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la asociaci&#243;n de factores de riesgo con la EVAC determin&#243; una asociaci&#243;n entre la EVAC y la hipertensi&#243;n arterial &#40;HTA&#41;&#44; la diabetes mellitus&#44; la hipercolesterolemia y los niveles bajos de colesterol-HDL<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">4</span></a>&#46; En los estudios epidemiol&#243;gicos publicados los resultados sobre los factores de riesgo cardiovascular &#40;FRCV&#41; asociados con la EVAC o la EA no son homog&#233;neos&#46; Adem&#225;s&#44; diversos FRCV se asocian con la tasa de progresi&#243;n de la EA y tambi&#233;n con otras comorbilidades relacionadas con la EVAC o la EA<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">4&#8211;12</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Se han realizado pocos estudios epidemiol&#243;gicos que investiguen la asociaci&#243;n de los diferentes FRCV y comorbilidades con la EA en un &#225;mbito poblacional determinado&#44; y solo uno de ellos ha sido realizado en Espa&#241;a<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">4&#44;6&#8211;10&#44;13&#44;14</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">La EA es habitualmente una enfermedad de inicio lento y silente&#44; que se puede acompa&#241;ar de un retraso diagn&#243;stico y una dilaci&#243;n en la indicaci&#243;n de intervenci&#243;n terap&#233;utica que puede empeorar su pron&#243;stico&#46; Identificar factores de riesgo de EA grave podr&#237;a facilitar la identificaci&#243;n de la poblaci&#243;n con mayor riesgo y reducir el retraso diagn&#243;stico&#44; y sobre todo el de intervenci&#243;n terap&#233;utica quir&#250;rgica o intervencionista<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">15</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">El objetivo del presente estudio fue evaluar la asociaci&#243;n de diferentes FRCV y comorbilidades con la EA grave sintom&#225;tica en pacientes mayores de 65 a&#241;os&#44; 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Los casos se seleccionaron entre todos los pacientes que se hab&#237;an remitido a la comisi&#243;n interdisciplinar de cardiolog&#237;a y cirug&#237;a cardiovascular para valorar el tipo de tratamiento de su EA grave sintom&#225;tica&#46; Todos los pacientes cumpl&#237;an los criterios establecidos por la gu&#237;a de la Sociedad Europea de Cardiolog&#237;a vigente en el per&#237;odo de estudio y que consist&#237;an en presencia de cl&#237;nica &#40;angor&#44; disnea o s&#237;ncope&#41; y de gravedad ecocardiogr&#225;fica &#40;un gradiente medio superior a 40<span class="elsevierStyleHsp" style=""></span>mmHg&#44; una velocidad de flujo transvalvular a&#243;rtico superior a 4<span class="elsevierStyleHsp" style=""></span>m&#47;s&#44; una &#225;rea valvular a&#243;rtica inferior a 1<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span> o un &#225;rea valvular indexada inferior a 0&#44;6<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span>&#47;m<span class="elsevierStyleSup">2</span>&#41;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">16</span></a>&#46; Se defini&#243; como &#171;control&#187; al individuo<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>65 a&#241;os de las comarcas de una provincia de Espa&#241;a&#44; sin EA conocida y procedente del mismo centro de atenci&#243;n primaria &#40;CAP&#41; que el caso apareado por edad &#40;&#177;<span class="elsevierStyleHsp" style=""></span>5 a&#241;os&#41; y sexo&#46; Los controles fueron seleccionados por el propio m&#233;dico de atenci&#243;n primaria entre los pacientes &#8805;<span class="elsevierStyleHsp" style=""></span>65<span class="elsevierStyleHsp" style=""></span>a&#241;os que hab&#237;a consultado y no presentaban cl&#237;nica de EA&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">La recogida de informaci&#243;n se realiz&#243; de forma prospectiva a trav&#233;s de entrevistas con los pacientes&#44; exploraci&#243;n f&#237;sica y consulta de las historias cl&#237;nicas electr&#243;nicas del &#225;mbito hospitalario y de atenci&#243;n primaria&#46; La recogida de datos&#44; almacenamiento y an&#225;lisis se realiz&#243; de conformidad con la normativa vigente&#46; Los pacientes otorgaron el consentimiento informado por escrito y el estudio fue aprobado por el comit&#233; de &#233;tica de investigaci&#243;n cl&#237;nica de nuestro centro y por el comit&#233; de &#233;tica de investigaci&#243;n del centro de atenci&#243;n primaria de la provincia donde se realiz&#243; el estudio&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">La variable dependiente del estudio fue ser &#171;caso&#187; o &#171;control&#187;&#44; y las variables independientes las caracter&#237;sticas demogr&#225;ficas &#40;edad y sexo&#41; y cl&#237;nicas de los pacientes&#46; En relaci&#243;n con el tama&#241;o muestral se calcul&#243; el n&#250;mero de casos y controles para detectar una <span class="elsevierStyleItalic">odds ratio</span> &#40;OR&#41; de 2&#44;5&#44; con un riesgo &#945;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;05 y un &#946;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;10&#44; a partir de&#58; P<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#40;P<span class="elsevierStyleInf">1</span><span class="elsevierStyleHsp" style=""></span>&#42;<span class="elsevierStyleHsp" style=""></span>OR&#41;&#47;&#40;1<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>P<span class="elsevierStyleInf">1</span><span class="elsevierStyleHsp" style=""></span>&#42;<span class="elsevierStyleHsp" style=""></span> &#91;OR-1&#93;&#41;&#46; Para una P<span class="elsevierStyleInf">1</span> esperada de 0&#44;50 se estim&#243; que ser&#237;an necesarios 87 casos y 261 controles&#46; As&#237;&#44; para cada caso que entraba en el estudio se pretend&#237;a seleccionar 3 controles apareados por edad &#40;&#177;5 a&#241;os&#41; y sexo procedentes del mismo CAP o &#225;rea b&#225;sica de salud &#40;ABS&#41; del caso&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Se realiz&#243; un an&#225;lisis en 2 etapas&#58; primero se realiz&#243; un an&#225;lisis bivariado de las variables cl&#237;nicas del estudio y en segundo lugar se construy&#243; un modelo de regresi&#243;n log&#237;stica m&#250;ltiple para estudiar los FRCV y comorbilidades asociadas al riesgo de EA grave sintom&#225;tica&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Se estudi&#243; la asociaci&#243;n estad&#237;stica de la variable dependiente &#40;caso&#47;control&#41; con las variables cualitativas independientes con la prueba de Chi cuadrado o el test exacto de Fisher&#46; Para las variables cuantitativas independientes se utiliz&#243; la &#171;t&#187; de Student o la prueba no param&#233;trica de Mann-Whitney en caso de no cumplir la hip&#243;tesis de normalidad&#46; En los 2 casos se acept&#243; un nivel de significaci&#243;n estad&#237;stica p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46; La fuerza de la asociaci&#243;n de los FRCV y las comorbilidades con la variable dependiente se estudi&#243; con la <span class="elsevierStyleItalic">odds ratio</span> cruda &#40;ORc&#41; con su intervalo de confianza &#40;IC&#41; del 95&#37;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">La implicaci&#243;n independiente de cada factor al riesgo de ser &#171;caso&#187; se estim&#243; mediante la <span class="elsevierStyleItalic">odds ratio</span> ajustada &#40;ORa&#41; a trav&#233;s de modelos de regresi&#243;n log&#237;stica en los cuales la variable dependiente fue caso&#47;control&#44; y las independientes los diferentes FRCV y las comorbilidades&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Se construyeron 2 tipos de modelo de regresi&#243;n log&#237;stica m&#250;ltiple&#58; 1&#41; FRCV&#59; y 2&#41; comorbilidades&#46; Se consideraron candidatas las variables con un valor de p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;2 y su entrada se realiz&#243; a partir de los algoritmos de selecci&#243;n de variables hacia adelante y hacia atr&#225;s&#46; A continuaci&#243;n se ajust&#243; nuevamente el modelo probando aquellos factores que quedaron en la zona l&#237;mite del valor p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;1&#46; Se estudiaron las caracter&#237;sticas de calibrado a partir del contraste de Hosmer y Lemeshow y el poder de discriminaci&#243;n &#40;estad&#237;stico c del AUC&#41;&#46; Se probaron los efectos cuadr&#225;ticos de las variables num&#233;ricas y las posibles interacciones&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Todos los c&#225;lculos se realizaron con el paquete estad&#237;stico SPSS 15&#46;0 y R&#44; fijando la significaci&#243;n en 0&#44;05&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados</span><p id="par0075" class="elsevierStylePara elsevierViewall">Se estudiaron un total de 102 casos y 221 controles&#46; Para cada caso se incluyeron entre uno y 3 controles procedentes del mismo CAP&#44; apareados por sexo y edad con una media de 2&#44;17 controles para cada caso&#46; La edad media de los casos fue de 77&#44;6 a&#241;os y de los controles de 75&#44;5 a&#241;os&#44; con una diferencia de 2&#44;1 a&#241;os entre ambos &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46; Esta diferencia se debe a que el apareamiento de casos y controles fue de &#177;5<span class="elsevierStyleHsp" style=""></span>a&#241;os&#46; No se encontraron diferencias significativas respecto al sexo ni otras variables antropom&#233;tricas&#44; aunque se observ&#243; un grado elevado de sobrepeso y obesidad&#46; El per&#237;metro abdominal y la presencia de obesidad central fueron significativamente superiores en los casos&#44; pero no se encontraron diferencias respecto al valor absoluto del &#237;ndice tobillo-brazo &#40;ITB&#41; ni en la presencia de un ITB patol&#243;gico &#40;&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;9&#41;&#46; Finalmente&#44; tanto la hemoglobina como el hematocrito fueron significativamente menores en los casos&#44; de manera que la prevalencia de anemia fue significativamente mayor en los casos frente a los controles &#40;37&#44;3&#37; y 13&#44;3&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">Con relaci&#243;n a los FRCV&#44; los casos mostraron una diferencia significativa frente a los controles en el consumo de tabaco actual o previo &#40;38&#44;2&#37; y 25&#44;4&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;020&#41;&#44; HTA &#40;85&#44;3&#37; y 70&#44;3&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;004&#41;&#44; hipercolesterolemia &#40;71&#44;6&#37; y 51&#44;2&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; y niveles bajos de colesterol-HDL &#40;34&#44;3&#37; y 19&#44;1&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;003&#41;&#46; En cambio&#44; no se observaron diferencias significativas en la prevalencia de obesidad&#44; diabetes e historia familiar de cardiopat&#237;a isqu&#233;mica documentada&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">En relaci&#243;n con los antecedentes patol&#243;gicos o comorbilidades&#44; los casos presentaron un porcentaje significativamente mayor de insuficiencia renal cr&#243;nica &#40;IRC&#41; &#40;28&#44;4&#37; y 8&#44;1&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; EPOC &#40;18&#44;6&#37; y 11&#44;9&#37;&#44; otras 11&#44;8&#37; y 7&#44;6&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;049&#41;&#44; AVC &#40;8&#44;8&#37; y 2&#44;4&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#41; y estenosis carot&#237;dea &#40;EC&#41; &#40;5&#44;9&#37; y 0&#44;5&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#41;&#46; Sin embargo&#44; no hubo diferencias estad&#237;sticamente significativas respecto al antecedente de arteriopat&#237;a perif&#233;rica&#44; enfermedad endocrina o digestiva&#46; En el grupo de casos hubo m&#225;s antecedentes de historia cardiol&#243;gica en comparaci&#243;n con los controles&#44; y presentaron una mayor frecuencia de alg&#250;n episodio previo de IAM &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; y de intervencionismo cardiol&#243;gico previo &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a> se muestra el resultado del modelo de regresi&#243;n log&#237;stica m&#250;ltiple de FRCV&#46; Se encontr&#243; una asociaci&#243;n estad&#237;sticamente significativa entre la EA grave sintom&#225;tica y los FRCV siguientes&#58; hipercolesterolemia &#40;ORa<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44;67&#59; IC 95&#37;&#58; 1&#44;54-4&#44;64&#41;&#44; tabaquismo &#40;ORa<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44;60&#59; IC 95&#37;&#58; 1&#44;48-4&#44;58&#41;&#44; HTA &#40;ORa<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44;41&#59; IC 95&#37;&#58; 1&#44;23-4&#44;72&#41;&#44; cifras bajas de colesterol-HDL &#40;ORa<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44;20&#59; IC 95&#37;&#58; 1&#44;25-3&#44;88&#41; y edad &#40;ORa<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;08&#59; IC 95&#37;&#58; 1&#44;03-1&#44;13&#41;&#46; En la <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a> se observa que la curva de eficacia diagn&#243;stica &#40;<span class="elsevierStyleItalic">Receiving Operating Characteristic</span> &#91;ROC&#93;&#41; del modelo de regresi&#243;n log&#237;stica de los FRCV mostr&#243; una buena discriminaci&#243;n &#40;0&#44;74&#59; 0&#44;68-0&#44;80&#41; de la asociaci&#243;n de los diferentes FRCV con la EA&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">La <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a> muestra los resultados del modelo de regresi&#243;n log&#237;stica m&#250;ltiple de comorbilidades&#44; donde se encontr&#243; una asociaci&#243;n estad&#237;sticamente significativa entre la EA grave sintom&#225;tica y las comorbilidades&#58; arteriopat&#237;a carot&#237;dea &#40;ORa<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>14&#44;5&#59; IC 95&#37;&#58; 1&#44;61-129&#41;&#44; AVC &#40;ORa<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#44;14&#59; IC 95&#37;&#58; 1&#44;20-14&#44;2&#41; e IRC &#40;ORa<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#44;78&#59; IC 95&#37;&#58; 1&#44;88-7&#44;59&#41;&#46; Por contra&#44; los niveles de hemoglobina se asociaron de forma inversa con la EA grave &#40;ORa<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;76&#59; IC 95&#37;&#58; 0&#44;65-0&#44;90&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; En la <a class="elsevierStyleCrossRef" href="#fig0010">figura 2</a> se muestra que la curva ROC del modelo de regresi&#243;n log&#237;stica de comorbilidades present&#243; un &#225;rea bajo la curva de 0&#44;74 &#40;0&#44;68-0&#44;80&#41;&#44; de forma que este modelo evidenci&#243; una buena discriminaci&#243;n&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discusi&#243;n</span><p id="par0100" class="elsevierStylePara elsevierViewall">Este estudio ha permitido constatar que FRCV asociados a la cardiopat&#237;a isqu&#233;mica &#40;hipertensi&#243;n&#44; tabaquismo&#44; hipercolesterolemia y cifras bajas de HDL&#41; son tambi&#233;n factores de riesgo para la EA&#46; An&#225;logamente al estudio Framingham&#44; todos ellos presentan OR entre 2 y 3&#44; y podr&#237;an tener un valor predictivo del riesgo en pacientes mayores de 65 a&#241;os&#46; El estudio tambi&#233;n identifica que la EA se asocia a comorbilidades &#40;muy especialmente la estenosis carot&#237;dea&#44; el AVC y la insuficiencia renal&#41; que podr&#237;an ser marcadores de riesgo&#46; Dada la elevada prevalencia de EA en ancianos y el envejecimiento poblacional actual&#44; este estudio presenta importantes aplicaciones pr&#225;cticas<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">18</span></a>&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Existe un estudio epidemiol&#243;gico que explor&#243; la asociaci&#243;n entre FRCV y la gravedad de la EVAC en un grupo de pacientes similar al nuestro&#46; Este estudio observ&#243; que la edad&#44; el tabaquismo&#44; la HTA&#44; el per&#237;metro abdominal y un ITB<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;9 presentaban una asociaci&#243;n estad&#237;sticamente significativa con la EVAC&#46; Por otro lado&#44; el an&#225;lisis multivariante del <span class="elsevierStyleItalic">Helsinki Ageing Study</span> demostr&#243; que solo la edad&#44; la HTA y un IMC bajo se asociaban con la calcificaci&#243;n valvular a&#243;rtica&#44; y que la edad y los niveles de calcio en suero eran los &#250;nicos factores que se asociaron con la EA&#46; Finalmente&#44; los datos epidemiol&#243;gicos del <span class="elsevierStyleItalic">Cardiovascular Health Study</span> evidenciaron que la edad&#44; el sexo masculino y la lipoprote&#237;na A se correlacionaban fuertemente con la prevalencia de EVAC o EA&#44; y que los antecedentes de HTA&#44; el tabaquismo activo&#44; el colesterol-LDL y la altura se asociaban&#44; en una magnitud menor&#44; con la presencia de EVAC o EA&#46; Adem&#225;s&#44; en el an&#225;lisis bivariante observaron una asociaci&#243;n inversa estad&#237;sticamente significativa con los niveles de colesterol-HDL&#44; en l&#237;nea con nuestros resultados<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">6&#44;7&#44;14</span></a>&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">En relaci&#243;n con las comorbilidades asociadas con la EA grave&#44; hay que tener en cuenta que algunas comparten FRCV en su etiopatogenia y que estas comorbilidades podr&#237;an estar relacionadas desde el punto de vista fisiopatol&#243;gico con el desarrollo y progresi&#243;n de la EA&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">En el an&#225;lisis multivariante Ferreira-Gonz&#225;lez et al&#46;<span class="elsevierStyleSup">6</span> mostraron que la EVAC se asociaba a la insuficiencia renal moderada-grave&#44; pero no a la enfermedad leve-moderada&#46; De hecho&#44; como la insuficiencia renal lleva a un desarrollo r&#225;pido de la aterosclerosis&#44; ellos afirman que esto puede explicar que el fracaso renal se asocie a los estados avanzados de EVAC&#46; En nuestro estudio tambi&#233;n se hall&#243; una asociaci&#243;n entre IRC y EA&#46; Por el contrario&#44; otros estudios no observaron ninguna asociaci&#243;n en el an&#225;lisis multivariante entre una tasa de filtrado glomerular estimado<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#44;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> y la EVAC&#44; ni entre los niveles de creatinina y la progresi&#243;n de la EA&#46; En este sentido&#44; el <span class="elsevierStyleItalic">Framingham Offspring Study</span> tampoco hall&#243; una asociaci&#243;n estad&#237;sticamente significativa entre la IRC y la esclerosis valvular a&#243;rtica o la calcificaci&#243;n anular a&#243;rtica&#46; En efecto&#44; la relaci&#243;n entre la IRC y una calcificaci&#243;n valvular importante &#40;mitral y a&#243;rtica&#41; se mostr&#243; marcadamente atenuada despu&#233;s de ser ajustada por los FRCV en el an&#225;lisis multivariante&#46; Los autores sugieren que los factores de riesgo que comparten la enfermedad renal cr&#243;nica y la calcificaci&#243;n valvular podr&#237;an explicar parcialmente la prevalencia de calcificaci&#243;n valvular en la enfermedad renal cr&#243;nica<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">6&#44;9&#44;10&#44;19&#44;20</span></a>&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">En relaci&#243;n con la aterosclerosis o la estenosis carot&#237;dea no encontramos ning&#250;n estudio que eval&#250;e su asociaci&#243;n con la EVAC o la EA en un modelo de regresi&#243;n log&#237;stica&#46; Existen estudios que eval&#250;an otros tipos de asociaciones&#44; por ejemplo en un an&#225;lisis multivariante se observ&#243; que los predictores de estenosis carot&#237;dea hemodin&#225;micamente significativa en el <span class="elsevierStyleItalic">screening</span> mediante ecograf&#237;a-Doppler carot&#237;dea previo a cirug&#237;a valvular incluyen la edad avanzada &#40;&#8805;<span class="elsevierStyleHsp" style=""></span>75<span class="elsevierStyleHsp" style=""></span>a&#241;os&#41;&#44; la enfermedad valvular a&#243;rtica&#44; la enfermedad renal cr&#243;nica y la vasculopat&#237;a perif&#233;rica<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">21</span></a>&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">En referencia a la asociaci&#243;n del AVC con la EVAC o la EA cabe decir que Ferreira et al&#46; tambi&#233;n observaron una asociaci&#243;n estad&#237;sticamente significativa del AVC con la EVAC que no se mantuvo en el modelo multinomial de regresi&#243;n&#46; Esto puede ser debido en parte a que la EA podr&#237;a ser un factor de riesgo para el AVC &#40;y no a la inversa&#41;&#44; o que el AVC comparte FRCV con la EA y&#44; por tanto&#44; no es un aut&#233;ntico factor de riesgo de EA&#46; Esta misma explicaci&#243;n podr&#237;a ser v&#225;lida para el resto de comorbilidades analizadas en nuestro estudio<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">6&#44;22&#8211;27</span></a>&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Tanto los niveles de hemoglobina como el hematocrito fueron significativamente menores en los casos respecto a los controles y&#44; consecuentemente&#44; se observ&#243; una mayor prevalencia de anemia en los casos&#46; La posible asociaci&#243;n con la anemia y la insuficiencia renal&#44; y su eventual papel confusor&#44; se ha neutralizado introduciendo las 2 variables en el modelo multivariante final de comorbilidades&#46; En diversos estudios epidemiol&#243;gicos se ha asociado una elevada prevalencia de anemia con la presencia&#44; gravedad y peor pron&#243;stico de la EA&#46; Asimismo&#44; la elevada prevalencia de anemia puede afectar a la calidad de vida y al estado de salud percibido por el paciente dado que&#44; especialmente en pacientes ancianos&#44; la anemia se asocia con puntuaciones menores en las escalas de valoraci&#243;n de la calidad de vida y con un mayor riesgo de hospitalizaci&#243;n y ca&#237;das<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">28&#8211;30</span></a>&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">La EA es una enfermedad silente&#44; de instauraci&#243;n lenta y que a menudo se diagnostica cuando aparecen s&#237;ntomas que afectan la calidad de vida del paciente&#46; La identificaci&#243;n de los factores de riesgo y comorbilidades asociados a la EA grave podr&#237;a facilitar modelos predictivos para la identificaci&#243;n y el seguimiento de los pacientes&#44; reducir el retraso diagn&#243;stico &#40;basado en la auscultaci&#243;n&#44; anamnesis y eventual estudio ecogr&#225;fico&#41; y terap&#233;utico&#44; y as&#237; mejorar el pron&#243;stico y la calidad de vida de los pacientes&#46; Del valor predictivo de las comorbilidades&#44; en concreto&#44; se deber&#237;a valorar la posibilidad de presentaci&#243;n de la EA en pacientes con estenosis carotidea e IRC&#46; Finalmente&#44; la prevenci&#243;n de la exposici&#243;n a los factores de riesgo a nivel poblacional podr&#237;a tener un efecto multiplicativo para otras enfermedades cr&#243;nicas que comparten los mismos factores de riesgo y repercutir directamente en la reducci&#243;n de la morbimortalidad&#46; De hecho&#44; en un estudio poblacional realizado en Suecia entre 1989 y 2009 se observ&#243; una disminuci&#243;n en la incidencia de EA y una mejora en el pron&#243;stico de esta enfermedad&#44; que sugieren que se debe al mejor control de los factores de riesgo&#44; junto con el tratamiento adecuado<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">15&#44;31</span></a>&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Este estudio tiene algunas limitaciones&#59; algunos casos candidatos a formar parte del estudio podr&#237;an haber fallecido y esto podr&#237;a comportar un sesgo&#44; al estar sobrerrepresentados los pacientes con mejor pron&#243;stico&#46; Ello podr&#237;a sesgar los resultados hacia la hip&#243;tesis nula&#44; reforzando el valor de los factores detectados&#46; En el mismo sentido&#44; los controles podr&#237;an ser un potencial caso no diagnosticado&#44; dado que la EA puede no tener traducci&#243;n cl&#237;nica incluso en etapas avanzadas&#46; Este supuesto tambi&#233;n sesgar&#237;a los resultados hacia la hip&#243;tesis nula y&#44; por lo tanto&#44; la detecci&#243;n de cualquier factor de riesgo se afianzar&#237;a a&#250;n m&#225;s en esta situaci&#243;n&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">En relaci&#243;n con el tama&#241;o de la muestra&#44; para algunos casos no se pudieron seleccionar los 3 controles y la muestra final fue algo inferior a la prevista &#40;221 versus 261&#41;&#44; con lo que disminuy&#243; la precisi&#243;n y la potencia estad&#237;stica del estudio&#46; La edad de los controles fue 2&#44;1 a&#241;os inferior a los casos debido a que estaban apareados<span class="elsevierStyleHsp" style=""></span>&#177;5<span class="elsevierStyleHsp" style=""></span>a&#241;os&#46; De todos modos&#44; el n&#250;mero absoluto de a&#241;os no se considera muy elevado y esta variable se tuvo en cuenta en todos los modelos de regresi&#243;n log&#237;stica para neutralizar su posible papel de confusi&#243;n&#46; Asimismo&#44; dado que los controles eran pacientes que fueron a consulta en atenci&#243;n primaria&#44; es plausible que puedan presentar una prevalencia de comorbilidades algo mayor que la poblaci&#243;n general no seleccionada&#44; lo que podr&#237;a sesgar tambi&#233;n los resultados hacia la hip&#243;tesis nula&#46; Adem&#225;s&#44; debido a la naturaleza del estudio observacional no se puede inferir relaciones causales entre FRCV y casos de EA grave&#46; El hecho de que el estudio fue limitado a personas mayores de 65 a&#241;os podr&#237;a influir en la magnitud de la asociaci&#243;n de FRCV y EA grave&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Los resultados de la regresi&#243;n se obtuvieron de los pacientes que aportaron todos los datos&#46; En el caso de la regresi&#243;n donde se determina el efecto de la hemoglobina&#44; un 7&#44;7&#37; de los pacientes no registr&#243; el dato&#44; por lo que los resultados de la regresi&#243;n obviaron el perfil de este 7&#44;7&#37; de los pacientes&#46; Dicha limitaci&#243;n podr&#237;a o no introducir un posible sesgo que los autores consideramos improbable&#44; teniendo en cuenta que consideramos que no existen caracter&#237;sticas diferentes entre los pacientes que registraron o no el dato de inter&#233;s&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Finalmente&#44; los resultados podr&#237;an no ser extrapolables a otras &#225;reas geogr&#225;ficas&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Con este estudio hemos podido cuantificar el papel de los factores de riesgo y las comobilidades que acompa&#241;an a la EA grave&#46; La identificaci&#243;n de pacientes con un riesgo mayor de poder desarrollar esta enfermedad permite reducir el tiempo de diagn&#243;stico y de tratamiento&#44; mejorando&#44; a su vez&#44; su calidad de vida&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusiones</span><p id="par0160" class="elsevierStylePara elsevierViewall">Los FRCV tabaquismo&#44; HTA&#44; hipercolesterolemia y niveles bajos de colesterol-HDL se asocian con la EA grave en personas<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>65<span class="elsevierStyleHsp" style=""></span>a&#241;os&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">La enfermedad renal cr&#243;nica&#44; el accidente vascular cerebral y la estenosis carot&#237;dea son las comorbilidades que se asocian con la EA grave en personas<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>65<span class="elsevierStyleHsp" style=""></span>a&#241;os&#44; y tambi&#233;n se asocian de forma inversa los niveles de hemoglobina&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Este estudio&#44; respecto a anteriores trabajos&#44; ha permitido cuantificar el papel de factores de riesgo y comorbilidades que acompa&#241;an a la EA grave y que podr&#237;an facilitar la identificaci&#243;n de pacientes con mayor riesgo de desarrollar la enfermedad&#46; Esto podr&#237;a reducir el retraso diagn&#243;stico y terap&#233;utico&#44; y con ello mejorar la calidad de vida de los pacientes&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Financiaci&#243;n</span><p id="par0175" class="elsevierStylePara elsevierViewall">El presente trabajo ha sido financiado parcialmente por la Unitat d&#8217;Assaigs Cl&#237;nics i Investigaci&#243; del Servei de Cardiologia de l&#8217;Hospital Arnau de Vilanova de Lleida&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflicto de intereses</span><p id="par0180" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Antecedentes y objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La estenosis a&#243;rtica &#40;EA&#41; es una de las enfermedades cardiovasculares m&#225;s prevalentes en sujetos<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>65<span class="elsevierStyleHsp" style=""></span>a&#241;os&#46; Algunos estudios epidemiol&#243;gicos sugieren que ciertos factores de riesgo cardiovascular &#40;FRCV&#41; y comorbilidades pueden estar asociados con la EA&#46; El objetivo del estudio es evaluar la asociaci&#243;n de FRCV y comorbilidades con la EA grave sintom&#225;tica en pacientes<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>65<span class="elsevierStyleHsp" style=""></span>a&#241;os en una regi&#243;n sanitaria espa&#241;ola&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Pacientes y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Se realiz&#243; un estudio epidemiol&#243;gico de casos y controles procedentes del mismo centro de atenci&#243;n primaria&#46; Se recogi&#243; informaci&#243;n sobre la exposici&#243;n a FRCV y comorbilidades&#44; y se determin&#243; la asociaci&#243;n de ambos con la EA con <span class="elsevierStyleItalic">odds ratio</span> ajustadas &#40;ORa&#41;&#44; mediante modelos de regresi&#243;n log&#237;stica m&#250;ltiple&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron un total de 102 casos &#40;edad media<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>77&#44;6 a&#241;os&#41; y 221 controles &#40;edad media<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>75&#44;5 a&#241;os&#41;&#46; Los FRCV significativamente asociados con la EA grave sintom&#225;tica fueron hipercolesterolemia &#40;ORa<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44;67&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; tabaquismo &#40;ORa<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44;60&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; hipertensi&#243;n &#40;ORa<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44;41&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;010&#41; y cifras bajas de colesterol-HDL &#40;ORa<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44;20&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;007&#41;&#46; Las comorbilidades significativamente asociadas con la EA grave sintom&#225;tica fueron estenosis carot&#237;dea &#40;ORa<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>14&#44;5&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;017&#41;&#44; accidente vascular cerebral &#40;ORa<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#44;14&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;024&#41;&#44; insuficiencia renal cr&#243;nica &#40;ORa<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#44;78&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; y bajos niveles de hemoglobina &#40;ORa<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;76&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La hipercolesterolemia&#44; el tabaquismo&#44; la hipertensi&#243;n arterial y los niveles bajos de colesterol-HDL son los FRCV que comportan mayor riesgo de EA grave&#46; Asimismo&#44; esta enfermedad se asocia con algunas comorbilidades &#40;insuficiencia renal cr&#243;nica&#44; accidente vascular cerebral&#44; estenosis carot&#237;dea y niveles de hemoglobina m&#225;s bajos&#41; que podr&#237;an ser marcadores de EA&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Background and objective</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Aortic stricture &#40;AS&#41; is one of the most prevalent cardiovascular diseases in individuals 65 years of age or older&#46; A number of epidemiological studies have suggested that certain cardiovascular risk factors &#40;CRFs&#41; and comorbidities could be associated with AS&#46; The aim of this study was to evaluate the association between CRFs and comorbidities and severe symptomatic AS in individuals 65 years of age or older in a Spanish healthcare region&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Patients and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">We conducted an epidemiological case-control study from a single primary care centre&#46; We collected information on exposure to CRFs and comorbidities and determined their association with AS&#44; employing adjusted odds ratios &#40;OR&#41; and multiple logistic regression models&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The study included 102 cases &#40;mean age&#44; 77&#46;6 years&#41; and 221 controls &#40;mean age&#44; 75&#46;5 years&#41;&#46; The CRFs significantly associated with severe symptomatic AS were hypercholesterolaemia &#40;OR&#44; 2&#46;67&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#44; tobacco use &#40;OR&#44; 2&#46;60&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#44; hypertension &#40;OR&#44; 2&#46;41&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;010&#41; and low HDL cholesterol readings &#40;OR&#44; 2&#46;20&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;007&#41;&#46; The comorbidities significantly associated with severe symptomatic AS were carotid stenosis &#40;OR&#44; 14&#46;5&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;017&#41;&#44; stroke &#40;OR&#44; 4&#46;14&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;024&#41;&#44; chronic renal failure &#40;OR&#44; 3&#46;78&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; and low haemoglobin levels &#40;OR&#44; 0&#46;76&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Hypercholesterolaemia&#44; tobacco use&#44; arterial hypertension and low HDL cholesterol levels are the CRFs with a greater risk of severe AS&#46; Furthermore&#44; this disease is associated with a number of comorbidities &#40;chronic renal failure&#44; stroke&#44; carotid stenosis and low haemoglobin levels&#41;&#44; which could be markers of AS&#46;</p></span>"
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          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">AIT&#58; accidente isqu&#233;mico transitorio&#59; AVC&#58; accidente vascular cerebral&#59; DE&#58; desviaci&#243;n est&#225;ndar&#59; EC&#58; estenosis carot&#237;dea&#59; EPOC&#58; enfermedad pulmonar obstructiva cr&#243;nica&#59; HDL&#58; lipoprote&#237;nas de alta densidad &#40;<span class="elsevierStyleItalic">high density lipoproteins</span>&#41;&#59; IAM&#44; infarto agudo de miocardio&#59; IMC&#44; &#237;ndice de masa corporal&#59; IRC&#58; insuficiencia renal cr&#243;nica&#59; ITB&#58; &#237;ndice tobillo-brazo&#46;</p><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">La obesidad central se ha definido como un per&#237;metro abdominal<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>102<span class="elsevierStyleHsp" style=""></span>cm en varones y<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>88<span class="elsevierStyleHsp" style=""></span>cm en mujeres&#44; y la prevalencia de anemia se ha definido como niveles de hemoglobina<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>13<span class="elsevierStyleHsp" style=""></span>g&#47;dl en varones y &#60;<span class="elsevierStyleHsp" style=""></span>12<span class="elsevierStyleHsp" style=""></span>g&#47;dl en mujeres&#46;</p>"
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Casos&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>102&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Controles&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>221&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Edad en a&#241;os&#44; media</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#177;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">DE</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">77&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">75&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#44;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;003<a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Sexo&#44; n &#40;&#37; femenino&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39 &#40;38&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">92 &#40;41&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;564&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">Peso &#40;kg&#41;&#44; media</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#177;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">DE</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">77<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#44;9<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">74&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#44;4<a class="elsevierStyleCrossRef" href="#tblfn0040"><span class="elsevierStyleSup">g</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;076&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">IMC &#40;kg&#47;m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">&#41;&#44; media</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#177;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">DE</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">29<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;9<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;5<a class="elsevierStyleCrossRef" href="#tblfn0040"><span class="elsevierStyleSup">g</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;118&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">IMC categorizado &#40;kg&#47;m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">&#41;&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" 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">0&#44;335&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>Normal &#40;&#8804;<span class="elsevierStyleHsp" style=""></span>24&#44;9<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#40;18&#44;2&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43 &#40;20&#44;9&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0040"><span class="elsevierStyleSup">g</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" 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>Sobrepeso &#40;25-29&#44;9<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43 &#40;43&#44;4&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">96 &#40;46&#44;6&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0040"><span class="elsevierStyleSup">g</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" 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>Obesidad &#40;&#8805;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38 &#40;38&#44;4&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">67 &#40;32&#44;5&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0040"><span class="elsevierStyleSup">g</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" 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="elsevierStyleItalic">Per&#237;metro abdominal &#40;cm&#41;&#44; media</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#177;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">DE</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">107&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#44;6<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">102&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#44;1<a class="elsevierStyleCrossRef" href="#tblfn0045"><span class="elsevierStyleSup">h</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;003<a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Obesidad central&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45 &#40;83&#44;3&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">109 &#40;67&#44;3&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0045"><span class="elsevierStyleSup">h</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;024<a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">ITB&#44; media</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#177;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">DE</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">1&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;2<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">d</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;2<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;622&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">ITB</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#60;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">0&#44;9&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;8&#44;9&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">d</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;15&#44;2&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;267&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">Hemoglobina &#40;media</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#177;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">DE&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;8<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">e</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;7<a class="elsevierStyleCrossRef" href="#tblfn0050"><span class="elsevierStyleSup">i</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001<a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Hematocrito &#40;media</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#177;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">DE&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#44;1<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">e</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#44;3<a class="elsevierStyleCrossRef" href="#tblfn0055"><span class="elsevierStyleSup">j</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001<a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Factores de riesgo cardiovascular</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Tabaquismo &#40;actual o previo&#41;&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39 &#40;38&#44;2&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">e</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53 &#40;25&#44;4&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0060"><span class="elsevierStyleSup">k</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;020<a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Antecedentes de hipertensi&#243;n&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">87 &#40;85&#44;3&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">e</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">147 &#40;70&#44;3&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0060"><span class="elsevierStyleSup">k</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;004<a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Antecedentes de hipercolesterolemia&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">73 &#40;71&#44;6&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">e</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">107 &#40;51&#44;2&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0060"><span class="elsevierStyleSup">k</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;001<a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Antecedentes de HDL bajo&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35 &#40;34&#44;3&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">e</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40 &#40;19&#44;1&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0060"><span class="elsevierStyleSup">k</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;003<a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Antecedentes de diabetes&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34 &#40;33&#44;7&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">f</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59 &#40;28&#44;8&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0065"><span class="elsevierStyleSup">l</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;383&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">Antecedentes de obesidad&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44 &#40;43&#44;1&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">e</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71 &#40;34&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0060"><span class="elsevierStyleSup">k</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;116&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">Historia familiar de cardiopat&#237;a isqu&#233;mica&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" 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">0&#44;833&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>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">89 &#40;89&#44;9&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">186 &#40;91&#44;6&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0070"><span class="elsevierStyleSup">m</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" 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>Dudosa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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 &#40;2&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0070"><span class="elsevierStyleSup">m</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" 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>S&#237; &#40;documentada&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;8&#44;1&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17 &#40;8&#44;4&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0070"><span class="elsevierStyleSup">m</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" 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" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Antecedentes patol&#243;gicos</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Antecedentes nefrol&#243;gicos &#40;IRC&#41;&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29 &#40;28&#44;4&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">e</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17 &#40;8&#44;1&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0075"><span class="elsevierStyleSup">n</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001<a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Antecedentes patol&#243;gicos respiratorios&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" 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">0&#44;049<a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71 &#40;69&#44;6&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">e</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">169 &#40;80&#44;5&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0075"><span class="elsevierStyleSup">n</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" 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>EPOC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19 &#40;18&#44;6&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">e</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25 &#40;11&#44;9&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0075"><span class="elsevierStyleSup">n</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" 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>Otros&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;11&#44;8&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">e</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;7&#44;6&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0075"><span class="elsevierStyleSup">n</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" 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="elsevierStyleItalic">Antecedentes neurol&#243;gicos&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" 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">0&#44;002<a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">90 &#40;88&#44;2&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">e</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">179 &#40;85&#44;2&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0075"><span class="elsevierStyleSup">n</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" 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>AIT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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 &#40;2&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">e</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;1&#44;9&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0075"><span class="elsevierStyleSup">n</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" 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>AVC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;8&#44;8&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">e</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;2&#44;4&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0075"><span class="elsevierStyleSup">n</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" 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>Otros&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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 &#40;1&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">e</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22 &#40;10&#44;5&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0075"><span class="elsevierStyleSup">n</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" 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="elsevierStyleItalic">Antecedentes arteriopat&#237;a carot&#237;dea &#40;EC&#41;&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;5&#44;9&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">e</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;0&#44;5&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0075"><span class="elsevierStyleSup">n</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;002<a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Antecedentes arteriopat&#237;a perif&#233;rica&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;2&#44;9&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">e</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;4&#44;3&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0075"><span class="elsevierStyleSup">n</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;562&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">IAM&#44; n &#40;&#37;&#41;</span><span class="elsevierStyleHsp" style=""></span>Ninguno<span class="elsevierStyleHsp" style=""></span>Uno<span class="elsevierStyleHsp" style=""></span>Dos o m&#225;s&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">88 &#40;86&#44;3&#37;&#41;10 &#40;9&#44;8&#37;&#41;4 &#40;3&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">190 &#40;96&#44;4&#37;&#41;7 &#40;3&#44;6&#37;&#41;0 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001<a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Intervencionismo cardiol&#243;gico previo&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#40;17&#44;65&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;0&#44;95&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0075"><span class="elsevierStyleSup">n</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001<a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Antecedentes patol&#243;gicos endocrinol&#243;gicos&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;6&#44;9&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">e</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24 &#40;11&#44;4&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0075"><span class="elsevierStyleSup">n</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;206&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">Antecedentes digestivos&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#40;17&#44;6&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">e</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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Vol. 221. Núm. 5.
Páginas 249-257 (mayo 2021)
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127
Vol. 221. Núm. 5.
Páginas 249-257 (mayo 2021)
Original
Factores de riesgo y comorbilidades asociadas a la estenosis aórtica grave: estudio de casos y controles
Risk factors and comorbidities associated with severe aortic stenosis: a case-control study
Visitas
127
J.M. Gracia Baenaa,b,
Autor para correspondencia
drjmccv@hotmail.com

Autor para correspondencia.
, I. Calaf Vallc, M. Zielonkac, J.R. Marsal Morad, P. Godoyb,e,f, F. Worner Dizc
a Servei de Cirurgia Cardíaca d’Adults, Hospital Universitari Vall d’Hebron, Barcelona, España
b Unitat d’Epidemiologia Aplicada, Departament de Cirurgia, Universitat de Lleida, Lérida, España
c Servei de Cardiologia, Hospital Universitari Arnau de Vilanova, Lérida, España
d Unitat de Suport a la Recerca Lleida, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, España
e CIBER de Epidemiología y Salud Pública CIBERESP, Barcelona, España
f Agència de Salut Pública de Catalunya, Barcelona, España
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Estadísticas
Figuras (2)
Tablas (3)
Tabla 1. Características demográficas y clínicas de casos y controles
Tabla 2. Análisis de la magnitud de asociación de factores de riesgo cardiovascular con la EA grave
Tabla 3. Análisis de la magnitud de asociación de comorbilidades con la EA grave
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Resumen
Antecedentes y objetivo

La estenosis aórtica (EA) es una de las enfermedades cardiovasculares más prevalentes en sujetos65años. Algunos estudios epidemiológicos sugieren que ciertos factores de riesgo cardiovascular (FRCV) y comorbilidades pueden estar asociados con la EA. El objetivo del estudio es evaluar la asociación de FRCV y comorbilidades con la EA grave sintomática en pacientes65años en una región sanitaria española.

Pacientes y métodos

Se realizó un estudio epidemiológico de casos y controles procedentes del mismo centro de atención primaria. Se recogió información sobre la exposición a FRCV y comorbilidades, y se determinó la asociación de ambos con la EA con odds ratio ajustadas (ORa), mediante modelos de regresión logística múltiple.

Resultados

Se incluyeron un total de 102 casos (edad media=77,6 años) y 221 controles (edad media=75,5 años). Los FRCV significativamente asociados con la EA grave sintomática fueron hipercolesterolemia (ORa=2,67; p<0,001), tabaquismo (ORa=2,60; p<0,001), hipertensión (ORa=2,41; p=0,010) y cifras bajas de colesterol-HDL (ORa=2,20; p=0,007). Las comorbilidades significativamente asociadas con la EA grave sintomática fueron estenosis carotídea (ORa=14,5; p=0,017), accidente vascular cerebral (ORa=4,14; p=0,024), insuficiencia renal crónica (ORa=3,78; p<0,001) y bajos niveles de hemoglobina (ORa=0,76; p<0,001).

Conclusiones

La hipercolesterolemia, el tabaquismo, la hipertensión arterial y los niveles bajos de colesterol-HDL son los FRCV que comportan mayor riesgo de EA grave. Asimismo, esta enfermedad se asocia con algunas comorbilidades (insuficiencia renal crónica, accidente vascular cerebral, estenosis carotídea y niveles de hemoglobina más bajos) que podrían ser marcadores de EA.

Palabras clave:
Estenosis aórtica
Factor de riesgo cardiovascular
Comorbilidades
Epidemiología
Abstract
Background and objective

Aortic stricture (AS) is one of the most prevalent cardiovascular diseases in individuals 65 years of age or older. A number of epidemiological studies have suggested that certain cardiovascular risk factors (CRFs) and comorbidities could be associated with AS. The aim of this study was to evaluate the association between CRFs and comorbidities and severe symptomatic AS in individuals 65 years of age or older in a Spanish healthcare region.

Patients and methods

We conducted an epidemiological case-control study from a single primary care centre. We collected information on exposure to CRFs and comorbidities and determined their association with AS, employing adjusted odds ratios (OR) and multiple logistic regression models.

Results

The study included 102 cases (mean age, 77.6 years) and 221 controls (mean age, 75.5 years). The CRFs significantly associated with severe symptomatic AS were hypercholesterolaemia (OR, 2.67; p<.001), tobacco use (OR, 2.60; p<.001), hypertension (OR, 2.41; p=.010) and low HDL cholesterol readings (OR, 2.20; p=.007). The comorbidities significantly associated with severe symptomatic AS were carotid stenosis (OR, 14.5; p=.017), stroke (OR, 4.14; p=.024), chronic renal failure (OR, 3.78; p<.001) and low haemoglobin levels (OR, 0.76; p<.001).

Conclusions

Hypercholesterolaemia, tobacco use, arterial hypertension and low HDL cholesterol levels are the CRFs with a greater risk of severe AS. Furthermore, this disease is associated with a number of comorbidities (chronic renal failure, stroke, carotid stenosis and low haemoglobin levels), which could be markers of AS.

Keywords:
Aortic stricture
Cardiovascular risk factor
Comorbidities
Epidemiology

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