was read the article
array:23 [ "pii" => "S2529912321000358" "issn" => "25299123" "doi" => "10.1016/j.artere.2021.07.002" "estado" => "S300" "fechaPublicacion" => "2021-07-01" "aid" => "589" "copyrightAnyo" => "2021" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Clin Investig Arterioscler. 2021;33:198-202" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0214916821000425" "issn" => "02149168" "doi" => "10.1016/j.arteri.2021.02.009" "estado" => "S300" "fechaPublicacion" => "2021-07-01" "aid" => "589" "copyright" => "Sociedad Española de Arteriosclerosis" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Clin Invest Arterioscl. 2021;33:198-202" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">ORIGINAL BREVE</span>" "titulo" => "Grado de control lipídico de un Área de Gestión Sanitaria en pacientes de muy alto riesgo cardiovascular" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "198" "paginaFinal" => "202" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Degree of lipid control in a Healthcare Management Area in patients at very high cardiovascular risk" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 869 "Ancho" => 2248 "Tamanyo" => 72748 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Distribución de la población a estudio según rangos de cLDL en la analítica basal realizada durante el ingreso y la analítica de control en la consulta de revisión tras el ajuste de tratamiento.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "María Aneri, Gloria Fernández, Marina Gras, Alejandro Campaña, Rosario Sánchez, Justo Sánchez" "autores" => array:6 [ 0 => array:2 [ "nombre" => "María" "apellidos" => "Aneri" ] 1 => array:2 [ "nombre" => "Gloria" "apellidos" => "Fernández" ] 2 => array:2 [ "nombre" => "Marina" "apellidos" => "Gras" ] 3 => array:2 [ "nombre" => "Alejandro" "apellidos" => "Campaña" ] 4 => array:2 [ "nombre" => "Rosario" "apellidos" => "Sánchez" ] 5 => array:2 [ "nombre" => "Justo" "apellidos" => "Sánchez" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2529912321000358" "doi" => "10.1016/j.artere.2021.07.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529912321000358?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0214916821000425?idApp=UINPBA00004N" "url" => "/02149168/0000003300000004/v1_202107150538/S0214916821000425/v1_202107150538/es/main.assets" ] ] "itemSiguiente" => array:18 [ "pii" => "S252991232100036X" "issn" => "25299123" "doi" => "10.1016/j.artere.2021.07.003" "estado" => "S300" "fechaPublicacion" => "2021-07-01" "aid" => "595" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Clin Investig Arterioscler. 2021;33:203-5" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case Report</span>" "titulo" => "Who shot first? Three possible causes of a kidney infarction" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "203" "paginaFinal" => "205" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "¿Quién disparó primero? Infarto renal de tres posibles causas" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1017 "Ancho" => 1342 "Tamanyo" => 113850 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">AngioCT revealing an image of a wedge-shaped renal perfusion defect suggestive of left lower pole renal infarction.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Pablo González-Bustos, Ricardo Roa-Chamorro, Fernando Jaén-Águila" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Pablo" "apellidos" => "González-Bustos" ] 1 => array:2 [ "nombre" => "Ricardo" "apellidos" => "Roa-Chamorro" ] 2 => array:2 [ "nombre" => "Fernando" "apellidos" => "Jaén-Águila" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S021491682100053X" "doi" => "10.1016/j.arteri.2021.03.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S021491682100053X?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S252991232100036X?idApp=UINPBA00004N" "url" => "/25299123/0000003300000004/v1_202107270534/S252991232100036X/v1_202107270534/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S2529912321000395" "issn" => "25299123" "doi" => "10.1016/j.artere.2021.07.006" "estado" => "S300" "fechaPublicacion" => "2021-07-01" "aid" => "605" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Clin Investig Arterioscler. 2021;33:195-7" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "Earth: The planet of the annexins" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "195" "paginaFinal" => "197" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "La Tierra: el planeta de las anexinas" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "José Martínez-González, Irene Corrales" "autores" => array:2 [ 0 => array:2 [ "nombre" => "José" "apellidos" => "Martínez-González" ] 1 => array:2 [ "nombre" => "Irene" "apellidos" => "Corrales" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0214916821001121" "doi" => "10.1016/j.arteri.2021.06.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0214916821001121?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529912321000395?idApp=UINPBA00004N" "url" => "/25299123/0000003300000004/v1_202107270534/S2529912321000395/v1_202107270534/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Brief report</span>" "titulo" => "Degree of lipid control in a Healthcare Management Area in patients at very high cardiovascular risk" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "198" "paginaFinal" => "202" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "María Aneri, Gloria Fernández, Marina Gras, Alejandro Campaña, Rosario Sánchez, Justo Sánchez" "autores" => array:6 [ 0 => array:3 [ "nombre" => "María" "apellidos" => "Aneri" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "Gloria" "apellidos" => "Fernández" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:4 [ "nombre" => "Marina" "apellidos" => "Gras" "email" => array:1 [ 0 => "dramgr@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 3 => array:3 [ "nombre" => "Alejandro" "apellidos" => "Campaña" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 4 => array:3 [ "nombre" => "Rosario" "apellidos" => "Sánchez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "Justo" "apellidos" => "Sánchez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "CS Lucena I, Lucena, Córdoba, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "CS Rute, Rute, Córdoba, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "CS Priego de Córdoba, Priego de Córdoba, Córdoba, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Hospital Infanta Margarita, Cabra, Córdoba, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Grado de control lipídico de un Área de Gestión Sanitaria en pacientes de muy alto riesgo cardiovascular" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1269 "Ancho" => 2169 "Tamanyo" => 80918 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Distribution of the study population by disease according to the LDL-C range in baseline blood tests on admission (mg/dl).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The degree of lipid control has been the starting point for countless debates in the medicine of today, addressed during both primary care consultations and specialised cardiovascular risk consults. The main objective they focus on is secondary prevention in those patients who have already presented a cardiovascular event, which places them in the very high risk category.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The latest updates of the leading guidelines on lipid control tend to be increasingly stringent in terms of cholesterol levels, proposing optimisation of the levels currently considered to reflect control. Thus, recommended LDL-C levels for these patients according to the European Society of Cardiology Guidelines on Management of Dyslipidaemia (ESC/EAS 2019)<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> and the American Endocrinology Guidelines for the Management of Dyslipidaemia and the Prevention of Cardiovascular Disease (AACE/ACE 2017)<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> have recently been modified. Whereas previously, according to the guidelines published in 2016, the target figure was set at less than 70 mg/dl, LDL-C levels below 55 mg/dl are now contemplated as optimal control for these patients.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Despite the trend towards lower and lower LDL-C, studies carried out to date, such as REPAR3 and EURASPIRE4, reveal that there is still some way to go before these ambitious goals are met.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Therefore, as a result of this need to improve the control of these patients, the main objective of this study was to determine the degree of alignment of lipid control in relation to the primary cardiovascular risk guidelines in our health management area. To this end, we used the computer tools available to us, with the intention of discerning our starting point, so as to enhance the quality of care in our healthcare area in a multidisciplinary manner.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">We designed an observational, descriptive, retrospective, multicentre, retrospective study, conducted in agreement with Primary Care of the Southern Health Area of Cordoba and the Internal Medicine Department of the Hospital Infanta Margarita. The sample was collected through the minimum basic set of hospital discharge data.</p><p id="par0030" class="elsevierStylePara elsevierViewall">It included 446 patients who were discharged between June 2017 and June 2018 with a diagnosis of acute coronary syndrome, ischaemic stroke, or peripheral arterial disease. No exclusion criteria were applied, although analytical control data could not be obtained for all patients; consequently, the statistical study was finally conducted with 352 patients.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Using computerised medical records in the DIRAYA programme, data were collected with respect to the variables of age, sex, smoking status, and the presence or absence of the following diseases in their history: type 2 diabetes mellitus, arterial hypertension, chronic renal failure, and previous cardiovascular events (those described above).</p><p id="par0040" class="elsevierStylePara elsevierViewall">Other laboratory values were similarly collected, such as: serum creatinine (mg/dl), total cholesterol (mg/dl), LDL-C (mg/dl), HDL-C (mg/dl), non-HDL cholesterol (mg/dl), triglycerides (mg/dl), and glycosylated haemoglobin (HbA1c [%]).</p><p id="par0045" class="elsevierStylePara elsevierViewall">Data relative to lipid control and treatment of the selected patients were collected in 2 phases: pre-event (baseline analysis and most recent treatment before the diagnosis of the cardiovascular event studied) and post-event (analytical control and treatment following the cardiovascular event).</p><p id="par0050" class="elsevierStylePara elsevierViewall">In addition, readmissions or deaths of the participants selected were collected between June 2018 and June 2019, as well as information about the healthcare centre the patients corresponded to and their assigned Primary Care Physician for future contacts.</p><p id="par0055" class="elsevierStylePara elsevierViewall">To establish the degree of control, the AACE/ACE 2017 and ESC/EAS 2019 guidelines were used, which set a treatment target of LDL-C of less than 70 mg/dl and less than 55 mg/dl, respectively, for patients at very high cardiovascular risk.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Data were collected using the Microsoft Excel office application for Microsoft 365 MSO (16.0.13801.20240, 32-bit. Version 2102) and statistical analyses were performed using SPSS version 25 (IBM SPSS Statistics for MacOS, Version 25.0. Armonk, NY, USA).</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0065" class="elsevierStylePara elsevierViewall">A total of 446 patients were identified for the specified period of time; of them, 94 were ruled out due to lack of analytical data (no laboratory data, determination made at a different centre, deaths, etc.), so that statistical analyses were conducted with [the data from] 352 patients. As for the different types of events recorded, 212 fall within the spectrum of acute coronary syndrome; 125, ischaemic stroke, and 15, peripheral arterial disease. Other clinical and analytical variables were also analysed and are presented in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Analytical values determined</span><p id="par0070" class="elsevierStylePara elsevierViewall">To reach the conclusions of the study, we concentrated chiefly on LDL-C values; 73 patients from of our sample displayed [acceptable] lipid control <70 mg/dl at baseline (20.7%), while the remaining 279 patients (79.3%) had LDL-C values exceeding 70 mg/dl. Other determinations of note were: total cholesterol, 170 ± 46 mg/dl; triglycerides, 141 ± 93 mg/dl; HDL-C 42 ± 13 mg/dl, and HbA1c, 7 ± 1.5%.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Of all those patients whose LDL-C was >70 mg/dl levels at baseline, 75.6% were on statin therapy; 5.8% were taking statin plus ezetimibe; 0.7% were receiving statin plus fibrates; 1% were taking fibrates alone, and 16.8% of the patients were not receiving any lipid-lowering treatment.</p><p id="par0080" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> illustrates how better lipid control is achieved after optimal treatment adjustment at their clinical check-up three months after the event.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Degree of lipid control</span><p id="par0085" class="elsevierStylePara elsevierViewall">The data reviewed indicate that 36.6% of the patients meet the control criteria set by the 2016 guidelines (LDL < 70 mg/dl) and only 14.8% meet the criteria of the current guidelines (LDL < 55 mg/dl) (of a total of 284 available post-admission control analyses).</p><p id="par0090" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a> shows the distribution of the study population according to the event presented, based on the range of LDL-C in the baseline analysis at the time of admission (mg/dl), with most patients exhibiting acute coronary syndrome in relation to LDL-C levels.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">As for the relationship between the absolute number of events and LDL-C, 80.62% of the sample had LDL-C levels of >70 mg/dl and only 5.33% had LDL-C levels of <55 mg/dl.</p><p id="par0100" class="elsevierStylePara elsevierViewall">Upon examining the relationship between LDL-C levels and non-modifiable patient factors and other cardiovascular risk factors, increased prevalence was observed in males compared to females and an increase in the absolute number of events in hypertensive patients compared to patients who only had diabetic.</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discussion</span><p id="par0105" class="elsevierStylePara elsevierViewall">Of all the patients reviewed, only 36.6% of them met the lipid control targets set by the 2016 guidelines (LDL-C <70 mg/dl) and 14.8% as per the guidelines currently in force (LDL-C <55 mg/dl).</p><p id="par0110" class="elsevierStylePara elsevierViewall">The data from the present study reveal that there is room for improvement in the degree of lipid control in secondary prevention in very high-risk patients in our healthcare area. If we compare them with published studies applying a similar approach, the data from our area are a long way from, for instance, the figures achieved in the health area of the Hospital Costa del Sol, as reflected in the communication by Martín Domínguez et al.,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> inasmuch as they achieved control figures of up to 75.8% three months following the event. In contrast, our results are more in line with those reported in other international studies, such as REPAR, in which only 26% of patients had LDL-C concentrations below 70 mg/dl, despite 95.3% of patients receiving lipid-lowering drugs, or CODIMET,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> in which more than half of the participants studied did not achieve their targets, also reflecting the fact that high-intensity treatment is the key factor in achieving proper control.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7,8</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">Furthermore, therapeutic inertia may have influenced the poor results of our study, since the vast majority of the patients included were receiving hypolipidemic treatment and yet, after the cardiovascular event occurred, this treatment had not been modified, leaving the possibility open of moving up the treatment ladder with other high-potency lipid-lowering drugs or with pharmacological associations.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">This is where the question arises as to why these results may be so far off the targets set. On the one hand, we may think of a lack of lifestyle modification on the patient’s part, including changes in dietary habits, exercise, or smoking cessation,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> as well as adherence, and therapeutic optimisation,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> a basic pillar of the treatment to maintain optimal cholesterol levels, as demonstrated in previous studies, such as ESPROCOL.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conclusions</span><p id="par0125" class="elsevierStylePara elsevierViewall">The implementation of protocols that focus on optimising the treatment of patients at very high cardiovascular risk, including changes in lifestyle (diet, exercise, smoking, etc.), as well as promoting adherence to treatment, are a basic mainstay in improving LDL-C values. Moreover, our results show that it is essential to optimise treatment, by using high-potency statins or a combination of several lipid-lowering drugs, as well as screening individuals who can be studied at a Vascular Risk consultation to assess the possibility of starting treatment with PCSK9 inhibitors, as it is key that we locate patients with very high LDL-C values that point toward familial hypercholesterolaemia and investigate their diagnosis. To this end, we believe that close collaboration between Internal Medicine and Primary Care is essential.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflict of interests</span><p id="par0130" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres1554727" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1403317" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1554726" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1403316" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Material and methods" ] 6 => array:3 [ "identificador" => "sec0015" "titulo" => "Results" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Analytical values determined" ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Degree of lipid control" ] ] ] 7 => array:2 [ "identificador" => "sec0030" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0035" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0040" "titulo" => "Conflict of interests" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-12-13" "fechaAceptado" => "2021-02-09" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1403317" "palabras" => array:3 [ 0 => "Cardiovascular risk" 1 => "Dyslipidaemia" 2 => "LDLc" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1403316" "palabras" => array:3 [ 0 => "Riesgo cardiovascular" 1 => "Dislipemia" 2 => "cLDL" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The latest cardiovascular risk guides, European and American, establish hard lipid control objectives, that suppose a therapeutic challenge for both, doctor and patient. The objective of this study is determine the degree of adequacy of low-density lipoprotein cholesterol levels (LDLc) presented by patients with very high cardiovascular risk in our healthcare area, with respect to European and American cardiovascular risk guidelines.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">This is an observational and retrospective study of 446 patients discharged between June 2017 and June 2018 with a diagnosis of acute coronary syndrome, ischemic stroke and peripheral arterial disease. We have defined a series of variables among which we want to highlight the levels of LDLc at admission, and its follow-up at discharge, in order to know the degree of lipid control according to current European guidelines, which set the threshold to consider optimal control in patients of very high cardiovascular risk, below 55 mg/dl.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The revised data indicates a control of the patients in 36.6% according to the 2016 guidelines (LDLc <70 mg/dl) and 14.8% according to the current 2019 guidelines (LDLc <55 mg/dl), 75.3% of them received lipid lowering treatment. We have also found that the number of absolute events increases exponentially depending on the levels of LDLc, being more evident in patients with acute coronary syndrome.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">In this study, we demonstrated that the adequacy of the vascular risk clinical practice guidelines is insufficient in the population with very high vascular risk, in line with other published studies, further studies would be needed to determine the causes. A solution to this problem could be collaboration with the Internal Medicine service that has been launched in our healthcare area in order to derivate patients to the Vascular Consultation whom could be beneficiated by the administration of the PCSK9 inhibitors.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducción</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Las últimas guías de riesgo cardiovascular tanto europeas como estadounidenses, establecen unos objetivos de control lipídico muy exigentes que suponen un reto terapéutico tanto para el médico como para el paciente. El objetivo de este estudio es conocer el grado de adecuación de los niveles de colesterol unido a lipoproteínas de baja densidad (cLDL) que presentan los pacientes de muy alto riesgo cardiovascular de nuestra área sanitaria, con respecto a las guías de riesgo cardiovascular europeas y estadounidenses.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Métodos</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Se trata de un estudio observacional y retrospectivo de 446 pacientes dados de alta entre junio 2017 y junio 2018 con diagnóstico de síndrome coronario agudo, ictus isquémico y enfermedad arterial periférica. Hemos definido una serie de variables entre las que queremos destacar las cifras de cLDL al ingreso y su evolución tras el alta con el objetivo de conocer el grado de control lipídico acorde a las guías europeas actuales, que sitúan el umbral para considerar un control óptimo en pacientes de muy alto riesgo cardiovascular, por debajo de los 55 mg/dl.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Los datos revisados indican un control en el 36,6% de los pacientes según las guías de 2016 (cLDL<70 mg/dl) y del 14,8% según las actuales de 2019 (cLDL<55 mg/dl), de todos ellos recibían tratamiento hipolipemiante el 75,3%. También hemos evidenciado que el número de eventos absolutos aumenta exponencialmente en función de las cifras de cLDL, siendo más evidente en los pacientes con síndrome coronario agudo.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">En este estudio, demostramos que la adecuación de las guías de práctica clínica de riesgo vascular es insuficiente en la población de muy alto riesgo vascular, lo que está en consonancia con otros estudios publicados, harían falta más estudios para determinar las causas. Una solución para este problema podría ser la colaboración con el servicio de Medicina Interna que se ha puesto en marcha en nuestra área sanitaria para derivar a la consulta de Riesgo Vascular a aquellos pacientes candidatos a la administración de los inhibidores de PCSK9.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as: Aneri M, Fernández G, Gras M, Campaña A, Sánchez R, Sánchez J. Grado de control lipídico de un Área de Gestión Sanitaria en pacientes de muy alto riesgo cardiovascular. Clin Investig Arterioscler. 2021;33:198–202.</p>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 869 "Ancho" => 2248 "Tamanyo" => 72748 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Distribution of the study population based on LDL-C ranges in the baseline blood test performed during admission and the control blood test at the follow-up visit after treatment adjustment.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1269 "Ancho" => 2169 "Tamanyo" => 80918 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Distribution of the study population by disease according to the LDL-C range in baseline blood tests on admission (mg/dl).</p>" ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Population, n = 352 \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">N (%) or mean ± standard deviation \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Clinical variables</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="elsevierStyleHsp" style=""></span>Age (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">72 ± 13 \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>Men \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">239 (68) \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>HTA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">260 (74) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Diabetes mellitus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">156 (44) \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>Active smoker \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 (20) \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>Personal history of disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">115 (33) \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="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">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="elsevierStyleHsp" style=""></span>Chronic renal failure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">33 (9) \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="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Analytical variables</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="elsevierStyleHsp" style=""></span>Total Cholesterol (mg/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">170 ± 46 \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>cLDL (mg/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100 ± 34 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>cHDL (mg/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 ± 13 \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>Triglycerids (mg/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">141 ± 93 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>HbA1c (%)<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\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 ± 1.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2664745.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Reading in 180 patients.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Clinical variables and analytical determinations in the baseline sample.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. The Task Force for the management of dyslipidaemias of the European society of Cardiology (ESC) and European Atherosclerosis Society (EAS)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F Mach" 1 => "C Baigent" 2 => "AL Catapano" 3 => "KC Koskinas" 4 => "M Casula" 5 => "L Badimon" ] ] ] ] ] "host" => array:2 [ 0 => array:2 [ "doi" => "10.1093/eurheartj/ehz455" "Revista" => array:6 [ "tituloSerie" => "Eur Heart J [Internet]." "fecha" => "2020" "volumen" => "41" "paginaInicial" => "111" "paginaFinal" => "188" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31504418" "web" => "Medline" ] ] ] ] 1 => array:2 [ "doi" => "10.1093/eurheartj/ehz455" "WWW" => array:1 [ "link" => "https://doi.org/10.1093/eurheartj/ehz455" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "American association of clinical endocrinologists and american college of endocrinology guidelines for management of dyslipidemia and prevention of cardiovascular disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Jellinger" 1 => "Y. Handelsman" 2 => "P. Rosenblit" 3 => "Z. Bloomgarden" 4 => "V. Fonseca" 5 => "A. Garber" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4158/1934-2403-23.s3.1" "Revista" => array:7 [ "tituloSerie" => "Endocrine Practice." "fecha" => "2017" "volumen" => "23" "numero" => "Suplemento 2" "paginaInicial" => "1" "paginaFinal" => "87" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28535141" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Grado de control lipídico en pacientes coronarios y medidas adoptadas por los médicos. estudio REPAR" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "E. Galve" 1 => "A. Cordero" 2 => "A. Cequier" 3 => "E. Ruiz" 4 => "J. González-Juanatey" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rec.2016.02.012" "Revista" => array:6 [ "tituloSerie" => "Revista Española de Cardiología." "fecha" => "2016" "volumen" => "69" "paginaInicial" => "931" "paginaFinal" => "938" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27178117" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of dyslipidaemia in patients with coronary heart disease: Results from the ESC-EORP EUROASPIRE V survey in 27 countries" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. De Backer" 1 => "P. Jankowski" 2 => "K. Kotseva" 3 => "E. Mirrakhimov" 4 => "Ž Reiner" 5 => "L. Rydén" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.atherosclerosis.2019.03.014" "Revista" => array:6 [ "tituloSerie" => "Atherosclerosis." "fecha" => "2019" "volumen" => "285" "paginaInicial" => "135" "paginaFinal" => "146" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31054483" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Concordancia de los resultados lipídicos obtenidos en pacientes de muy alto riesgo cardiovascular en consulta de cardiología con el nuevo consenso de actuación de la sociedad española de cardiología" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Martín Domínguez" 1 => "P. Chinchurreta Capote" 2 => "S. López Tejero" 3 => "R. Bravo Marques" 4 => "A. Valle Alberca" 5 => "E. Mariscal López" ] ] ] ] ] "host" => array:2 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Esp Cardiol [Internet]." "fecha" => "2020" "volumen" => "73" "numero" => "Supl1" "paginaInicial" => "965" ] ] 1 => array:1 [ "WWW" => array:1 [ "link" => "https://www.revespcardiol.org/es-congresos-sec-2020-el-e-congreso-110-sesion-factores-riesgo-modificables-no-modificables-6051" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalencia de colesterol LDL inadecuado en pacientes con enfermedad coronaria y/o diabetes mellitus tipo 2" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "L. Pérez" 1 => "A. Saltijeral" 2 => "G. Vitale" 3 => "B. González" 4 => "A. Torres" 5 => "L.A. Álvarez-Sala" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Clin Esp." "fecha" => "2012" "volumen" => "112" "paginaInicial" => "475" "paginaFinal" => "481" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Control del colesterol LDL en pacientes de muy alto riesgo Vascular. Algoritmo simplificado para alcanzar objetivos de colesterol LDL «En Dos Pasos»" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C. Guijarro" 1 => "L. Masana" 2 => "E. Galve" 3 => "A. Cordero" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arteri.2014.05.004" "Revista" => array:6 [ "tituloSerie" => "Clin Investig Arterioscler [Internet]." "fecha" => "2016" "volumen" => "26" "paginaInicial" => "242" "paginaFinal" => "252" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25048471" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Quantifying effect of statins on low density lipoprotein cholesterol, ischaemic heart disease, and stroke: systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.R. Law" 1 => "N.J. Wald" 2 => "A.R. Rudnicka" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/bmj.326.7404.1423" "Revista" => array:5 [ "tituloSerie" => "BMJ." "fecha" => "2003" "volumen" => "326" "paginaInicial" => "1423" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12829554" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intervención activa en la hipercolesterolemia de pacientes con riesgo cardiovascular alto de Atención Primaria; estudio ESPROCOL" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P.J. Tárraga" 1 => "F.J. García-Norro" 2 => "L. Tárraga" 3 => "J. Solera" 4 => "E. González" 5 => "A. Ruiz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3305/nh.2015.31.6.8998" "Revista" => array:6 [ "tituloSerie" => "Nutr Hosp." "fecha" => "2015" "volumen" => "31" "paginaInicial" => "2727" "paginaFinal" => "2734" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26040387" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/25299123/0000003300000004/v1_202107270534/S2529912321000358/v1_202107270534/en/main.assets" "Apartado" => array:4 [ "identificador" => "75945" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Brief report" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/25299123/0000003300000004/v1_202107270534/S2529912321000358/v1_202107270534/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529912321000358?idApp=UINPBA00004N" ]
Year/Month | Html | Total | |
---|---|---|---|
2024 November | 1 | 0 | 1 |
2024 October | 12 | 2 | 14 |
2024 September | 24 | 5 | 29 |
2024 August | 28 | 2 | 30 |
2024 July | 13 | 4 | 17 |
2024 June | 16 | 4 | 20 |
2024 May | 7 | 7 | 14 |
2024 April | 13 | 5 | 18 |
2024 March | 30 | 11 | 41 |
2024 February | 29 | 5 | 34 |
2024 January | 17 | 2 | 19 |
2023 December | 34 | 4 | 38 |
2023 November | 23 | 11 | 34 |
2023 October | 38 | 3 | 41 |
2023 September | 14 | 5 | 19 |
2023 August | 16 | 0 | 16 |
2023 July | 9 | 1 | 10 |
2023 June | 9 | 4 | 13 |
2023 May | 9 | 1 | 10 |
2023 April | 5 | 5 | 10 |
2023 March | 3 | 3 | 6 |
2023 February | 6 | 3 | 9 |
2023 January | 11 | 5 | 16 |
2022 December | 8 | 6 | 14 |
2022 November | 6 | 6 | 12 |
2022 October | 15 | 3 | 18 |
2022 September | 9 | 32 | 41 |
2022 August | 10 | 23 | 33 |
2022 July | 9 | 9 | 18 |