la glucemia en ayunas y el diagn&#243;stico m&#233;dico de hipertensi&#243;n&#44; hipercolesterolemia&#44; diabetes mellitus o tratamiento farmacol&#243;gico espec&#237;fico para estos procesos&#46; El CT s&#233;rico se determin&#243; por m&#233;todos enzim&#225;ticos<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">15</span></a>&#46; No se calcul&#243; el colesterol LDL en el conjunto de la cohorte porque solo se dispon&#237;a de los valores de colesterol HDL en una peque&#241;a proporci&#243;n de los participantes&#46; Se determin&#243; la glucemia plasm&#225;tica mediante el m&#233;todo de la glucosa-oxidasa<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">16</span></a>&#46; En el modelo de riesgos proporcionales de Cox&#44; se agruparon las variables utilizando las categor&#237;as de factores de riesgo de Framingham<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">17</span></a>&#58; la edad se agrup&#243; en categor&#237;as de 5 a&#241;os a partir de los 65-69 a&#241;os&#44; y se clasific&#243; la PAS en 3 categor&#237;as y el CT en 4&#46; Se clasific&#243; a los participantes como fumadores &#40;los que fumaban en el momento basal o hab&#237;an dejado de fumar en los 6 meses previos&#41; o como no fumadores&#47;exfumadores &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46; Se consider&#243; que exist&#237;a hipertensi&#243;n si la PAS era<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>140<span class="elsevierStyleHsp" style=""></span>mmHg o la presi&#243;n arterial diast&#243;lica era<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>90<span class="elsevierStyleHsp" style=""></span>mmHg o el sujeto recib&#237;a tratamiento antihipertensivo<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">18</span></a>&#46; Se consider&#243; que exist&#237;a hipercolesterolemia si el CT era<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>5&#44;1<span class="elsevierStyleHsp" style=""></span>mmol&#47;L o el sujeto recib&#237;a tratamiento hipolipidemiante<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">15</span></a>&#46; Se consider&#243; la existencia de diabetes si la glucemia en ayunas era<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>7&#44;0<span class="elsevierStyleHsp" style=""></span>mmol&#47;L o el sujeto recib&#237;a tratamiento antidiab&#233;tico<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">19</span></a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Se realiz&#243; una b&#250;squeda exhaustiva de datos de posibles episodios de ECV en la cohorte inicial a trav&#233;s de las historias cl&#237;nicas de atenci&#243;n primaria y hospitalaria&#44; de la informaci&#243;n aportada por los m&#233;dicos de atenci&#243;n primaria y mediante encuestas postales y llamadas telef&#243;nicas al sujeto o a sus familiares&#46; La fecha y la causa de la muerte de los fallecidos de la cohorte se confirmaron mediante el &#205;ndice Nacional de Defunciones y los registros de defunciones de cada distrito asistencial&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Se us&#243; la Clasificaci&#243;n Internacional de Enfermedades &#40;CIE&#41; 9 y 10 para registrar la cardiopat&#237;a coronaria &#40;CIE-9&#58; 410-414&#59; CIE-10&#58; I20-I25&#41; y otras enfermedades cardiovasculares &#40;CIE-9&#58; 797-799&#59; CIE-10&#58; I46&#44; R96&#44; R98&#44; I50&#41;&#46; Los episodios coronarios se confirmaron con el algoritmo MONICA de la OMS<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">20</span></a>&#46; El criterio de valoraci&#243;n de ECV se defini&#243; como una combinaci&#243;n de primer episodio coronario &#40;infarto de miocardio definido mortal o no mortal e infarto de miocardio mortal posible&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Para describir los datos seleccionados&#44; se calcularon la media aritm&#233;tica con desviaci&#243;n est&#225;ndar para las variables continuas y la distribuci&#243;n por frecuencias relativas para las variables categ&#243;ricas&#46; Para comparar proporciones&#44; se realizaron la prueba de la ji al cuadrado de Pearson y la prueba de la D de Somers en el caso de las variables ordinales&#46; Para comparar grupos se utilizaron la prueba de la <span class="elsevierStyleItalic">t</span> de Student para medidas binarias independientes y el an&#225;lisis de la varianza para variables con m&#225;s de 2 categor&#237;as&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Las variables independientes antes citadas se incluyeron en los modelos multivariantes mediante el m&#233;todo Enter&#46; Se crearon modelos separados para hombres y mujeres&#46; En el primer paso&#44; la PAS y el CT fueron tratados como variables continuas para valorar las interacciones entre el tratamiento antihipertensivo y los valores de PAS y entre el uso de hipolipidemiantes y las concentraci&#243;n de CT&#46; En un segundo paso&#44; la PAS y el CT fueron categorizados y en el tercer paso se eliminaron las interacciones&#46; Finalmente&#44; para simplificar el modelo se elimin&#243; la variable tratamiento hipolipidemiante porque no fue estad&#237;sticamente significativa&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Se valoraron las asociaciones bivariantes y multivariantes entre cada variable independiente del modelo y el desenlace&#46; Se estimaron los coeficientes &#223; asociados a cada posible FRCV con el primer episodio de ECV registrado mediante el modelo de riesgos proporcionales de Cox&#44; de forma separada para varones y mujeres&#46; Se determinaron las curvas de supervivencia de Kaplan-Meier a los 10 a&#241;os para el primer episodio de ECV mortal&#47;no mortal con el fin de calcular la incidencia acumulada promedio&#46; La estimaci&#243;n de la funci&#243;n de supervivencia se calcul&#243; mediante un modelo de Cox ajustado en funci&#243;n de la mortalidad competitiva a los 10 a&#241;os por otras enfermedades no cardiovasculares&#44; utilizando el modelo de Fine-Gray y se estratific&#243; por sexo&#46; Se utiliz&#243; la prueba &#171;&#243;mnibus&#187; para validar el modelo &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; A partir de los coeficientes &#223; de los modelos de riesgos proporcionales de Cox&#44; se calcularon las puntuaciones de riesgo espec&#237;ficas para la predicci&#243;n de las ECV mortales y no mortales en cada sexo&#44; utilizando las variables categorizadas&#46; El riesgo total de ECV a los 10 a&#241;os observado se clasific&#243; finalmente como riesgo bajo &#40;&#60;<span class="elsevierStyleHsp" style=""></span>20&#37;&#41;&#44; riesgo leve &#40;20-29&#37;&#41;&#44; riesgo moderado &#40;30-39&#37;&#41;&#44; riesgo moderado alto &#40;40-49&#37;&#41;&#44; riesgo alto &#40;50-59&#37;&#41; o riesgo muy alto &#40;&#8805;<span class="elsevierStyleHsp" style=""></span>60&#37;&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Todos los an&#225;lisis estad&#237;sticos se realizaron con el programa estad&#237;stico R &#40;<a href="http://www.r-project.org/">http&#58;&#47;&#47;www&#46;R-project&#46;org</a>&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">En el <a class="elsevierStyleCrossRef" href="#sec0045">material suplementario</a> se muestran an&#225;lisis estad&#237;sticos adicionales realizados&#44; incluidos el c&#225;lculo de los coeficientes &#223; para distintos factores de riesgo en el modelo t&#237;pico de riesgo de ECV a 10 a&#241;os&#44; la utilizaci&#243;n de la edad como variable de escala temporal&#44; la calibraci&#243;n del modelo&#44; la discriminaci&#243;n de las funciones de riesgo y la comparaci&#243;n del riesgo cardiovascular promedio a los 10 a&#241;os con la escala SCORE-OP&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">El estudio se realiz&#243; de conformidad con la Declaraci&#243;n de Helsinki &#40;<a href="http://www.wma.net/e/policy/b3.htm">http&#58;&#47;&#47;www&#46;wma&#46;net&#47;e&#47;policy&#47;b3&#46;htm</a>&#41;&#46; Se obtuvo el consentimiento informado por escrito de todos los participantes durante la entrevista basal&#46; El protocolo del estudio fue aprobado por el Comit&#233; &#201;tico del Hospital Universitario de La Princesa de Madrid&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados</span><p id="par0075" class="elsevierStylePara elsevierViewall">Se incluyeron 3&#46;474 participantes&#44; lo que supuso un total de 27&#46;749 personas-a&#241;o de seguimiento&#46; En el examen basal&#44; el 42&#44;5&#37; de la muestra ten&#237;a hipertensi&#243;n&#44; el 28&#44;4&#37; hipercolesterolemia&#44; el 11&#44;5&#37; diabetes mellitus&#44; el 11&#44;9&#37; fumaba y el 52&#37; recib&#237;a tratamiento antihipertensivo&#46; Se obtuvo informaci&#243;n del seguimiento en 3&#46;474 personas &#40;99&#44;8&#37;&#59; 1&#46;462 varones y 2&#46;012 mujeres&#41;&#46; Durante el per&#237;odo de seguimiento se produjeron 1&#46;340 fallecimientos en el conjunto de la cohorte &#40;38&#44;6&#37;&#59; 702 entre los hombres y 638 entre las mujeres&#41;&#59; 457 de estos fallecimientos fueron por ECV &#40;222 en los hombres y 235 en las mujeres&#41;&#46; Se observaron en total 768 episodios de ECV &#40;457 mortales y 311 no mortales&#41;&#46; En la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> se muestra la distribuci&#243;n de los FRCV y los episodios de ECV seg&#250;n el sexo&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">La <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a> muestra el riesgo promedio a los 10 a&#241;os de un primer episodio de ECV&#44; mortal o no&#44; en hombres &#40;panel A&#41; y en mujeres &#40;panel B&#41;&#44; seg&#250;n el modelo de riesgos proporcionales de Cox&#46; La edad fue el factor predictivo de ECV m&#225;s potente en los 2 sexos&#46; Las variables asociadas con mayor intensidad con ECV en los varones fueron el tratamiento de la hipertensi&#243;n &#40;HR&#58; 1&#44;35&#59; IC a95&#37;&#58; 1&#44;067-1&#44;710&#41;&#44; la diabetes &#40;HR&#58; 1&#44;359&#59; IC 95&#37;&#58; 0&#44;997-1&#44;852&#41; y el tabaquismo &#40;HR&#58; 1&#44;207&#59; IC 95&#37;&#58; 0&#44;945-1&#44;541&#41;&#44; y en las mujeres&#44; el tabaquismo &#40;HR&#58; 1&#44;881&#59; IC 95&#37;&#58; 1&#44;356-2&#44;609&#41; y la diabetes &#40;HR&#58; 1&#44;285&#59; IC 95&#37;&#58; 0&#44;967-1&#44;707&#41;&#46; El poder discriminativo &#40;estad&#237;stico C&#41; del modelo fue 0&#44;656 &#40;IC 95&#37; 0&#44;601-0&#44;701&#41; en los hombres y 0&#44;702 &#40;IC 95&#37; 0&#44;669-0&#44;723&#41; en las mujeres&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">En una segunda etapa del an&#225;lisis se utiliz&#243; la edad como variable de escala temporal en lugar de como una variable t&#237;pica independiente&#46; La HR para la diabetes aument&#243; significativamente de 1&#44;37 a 1&#44;48 en los hombres y de 1&#44;28 a 1&#44;34 en las mujeres &#40;datos mostrados en el <a class="elsevierStyleCrossRef" href="#sec0045">material suplementario</a>&#41; cuando se utiliz&#243; la edad como variable de escala temporal&#46; Sin embargo&#44; las HR de las otras variables incluidas en el modelo de riesgos proporcionales de Cox &#40;CT&#44; tabaquismo&#44; PAS y tratamiento antihipertensivo&#41; no aumentaron cuando se utiliz&#243; la edad como variable de escala temporal&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a> se muestra el riesgo cardiovascular absoluto individual a los 10 a&#241;os espec&#237;fico para hombres no fumadores &#40;panel A&#41; y para fumadores &#40;panel B&#41;&#46; La <a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a> muestra los valores correspondientes para las mujeres no fumadoras &#40;panel A&#41; y fumadoras &#40;panel B&#41;&#46; Este formato visual facilita la interpretaci&#243;n del riesgo cardiovascular total individual a los 10 a&#241;os &#40;ECV mortal y no mortal&#41;&#44; seg&#250;n el sexo y el h&#225;bito tab&#225;quico de cada persona&#44; teniendo adem&#225;s en cuenta el tratamiento antihipertensivo&#44; la presencia o no de diabetes&#44; la edad&#44; la concentraci&#243;n de CT y el nivel de PAS&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discusi&#243;n</span><p id="par0095" class="elsevierStylePara elsevierViewall">La escala EPICARDIAN se basa en una amplia cohorte de 3&#46;474 ciudadanos espa&#241;oles de edad avanzada contempor&#225;nea&#46; Las ecuaciones previas&#44; como la de Framingham y la europea SCORE&#44; se basan en cambio en poblaciones seleccionadas antes de la d&#233;cada de 1980&#44; cuando la prevalencia de factores de riesgo en la poblaci&#243;n era menor&#46; Por el contrario&#44; la cohorte EPICARDIAN&#44; m&#225;s reciente que estas&#44; permite estimar el riesgo teniendo tambi&#233;n en cuenta el tratamiento de la hipertensi&#243;n arterial&#44; tan frecuente en los ancianos&#46; La ecuaci&#243;n EPICARDIAN ayuda tambi&#233;n a solucionar el problema de aplicar coeficientes &#223; derivados de poblaciones adultas de mediana edad a poblaciones de edad m&#225;s avanzada&#44; lo que suele producir estimaciones inadecuadas del riesgo cardiovascular en los ancianos&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">La edad es el factor predictivo m&#225;s potente del riesgo cardiovascular tanto en los hombres como en las mujeres de edad avanzada&#46; La utilizaci&#243;n de la edad como una variable de escala temporal en lugar de como una variable est&#225;ndar mejora el rendimiento del modelo de riesgos proporcionales de Cox&#44; sobre todo en las mujeres&#46; En concreto&#44; la diabetes surge como factor predictivo independiente en las mujeres&#44; cuando en el modelo original la diabetes estaba en el l&#237;mite&#44; sin alcanzar la significaci&#243;n estad&#237;stica&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Se observ&#243; un patr&#243;n de riesgo diferente en los hombres que en las mujeres&#46; En los primeros&#44; la diabetes fue el factor predictivo m&#225;s potente y el tratamiento de la hipertensi&#243;n tuvo mayor repercusi&#243;n cardiovascular que en las mujeres&#46; El tabaquismo tambi&#233;n mostr&#243; una asociaci&#243;n significativa con la ECV&#44; que fue m&#225;s intensa en las mujeres que en los hombres&#46; Como en estudios anteriores<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">21&#44;22</span></a>&#44; la contribuci&#243;n del CT a la ECV act&#250;a de forma inversa en los mayores de 70 a&#241;os que en los menores de 70 a&#241;os&#46; La ausencia de un valor predictivo positivo del CT plantea la cuesti&#243;n de si la estimaci&#243;n del riesgo en los ancianos puede justificar un enfoque diferente que en las personas de mediana edad&#44; y confirma que el poder predictivo de ciertos factores de riesgo cl&#225;sicos&#44; como la hipercolesterolemia&#44; disminuye con la edad&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Las ecuaciones usadas actualmente para predecir la ECV en los ancianos se basan principalmente en funciones de riesgo calibradas a partir de las escalas de riesgo originales de Framingham<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">23</span></a> y SCORE europea<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">24</span></a>&#46; Estas ecuaciones tienen limitaciones importantes&#44; como el peque&#241;o n&#250;mero de participantes mayores de 70 a&#241;os&#44; el origen laboral de algunas cohortes y la consideraci&#243;n de la mortalidad por ECV como &#250;nica variable de desenlace&#46; Por el contrario&#44; la ecuaci&#243;n EPICARDIAN incluye una proporci&#243;n significativa de personas mayores de 75 a&#241;os y estima el riesgo total de ECV&#44; una mejor aproximaci&#243;n del riesgo total individual en un pa&#237;s mediterr&#225;neo como Espa&#241;a&#44; con tasas m&#225;s bajas de cardiopat&#237;a coronaria que otros pa&#237;ses del centro y norte de Europa&#46; Adem&#225;s&#44; las ecuaciones de riesgo europeas en ancianos no incluyen tampoco la diabetes o&#44; como en el estudio de Framingham&#44; sus predicciones se basan en una peque&#241;a proporci&#243;n &#40;4&#37;&#41; de personas con medici&#243;n de glucemia y en las que el diagn&#243;stico de diabetes no utiliz&#243; la definici&#243;n internacional actual de dicha enfermedad&#46; Por &#250;ltimo&#44; un rasgo &#250;nico de la ecuaci&#243;n EPICARDIAN es que tiene en cuenta el uso de antihipertensivos &#8212;el tratamiento m&#225;s frecuente en los adultos de edad avanzada&#8212;&#44; lo que cubre una laguna importante en los instrumentos previos de valoraci&#243;n del riesgo<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">25</span></a>&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Recientemente se ha publicado una nueva versi&#243;n de la escala de riesgo europea SCORE para personas de edad avanzada&#44; el SCORE-OP<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">26</span></a>&#46; Aplicamos la funci&#243;n SCORE-OP a nuestra poblaci&#243;n y observamos que el riesgo promedio de ECV a los 10 a&#241;os era significativamente menor tanto en hombres como en mujeres con respecto al obtenido con la escala EPICARDIAN<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">27</span></a>&#46; Lo m&#225;s probable es que esto sea debido a que la edad media de la poblaci&#243;n del estudio EPICARDIAN es mayor y la prevalencia de diabetes y de tabaquismo es tambi&#233;n superior que en las cohortes incluidas en el SCORE-OP&#44; que proced&#237;an principalmente del norte y centro de Europa&#46; Adem&#225;s&#44; las 2 ecuaciones no incluyen exactamente los mismos par&#225;metros&#46; Por ejemplo&#44; la ecuaci&#243;n EPICARDIAN incluye el tratamiento de la hipertensi&#243;n como variable en el modelo&#44; mientras que el SCORE-OP incluye los valores de colesterol HDL&#46; Tambi&#233;n hemos observado que el SCORE-OP identifica a menos pacientes mayores de 65 a&#241;os con riesgo alto o muy alto que la escala de riesgo SCORE original para pa&#237;ses con riesgo bajo como Espa&#241;a<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">27</span></a>&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">La escala EPICARDIAN solo tiene en cuenta los FRCV m&#225;s importantes&#46; Otros factores&#44; como los antecedentes familiares de ECV&#44; las concentraciones de fibrin&#243;geno&#44; la actividad f&#237;sica&#44; el per&#237;metro de la cintura o las concentraciones de prote&#237;na C reactiva&#44; pueden modular te&#243;ricamente el riesgo de ECV en los ancianos&#46; En contraste&#44; como ya se ha dicho&#44; el valor predictivo de algunos factores de riesgo cl&#225;sicos como la hipercolesterolemia o la hipertensi&#243;n sist&#243;lica se debilita con la edad<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">8&#44;21</span></a>&#46; En consecuencia&#44; las estimaciones del riesgo en algunas celdillas&#44; sobre todo en los grupos m&#225;s ancianos y con muy pocos individuos con concentraciones muy elevadas de CT y de PAS&#44; pueden ser menos exactas&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Nuestros hallazgos concuerdan con los de una revisi&#243;n sistem&#225;tica publicada recientemente<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">28</span></a> que muestra la falta de uniformidad de los valores predictivos de los FRCV tradicionales como son las fracciones de colesterol&#44; la presi&#243;n arterial&#44; el tabaquismo o el &#237;ndice de masa corporal en los ancianos&#46; Estos hallazgos justifican el desarrollo de nuevos modelos de riesgo&#44; como la ecuaci&#243;n EPICARDIAN&#44; que considera otras posibles causas competitivas de riesgo de muerte&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Nuestro estudio tiene varias fortalezas&#46; La muestra incluy&#243; a personas seleccionadas en entornos urbanos y rurales&#44; de distintas localizaciones geogr&#225;ficas&#44; de un intervalo de edades amplio dentro del segmento de la poblaci&#243;n definida como anciana y contiene una proporci&#243;n alta de personas con diabetes&#46; La disponibilidad de informaci&#243;n sobre el tratamiento de los FRCV&#44; sobre todo el antihipertensivo&#44; es otra fortaleza de este estudio&#46; Nuestra escala puede aportar informaci&#243;n &#250;til a los m&#233;dicos a la hora de ajustar el riesgo estimado de ECV en pacientes que ya reciben tratamiento antihipertensivo&#46; La cohorte EPICARDIAN proporciona la primera asociaci&#243;n prospectiva entre la ECV total y varios FRCV en la poblaci&#243;n anciana de Espa&#241;a&#44; un pa&#237;s con baja incidencia de ECV&#46; La ecuaci&#243;n EPICARDIAN permite adem&#225;s la estimaci&#243;n directa del riesgo total de ECV basada en el riesgo actual espec&#237;fico de la poblaci&#243;n anciana espa&#241;ola&#44; en lugar de basarse en estimaciones extranjeras calibradas para poblaciones europeas de bajo riesgo&#46; Las predicciones basadas en estas calibraciones pueden no ser exactas si pas&#243; mucho tiempo y se produjo un cambio marcado de la mortalidad por ECV entre el momento en que se obtuvo la ecuaci&#243;n de riesgo y su aplicaci&#243;n&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusiones</span><p id="par0135" class="elsevierStylePara elsevierViewall">Nuestros resultados permiten ajustar el grado en que algunos FRCV espec&#237;ficos&#44; como los valores de colesterol&#44; pueden afectar a la poblaci&#243;n espec&#237;fica de la que proceden&#46; Se espera que esta ecuaci&#243;n de riesgo se valide en el futuro&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">La escala EPICARDIAN ofrece una nueva estimaci&#243;n del riesgo total de ECV al incorporar el tratamiento antihipertensivo al c&#225;lculo del riesgo&#46; El riesgo de ECV es significativamente mayor en los hombres ancianos con diabetes y que reciben tratamiento antihipertensivo que en el conjunto de los hombres&#44; y en las mujeres ancianas que fuman que en el conjunto de las mujeres&#46; Consideramos que esta ecuaci&#243;n es un instrumento pr&#225;ctico que pueden utilizar los m&#233;dicos para calcular el riesgo individual total de ECV en personas espa&#241;olas mayores de 70 a&#241;os&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Financiaci&#243;n</span><p id="par0145" class="elsevierStylePara elsevierViewall">FIS 93&#47;012&#59; FIS 96&#47;1993&#59; FIS 02&#47;0896 del Instituto de Salud Carlos III<span class="elsevierStyleSmallCaps">&#44;</span> y DGICyT PB&#47;255-Co4&#44; Espa&#241;a&#46;&#160;Los financiadores no han intervenido en el estudio excepto para financiarlo&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflicto de intereses</span><p id="par0150" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Antecedentes y objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La estimaci&#243;n del riesgo cardiovascular en personas mayores de 70 a&#241;os es problem&#225;tica&#46; La mayor&#237;a de las escalas se han creado bas&#225;ndose en cohortes de personas de mediana edad&#44; con una representaci&#243;n insuficiente de los adultos de m&#225;s edad&#46; El poder predictivo de los factores de riesgo cardiovascular cl&#225;sicos disminuye con la edad&#46; El objetivo de este estudio es desarrollar una escala espec&#237;fica para estimar el riesgo cardiovascular de la poblaci&#243;n anciana espa&#241;ola&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Este estudio se realiz&#243; en una cohorte poblacional establecida en 1995&#46; Marco&#58; 3 zonas geogr&#225;ficas de Espa&#241;a &#40;Madrid&#44; &#193;vila y Lugo&#41;&#46; Participantes&#58; 3&#46;729 personas mayores de 64 a&#241;os sin enfermedades cardiovasculares &#40;ECV&#41; al inicio del seguimiento&#46; Mediciones&#58; se investigaron anualmente las sospechas de ECV mortal y no mortal &#40;cardiopat&#237;a coronaria e ictus&#41; y se confirmaron usando los criterios del proyecto MONICA de la OMS&#46; Se sigui&#243; a todos los participantes hasta que apareci&#243; el primer episodio de ECV&#44; hasta su muerte o hasta el 31 de diciembre de 2015&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">La edad fue el factor predictivo m&#225;s potente de ECV a los 10 a&#241;os en ambos sexos&#46; Las variables asociadas con ECV en los varones fueron el tratamiento de la hipertensi&#243;n arterial &#40;HR&#58; 1&#44;35&#59; IC 95&#37;&#58; 1&#44;067-1&#44;710&#41;&#44; la diabetes &#40;HR&#58; 1&#44;359&#59; IC 95&#37;&#58; 0&#44;997-1&#44;852&#41; y el tabaquismo &#40;HR&#58; 1&#44;207&#59; IC 95&#37;&#58; 0&#44;945-1&#44;541&#41;&#44; y en las mujeres&#44; el tabaquismo &#40;HR&#58; 1&#44;881&#59; IC 95&#37;&#58; 1&#44;356-2&#44;609&#41; y la diabetes &#40;HR&#58; 1&#44;285&#59; IC 95&#37;&#58; 0&#44;967-1&#44;707&#41;&#46; El colesterol total no aument&#243; el riesgo de ECV ni en varones ni en mujeres&#46; Sin embargo&#44; las concentraciones de colesterol total<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>200<span class="elsevierStyleHsp" style=""></span>mg&#47;dL se asociaron inversamente al riesgo de ECV a los 10 a&#241;os&#44; tanto en varones como en mujeres&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La ECV total a los 10 a&#241;os aumenta significativamente en los varones espa&#241;oles de edad avanzada con la edad&#44; la diabetes y el tratamiento antihipertensivo&#44; y en las mujeres con la diabetes y el tabaquismo&#46; Los niveles de colesterol total no aumentaron el riesgo de ECV&#44; sobre todo en los varones&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Background and objectives</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Cardiovascular risk estimation in people over 70 years of age is problematic&#46; Most scores have been created based on cohorts of middle-aged people&#44; with an underrepresentation of older adults&#46; The predictive power of classical cardiovascular risk factors declines with age&#46; The aim of this work is to develop a specific score for estimating cardiovascular risk among the elderly population in Spain&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">This work is a population-based cohort established in 1995&#46; Setting&#58; 3 geographical areas of Spain &#40;Madrid&#44; &#193;vila&#44; and Lugo&#41;&#46; Participants&#58; 3&#44;729 people older than 64 years with no cardiovascular diseases &#40;CVD&#41; at baseline&#46; Measurements&#58; suspected fatal and nonfatal CVD &#40;both coronary heart disease and stroke&#41; were investigated annually and confirmed using the WHO-MONICA criteria&#46; All participants were followed-up on until occurrence of a first CVD event&#44; until death&#44; or until December 31&#44; 2015&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Age was the strongest predictor of CVD at 10 years in both men and women&#46; In men&#44; variables associated with CVD were high blood pressure treatment &#40;HR&#58; 1&#46;35&#59; 95&#37; CI&#58; 1&#46;067-1&#46;710&#41;&#44; diabetes &#40;HR&#58; 1&#46;359&#59; 95&#37; CI&#58; 0&#46;997-1&#46;852&#41;&#44; and smoking &#40;HR&#58; 1&#46;207&#59; 95&#37; CI&#58; 0&#46;945-1&#46;541&#41; and in women&#44; the variables were smoking &#40;HR&#58; 1&#46;881&#59; 95&#37; CI&#58; 1&#46;356-2&#46;609&#41; and diabetes &#40;HR&#58; 1&#46;285&#59; 95&#37; CI&#58; 0&#46;967-1&#46;707&#41;&#46; Total cholesterol did not increase the risk of CVD in men or women&#46; However&#44; total cholesterol levels<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>200<span class="elsevierStyleHsp" style=""></span>mg&#47;dL were inversely associated with 10-year risk of CVD in men and women&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">In elderly Spanish men&#44; total CVD at 10 years is significantly increased by age&#44; diabetes&#44; and antihypertensive treatment and in elderly Spanish women by diabetes and smoking&#46; Total cholesterol levels did not increase the risk of CVD&#44; particularly in males&#46;</p></span>"
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                  \t\t\t\t" scope="col">exp&#46; &#40;&#946;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">IC 95&#37; para exp &#40;&#946;&#41;</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>70-74 a&#241;os&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>80-84 a&#241;os&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;207&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;945&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">1&#44;541&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="elsevierStyleItalic">Presi&#243;n arterial sist&#243;lica &#40;ref&#46; &#60;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">140</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">mmHg&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" 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="" 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">3&#44;027&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">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;387&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="" 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="" 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="" 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></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>140-149 mmHg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;098&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;140&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;485&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">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;486&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">1&#44;103&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;837&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">1&#44;452&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>150-159 mmHg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;092&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;162&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;325&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">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;569&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">1&#44;096&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;799&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">1&#44;505&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>&#8805;<span class="elsevierStyleHsp" style=""></span>160 mmHg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;257&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;148&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;022&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">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;082&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">1&#44;293&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;968&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">1&#44;726&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="elsevierStyleItalic">Colesterol total &#40;ref&#46; &#60;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">160</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">mg&#47;dL&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" 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="" 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">5&#44;916&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">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;116&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="" 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="" 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="" 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></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>160-199 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">0&#44;175&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;179&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;956&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">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;328&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">1&#44;191&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;839&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">1&#44;692&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>200-239 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">0&#44;119&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;176&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;455&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">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;500&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">1&#44;126&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;797&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">1&#44;590&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>&#8805;<span class="elsevierStyleHsp" style=""></span>240 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">&#8722;0&#44;170&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;191&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;791&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">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;374&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  """
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            1 => array:2 [
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;000&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">7&#44;677&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">5&#44;500&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">10&#44;716&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="elsevierStyleItalic">Diabetes</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;251&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;145&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">2&#44;996&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">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;083&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">1&#44;285&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;967&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">1&#44;707&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="elsevierStyleItalic">Tabaquismo</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;632&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;167&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">14&#44;317&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">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;000&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">1&#44;881&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">1&#44;356&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">2&#44;609&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="elsevierStyleItalic">Presi&#243;n arterial sist&#243;lica &#40;ref&#46; &#60;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">140</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">mmHg&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" 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="" 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">2&#44;998&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">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;392&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="" 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="" 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="" 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></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>140-149 mmHg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;135&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;009&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">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;925&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">1&#44;013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;777&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">1&#44;320&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>150-159 mmHg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;141&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;145&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;944&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">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;331&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;868&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;653&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">1&#44;154&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>&#8805;<span class="elsevierStyleHsp" style=""></span>160 mmHg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;198&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;138&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">2&#44;062&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">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;151&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;820&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;626&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">1&#44;075&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="elsevierStyleItalic">Colesterol total &#40;ref&#46; &#60;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">160</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">mg&#47;dL&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" 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="" 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">3&#44;129&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">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;372&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="" 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="" 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="" 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></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>160-199 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">0&#44;229&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;213&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">1&#44;160&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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ORIGINAL
Riesgo cardiovascular en la población anciana española. Escala de riesgo EPICARDIAN
Cardiovascular risk in the elderly population of Spain. The EPICARDIAN risk score
R. Gabriela,
Autor para correspondencia
rgabriel@isciii.es

Autor para correspondencia.
, J. Muñizb, S. Vegac, I. Morald, T.R. Pérez Castrob, F. Rodriguez-Salvanése, C. Suáreze, B. Novellae, C. Brotonsd, en representación del Grupo de estudio EPICARDIAN
a Departamento de Salud Internacional, Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Madrid, España
b Instituto Universitario de Ciencias de la Salud, Universidad de La Coruña, A Coruña, España
c Centro de Salud de Arévalo, SACyL, Arévalo, Ávila, España
d Unidad de Investigación, EAP Sardenya-IIB, Barcelona, España
e Instituto de Investigación Sanitaria Hospital Universitario de La Princesa, Madrid, España
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">Actualmente existen varias escalas de riesgo de enfermedad cardiovascular &#40;ECV&#41;&#44; pero la mayor&#237;a se han desarrollado bas&#225;ndose en poblaciones de mediana edad con poca representaci&#243;n de personas de m&#225;s de 70 a&#241;os<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">1&#44;2</span></a>&#46; Adem&#225;s&#44; las escalas existentes tienen varias limitaciones para su uso en ancianos&#44; ya que no suelen tener en cuenta el efecto del tratamiento de los factores de riesgo cardiovascular &#40;FRCV&#41;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">3</span></a> o de la fragilidad&#44; que son determinantes importantes de la ECV en los adultos mayores&#46; Por consiguiente&#44; pueden calcular err&#243;neamente el riesgo real de ECV en este grupo de poblaci&#243;n<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">4&#44;5</span></a>&#46; Por ejemplo&#44; la escala europea SCORE est&#225; pensada principalmente para personas de mediana edad&#44; recomend&#225;ndose su uso principalmente para las personas de 40 a 65 a&#241;os<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">1</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Adem&#225;s&#44; estudios observacionales en ancianos han mostrado que la estimaci&#243;n del riesgo en personas mayores de 70 a&#241;os es problem&#225;tica porque la capacidad predictiva de los FRCV disminuye con la edad&#46; El estudio Leiden 85-plus mostr&#243; que la funci&#243;n de riesgo de Framingham no es &#250;til en las personas de m&#225;s de 70 a&#241;os por su bajo poder de discriminaci&#243;n<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">6</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">En varios estudios se ha comunicado que la asociaci&#243;n entre hipertensi&#243;n arterial y mortalidad se aten&#250;a en los ancianos&#44; por lo que la edad podr&#237;a hacer que la hipertensi&#243;n fuera un mal determinante del riesgo de ECV en este grupo etario<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">7&#8211;10</span></a>&#46; Por otro lado&#44; las medidas de la fragilidad y de la funcionalidad pueden llegar a identificar mejor a los ancianos con riesgo de consecuencias adversas de la hipertensi&#243;n&#44; habi&#233;ndose se&#241;alado que la presi&#243;n arterial sist&#243;lica &#40;PAS&#41; se asocia con un aumento del riesgo de mortalidad en las personas mayores con una velocidad de marcha reducida<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">11</span></a>&#46; Adem&#225;s&#44; los efectos de algunos FRCV cl&#225;sicos como el colesterol total &#40;CT&#41; se tornan nebulosos o incluso se invierten con la edad avanzada<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">12</span></a>&#46; Por ello&#44; es deseable una valoraci&#243;n m&#225;s adecuada del riesgo de ECV en las personas de edad avanzada y muy avanzada para abordar y optimizar la prevenci&#243;n y el tratamiento&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">El objetivo de este estudio fue determinar los principales factores predictivos del riesgo total de ECV en la poblaci&#243;n de edad avanzada en Espa&#241;a y desarrollar tablas espec&#237;ficas del riesgo de ECV para este grupo de edad&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">M&#233;todos</span><p id="par0025" class="elsevierStylePara elsevierViewall">El estudio EPICARDIAN es un estudio poblacional&#44; de cohortes&#44; multic&#233;ntrico en personas de 65 a&#241;os o m&#225;s al inicio&#44; de 3 regiones geogr&#225;ficas de Espa&#241;a&#58; la ciudad de Madrid&#44; el municipio de Ar&#233;valo &#40;provincia de &#193;vila&#41; y el municipio de Begonte &#40;provincia de Lugo&#41;&#46; El dise&#241;o y los m&#233;todos del estudio ya se han publicado en otros art&#237;culos<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">13&#44;14</span></a>&#46; En resumen&#44; un total de 3&#46;729 personas mayores de 64 a&#241;os participaron en la examen cl&#237;nico basal&#46; De ellos&#44; 255 &#40;6&#44;8&#37;&#41; presentaban ECV cl&#237;nica manifiesta en ese momento&#46; Solo se incluyeron en los an&#225;lisis las personas sin ECV en el examen basal&#46; As&#237; pues&#44; la cohorte inicial estaba formada por 3&#46;474 sujetos &#40;1&#46;462 varones y 2&#46;012 mujeres&#41;&#46; Se sigui&#243; a todos los participantes hasta la aparici&#243;n de un primer episodio de ECV&#44; el fallecimiento o hasta completar 10 a&#241;os de seguimiento&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">En el examen basal se midieron las siguientes variables&#44; que fueron incluidas en la funci&#243;n de riesgo&#58; la edad&#44; el sexo&#44; la PAS&#44; el tabaquismo&#44; el CT&#44; la glucemia en ayunas y el diagn&#243;stico m&#233;dico de hipertensi&#243;n&#44; hipercolesterolemia&#44; diabetes mellitus o tratamiento farmacol&#243;gico espec&#237;fico para estos procesos&#46; El CT s&#233;rico se determin&#243; por m&#233;todos enzim&#225;ticos<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">15</span></a>&#46; No se calcul&#243; el colesterol LDL en el conjunto de la cohorte porque solo se dispon&#237;a de los valores de colesterol HDL en una peque&#241;a proporci&#243;n de los participantes&#46; Se determin&#243; la glucemia plasm&#225;tica mediante el m&#233;todo de la glucosa-oxidasa<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">16</span></a>&#46; En el modelo de riesgos proporcionales de Cox&#44; se agruparon las variables utilizando las categor&#237;as de factores de riesgo de Framingham<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">17</span></a>&#58; la edad se agrup&#243; en categor&#237;as de 5 a&#241;os a partir de los 65-69 a&#241;os&#44; y se clasific&#243; la PAS en 3 categor&#237;as y el CT en 4&#46; Se clasific&#243; a los participantes como fumadores &#40;los que fumaban en el momento basal o hab&#237;an dejado de fumar en los 6 meses previos&#41; o como no fumadores&#47;exfumadores &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46; Se consider&#243; que exist&#237;a hipertensi&#243;n si la PAS era<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>140<span class="elsevierStyleHsp" style=""></span>mmHg o la presi&#243;n arterial diast&#243;lica era<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>90<span class="elsevierStyleHsp" style=""></span>mmHg o el sujeto recib&#237;a tratamiento antihipertensivo<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">18</span></a>&#46; Se consider&#243; que exist&#237;a hipercolesterolemia si el CT era<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>5&#44;1<span class="elsevierStyleHsp" style=""></span>mmol&#47;L o el sujeto recib&#237;a tratamiento hipolipidemiante<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">15</span></a>&#46; Se consider&#243; la existencia de diabetes si la glucemia en ayunas era<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>7&#44;0<span class="elsevierStyleHsp" style=""></span>mmol&#47;L o el sujeto recib&#237;a tratamiento antidiab&#233;tico<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">19</span></a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Se realiz&#243; una b&#250;squeda exhaustiva de datos de posibles episodios de ECV en la cohorte inicial a trav&#233;s de las historias cl&#237;nicas de atenci&#243;n primaria y hospitalaria&#44; de la informaci&#243;n aportada por los m&#233;dicos de atenci&#243;n primaria y mediante encuestas postales y llamadas telef&#243;nicas al sujeto o a sus familiares&#46; La fecha y la causa de la muerte de los fallecidos de la cohorte se confirmaron mediante el &#205;ndice Nacional de Defunciones y los registros de defunciones de cada distrito asistencial&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Se us&#243; la Clasificaci&#243;n Internacional de Enfermedades &#40;CIE&#41; 9 y 10 para registrar la cardiopat&#237;a coronaria &#40;CIE-9&#58; 410-414&#59; CIE-10&#58; I20-I25&#41; y otras enfermedades cardiovasculares &#40;CIE-9&#58; 797-799&#59; CIE-10&#58; I46&#44; R96&#44; R98&#44; I50&#41;&#46; Los episodios coronarios se confirmaron con el algoritmo MONICA de la OMS<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">20</span></a>&#46; El criterio de valoraci&#243;n de ECV se defini&#243; como una combinaci&#243;n de primer episodio coronario &#40;infarto de miocardio definido mortal o no mortal e infarto de miocardio mortal posible&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Para describir los datos seleccionados&#44; se calcularon la media aritm&#233;tica con desviaci&#243;n est&#225;ndar para las variables continuas y la distribuci&#243;n por frecuencias relativas para las variables categ&#243;ricas&#46; Para comparar proporciones&#44; se realizaron la prueba de la ji al cuadrado de Pearson y la prueba de la D de Somers en el caso de las variables ordinales&#46; Para comparar grupos se utilizaron la prueba de la <span class="elsevierStyleItalic">t</span> de Student para medidas binarias independientes y el an&#225;lisis de la varianza para variables con m&#225;s de 2 categor&#237;as&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Las variables independientes antes citadas se incluyeron en los modelos multivariantes mediante el m&#233;todo Enter&#46; Se crearon modelos separados para hombres y mujeres&#46; En el primer paso&#44; la PAS y el CT fueron tratados como variables continuas para valorar las interacciones entre el tratamiento antihipertensivo y los valores de PAS y entre el uso de hipolipidemiantes y las concentraci&#243;n de CT&#46; En un segundo paso&#44; la PAS y el CT fueron categorizados y en el tercer paso se eliminaron las interacciones&#46; Finalmente&#44; para simplificar el modelo se elimin&#243; la variable tratamiento hipolipidemiante porque no fue estad&#237;sticamente significativa&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Se valoraron las asociaciones bivariantes y multivariantes entre cada variable independiente del modelo y el desenlace&#46; Se estimaron los coeficientes &#223; asociados a cada posible FRCV con el primer episodio de ECV registrado mediante el modelo de riesgos proporcionales de Cox&#44; de forma separada para varones y mujeres&#46; Se determinaron las curvas de supervivencia de Kaplan-Meier a los 10 a&#241;os para el primer episodio de ECV mortal&#47;no mortal con el fin de calcular la incidencia acumulada promedio&#46; La estimaci&#243;n de la funci&#243;n de supervivencia se calcul&#243; mediante un modelo de Cox ajustado en funci&#243;n de la mortalidad competitiva a los 10 a&#241;os por otras enfermedades no cardiovasculares&#44; utilizando el modelo de Fine-Gray y se estratific&#243; por sexo&#46; Se utiliz&#243; la prueba &#171;&#243;mnibus&#187; para validar el modelo &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; A partir de los coeficientes &#223; de los modelos de riesgos proporcionales de Cox&#44; se calcularon las puntuaciones de riesgo espec&#237;ficas para la predicci&#243;n de las ECV mortales y no mortales en cada sexo&#44; utilizando las variables categorizadas&#46; El riesgo total de ECV a los 10 a&#241;os observado se clasific&#243; finalmente como riesgo bajo &#40;&#60;<span class="elsevierStyleHsp" style=""></span>20&#37;&#41;&#44; riesgo leve &#40;20-29&#37;&#41;&#44; riesgo moderado &#40;30-39&#37;&#41;&#44; riesgo moderado alto &#40;40-49&#37;&#41;&#44; riesgo alto &#40;50-59&#37;&#41; o riesgo muy alto &#40;&#8805;<span class="elsevierStyleHsp" style=""></span>60&#37;&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Todos los an&#225;lisis estad&#237;sticos se realizaron con el programa estad&#237;stico R &#40;<a href="http://www.r-project.org/">http&#58;&#47;&#47;www&#46;R-project&#46;org</a>&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">En el <a class="elsevierStyleCrossRef" href="#sec0045">material suplementario</a> se muestran an&#225;lisis estad&#237;sticos adicionales realizados&#44; incluidos el c&#225;lculo de los coeficientes &#223; para distintos factores de riesgo en el modelo t&#237;pico de riesgo de ECV a 10 a&#241;os&#44; la utilizaci&#243;n de la edad como variable de escala temporal&#44; la calibraci&#243;n del modelo&#44; la discriminaci&#243;n de las funciones de riesgo y la comparaci&#243;n del riesgo cardiovascular promedio a los 10 a&#241;os con la escala SCORE-OP&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">El estudio se realiz&#243; de conformidad con la Declaraci&#243;n de Helsinki &#40;<a href="http://www.wma.net/e/policy/b3.htm">http&#58;&#47;&#47;www&#46;wma&#46;net&#47;e&#47;policy&#47;b3&#46;htm</a>&#41;&#46; Se obtuvo el consentimiento informado por escrito de todos los participantes durante la entrevista basal&#46; El protocolo del estudio fue aprobado por el Comit&#233; &#201;tico del Hospital Universitario de La Princesa de Madrid&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados</span><p id="par0075" class="elsevierStylePara elsevierViewall">Se incluyeron 3&#46;474 participantes&#44; lo que supuso un total de 27&#46;749 personas-a&#241;o de seguimiento&#46; En el examen basal&#44; el 42&#44;5&#37; de la muestra ten&#237;a hipertensi&#243;n&#44; el 28&#44;4&#37; hipercolesterolemia&#44; el 11&#44;5&#37; diabetes mellitus&#44; el 11&#44;9&#37; fumaba y el 52&#37; recib&#237;a tratamiento antihipertensivo&#46; Se obtuvo informaci&#243;n del seguimiento en 3&#46;474 personas &#40;99&#44;8&#37;&#59; 1&#46;462 varones y 2&#46;012 mujeres&#41;&#46; Durante el per&#237;odo de seguimiento se produjeron 1&#46;340 fallecimientos en el conjunto de la cohorte &#40;38&#44;6&#37;&#59; 702 entre los hombres y 638 entre las mujeres&#41;&#59; 457 de estos fallecimientos fueron por ECV &#40;222 en los hombres y 235 en las mujeres&#41;&#46; Se observaron en total 768 episodios de ECV &#40;457 mortales y 311 no mortales&#41;&#46; En la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> se muestra la distribuci&#243;n de los FRCV y los episodios de ECV seg&#250;n el sexo&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">La <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a> muestra el riesgo promedio a los 10 a&#241;os de un primer episodio de ECV&#44; mortal o no&#44; en hombres &#40;panel A&#41; y en mujeres &#40;panel B&#41;&#44; seg&#250;n el modelo de riesgos proporcionales de Cox&#46; La edad fue el factor predictivo de ECV m&#225;s potente en los 2 sexos&#46; Las variables asociadas con mayor intensidad con ECV en los varones fueron el tratamiento de la hipertensi&#243;n &#40;HR&#58; 1&#44;35&#59; IC a95&#37;&#58; 1&#44;067-1&#44;710&#41;&#44; la diabetes &#40;HR&#58; 1&#44;359&#59; IC 95&#37;&#58; 0&#44;997-1&#44;852&#41; y el tabaquismo &#40;HR&#58; 1&#44;207&#59; IC 95&#37;&#58; 0&#44;945-1&#44;541&#41;&#44; y en las mujeres&#44; el tabaquismo &#40;HR&#58; 1&#44;881&#59; IC 95&#37;&#58; 1&#44;356-2&#44;609&#41; y la diabetes &#40;HR&#58; 1&#44;285&#59; IC 95&#37;&#58; 0&#44;967-1&#44;707&#41;&#46; El poder discriminativo &#40;estad&#237;stico C&#41; del modelo fue 0&#44;656 &#40;IC 95&#37; 0&#44;601-0&#44;701&#41; en los hombres y 0&#44;702 &#40;IC 95&#37; 0&#44;669-0&#44;723&#41; en las mujeres&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">En una segunda etapa del an&#225;lisis se utiliz&#243; la edad como variable de escala temporal en lugar de como una variable t&#237;pica independiente&#46; La HR para la diabetes aument&#243; significativamente de 1&#44;37 a 1&#44;48 en los hombres y de 1&#44;28 a 1&#44;34 en las mujeres &#40;datos mostrados en el <a class="elsevierStyleCrossRef" href="#sec0045">material suplementario</a>&#41; cuando se utiliz&#243; la edad como variable de escala temporal&#46; Sin embargo&#44; las HR de las otras variables incluidas en el modelo de riesgos proporcionales de Cox &#40;CT&#44; tabaquismo&#44; PAS y tratamiento antihipertensivo&#41; no aumentaron cuando se utiliz&#243; la edad como variable de escala temporal&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a> se muestra el riesgo cardiovascular absoluto individual a los 10 a&#241;os espec&#237;fico para hombres no fumadores &#40;panel A&#41; y para fumadores &#40;panel B&#41;&#46; La <a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a> muestra los valores correspondientes para las mujeres no fumadoras &#40;panel A&#41; y fumadoras &#40;panel B&#41;&#46; Este formato visual facilita la interpretaci&#243;n del riesgo cardiovascular total individual a los 10 a&#241;os &#40;ECV mortal y no mortal&#41;&#44; seg&#250;n el sexo y el h&#225;bito tab&#225;quico de cada persona&#44; teniendo adem&#225;s en cuenta el tratamiento antihipertensivo&#44; la presencia o no de diabetes&#44; la edad&#44; la concentraci&#243;n de CT y el nivel de PAS&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discusi&#243;n</span><p id="par0095" class="elsevierStylePara elsevierViewall">La escala EPICARDIAN se basa en una amplia cohorte de 3&#46;474 ciudadanos espa&#241;oles de edad avanzada contempor&#225;nea&#46; Las ecuaciones previas&#44; como la de Framingham y la europea SCORE&#44; se basan en cambio en poblaciones seleccionadas antes de la d&#233;cada de 1980&#44; cuando la prevalencia de factores de riesgo en la poblaci&#243;n era menor&#46; Por el contrario&#44; la cohorte EPICARDIAN&#44; m&#225;s reciente que estas&#44; permite estimar el riesgo teniendo tambi&#233;n en cuenta el tratamiento de la hipertensi&#243;n arterial&#44; tan frecuente en los ancianos&#46; La ecuaci&#243;n EPICARDIAN ayuda tambi&#233;n a solucionar el problema de aplicar coeficientes &#223; derivados de poblaciones adultas de mediana edad a poblaciones de edad m&#225;s avanzada&#44; lo que suele producir estimaciones inadecuadas del riesgo cardiovascular en los ancianos&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">La edad es el factor predictivo m&#225;s potente del riesgo cardiovascular tanto en los hombres como en las mujeres de edad avanzada&#46; La utilizaci&#243;n de la edad como una variable de escala temporal en lugar de como una variable est&#225;ndar mejora el rendimiento del modelo de riesgos proporcionales de Cox&#44; sobre todo en las mujeres&#46; En concreto&#44; la diabetes surge como factor predictivo independiente en las mujeres&#44; cuando en el modelo original la diabetes estaba en el l&#237;mite&#44; sin alcanzar la significaci&#243;n estad&#237;stica&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Se observ&#243; un patr&#243;n de riesgo diferente en los hombres que en las mujeres&#46; En los primeros&#44; la diabetes fue el factor predictivo m&#225;s potente y el tratamiento de la hipertensi&#243;n tuvo mayor repercusi&#243;n cardiovascular que en las mujeres&#46; El tabaquismo tambi&#233;n mostr&#243; una asociaci&#243;n significativa con la ECV&#44; que fue m&#225;s intensa en las mujeres que en los hombres&#46; Como en estudios anteriores<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">21&#44;22</span></a>&#44; la contribuci&#243;n del CT a la ECV act&#250;a de forma inversa en los mayores de 70 a&#241;os que en los menores de 70 a&#241;os&#46; La ausencia de un valor predictivo positivo del CT plantea la cuesti&#243;n de si la estimaci&#243;n del riesgo en los ancianos puede justificar un enfoque diferente que en las personas de mediana edad&#44; y confirma que el poder predictivo de ciertos factores de riesgo cl&#225;sicos&#44; como la hipercolesterolemia&#44; disminuye con la edad&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Las ecuaciones usadas actualmente para predecir la ECV en los ancianos se basan principalmente en funciones de riesgo calibradas a partir de las escalas de riesgo originales de Framingham<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">23</span></a> y SCORE europea<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">24</span></a>&#46; Estas ecuaciones tienen limitaciones importantes&#44; como el peque&#241;o n&#250;mero de participantes mayores de 70 a&#241;os&#44; el origen laboral de algunas cohortes y la consideraci&#243;n de la mortalidad por ECV como &#250;nica variable de desenlace&#46; Por el contrario&#44; la ecuaci&#243;n EPICARDIAN incluye una proporci&#243;n significativa de personas mayores de 75 a&#241;os y estima el riesgo total de ECV&#44; una mejor aproximaci&#243;n del riesgo total individual en un pa&#237;s mediterr&#225;neo como Espa&#241;a&#44; con tasas m&#225;s bajas de cardiopat&#237;a coronaria que otros pa&#237;ses del centro y norte de Europa&#46; Adem&#225;s&#44; las ecuaciones de riesgo europeas en ancianos no incluyen tampoco la diabetes o&#44; como en el estudio de Framingham&#44; sus predicciones se basan en una peque&#241;a proporci&#243;n &#40;4&#37;&#41; de personas con medici&#243;n de glucemia y en las que el diagn&#243;stico de diabetes no utiliz&#243; la definici&#243;n internacional actual de dicha enfermedad&#46; Por &#250;ltimo&#44; un rasgo &#250;nico de la ecuaci&#243;n EPICARDIAN es que tiene en cuenta el uso de antihipertensivos &#8212;el tratamiento m&#225;s frecuente en los adultos de edad avanzada&#8212;&#44; lo que cubre una laguna importante en los instrumentos previos de valoraci&#243;n del riesgo<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">25</span></a>&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Recientemente se ha publicado una nueva versi&#243;n de la escala de riesgo europea SCORE para personas de edad avanzada&#44; el SCORE-OP<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">26</span></a>&#46; Aplicamos la funci&#243;n SCORE-OP a nuestra poblaci&#243;n y observamos que el riesgo promedio de ECV a los 10 a&#241;os era significativamente menor tanto en hombres como en mujeres con respecto al obtenido con la escala EPICARDIAN<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">27</span></a>&#46; Lo m&#225;s probable es que esto sea debido a que la edad media de la poblaci&#243;n del estudio EPICARDIAN es mayor y la prevalencia de diabetes y de tabaquismo es tambi&#233;n superior que en las cohortes incluidas en el SCORE-OP&#44; que proced&#237;an principalmente del norte y centro de Europa&#46; Adem&#225;s&#44; las 2 ecuaciones no incluyen exactamente los mismos par&#225;metros&#46; Por ejemplo&#44; la ecuaci&#243;n EPICARDIAN incluye el tratamiento de la hipertensi&#243;n como variable en el modelo&#44; mientras que el SCORE-OP incluye los valores de colesterol HDL&#46; Tambi&#233;n hemos observado que el SCORE-OP identifica a menos pacientes mayores de 65 a&#241;os con riesgo alto o muy alto que la escala de riesgo SCORE original para pa&#237;ses con riesgo bajo como Espa&#241;a<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">27</span></a>&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">La escala EPICARDIAN solo tiene en cuenta los FRCV m&#225;s importantes&#46; Otros factores&#44; como los antecedentes familiares de ECV&#44; las concentraciones de fibrin&#243;geno&#44; la actividad f&#237;sica&#44; el per&#237;metro de la cintura o las concentraciones de prote&#237;na C reactiva&#44; pueden modular te&#243;ricamente el riesgo de ECV en los ancianos&#46; En contraste&#44; como ya se ha dicho&#44; el valor predictivo de algunos factores de riesgo cl&#225;sicos como la hipercolesterolemia o la hipertensi&#243;n sist&#243;lica se debilita con la edad<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">8&#44;21</span></a>&#46; En consecuencia&#44; las estimaciones del riesgo en algunas celdillas&#44; sobre todo en los grupos m&#225;s ancianos y con muy pocos individuos con concentraciones muy elevadas de CT y de PAS&#44; pueden ser menos exactas&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Nuestros hallazgos concuerdan con los de una revisi&#243;n sistem&#225;tica publicada recientemente<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">28</span></a> que muestra la falta de uniformidad de los valores predictivos de los FRCV tradicionales como son las fracciones de colesterol&#44; la presi&#243;n arterial&#44; el tabaquismo o el &#237;ndice de masa corporal en los ancianos&#46; Estos hallazgos justifican el desarrollo de nuevos modelos de riesgo&#44; como la ecuaci&#243;n EPICARDIAN&#44; que considera otras posibles causas competitivas de riesgo de muerte&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Nuestro estudio tiene varias fortalezas&#46; La muestra incluy&#243; a personas seleccionadas en entornos urbanos y rurales&#44; de distintas localizaciones geogr&#225;ficas&#44; de un intervalo de edades amplio dentro del segmento de la poblaci&#243;n definida como anciana y contiene una proporci&#243;n alta de personas con diabetes&#46; La disponibilidad de informaci&#243;n sobre el tratamiento de los FRCV&#44; sobre todo el antihipertensivo&#44; es otra fortaleza de este estudio&#46; Nuestra escala puede aportar informaci&#243;n &#250;til a los m&#233;dicos a la hora de ajustar el riesgo estimado de ECV en pacientes que ya reciben tratamiento antihipertensivo&#46; La cohorte EPICARDIAN proporciona la primera asociaci&#243;n prospectiva entre la ECV total y varios FRCV en la poblaci&#243;n anciana de Espa&#241;a&#44; un pa&#237;s con baja incidencia de ECV&#46; La ecuaci&#243;n EPICARDIAN permite adem&#225;s la estimaci&#243;n directa del riesgo total de ECV basada en el riesgo actual espec&#237;fico de la poblaci&#243;n anciana espa&#241;ola&#44; en lugar de basarse en estimaciones extranjeras calibradas para poblaciones europeas de bajo riesgo&#46; Las predicciones basadas en estas calibraciones pueden no ser exactas si pas&#243; mucho tiempo y se produjo un cambio marcado de la mortalidad por ECV entre el momento en que se obtuvo la ecuaci&#243;n de riesgo y su aplicaci&#243;n&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusiones</span><p id="par0135" class="elsevierStylePara elsevierViewall">Nuestros resultados permiten ajustar el grado en que algunos FRCV espec&#237;ficos&#44; como los valores de colesterol&#44; pueden afectar a la poblaci&#243;n espec&#237;fica de la que proceden&#46; Se espera que esta ecuaci&#243;n de riesgo se valide en el futuro&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">La escala EPICARDIAN ofrece una nueva estimaci&#243;n del riesgo total de ECV al incorporar el tratamiento antihipertensivo al c&#225;lculo del riesgo&#46; El riesgo de ECV es significativamente mayor en los hombres ancianos con diabetes y que reciben tratamiento antihipertensivo que en el conjunto de los hombres&#44; y en las mujeres ancianas que fuman que en el conjunto de las mujeres&#46; Consideramos que esta ecuaci&#243;n es un instrumento pr&#225;ctico que pueden utilizar los m&#233;dicos para calcular el riesgo individual total de ECV en personas espa&#241;olas mayores de 70 a&#241;os&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Financiaci&#243;n</span><p id="par0145" class="elsevierStylePara elsevierViewall">FIS 93&#47;012&#59; FIS 96&#47;1993&#59; FIS 02&#47;0896 del Instituto de Salud Carlos III<span class="elsevierStyleSmallCaps">&#44;</span> y DGICyT PB&#47;255-Co4&#44; Espa&#241;a&#46;&#160;Los financiadores no han intervenido en el estudio excepto para financiarlo&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflicto de intereses</span><p id="par0150" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Antecedentes y objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La estimaci&#243;n del riesgo cardiovascular en personas mayores de 70 a&#241;os es problem&#225;tica&#46; La mayor&#237;a de las escalas se han creado bas&#225;ndose en cohortes de personas de mediana edad&#44; con una representaci&#243;n insuficiente de los adultos de m&#225;s edad&#46; El poder predictivo de los factores de riesgo cardiovascular cl&#225;sicos disminuye con la edad&#46; El objetivo de este estudio es desarrollar una escala espec&#237;fica para estimar el riesgo cardiovascular de la poblaci&#243;n anciana espa&#241;ola&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Este estudio se realiz&#243; en una cohorte poblacional establecida en 1995&#46; Marco&#58; 3 zonas geogr&#225;ficas de Espa&#241;a &#40;Madrid&#44; &#193;vila y Lugo&#41;&#46; Participantes&#58; 3&#46;729 personas mayores de 64 a&#241;os sin enfermedades cardiovasculares &#40;ECV&#41; al inicio del seguimiento&#46; Mediciones&#58; se investigaron anualmente las sospechas de ECV mortal y no mortal &#40;cardiopat&#237;a coronaria e ictus&#41; y se confirmaron usando los criterios del proyecto MONICA de la OMS&#46; Se sigui&#243; a todos los participantes hasta que apareci&#243; el primer episodio de ECV&#44; hasta su muerte o hasta el 31 de diciembre de 2015&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">La edad fue el factor predictivo m&#225;s potente de ECV a los 10 a&#241;os en ambos sexos&#46; Las variables asociadas con ECV en los varones fueron el tratamiento de la hipertensi&#243;n arterial &#40;HR&#58; 1&#44;35&#59; IC 95&#37;&#58; 1&#44;067-1&#44;710&#41;&#44; la diabetes &#40;HR&#58; 1&#44;359&#59; IC 95&#37;&#58; 0&#44;997-1&#44;852&#41; y el tabaquismo &#40;HR&#58; 1&#44;207&#59; IC 95&#37;&#58; 0&#44;945-1&#44;541&#41;&#44; y en las mujeres&#44; el tabaquismo &#40;HR&#58; 1&#44;881&#59; IC 95&#37;&#58; 1&#44;356-2&#44;609&#41; y la diabetes &#40;HR&#58; 1&#44;285&#59; IC 95&#37;&#58; 0&#44;967-1&#44;707&#41;&#46; El colesterol total no aument&#243; el riesgo de ECV ni en varones ni en mujeres&#46; Sin embargo&#44; las concentraciones de colesterol total<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>200<span class="elsevierStyleHsp" style=""></span>mg&#47;dL se asociaron inversamente al riesgo de ECV a los 10 a&#241;os&#44; tanto en varones como en mujeres&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La ECV total a los 10 a&#241;os aumenta significativamente en los varones espa&#241;oles de edad avanzada con la edad&#44; la diabetes y el tratamiento antihipertensivo&#44; y en las mujeres con la diabetes y el tabaquismo&#46; Los niveles de colesterol total no aumentaron el riesgo de ECV&#44; sobre todo en los varones&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Background and objectives</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Cardiovascular risk estimation in people over 70 years of age is problematic&#46; Most scores have been created based on cohorts of middle-aged people&#44; with an underrepresentation of older adults&#46; The predictive power of classical cardiovascular risk factors declines with age&#46; The aim of this work is to develop a specific score for estimating cardiovascular risk among the elderly population in Spain&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">This work is a population-based cohort established in 1995&#46; Setting&#58; 3 geographical areas of Spain &#40;Madrid&#44; &#193;vila&#44; and Lugo&#41;&#46; Participants&#58; 3&#44;729 people older than 64 years with no cardiovascular diseases &#40;CVD&#41; at baseline&#46; Measurements&#58; suspected fatal and nonfatal CVD &#40;both coronary heart disease and stroke&#41; were investigated annually and confirmed using the WHO-MONICA criteria&#46; All participants were followed-up on until occurrence of a first CVD event&#44; until death&#44; or until December 31&#44; 2015&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Age was the strongest predictor of CVD at 10 years in both men and women&#46; In men&#44; variables associated with CVD were high blood pressure treatment &#40;HR&#58; 1&#46;35&#59; 95&#37; CI&#58; 1&#46;067-1&#46;710&#41;&#44; diabetes &#40;HR&#58; 1&#46;359&#59; 95&#37; CI&#58; 0&#46;997-1&#46;852&#41;&#44; and smoking &#40;HR&#58; 1&#46;207&#59; 95&#37; CI&#58; 0&#46;945-1&#46;541&#41; and in women&#44; the variables were smoking &#40;HR&#58; 1&#46;881&#59; 95&#37; CI&#58; 1&#46;356-2&#46;609&#41; and diabetes &#40;HR&#58; 1&#46;285&#59; 95&#37; CI&#58; 0&#46;967-1&#46;707&#41;&#46; Total cholesterol did not increase the risk of CVD in men or women&#46; However&#44; total cholesterol levels<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>200<span class="elsevierStyleHsp" style=""></span>mg&#47;dL were inversely associated with 10-year risk of CVD in men and women&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">In elderly Spanish men&#44; total CVD at 10 years is significantly increased by age&#44; diabetes&#44; and antihypertensive treatment and in elderly Spanish women by diabetes and smoking&#46; Total cholesterol levels did not increase the risk of CVD&#44; particularly in males&#46;</p></span>"
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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"><span class="elsevierStyleItalic">Diabetes</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;307&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;158&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">3&#44;778&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">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;052&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">1&#44;359&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;997&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">1&#44;852&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="elsevierStyleItalic">Tabaquismo</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;188&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;125&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">2&#44;275&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">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;131&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">1&#44;207&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;945&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">1&#44;541&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="elsevierStyleItalic">Presi&#243;n arterial sist&#243;lica &#40;ref&#46; &#60;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">140</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">mmHg&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" 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="" 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">3&#44;027&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">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;387&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="" 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="" 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="" 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></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>140-149 mmHg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;098&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;140&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;485&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">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;486&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">1&#44;103&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;837&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">1&#44;452&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>150-159 mmHg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;092&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;162&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;325&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">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;569&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">1&#44;096&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;799&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">1&#44;505&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>&#8805;<span class="elsevierStyleHsp" style=""></span>160 mmHg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;257&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;148&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;022&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">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;082&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">1&#44;293&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;968&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">1&#44;726&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="elsevierStyleItalic">Colesterol total &#40;ref&#46; &#60;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">160</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">mg&#47;dL&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" 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="" 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">5&#44;916&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">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;116&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="" 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="" 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="" 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></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>160-199 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">0&#44;175&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;179&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;956&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">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;328&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">1&#44;191&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;839&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">1&#44;692&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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                  """
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            1 => array:2 [
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                  \t\t\t\t">1&#44;915&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">3&#44;639&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>80-84 a&#241;os&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">1&#44;380&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;170&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">66&#44;284&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">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;000&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">3&#44;976&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">2&#44;852&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">5&#44;544&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>&#8805;<span class="elsevierStyleHsp" style=""></span>85 a&#241;os&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">2&#44;038&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;170&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">143&#44;523&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">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;000&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">7&#44;677&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">5&#44;500&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">10&#44;716&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="elsevierStyleItalic">Diabetes</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;251&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;145&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">2&#44;996&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">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;083&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">1&#44;285&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;967&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">1&#44;707&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="elsevierStyleItalic">Tabaquismo</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;632&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;167&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">14&#44;317&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">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;000&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">1&#44;881&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">1&#44;356&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">2&#44;609&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="elsevierStyleItalic">Presi&#243;n arterial sist&#243;lica &#40;ref&#46; &#60;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">140</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">mmHg&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" 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="" 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">2&#44;998&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">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;392&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="" 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="" 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="" 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></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>140-149 mmHg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;135&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;009&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">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;925&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">1&#44;013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;777&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">1&#44;320&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>150-159 mmHg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;141&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;145&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;944&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">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;331&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;868&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;653&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">1&#44;154&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>&#8805;<span class="elsevierStyleHsp" style=""></span>160 mmHg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;198&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;138&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">2&#44;062&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">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;151&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;820&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t">1&#44;075&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Colesterol total &#40;ref&#46; &#60;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">160</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">mg&#47;dL&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#44;129&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
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ISSN: 00142565
Idioma original: Español
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