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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Antecedentes</span><p id="par0005" class="elsevierStylePara elsevierViewall">La diabetes es un trastorno metab&#243;lico resultante de un metabolismo anormal de la glucosa&#44; y es una de las enfermedades cr&#243;nicas m&#225;s prevalentes en todo el mundo<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46; Seg&#250;n los &#250;ltimos estudios epidemiol&#243;gicos&#44; la tasa de prevalencia es de 6&#46;059 casos por 100&#46;000 personas&#44; y la carga mundial de la diabetes aumenta constantemente&#46; Se prev&#233; que en 2030 la incidencia de la diabetes de tipo<span class="elsevierStyleHsp" style=""></span>2 en todo el mundo aumente a 7&#46;079 casos por 100&#46;000 personas<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a>&#46; Conforme progresa la diabetes&#44; puede causar discapacidad a largo plazo y afectar significativamente a la calidad de vida&#46; La enfermedad puede causar lesiones multiorg&#225;nicas&#44; lo que origina complicaciones como episodios cardiovasculares&#44; enfermedades cerebrovasculares&#44; nefropat&#237;as y enfermedades oculares<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a>&#46; Por consiguiente&#44; la identificaci&#243;n de poblaciones con alto riesgo de padecer diabetes mediante m&#233;todos sencillos y eficaces tiene gran importancia&#44; dada la considerable carga que supone para los pacientes&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">La gen&#233;tica&#44; la dieta&#44; los h&#225;bitos poco saludables y los factores ambientales contribuyen al desarrollo de la diabetes&#44; y la obesidad est&#225; estrechamente relacionada con la enfermedad&#46; Numerosos estudios han demostrado que el &#237;ndice de masa corporal &#40;IMC&#41;&#44; como indicador de obesidad&#44; puede predecir eficazmente la diabetes<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6-8</span></a>&#46; Adem&#225;s&#44; las investigaciones indican que el aumento de la rigidez arterial se asocia estrechamente a hiperglucemia&#44; hiperinsulinemia y tolerancia anormal a la glucosa<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#46; La velocidad estimada de la onda del pulso &#40;ePWV&#41;&#44; un nuevo indicador de la rigidez arterial&#44; ofrece ventajas sobre la velocidad de la onda de pulso &#40;PWV&#41; tradicional&#44; puesto que su determinaci&#243;n es m&#225;s sencilla y menos costosa&#46; En estudios anteriores la ePWV se ha relacionado con el deterioro cognitivo&#44; el ictus&#44; los episodios cardiovasculares y la hipertensi&#243;n<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10-13</span></a>&#46; Sin embargo&#44; su valor predictivo de la diabetes sigue siendo insuficiente&#46; Este estudio pretende evaluar el valor predictivo combinado de la ePWv y el IMC para detectar la diabetes <span class="elsevierStyleItalic">de novo</span> en los pacientes&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">M&#233;todos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Dise&#241;o del estudio y fuente de los datos</span><p id="par0015" class="elsevierStylePara elsevierViewall">Este estudio es un an&#225;lisis secundario de un estudio de cohortes realizado por Rich Healthcare&#44; detallado anteriormente<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a>&#46; En el estudio de cohortes de Rich Healthcare se reclut&#243; a 685&#46;277 adultos de 11 ciudades de China que se sometieron a reconocimientos m&#233;dicos entre 2011 y 2016&#46; El proyecto tiene como objetivo promover la salud entre la poblaci&#243;n china y evaluar la diabetes y sus factores de riesgo mediante chequeos m&#233;dicos y seguimientos&#46; Los conjuntos de datos generados y analizados durante el presente estudio est&#225;n disponibles en el repositorio de Dryad &#40;<a href="http://datadryad.org/withthedoi:10.5061/dryad.ft8750v">http&#58;&#47;&#47;datadryad&#46;org&#47;withthedoi&#58;10&#46;5061&#47;dryad&#46;ft8750v</a>&#41;&#46; Seg&#250;n las condiciones de servicio de la base de datos&#44; los investigadores pueden utilizar libremente datos p&#250;blicos para su posterior an&#225;lisis con el fin de maximizar su utilidad&#46; Dado que el anonimato de los datos y la &#233;tica de la investigaci&#243;n se aprobaron en estudios anteriores&#44; este estudio no requiere una nueva solicitud&#46; Este estudio es un an&#225;lisis <span class="elsevierStyleItalic">post hoc</span> basado en investigaciones previas&#46; Los criterios de exclusi&#243;n para los pacientes del estudio son&#58; 1&#41;<span class="elsevierStyleHsp" style=""></span>pacientes con un diagn&#243;stico de diabetes en la entrevista inicial&#59; 2&#41;<span class="elsevierStyleHsp" style=""></span>situaci&#243;n poco clara de la diabetes durante el seguimiento&#59; 3&#41;<span class="elsevierStyleHsp" style=""></span>menos de 2<span class="elsevierStyleHsp" style=""></span>a&#241;os de seguimiento&#59; 4&#41;<span class="elsevierStyleHsp" style=""></span>valores incompletos o extremos de sexo&#44; IMC&#44; glucemia en ayunas &#40;GA&#41; y lipidemia&#59; 5&#41;<span class="elsevierStyleHsp" style=""></span>falta de informaci&#243;n sobre la determinaci&#243;n de la estatura&#44; el peso o la presi&#243;n arterial&#44; y 6&#41;<span class="elsevierStyleHsp" style=""></span>pacientes que no participaron por motivos desconocidos&#46; Finalmente&#44; se analizaron 211&#46;833 pacientes elegibles&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Recogida de datos</span><p id="par0020" class="elsevierStylePara elsevierViewall">Todos los pacientes del estudio cumplimentaron un cuestionario est&#225;ndar que inclu&#237;a las caracter&#237;sticas demogr&#225;ficas y los resultados de la exploraci&#243;n f&#237;sica&#44; como la edad&#44; los antecedentes familiares de diabetes&#44; el sexo&#44; la presi&#243;n arterial&#44; la estatura&#44; el peso y el consumo de tabaco&#47;alcohol&#46; El peso y la estatura se determinaron en el interior&#44; con el paciente vestido con ropa ligera y descalzo&#46; La presi&#243;n arterial se determin&#243; con un esfigmoman&#243;metro de mercurio est&#225;ndar en un entorno tranquilo&#46; Las muestras de sangre venosa en ayunas fueron recogidas por personal formado y analizadas mediante un analizador autom&#225;tico &#40;Beckman 5800&#41; en un laboratorio est&#225;ndar&#46; Las concentraciones plasm&#225;ticas de glucosa se determinaron con el m&#233;todo de la glucosa oxidasa&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Definici&#243;n y c&#225;lculo</span><p id="par0025" class="elsevierStylePara elsevierViewall">El inicio del seguimiento comenz&#243; despu&#233;s de la evaluaci&#243;n cl&#237;nica inicial de la diabetes del paciente y el criterio de valoraci&#243;n se caracteriz&#243; por la aparici&#243;n de un nuevo episodio de diabetes&#46; El seguimiento se realiz&#243; principalmente una vez al a&#241;o en el centro de exploraci&#243;n&#46; El diagn&#243;stico de diabetes se bas&#243; en los antecedentes comunicados por el paciente o en una GA medida &#8805;<span class="elsevierStyleHsp" style=""></span>7&#44;00<span class="elsevierStyleHsp" style=""></span>mmol&#47;l durante el seguimiento<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a>&#46; En el caso de los pacientes con un diagn&#243;stico previo de diabetes&#44; los investigadores revisaron su glucemia el d&#237;a del diagn&#243;stico o en la &#250;ltima visita&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">C&#225;lculo de indicadores</span><p id="par0030" class="elsevierStylePara elsevierViewall">El c&#225;lculo de la ePWV afecta principalmente a la edad y a la presi&#243;n arterial&#44; y la f&#243;rmula de la ePWV es&#58;</p><p id="par0035" class="elsevierStylePara elsevierViewall">ePWV<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>9&#44;587<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>0&#44;402<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>edad<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>4&#44;560<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleHsp" style=""></span>&#8722;3<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>edad2<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>2&#44;621<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>5<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>edad2<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>MBP<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>3&#44;176<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleHsp" style=""></span>&#8722;3<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>edad<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>MBP<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>1&#44;832<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>MBP<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16&#44;17</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">El IMC se calcula como el peso dividido por la estatura al cuadrado&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">An&#225;lisis estad&#237;stico</span><p id="par0045" class="elsevierStylePara elsevierViewall">El an&#225;lisis estad&#237;stico se realiz&#243; con el programa R versi&#243;n 4&#46;2 e IBM SPSS Statistics versi&#243;n 23&#46;0&#46; Las variables continuas se presentaron como media &#177;<span class="elsevierStyleHsp" style=""></span>desviaci&#243;n est&#225;ndar &#40;DE&#41;&#44; mientras que las variables categ&#243;ricas se presentaron como valores absolutos y porcentajes&#46; Para las comparaciones param&#233;tricas se utilizaron la prueba de la t y el an&#225;lisis de la varianza &#40;ANOVA&#41; unidireccional&#44; mientras que para las comparaciones no param&#233;tricas se utilizaron las prueba de la U de Mann-Whitney y Kruskal-Wallis&#46; Se utiliz&#243; la prueba de la ji al cuadrado o la prueba exacta de Fisher para comparar las variables categ&#243;ricas seg&#250;n fuera necesario&#46; Los modelos log&#237;sticos multifactoriales incluyeron variables significativas con un valor de p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;1 en los an&#225;lisis univariantes&#46; Se utilizaron curvas ROC &#40;curvas de eficacia diagn&#243;stica&#41; para calcular la sensibilidad y la especificidad de la ePWV&#44; el IMC y la ePWV combinada con el IMC&#46; Las variables para la selecci&#243;n del modelo incluyeron todas las posibles variables de confusi&#243;n&#46; Todos los contrastes de hip&#243;tesis fueron bilaterales y se consider&#243; estad&#237;sticamente significativo un valor de p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Resultados</span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Caracter&#237;sticas antropom&#233;tricas y bioqu&#237;micas</span><p id="par0050" class="elsevierStylePara elsevierViewall">Tras excluir a los pacientes que no cumpl&#237;an los criterios&#44; se analizaron 211&#46;833 pacientes elegibles&#44; entre ellos 116&#46;123 hombres y 95&#46;710 mujeres&#44; con una edad media de 42&#44;10<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#44;65<span class="elsevierStyleHsp" style=""></span>a&#241;os&#44; una ePWV media de 7&#44;47<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;72 &#40;m&#47;s&#41; y un IMC medio de 23&#44;24<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;34 &#40;kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&#46; En funci&#243;n de si se les diagnostic&#243; diabetes al final del seguimiento&#44; se dividieron en el grupo de diabetes y el grupo sin diabetes&#46; Las caracter&#237;sticas antropom&#233;tricas y bioqu&#237;micas de los pacientes se muestran en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46; Puede observarse que&#44; en este estudio&#44; los pacientes con diabetes <span class="elsevierStyleItalic">de novo</span> tuvieron m&#225;s probabilidades de ser hombres&#44; de edad avanzada&#44; de ser m&#225;s altos y de ser m&#225;s pesados&#44; con un mayor IMC y presi&#243;n arterial sist&#243;lica &#40;PAS&#41; y presi&#243;n arterial diast&#243;lica &#40;PAD&#41; m&#225;s elevadas&#44; as&#237; como de fumar&#44; beber alcohol y tener antecedentes familiares de diabetes&#46; En cuanto a los indicadores hematol&#243;gicos&#44; presentaron niveles m&#225;s altos de colesterol&#44; triglic&#233;ridos&#44; lipoprote&#237;nas de baja densidad &#40;LDL&#41;&#44; alanina aminotransferasa &#40;ALT&#41;&#44; aspartato aminotransferasa &#40;AST&#41;&#44; nitr&#243;geno ureico en sangre &#40;BUN&#41;&#44; aclaramiento de creatinina &#40;CCR&#41;&#44; <span class="elsevierStyleItalic">mean arterial pressure</span> &#40;MAP&#41;&#44; ePWV y niveles m&#225;s bajos de colesterol de las lipoprote&#237;nas de alta densidad &#40;cHDL&#41; &#40;como se muestra en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">An&#225;lisis de regresi&#243;n log&#237;stica multivariante de los factores de riesgo de diabetes mellitus &#40;DM&#41;</span><p id="par0055" class="elsevierStylePara elsevierViewall">Para investigar la correlaci&#243;n entre diversos indicadores y la incidencia de diabetes <span class="elsevierStyleItalic">de novo</span> se realiz&#243; una regresi&#243;n log&#237;stica multivariante con la aparici&#243;n de DM como variable dependiente y diversos indicadores pertinentes como variables independientes&#46; Los resultados demostraron que el IMC&#44; los triglic&#233;ridos&#44; el ALT&#44; el BUN&#44; el CCR&#44; la ePWV y los antecedentes familiares de diabetes eran factores de alto riesgo de diabetes <span class="elsevierStyleItalic">de novo</span> &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46; La raz&#243;n de posibilidades &#40;IC del 95&#37;&#41; para el IMC fue de 1&#44;132 &#40;1&#44;087-1&#44;178&#41;&#44; y la raz&#243;n de posibilidades &#40;IC del 95&#37;&#41; para la ePWV fue de 1&#44;573 &#40;1&#44;464-1&#44;689&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">An&#225;lisis de curvas ROC</span><p id="par0060" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a> se muestra la capacidad de la ePWV&#44; el IMC y su combinaci&#243;n para predecir la diabetes <span class="elsevierStyleItalic">de novo</span>&#46; Se calcularon curvas ROC para demostrar la capacidad de la ePWV&#44; el IMC y la combinaci&#243;n de ambos factores para distinguir la DM de la no DM&#46; El &#225;rea bajo la curva ROC &#40;ABC&#41; se calcul&#243; para evaluar el rendimiento discriminatorio de cada biomarcador para la DM&#46; Las comparaciones emparejadas de las curvas ROC con el m&#233;todo de DeLong indicaron que ni el modelo de ePWV &#40;ABC&#58; 0&#44;789&#59; IC del 95&#37;&#58; 0&#44;783-0&#44;795&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; ni el modelo de IMC &#40;ABC&#58; 0&#44;740&#59; IC del 95&#37;&#58; 0&#44;733-0&#44;747&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; resultaron tan eficaces como el modelo combinado de ePWV e IMC &#40;ABC&#58; 0&#44;822&#59; IC del 95&#37;&#58; 0&#44;817-0&#44;828&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Discusi&#243;n</span><p id="par0065" class="elsevierStylePara elsevierViewall">En este estudio investigamos si la combinaci&#243;n de ePWV e IMC tiene un buen valor predictivo del riesgo de diabetes en un estudio de cohortes con una gran muestra de poblaci&#243;n china&#46; Tras el ajuste respecto a los factores de confusi&#243;n que podr&#237;an contribuir al riesgo de diabetes mediante regresi&#243;n log&#237;stica multivariante&#44; observamos una correlaci&#243;n positiva significativa entre la ePWV&#47;IMC y la diabetes <span class="elsevierStyleItalic">de novo</span> &#40;la RP &#91;IC del 95&#37;&#93; para el IMC fue de 1&#44;132 &#91;1&#44;087-1&#44;178&#93; y la RP &#91;IC del 95&#37;&#93; para la ePWV fue de 1&#44;573 &#91;1&#44;464-1&#44;689&#93;&#41;&#46; Adem&#225;s&#44; al utilizar curvas ROC observamos que el valor combinado de los dos factores es mayor que el valor de cualquiera de ellos por separado&#44; lo que indica un buen valor diagn&#243;stico&#47;predictivo&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">La incidencia de diabetes y sus complicaciones&#44; como las enfermedades cardiovasculares y renales&#44; est&#225; aumentando&#44; lo que supone una carga enorme en todo el mundo&#46; Aunque el riesgo de mortalidad relacionada con la diabetes ha disminuido en los &#250;ltimos a&#241;os&#44; el riesgo relativo de acontecimientos adversos cardiovasculares en los pacientes diab&#233;ticos sigue siendo elevado<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18&#44;19</span></a>&#46; Un metan&#225;lisis revel&#243; que la diabetes puede duplicar el riesgo de padecer diversas enfermedades cardiovasculares&#44; con independencia de otros factores de riesgo convencionales<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a>&#46; Por consiguiente&#44; sigue siendo urgente investigar m&#233;todos m&#225;s eficaces para el cribado y el diagn&#243;stico precoces de los pacientes diab&#233;ticos a fin de ayudar a aplicar estrategias de prevenci&#243;n espec&#237;ficas y proactivas&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Se cree que el aumento de la rigidez arterial en los pacientes diab&#233;ticos guarda relaci&#243;n con las variaciones cuantitativas y cualitativas de la elastina y el col&#225;geno de la pared arterial<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a>&#46; Los resultados de estudios relacionados indican que este cambio puede deberse a factores distintos de la hiperglucemia e hiperinsulinemia de corta duraci&#243;n&#44; como el estr&#233;s carbonilo y oxidativo&#44; la inflamaci&#243;n cr&#243;nica de bajo grado y la disfunci&#243;n endotelial&#44; incluida la hiperglucemia de larga duraci&#243;n y la formaci&#243;n de productos finales resultantes de la glucaci&#243;n avanzada<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">22-25</span></a>&#46; En la actualidad&#44; una gran cantidad de investigaciones demuestran que la diabetes puede aumentar la rigidez arterial<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">26&#44;27</span></a>&#44; y las &#250;ltimas investigaciones han revelado que puede haber bidireccionalidad entre ellas&#46; Tras el ajuste con respecto a posibles factores de confusi&#243;n&#44; para el tercer cuartil de velocidad de la onda del pulso de la car&#243;tida-femoral &#40;c-fPWV&#41;&#44; los cocientes de riesgo de diabetes fueron de 1&#44;00 &#40;referencia&#41;&#44; 1&#44;83 &#40;IC del 95&#37;&#58; 0&#44;88-3&#44;8&#41; y 3&#44;24 &#40;IC del 95&#37;&#58; 1&#44;51-6&#44;97&#41; &#40;p para la tendencia<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#41;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a>&#46; Weber coment&#243; la racionalidad de la relaci&#243;n bidireccional entre la rigidez arterial y el desarrollo de diabetes&#44; y recibi&#243; apoyo de diversos estudios<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a>&#46; Eiji Kimoto revel&#243; que la diabetes ten&#237;a una repercusi&#243;n significativa en la <span class="elsevierStyleItalic">heart-carotid pulse wave velocity</span> &#40;hcPWV&#58;&#41;&#44; <span class="elsevierStyleItalic">heart-to-brachium pulse wave velocity</span> &#40;hbPWV&#41; y la <span class="elsevierStyleItalic">femoral ankle pulse wave velocity</span> &#40;faPWV&#41; mediante comparaciones agrupadas de personas sanas y pacientes diab&#233;ticos&#46; La diabetes de tipo<span class="elsevierStyleHsp" style=""></span>2 tiene diferentes efectos sobre la rigidez arterial central y perif&#233;rica&#44; y la diabetes y la edad tienen un mayor efecto sobre la PWV car&#243;tida-femoral y la PWV cardiaca-inguinal que sobre la PWV tobillo-braquial y cardiaca-braquial<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a>&#46; Aunque en estos estudios se utilizaron diferentes indicadores de rigidez arterial&#44; como el &#237;ndice de presi&#243;n arterial central&#44; la presi&#243;n arterial perif&#233;rica y el &#237;ndice de aumento de la presi&#243;n arterial&#44; se lleg&#243; a conclusiones similares de que el aumento de la rigidez arterial se asocia a un mayor riesgo de padecer diabetes&#46; Tambi&#233;n obtuvimos resultados similares utilizando la ePWV no invasiva como indicador fiable para evaluar la rigidez arterial&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">El IMC puede reflejar la acumulaci&#243;n de grasa corporal y est&#225; estrechamente relacionado con el riesgo de padecer diabetes&#44; que es un factor de riesgo reconocido de desregulaci&#243;n de la glucemia&#46; En un estudio de Graham et al&#46;&#44; en el que se sigui&#243; a 114&#46;824 mujeres durante 14 a&#241;os y se ajust&#243; respecto a la edad&#44; el IMC fue el principal factor predictivo del riesgo de diabetes&#44; y el riesgo aument&#243; con el incremento del IMC&#44; incluso en las mujeres con un peso medio &#40;IMC 24&#44;0<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#41;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a>&#46; En otro estudio de estadounidenses de mediana edad y edad avanzada se demostr&#243; que el aumento de peso en etapas posteriores de la vida &#40;despu&#233;s de los 50 o 65<span class="elsevierStyleHsp" style=""></span>a&#241;os&#41; era un factor de riesgo importante de diabetes en las personas de edad avanzada&#46; Aunque el riesgo asociado a la obesidad parece disminuir con la edad&#44; entre los participantes de 75 o m&#225;s a&#241;os las personas con un IMC m&#225;s alto siguen teniendo el doble de riesgo de padecer diabetes que aquellas con un IMC m&#225;s bajo<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a>&#46; Un estudio japon&#233;s tambi&#233;n indic&#243; que los aumentos a largo plazo del IMC durante la edad adulta son factores predictivos importantes del desarrollo de diabetes&#44; con independencia del estado de peso alcanzado&#44; e incluso el aumento de peso dentro del intervalo de peso normal puede aumentar el riesgo de padecer diabetes<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a>&#46; Asimismo&#44; nuestro estudio tambi&#233;n encontr&#243; una correlaci&#243;n significativa entre el IMC y el riesgo de diabetes&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Los indicadores de la ePWV y del IMC pueden reflejar&#44; respectivamente&#44; el estado de salud del aparato circulatorio y la acumulaci&#243;n de grasa corporal&#44; y su uso combinado puede evaluar m&#225;s exhaustivamente el riesgo de desarrollar diabetes en las personas&#46; Adem&#225;s&#44; la combinaci&#243;n de estos dos biomarcadores tiene un mayor valor predictivo para la DM de diagn&#243;stico reciente que el uso de cualquiera de ellos por separado&#46; Por consiguiente&#44; recomendamos el uso combinado de indicadores de ePWV e IMC para evaluar el riesgo de diabetes en la pr&#225;ctica cl&#237;nica a fin de mejorar la exactitud de la predicci&#243;n&#46; Esto es importante para identificar a las personas con alto riesgo de padecer diabetes en una fase temprana y optimizar las estrategias terap&#233;uticas&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Sin embargo&#44; existen varias limitaciones que deben tenerse en cuenta en nuestro estudio&#46; 1&#41;<span class="elsevierStyleHsp" style=""></span>El presente estudio no clasific&#243; el tipo de diabetes&#46; Sin embargo&#44; dado que la diabetes tipo<span class="elsevierStyleHsp" style=""></span>2 representa aproximadamente el 95&#37; de todos los casos de diabetes&#44; los resultados de nuestro estudio podr&#237;an representar con mayor exactitud la diabetes tipo<span class="elsevierStyleHsp" style=""></span>2&#46; 2&#41;<span class="elsevierStyleHsp" style=""></span>El diagn&#243;stico de diabetes en este estudio se bas&#243; en el informe del propio paciente durante el seguimiento o en una GA &#62;<span class="elsevierStyleHsp" style=""></span>7&#44;0<span class="elsevierStyleHsp" style=""></span>mmol&#47;l&#44; lo que podr&#237;a dar lugar a una infravaloraci&#243;n de la prevalencia real de diabetes&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conclusiones</span><p id="par0095" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; observamos que unas cifras elevadas de ePWV e IMC son factores de riesgo independientes de diabetes <span class="elsevierStyleItalic">de novo</span>&#46; La combinaci&#243;n de ePWV e IMC puede predecir mejor la aparici&#243;n de diabetes en comparaci&#243;n con cualquiera de ellos por separado&#46; Este estudio proporciona indicadores de referencia sencillos y pr&#225;cticos para que los m&#233;dicos cl&#237;nicos pronostiquen&#44; identifiquen y eval&#250;en a los pacientes con alto riesgo de padecer diabetes y tomen decisiones cl&#237;nicas correctas para planificar e iniciar oportunamente el tratamiento m&#225;s adecuado de la enfermedad&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Aprobaci&#243;n &#233;tica</span><p id="par0100" class="elsevierStylePara elsevierViewall">Debido al anonimato de los datos&#44; la &#233;tica relativa a la investigaci&#243;n ya ha sido aprobada en estudios previos&#46; Por consiguiente&#44; no es necesario volver a solicitar estos datos para este estudio&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Consentimiento para participar</span><p id="par0105" class="elsevierStylePara elsevierViewall">Los datos pueden descargarse de la base de datos Nhanes &#40;www&#46;cdc&#46;gov&#47;nchs&#47;nhanes&#47;&#41;&#46; Se obtuvo el consentimiento informado de todos los participantes incluidos en el estudio&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Consentimiento para la publicaci&#243;n</span><p id="par0110" class="elsevierStylePara elsevierViewall">Los datos pueden descargarse de la base de datos Nhanes &#40;www&#46;cdc&#46;gov&#47;nchs&#47;nhanes&#47;&#41; y los pacientes firmaron el consentimiento informado para la publicaci&#243;n de sus datos&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Financiaci&#243;n</span><p id="par0130" class="elsevierStylePara elsevierViewall">La presente investigaci&#243;n no ha recibido ayudas espec&#237;ficas provenientes de agencias del sector p&#250;blico&#44; sector comercial o entidades sin &#225;nimo de lucro&#46;</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Conflicto de intereses</span><p id="par0120" class="elsevierStylePara elsevierViewall">Los autores declaran que carecen de conflicto de intereses&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La velocidad estimada de la onda del pulso &#40;ePWV&#41; y el &#237;ndice de masa corporal &#40;IMC&#41; est&#225;n estrechamente relacionados con la predicci&#243;n de diabetes <span class="elsevierStyleItalic">de novo</span>&#46; El objetivo de este estudio fue evaluar el impacto y el valor predictivo de la velocidad estimada de la onda de pulso &#40;ePWV&#41; y el &#237;ndice de masa corporal &#40;IMC&#41; en pacientes diab&#233;ticos <span class="elsevierStyleItalic">de novo</span>&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Se realiz&#243; un an&#225;lisis secundario de un estudio de cohorte realizado por Rich Healthcare &#40;China&#41; con un total de 211&#46;833 sujetos elegibles inscritos&#46; Se utiliz&#243; el an&#225;lisis de regresi&#243;n log&#237;stica para identificar los factores que influyen en la aparici&#243;n de diabetes&#44; y el an&#225;lisis de la curva ROC para evaluar el valor predictivo de ePWV&#44; IMC y su combinaci&#243;n en la diabetes <span class="elsevierStyleItalic">de novo</span>&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">En un seguimiento medio de 3&#44;12 a&#241;os&#44; se diagnostic&#243; diabetes en 3&#46;000 hombres &#40;1&#44;41&#37;&#41; y 1&#46;174 mujeres &#40;0&#44;55&#37;&#41;&#46; El an&#225;lisis de regresi&#243;n log&#237;stica mostr&#243; que el IMC&#44; los triglic&#233;ridos&#44; la alanina aminotransferasa&#44; el nitr&#243;geno uresangu&#237;neo&#44; la tasa de depuraci&#243;n de creatinina&#44; el ePWV y los antecedentes de diabetes en la familia son factores de alto riesgo para la diabetes <span class="elsevierStyleItalic">de novo</span>&#46; En comparaci&#243;n con el uso de ePWV o IMC de forma independiente&#44; la combinaci&#243;n de ePWV e IMC proporcion&#243; un &#225;rea bajo la curva ROC m&#225;s alta &#40;0&#44;822&#41; en comparaci&#243;n con ePWV o IMC de forma independiente&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusi&#243;n</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La elevaci&#243;n de los niveles de ePWV y IMC es un factor de riesgo independiente para la diabetes <span class="elsevierStyleItalic">de novo</span>&#44; y la combinaci&#243;n de ePWV y IMC puede predecir mejor el inicio de la diabetes en comparaci&#243;n con el uso de ambos indicadores de forma independiente&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Purpose</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Estimated pulse wave velocity &#40;ePWV&#41; and body mass index &#40;BMI&#41; are significant predictors of new-onset diabetes&#46; This study aims to evaluate the impact and predictive value of combining ePWV and BMI on the incidence of new-onset diabetes&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A secondary analysis was conducted on a cohort study by Rich Healthcare &#40;China&#41;&#44; involving 211&#44;833 eligible participants&#46; Logistic regression analysis identified factors influencing diabetes occurrence&#44; while ROC curve analysis assessed the predictive value of ePWV&#44; BMI&#44; and their combination for new-onset diabetes&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Over a mean follow-up period of 3&#46;12 years&#44; 3&#44;000 men &#40;1&#46;41&#37;&#41; and 1&#44;174 women &#40;0&#46;55&#37;&#41; were diagnosed with diabetes&#46; Logistic regression revealed that BMI&#44; triglycerides&#44; alanine aminotransferase&#44; blood urea nitrogen&#44; creatinine clearance rate&#44; ePWV&#44; and family history of diabetes are high-risk factors for new-onset diabetes&#46; The combination of ePWV and BMI provided a higher area under the ROC curve &#40;0&#46;822&#41; compared to ePWV or BMI alone&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusion</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Elevated levels of ePWV and BMI are independent risk factors for new-onset diabetes&#46; Combining these measures enhances predictive accuracy compared to using either indicator alone&#46;</p></span>"
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          "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Curva ROC de diabetes pronosticada por IMC&#44; ePWV e &#237;ndice combinado&#46; La curva de eficacia diagn&#243;stica del IMC combinado con la ePWV fue 0&#44;822&#44; mayor que el IMC o la ePWV en solitario&#46;</p> <p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">ABC&#58; &#225;rea bajo la curva ROC&#59; ePWV&#58; velocidad estimada de la onda de pulso&#59; IMC&#58; &#237;ndice de masa corporal&#59; ROC&#58; eficacia diagn&#243;stica&#46;</p>"
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                  \t\t\t\t"><span class="elsevierStyleItalic">cLDL &#40;mmol&#47;l&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">ALT &#40;U&#47;l&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">CCR &#40;&#956;mol&#47;l&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">72&#44;73 &#40;15&#44;82&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&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">Consumo de tabaco &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\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&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>Fumador activo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">12&#46;075 &#40;5&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">11&#46;660 &#40;5&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">415 &#40;9&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\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>Fumador ocasional&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">76 &#40;1&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\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>Nunca ha fumado&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">681 &#40;16&#44;3&#41;&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">Consumo de alcohol &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Bebedor activo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">49 &#40;1&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \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>Bebedor ocasional&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">8&#46;956 &#40;4&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">8&#46;769 &#40;4&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">187 &#40;4&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Nunca ha bebido&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">49&#46;923 &#40;23&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">48&#46;987 &#40;23&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">936 &#40;22&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\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 familiares de DM &#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
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                  \t\t\t\t">171 &#40;4&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&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">MAP</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">92&#44;13 &#40;12&#44;03&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">91&#44;95 &#40;11&#44;94&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">101&#44;03 &#40;13&#44;06&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&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">ePWV &#40;m&#47;s&#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
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                  \t\t\t\t">7&#44;47 &#40;1&#44;72&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;526&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">BUN&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;224-1&#44;284&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">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1&#44;078-1&#44;334&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&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">CCR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;008&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">1&#44;006-1&#44;010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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&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">0&#44;978&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">0&#44;966-0&#44;989&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">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&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">Fumador activo&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">Ref&nbsp;\t\t\t\t\t\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
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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">Ref&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fumador ocasional&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;86&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">0&#44;666-1&#44;095&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">0&#44;234&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;227&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">0&#44;710-2&#44;026&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">0&#44;442&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">Nunca ha fumado&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">0&#44;426&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">0&#44;377-0&#44;482&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">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;601&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;442-0&#44;817&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Bebedor activo&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">Ref&nbsp;\t\t\t\t\t\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
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ref&nbsp;\t\t\t\t\t\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
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \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
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Bebedor ocasional&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#44;415-0&#44;788&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">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;828&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">0&#44;468-1&#44;542&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</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">Nunca ha bebido&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;508&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
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\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&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">0&#44;881&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;522-1&#44;584&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;653&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">Antecedentes familiares de DM&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">2&#44;083&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">1&#44;776-2&#44;427&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;604&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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;697-3&#44;873&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&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">ePWV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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;48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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;462-1&#44;497&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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