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(A) Collagen volume fraction (CVF) and (B) representative microphotographs of myocardial sections staining with picrosirius red examined by light microscopy (magnification 40í) in heart from control rats (CT) and rats fed a high-fat diet (HFD). (C) Percentage of cross-linked collagen and (D) representative microphotographs of myocardial sections staining with picrosirius red examined by polarized light microscopy (magnification 40í) in heart from control rats (CT) and rats fed a high-fat diet (HFD). (E) Quantification of superoxide anions production in hearts from control rats (CT) and rats fed a high-fat diet (HFD) and (F) representative microphotographs of myocardial sections labeled with the oxidative dye hydroethidine by fluorescence microscopy (magnification 40í). Scale bar: 50<span class="elsevierStyleHsp" style=""></span>α/4m. 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Assistencial Universitària de Manresa, Manresa, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unitat de Medicina Vascular i Metabolisme (UVASMET), Hospital Universitari Sant Joan de Reus, Universitat Rovira i Virgili de Reus, Reus, Tarragona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Unitat de Recerca i Innovació, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Barcelona, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servei de Medicina Interna, Unitat de Risc Vascular i Lípids, Hospital de Sant Pau de Barcelona, Barcelona, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Servei de Medicina Interna, Unitat de Lípids, Consorci Sanitari de Terrassa-Hospital de Terrassa, Terrassa, Barcelona, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Servei de Medicina Interna, Unitat de Lípids, Hospital de Figueres, Figueres, Girona, Spain" "etiqueta" => "f" "identificador" => "aff0030" ] 6 => array:3 [ "entidad" => "Servei d’Endocrinologia i Nutrició, Unitat de Lípids, Hospital Sant Joan Despí Moisès Broggi, Consorci Sanitari Integral, Sant Joan Despí, Barcelona, Spain" "etiqueta" => "g" "identificador" => "aff0035" ] 7 => array:3 [ "entidad" => "Hospital de Santa Caterina de Salt, Parc Hospitalari Martí i Julià, Salt, Girona, Spain" "etiqueta" => "h" "identificador" => "aff0040" ] 8 => array:3 [ "entidad" => "Unitat de Lípids i Risc Vascular, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain" "etiqueta" => "i" "identificador" => "aff0045" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Causas de no consecución del objetivo terapéutico del colesterol de las lipoproteínas de baja densidad en pacientes de alto y muy alto riesgo vascular controlados en Unidades de Lípidos y Riesgo Vascular. Estudio EROMOT" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1199 "Ancho" => 2599 "Tamanyo" => 115402 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Attainment of the LDL cholesterol therapeutic target as defined by the 2012 European guidelines on cardiovascular disease prevention.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Lipid metabolism disorders are one of the primary causes of vascular risk.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">1</span></a> Reducing low-density lipoprotein cholesterol (LDL-C) concentrations by 1<span class="elsevierStyleHsp" style=""></span>mmol/l (38.8<span class="elsevierStyleHsp" style=""></span>mg/dl) results in a 22% fall in the relative risk of presenting a severe cardiovascular (CV) event.<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">It is important for patients with dyslipidaemia, and particularly patients at high or very high risk, to achieve the therapeutic targets recommended by the CV prevention clinical practice guidelines (CPGs).<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">1</span></a> Studies conducted in Europe<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">3–5</span></a> and in Spain<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">6–9</span></a> have revealed the low frequency with which these LDL-C treatment goals are achieved. The EDICONDIS-ULISEA study<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">10</span></a> estimated that 44.7% of dyslipidaemic patients treated at the Lipid and Vascular Risk Units of the Spanish Arteriosclerosis Society (Sociedad Española de Arteriosclerosis, SEA) achieved their LDL-C therapeutic target as defined by the 2007 European guidelines on CV disease prevention.<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">11</span></a> However, these results fell to below 20%<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">6–10</span></a> in patients at high or very high risk when the criteria of the most recent European guidelines were applied.<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">12</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The causes that could explain inadequate LDL-C control have been attributed to the organisation of the health system, to doctors and to the patients themselves.<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">13</span></a> One of the causes attributed to doctors is clinical inertia,<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">13–16</span></a> which is defined as treatment not being initiated or intensified despite being indicated in the CPGs.<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">14</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Lipid and vascular risk units are clinics run by specialists and experts in the diagnosis and treatment of dyslipidaemia.<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">17</span></a> Patients who attend such clinics are referred from primary care or from other specialties, such as cardiology, neurology and vascular surgery.<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">18</span></a> The aim of this study was to determine the percentage of patients who achieved their LDL-C therapeutic target, as well as to identify the reasons for failing to achieve this goal in patients with high and very high vascular risk treated by lipid and vascular risk units in actual clinical practice.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Patients and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Design</span><p id="par0025" class="elsevierStylePara elsevierViewall">Observational, retrospective and longitudinal multicentre study. The study consecutively enrolled patients over the age of 18 who were referred for a first visit to the lipid and vascular risk units of the Network of Lipid and Arteriosclerosis Units of Catalonia (<span class="elsevierStyleItalic">Xarxa d’Unitats de Lípids i Arteriosclerosi de Catalunya</span>) for dyslipidaemia and high or very high CV risk according to the 2012 European Guidelines on cardiovascular disease prevention in clinical practice<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">12</span></a> between January and June 2012, with follow-up two years after the first visit. Patients with uncontrolled dyslipidaemia secondary to their underlying disorder were excluded.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The study was approved by the central Independent Ethics Committee.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Information from two appointments at the unit was collected from the medical records: the first or baseline visit, conducted at the unit between January and June 2012, and the second follow-up visit conducted two years later. For patients who did not undergo two-year follow-up, the information was obtained from the last recorded visit to the unit at which the applicable data to complete the record were available. The data were collected between December 2014 and December 2015.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Age, gender, anthropometric characteristics (weight, height, body mass index, waist circumference), comorbidity, CV risk factors, type of dyslipidaemia and vascular risk according to the SCORE model were recorded.<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">12</span></a> Patients who had given up smoking for six months or more were deemed to be former smokers. Alcohol consumption was stratified as low-medium (<30<span class="elsevierStyleHsp" style=""></span>g/day for women; <40<span class="elsevierStyleHsp" style=""></span>g/day for men), high (≥30<span class="elsevierStyleHsp" style=""></span>g/day for women; ≥40<span class="elsevierStyleHsp" style=""></span>g/day for men) and non-drinker.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The cholesterol-lowering therapy strategy was classified as per the criteria proposed by Masana et al.<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">19</span></a> at the following LDL-C reduction intervals: low (LDL-C reduction <30%), moderate (LDL-C reduction 30–49%), high (LDL-C reduction 50–60%) and very high (LDL-C reduction >60%). Patients treated in monotherapy with ion-exchange resins at any dose or fibrates were classified as low.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Data pertaining to lipid profile, blood glucose, creatinine, creatine kinase (CK) and transaminases, advice concerning diet, smoking and physical exercise as well as pharmacological treatment at the baseline and follow-up visits were also collected. The reasons why the LDL-C therapeutic targets were not achieved were ascertained from the follow-up visit.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The primary dependent variable was the percentage of patients that achieved their LDL-C therapeutic target as established by the 2012 European Guidelines<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">12</span></a>: LDL-C <100<span class="elsevierStyleHsp" style=""></span>mg/dl (or non-HDL cholesterol <130<span class="elsevierStyleHsp" style=""></span>mg/dl in patients with triglyceride levels >400<span class="elsevierStyleHsp" style=""></span>mg/dl) objective for patients with high vascular risk and <70<span class="elsevierStyleHsp" style=""></span>mg/dl (or non-HDL cholesterol <100<span class="elsevierStyleHsp" style=""></span>mg/dl in patients with triglyceride levels >400<span class="elsevierStyleHsp" style=""></span>mg/dl) or a fall of 50% or more versus the baseline concentration for patients with very high vascular risk.</p><p id="par0060" class="elsevierStylePara elsevierViewall">The reasons for failing to achieve the LDL-C therapeutic targets were grouped into three sections. The first analysed the drug-related causes: having reached the maximum tolerated dose of the medication and onset of side effects (myalgia without CK elevation, CK elevation and transaminase elevation). The second analysed the doctor-related causes: obstacles to prescribing certain drugs, clinical inertia defined as an unjustified failure to modify the treatment when the therapeutic target is not achieved, failing to follow the European Guidelines,<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">12</span></a> prescription cancellation by another doctor and the doctor deeming the therapeutic target to have been achieved in patients with LDL-C levels above target levels. The third group analysed the patient-related causes: comorbidity or polypharmacy discouraged treatment intensification, inability to afford the treatment, non-adherence to treatment and failure to complete follow-up. The causes were not mutually exclusive.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Statistical analysis</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Sample size</span><p id="par0065" class="elsevierStylePara elsevierViewall">To estimate a therapeutic target attainment rate of 45%,<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">10</span></a> with a 95% confidence interval and 7% precision, it was necessary to enrol 194 patients. Assuming a loss to follow-up rate of 20%, a sample size of 238 patients was required.</p><p id="par0070" class="elsevierStylePara elsevierViewall">The categorical variables were summarised by absolute and relative frequency. The continuous variables were summarised by mean and standard deviation. In the event of non-normal distribution, they were summarised by median and the 25th and 75th percentiles (first and third quartiles).</p><p id="par0075" class="elsevierStylePara elsevierViewall">The quantitative values measured in the two visits were compared using the Student's <span class="elsevierStyleItalic">t</span> test of paired samples or the Wilcoxon tests depending on the proximity of the values to Gaussian distribution. McNemar's test was used to compare the qualitative values of paired samples.</p><p id="par0080" class="elsevierStylePara elsevierViewall">The two-tailed level of statistical significance used was 0.05. The software IBM<span class="elsevierStyleSup">®</span> SPSS<span class="elsevierStyleSup">®</span> Statistics v.22 (IBM Corporation, Armonk, New York) was used for the statistical analysis.</p></span></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><p id="par0085" class="elsevierStylePara elsevierViewall">Sixteen (55.2%) of the 29 lipid and vascular risk units that made up the Network of Lipid and Arteriosclerosis Units of Catalonia (<span class="elsevierStyleItalic">Xarxa d’Unitats de Lípids i Arteriosclerosi</span>) participated, and a total of 243 patients were enrolled. The median time between the two visits was 23 months, with an interquartile range of 11.3–29.4 months, and the median number of follow-up visits was four, with an interquartile range of three to five. Twenty-two patients (8.3%) were excluded for failing to attend any of the subsequent follow-up visits.</p><p id="par0090" class="elsevierStylePara elsevierViewall">The demographic, anthropometric and clinical characteristics are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. The mean age was 52.2 years (SD 13.7) and 62.6% of patients were male. 40.3% presented very high vascular risk.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">86.8% of patients were receiving lipid-lowering pharmacological treatment at the first visit, which increased to 95.0% by the last visit (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001). Statins were the most widely used drugs at both visits. At the first visit, the percentage of patients on combination lipid-lowering treatment was 25.1%, versus 47.3% at the last visit (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001). Ezetimibe was the most-used drug after statins, with a significant increase between the two visits (19.8% vs 33.7%; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001). It was administered in combination with statins in 95.9% of patients at the first visit and 100% of patients at the last visit. At the first visit, 44.4% of patients were receiving low-moderate lipid-lowering therapy, which subsequently fell to 37.4% by the end of follow-up. Meanwhile, 42.4% were receiving intensive-very intensive therapy at the first visit, which rose to 57.6% at the last visit (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">The changes in lipid profile are shown in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>. A significant reduction in total cholesterol, LDL-C, non-HDL cholesterol and triglycerides was observed between the two visits. No differences in HDL-C or significant transaminase increases were observed between the two visits.</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">6.6% (95% CI: 3.8–10.5) of patients attained the LDL-C therapeutic target at the first visit. 28.0% (95% CI: 22.4–34.1) attained the LDL-C therapeutic target at the last visit. In terms of vascular risk, 26.9% (95% CI: 19.9–34.9) of patients with high vascular risk and 29.6% (95% CI: 20.8–39.7) of patients with very high vascular risk attained the therapeutic target (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Approximately 9.1% of patients who did not achieve the LDL-C therapeutic target at the last visit did so at some point during follow-up: 9.9% for high vascular risk patients and 12.1% for patients with very high vascular risk.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> outlines the reasons for failing to achieve the LDL-C therapeutic target. The most common causes were patient-related (46.9%), primarily non-adherence to treatment (31.4%) and failure to complete follow-up (11.4%). Doctor-related causes accounted for 43.4%, primarily clinical inertia (19.4%) and the doctor having deemed the therapeutic target to have been attained despite LDL-C levels in excess of the reference values (13.7%). The doctor acknowledged not having followed the recommendations of the European Guidelines in 5.1% of cases. Drug-related causes accounted for 24.6% of cases, primarily the onset of side effects.</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discussion</span><p id="par0115" class="elsevierStylePara elsevierViewall">Compared to previous studies conducted in secondary care,<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">4,9,10,15</span></a> this study found an improvement in the attainment of LDL-C targets in patients with high and very high vascular risk according to the 2012 European guidelines.<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">12</span></a> Around one third of patients treated at lipid and vascular risk units achieved the LDL-C target. Patient non-adherence, followed by clinical inertia and side effects, are the primary causes that could explain these results.</p><p id="par0120" class="elsevierStylePara elsevierViewall">In studies conducted at specialised clinics in Spain,<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">9,10</span></a> the LDL-C target level <70<span class="elsevierStyleHsp" style=""></span>mg/dl was achieved in less than 20% of very high-risk patients. These findings are consistent with the published results of the EUROASPIRE IV study,<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">4</span></a> which found that only 19.5% of patients attained LDL-C levels <70<span class="elsevierStyleHsp" style=""></span>mg/dl despite the fact that 85.7% were receiving statins. In our study, 29.6% of very high-risk patients met the target, bettering the 27.3% of patients published by the REPAR Registry.<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">20</span></a> It is surprising that in specialised clinics where it is taken for granted that the healthcare professionals are aware of the importance of attaining the treatment goals recommended by the CPGs, fewer than 30% of patients meet this target.</p><p id="par0125" class="elsevierStylePara elsevierViewall">Although not conducted in the specific setting of lipid units, the LIPICERES study<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">21</span></a> found that 52.3% of patients achieved target LDL-C levels <70<span class="elsevierStyleHsp" style=""></span>mg/dl. Greater control was observed in 2015 than in previous years. The authors attribute this improvement to the publication of the IMPROVE-IT study.<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">22</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">If we consider the less-stringent targets of the Preventive Activities and Health Promotion Programme (<span class="elsevierStyleItalic">Programa de Actividades Preventivas y de Promoción de la Salud</span>, PAPPS)<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">23</span></a> applicable and current during the study period, 59.3% of high-risk patients (primary prevention, LDL-C target <130<span class="elsevierStyleHsp" style=""></span>mg/dl) and 53.1% of very high-risk patients (secondary prevention, LDL-C target <100<span class="elsevierStyleHsp" style=""></span>mg/dl) achieved the LDL-C goal. However, these goals were disputed by specialists for not following the European Guidelines.<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">12</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">It is striking that 93.4% of patients who attended lipid units for the first time did not achieve the LDL-C target, despite the fact that 86.8% were receiving lipid-lowering drugs. Statins were the drugs most commonly used, consistent with other studies.<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">4,10,20</span></a> In our study, more patients received combination therapy with cholesterol absorption inhibitors than in the EDICONDIS<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">10</span></a> and REPAR<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">20</span></a> studies.</p><p id="par0140" class="elsevierStylePara elsevierViewall">The greater number of patients who attained the LDL-C target in our study could be explained by the change to the very intensive treatment strategy used (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>), comparable to the EDICONDIS-ULISEA study,<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">10</span></a> in which use of the more intensive treatment increased from 15.7% to 29.9%.</p><p id="par0145" class="elsevierStylePara elsevierViewall">Non-adherence to treatment was the main barrier to achieving the treatment goals in our study. According to Fuster,<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">24</span></a> treatment adherence did not exceed 60% and more than 50% of patients with chronic conditions decided to discontinue treatment. In studies assessing treatment adherence in dyslipidaemia,<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">25,26</span></a> the percentage of non-compliant patients ranges from 26.7% to 46.7%.</p><p id="par0150" class="elsevierStylePara elsevierViewall">Treatment adherence recommended by the CPGs is associated with the reduced onset of severe CV events and healthcare cost savings.<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">27</span></a> A lack of treatment adherence by the patient should be considered as a cause of treatment failure. Concern over the onset of side effects in the future, the cost of treatment, possible interactions with other medicines or patients’ perception of a treatment's lack of efficacy, its short-term action or its ineffectiveness for CV prevention can all be associated with the presence of side effects.<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">28</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">In terms of doctor-related causes, clinical inertia was the primary factor. In our study, clinical inertia was associated with greater non-adherence to treatment. A total of 50% of patients subjected to clinical inertia were non-compliant, versus 27% of patients not subjected to clinical inertia (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.009). The inertia study,<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">15</span></a> which evaluated the degree of clinical inertia in the outpatient management of dyslipidaemia in patients with ischaemic heart disease, found 42.8% of consultations involved clinical inertia. According to cardiologists, one of the most common causes of undertreatment associated with clinical inertia was a lack of familiarity with the CPGs and the lack of protocols.</p><p id="par0160" class="elsevierStylePara elsevierViewall">Studies that have analysed the reasons for failing to achieve LDL-C targets in secondary care<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">9,15,29</span></a> in high- or very high-risk patients have been based on doctor surveys and questionnaires.<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">15,29</span></a> The study by Galve et al.,<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">29</span></a> which employed the Delphi method, recognised the complexity and debate surrounding the treatment of dyslipidaemia. It was mutually agreed that the number of patients with very high CV risk who meet the recommended LDL-C targets is inadequate and that clinical inertia is common in clinical practice.</p><p id="par0165" class="elsevierStylePara elsevierViewall">In 13.7% of cases where the LDL-C target was not met, the doctor considered that it had been. In 54.2% of these patients, LDL-C levels did not exceed 10% of the target (69.2% for high-risk patients and 36.4% for very high-risk patients). It may be that in these cases the doctor may have evaluated individual variability and the variability of the analytical method, as well as the risks and benefits of intensifying treatment, before concluding that treatment intensification is not necessary.</p><p id="par0170" class="elsevierStylePara elsevierViewall">The most commonly reported side effects attributed to statins<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">30,31</span></a> are muscle disorders and liver disease. The onset of side effects in our study was similar to that reported in the literature as the cause cannot be modified.</p><p id="par0175" class="elsevierStylePara elsevierViewall">It is important to identify the modifiable causes for failing to achieve the LDL-C therapeutic target recommended by the CPGs in actual clinical practice in lipid units, and to thereby understand the reason why specialists who have the necessary expertise and tools do not achieve this goal in a greater proportion of cases. A study performed in clinical practice<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">32</span></a> involving high-risk patients found that follow-up by a specialised unit and the implementation of CPGs improved the control of CV risk factors and led to a greater reduction in three-year morbidity and mortality.</p><p id="par0180" class="elsevierStylePara elsevierViewall">In this light, rather than lamenting the general failure to achieve LDL-C targets, strategies must be developed aimed at improving these outcomes. It is only by fully understanding the reasons that real solutions can be found. Extra effort must be made to not put the blame on the patient, to find ways to improve treatment adherence where side effects do not impede the administration of treatment and to overcome clinical inertia.<a class="elsevierStyleCrossRefs" href="#bib0340"><span class="elsevierStyleSup">33,34</span></a> Three quarters of the reasons why the LDL-C treatment targets are not met are modifiable. Clinical inertia can be overcome by applying an appropriate methodology, and the treatment goals can be met with the cholesterol-lowering drugs that are currently available. To achieve this, it is essential to be coherent with the CPGs and the implications of attaining the therapeutic targets, as well as to optimise the implementation of the available lipid-lowering strategies.<a class="elsevierStyleCrossRefs" href="#bib0340"><span class="elsevierStyleSup">33–35</span></a></p><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Limitations</span><p id="par0185" class="elsevierStylePara elsevierViewall">The limitations of the Retrospective, Observational, Therapeutic Target Management Study (EROMOT) mainly derive from its retrospective design. Nevertheless, this study contributes specific knowledge on the reasons why treatment targets are not met and the intensity of the therapeutic strategies used in lipid and vascular risk units, as well as the efficacy of lipid-lowering drugs in actual clinical practice.</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conclusion</span><p id="par0190" class="elsevierStylePara elsevierViewall">Despite a significant improvement in attaining LDL-C targets in lipid and vascular risk units, as well as increased uptake of very intensive treatment strategies, there is still much room for improvement. Fully understanding the reasons why LDL-C therapeutic targets are not met could help us to design strategies to optimise use of the available lipid-lowering drugs and thereby improve CV morbidity and mortality as cost-effectively as possible in actual clinical practice.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Ethical responsibilities</span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Protection of people and animals</span><p id="par0195" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this research.</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Data confidentiality</span><p id="par0200" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols implemented in their place of work regarding the publication of patient data.</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Right to privacy and informed consent</span><p id="par0205" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Funding</span><p id="par0210" class="elsevierStylePara elsevierViewall">This study was partially funded by an unrestricted grant from MSD España to the Network of Lipid and Arteriosclerosis Units of Catalonia (<span class="elsevierStyleItalic">Xarxa d’Unitats de Lípids i Arteriosclerosi de Catalunya</span>) to support atherosclerosis research activities.</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Conflicts of interest</span><p id="par0215" class="elsevierStylePara elsevierViewall">For this study, the authors declare that there was no interference in the attaining or interpretation of the results and that they therefore have no conflicts of interest.</p><p id="par0220" class="elsevierStylePara elsevierViewall">Some of the authors have received fees for conferences and/or scientific advice from various pharmaceutical companies, as detailed below.</p><p id="par0225" class="elsevierStylePara elsevierViewall">Dr Morales has received conference fees from MSD España, Rubió and Sanofi.</p><p id="par0230" class="elsevierStylePara elsevierViewall">Dr Plana has received conference fees from Alexion, Amgem, Ferrer, MSD, Rubió and Sanofi.</p><p id="par0235" class="elsevierStylePara elsevierViewall">Dr Masana has received conference and scientific advice fees from Amgen, MSD, Recordati and Sanofi.</p><p id="par0240" class="elsevierStylePara elsevierViewall">Dr Pedro-Botet has received conference fees from Astra Zeneca, Esteve, Ferrer, Merck, Mylan and Sanofi.</p><p id="par0245" class="elsevierStylePara elsevierViewall">Drs Arnau, Matas, Mauri, A. Vila, Ll. Vila, Soler and Montesinos declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres995129" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Patients and method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec958303" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres995128" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Pacientes y método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec958304" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Patients and methods" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Design" ] 1 => array:3 [ "identificador" => "sec0020" "titulo" => "Statistical analysis" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0025" "titulo" => "Sample size" ] ] ] ] ] 6 => array:2 [ "identificador" => "sec0030" "titulo" => "Results" ] 7 => array:3 [ "identificador" => "sec0035" "titulo" => "Discussion" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0040" "titulo" => "Limitations" ] ] ] 8 => array:2 [ "identificador" => "sec0045" "titulo" => "Conclusion" ] 9 => array:3 [ "identificador" => "sec0050" "titulo" => "Ethical responsibilities" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0055" "titulo" => "Protection of people and animals" ] 1 => array:2 [ "identificador" => "sec0060" "titulo" => "Data confidentiality" ] 2 => array:2 [ "identificador" => "sec0065" "titulo" => "Right to privacy and informed consent" ] ] ] 10 => array:2 [ "identificador" => "sec0070" "titulo" => "Funding" ] 11 => array:2 [ "identificador" => "sec0075" "titulo" => "Conflicts of interest" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-07-04" "fechaAceptado" => "2017-07-07" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec958303" "palabras" => array:3 [ 0 => "Low-density lipoprotein cholesterol" 1 => "Lipid units" 2 => "Therapeutic target" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec958304" "palabras" => array:3 [ 0 => "Colesterol de las lipoproteínas de baja densidad" 1 => "Unidades de Lípidos" 2 => "Objetivo terapéutico" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To determine the extent to which low-density lipoprotein cholesterol (LDL-C) therapeutic targets are achieved in patients with high and very high vascular risk treated in lipid units, and the reasons why these targets are not met.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Patients and method</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Observational and retrospective multi-centre study. Patients over the age of 18 with high or very high vascular risk according to the criteria set forth by the 2012 European guidelines on cardiovascular disease prevention who were consecutively referred to lipid units between January and June 2012 and with follow-up two years after the first visit were included.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">243 patients from 16 lipid units were enrolled. The mean age was 52.2 years (SD 13.7) and 62.6% of the patients were male. 40.3% were classified as very high risk. At the first visit, 86.8% were on lipid-lowering treatment (25.1% on combination therapy), which rose to 95.0% at the second visit (47.3% on combination therapy) (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001). A total of 28% (95% CI: 22.4–34.1) achieved the therapeutic target. In terms of the reasons why therapeutic targets were not met, 24.6% of failures were attributed to the medication (10.3% maximum tolerated dose and 10.9% due to the onset of side effects), 43.4% were attributed to the doctor (19.4% due to clinical inertia, 13.7% due to having deemed the goal to have been achieved) and 46.9% were attributed to the patient, primarily non-adherence to treatment (31.4%).</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">LDL-C therapeutic targets were achieved in around one third of patients. Patient non-adherence, followed by clinical inertia, are the primary causes that could explain these results.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Patients and method" ] 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">Objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Determinar el grado de consecución del objetivo terapéutico del colesterol de las lipoproteínas de baja densidad (cLDL) en pacientes de alto y muy alto riesgo vascular atendidos en las unidades de lípidos, así como las causas de no consecución.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Pacientes y método</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional retrospectivo multicéntrico. Se incluyó a los pacientes mayores de 18 años con alto o muy alto riesgo vascular, según los criterios de la Guía europea de prevención cardiovascular de 2012, remitidos de forma consecutiva a las unidades de lípidos entre enero y junio del 2012 y con seguimiento a los 2 años de la primera visita.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se incluyó a 243 pacientes procedentes de 16 unidades de lípidos. La edad media fue de 52,2 años (DE 13,7) con un 62,6% de varones. Un 40,3% eran de muy alto riesgo. En la primera visita seguían tratamiento hipolipidemiante el 86,8% (en combinación 25,1%) y en la segunda visita el 95,0% (en combinación 47,3%) (p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,001). El 28% (IC del 95%: 22,4-34,1) alcanzó el objetivo terapéutico. Sobre las causas de no consecución, el 24,6% de ellas estaban relacionadas con el medicamento (10,3% máxima dosis tolerada y 10,9% por aparición de efectos adversos), el 43,4% con el médico (19,4% por inercia, 13,7% por considerar que ya ha llegado al objetivo) y con el paciente el 46,9%, destacando el incumplimiento terapéutico (31,4%).</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Se consiguieron los objetivos de cLDL en cerca de un tercio de los pacientes. La baja adherencia del paciente, seguida de la inercia médica, son las causas más frecuentes que pueden explicar estos resultados.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Pacientes y método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:2 [ 0 => array:3 [ "etiqueta" => "◊" "nota" => "<p class="elsevierStyleNotepara" id="npar0035">The full list of members of the EROMOT-XULA research group can be found in <a class="elsevierStyleCrossRef" href="#sec0080">Annex 1</a>.</p>" "identificador" => "fn1" ] 1 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0030">Please cite this article as: Morales C, Plana N, Arnau A, Matas L, Mauri M, Vila À, et al. Causas de no consecución del objetivo terapéutico del colesterol de las lipoproteínas de baja densidad en pacientes de alto y muy alto riesgo vascular controlados en Unidades de Lípidos y Riesgo Vascular. Estudio EROMOT. Clin Invest Arterioscler. 2018;30:1–9.</p>" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:3 [ "apendice" => "<p id="par0250" class="elsevierStylePara elsevierViewall">Alphabetic list of the group members by lipid and vascular risk unit of the <span class="elsevierStyleItalic">Xarxa d’Unitats de Lípids i Arteriosclerosi</span>. EROMOT-XULA group.</p> <p id="par0255" class="elsevierStylePara elsevierViewall">Enric Ballestar Mas (Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Barcelona).</p> <p id="par0260" class="elsevierStylePara elsevierViewall">Mònica Berrocal Guevara (Fundació Hospital/Asil de Granollers, Granollers, Barcelona).</p> <p id="par0265" class="elsevierStylePara elsevierViewall">Rosa María Borrallo Almans (Consorci Sanitari de Terrassa, Hospital de Terrassa, Terrassa, Barcelona).</p> <p id="par0270" class="elsevierStylePara elsevierViewall">Assumpta Caixàs Pedragós (Hospital Parc Taulí de Sabadell, Sabadell, Barcelona).</p> <p id="par0275" class="elsevierStylePara elsevierViewall">Elisenda Climent (Hospital del Mar de Barcelona, Barcelona).</p> <p id="par0280" class="elsevierStylePara elsevierViewall">Montserrat García Cors (Hospital General de Catalunya, Sant Cugat del Vallès, Barcelona).</p> <p id="par0285" class="elsevierStylePara elsevierViewall">Carolina Guerrero Buitrago (Hospital Sant Joan de Déu de Martorell, Martorell, Barcelona).</p> <p id="par0290" class="elsevierStylePara elsevierViewall">Jordi Grau Amorós (Hospital Municipal de Badalona, Badalona, Barcelona).</p> <p id="par0295" class="elsevierStylePara elsevierViewall">Daiana Ibarretxe Guerediaga (Hospital Universitari Sant Joan de Reus, Reus, Tarragona).</p> <p id="par0300" class="elsevierStylePara elsevierViewall">Carlos Jericó Alba (Hospital de Sant Joan Despí Moisès Broggi, Consorci Sanitari Integral, Sant Joan Despí, Barcelona).</p> <p id="par0305" class="elsevierStylePara elsevierViewall">M. Teresa Julian Alagarda (Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Barcelona).</p> <p id="par0310" class="elsevierStylePara elsevierViewall">Esteve Llargués Rocabruna (Fundació Hospital/Asil de Granollers, Granollers, Barcelona).</p> <p id="par0315" class="elsevierStylePara elsevierViewall">Paquita Montaner Batlle (Hospital Sant Joan de Déu de Martorell, Martorell, Barcelona).</p> <p id="par0320" class="elsevierStylePara elsevierViewall">Abel Mujal Martínez (Hospital Parc Taulí de Sabadell, Sabadell, Barcelona).</p> <p id="par0325" class="elsevierStylePara elsevierViewall">Eduarda Pizarro Lozano (Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Barcelona).</p> <p id="par0330" class="elsevierStylePara elsevierViewall">Rafael Ramírez Montesinos (Hospital de Santa Tecla, Tarragona).</p> <p id="par0335" class="elsevierStylePara elsevierViewall">Joaquim Ripollés Edo (Hospital Sant Joan de Déu de Martorell, Martorell, Barcelona).</p> <p id="par0340" class="elsevierStylePara elsevierViewall">Cèlia Rodríguez-Borjabad (Hospital Universitari Sant Joan de Reus, Reus, Tarragona).</p> <p id="par0345" class="elsevierStylePara elsevierViewall">Elisabeth Sánchez Pujol (Fundació Hospital/Asil de Granollers, Granollers, Barcelona).</p> <p id="par0350" class="elsevierStylePara elsevierViewall">Mònica Vila Vall-llovera (Fundació Hospital/Asil de Granollers, Granollers, Barcelona).</p> <p id="par0355" class="elsevierStylePara elsevierViewall">Alberto Zamora Cervantes (Hospital de Blanes, Blanes, Girona).</p>" "etiqueta" => "Annex 1" "identificador" => "sec0080" ] ] ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1199 "Ancho" => 2599 "Tamanyo" => 115402 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Attainment of the LDL cholesterol therapeutic target as defined by the 2012 European guidelines on cardiovascular disease prevention.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">BMI: body mass index; TG: triglycerides.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Valid no. \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Age (years)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">243 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">52.2 (SD<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>13.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Gender (male)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">243 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">152 (62.6%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Smoking</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">229 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Non-smoker \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">90 (39.3%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Former smoker \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">68 (29.7%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Smoker \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">71 (31.0%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Alcohol</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">220 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Non-drinker \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">137 (62.3%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Low/moderate consumption \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">68 (30.9%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>High consumption \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 (6.8%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Weight (kg)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">217 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">80.5 (SD<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>16.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">BMI</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">194 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28.6 (SD<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>4.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span><25<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">43 (22.2%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>25–29.9<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">79 (40.7%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>≥30<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">72 (37.1%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Waist circumference (cm)</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Men \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">85 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100.6 (10.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Women \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">95.1 (13.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Type 2 diabetes mellitus</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">243 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">68 (28.0%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Hypertension</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">243 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">102 (42.0%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Ischaemic heart disease</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">243 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38 (15.6%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Ischaemic CVA</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">243 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 (4.9%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Peripheral artery disease</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">243 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23 (9.5%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Chronic kidney failure</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">243 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 (5.8%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Type of dyslipidaemia</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">243 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Heterozygous familial hypercholesterolaemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">72 (29.6%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Polygenic hypercholesterolaemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">76 (31.3%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Secondary dyslipidaemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (2.5%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Severe hypertriglyceridaemia (TG >500<span class="elsevierStyleHsp" style=""></span>mg/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 (4.5%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Mixed dyslipidaemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">76 (31.3%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Hypobetalipoproteinaemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (0.4%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Hyperalphalipoproteinaemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (0.4%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Vascular risk</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">243 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>High vascular risk \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">145 (59.7%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Very high vascular risk \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">98 (40.3%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Non-pharmacological treatment</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Diet \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">187 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">182 (97.3%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Phytosterols \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">152 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">71 (46.7%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Physical exercise \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">173 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">166 (96.0%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Smoking<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="table-entry " align="char" valign="top">55 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">54 (98.2%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1687286.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Smokers advised to quit smoking.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Demographic, anthropometric and clinical characteristics of the 243 patients.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">LDL-C: low-density lipoprotein cholesterol.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">First visit \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Last visit \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>-value \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Pharmacological treatment</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>243 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>243 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No medication \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">32 (13.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12 (4.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Monotherapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">150 (61.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">116 (47.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Combination \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">61 (25.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">115 (47.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">HMG-CoA reductase inhibitors</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">189 (77.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">221 (90.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Cholesterol absorption inhibitors</span><a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">48 (19.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">82 (33.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Ion-exchange resins</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 (1.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7 (2.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.453 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Fibrates</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">31 (12.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">43 (17.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.012 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Omega-3 fatty acids</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9 (3.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10 (4.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.000 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Intensity of the pharmacological strategy</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No treatment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">32 (13.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12 (4.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Low intensity (↓ LDL-C<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>30%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">30 (12.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">21 (8.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.136 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Moderate intensity (↓ LDL-C 30–49%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">78 (32.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">70 (28.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.389 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Intensive (↓ LDL-C 50–60%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">75 (30.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">86 (35.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.235 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Very intensive (↓ LDL-C<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>60%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">28 (11.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">54 (22.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1687288.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Statins.</p>" ] 1 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Ezetimibe.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Lipid-lowering pharmacological treatment at the two visits conducted.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Median (25th percentile–75th percentile).</p><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">HDL-C: high-density lipoprotein cholesterol; LDL-C: low-density lipoprotein cholesterol.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Valid no. \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">First visit \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Valid no. \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Last visit \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>-value<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total cholesterol (mg/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">242 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">237.5 (193.4–292.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">243 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">190.0 (161.0–216.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">LDL cholesterol (mg/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">203 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">143.0 (104.0–189.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">222 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">106.3 (83.8–132.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Non-HDL cholesterol (mg/dl)<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">32 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">246.5 (192.8–281.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">225.0 (177.3–274.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HDL cholesterol (mg/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">232 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">46.9 (38.0–56.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">239 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">46.4 (38.0–57.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.211 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Triglycerides (mg/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">238 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">151.5 (93.0–272.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">239 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">132.6 (86.0–206.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Blood glucose (mg/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">197 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">97.0 (87.0–117.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">212 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100.0 (90.0–120.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.767 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Alanine aminotransferase (U/l) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">179 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24.0 (18.0–33.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">203 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24.0 (18.0–35.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.910 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Aspartate aminotransferase (U/l) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">171 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23.0 (18.0–35.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">200 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22.6 (18.0–31.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.571 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gamma-glutamyltransferase (U/l) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">166 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">32.0 (17.3–54.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">158 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28.5 (18.0–54.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.292 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Creatine kinase (U/l) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">96 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">98.5 (70.4–154.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">101 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">101.0 (73.5–170.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.172 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Creatinine (mg/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">196 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.87 (0.72–1.00) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">202 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.90 (0.70–1.01) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.289 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1687287.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0020" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Patients with triglyceride levels >400<span class="elsevierStyleHsp" style=""></span>mg/dl.</p>" ] 1 => array:3 [ "identificador" => "tblfn0025" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="npar0025">Comparison performed with patients with valid values in the two visits.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Lipid profile at the two visits conducted.</p>" ] ] 4 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">The causes are not mutually exclusive.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>175 \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Drug-related causes</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">43 (24.6%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Patient reached maximum tolerated dose (possible)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 (10.3%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Treatment not modified due to onset of side effects</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19 (10.9%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Myalgia without CK elevation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 (5.7%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Elevated CK \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (2.9%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span><5 times the upper limit of normal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (2.3%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>≥5 times the upper limit of normal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0.0%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>≥10 times the upper limit of normal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (0.6%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Elevated transaminases (3 x upper limit of normal) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (1.1%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Intolerance to drugs \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 (5.7%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Doctor-related causes</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">76 (43.4%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Obstacles to prescribing certain drugs</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (1.1%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Clinical inertia</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34 (19.4%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Failure to follow the 2012 European Guidelines</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 (5.1%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Prescription cancellation by GP</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 (6.9%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Prescription cancellation by another specialist</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (0.6%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Doctor deems the therapeutic target to have been achieved</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24 (13.7%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Patient-related causes</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">82 (46.9%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Comorbidity</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 (5.7%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Polypharmacy</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (2.9%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Treatment non-adherence</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">55 (31.4%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Failure to complete follow-up</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 (11.4%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Unable to afford treatment</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (2.9%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1687289.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Reasons for failing to achieve the LDL-C therapeutic targets.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:35 [ 0 => array:3 [ "identificador" => "bib0180" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "ESC/EAS Guidelines for the management of dyslipidaemias: the Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Z. 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Original article
Causes of failure to achieve the low density lipoprotein cholesterol therapeutic target in patients with high and very high vascular risk controlled in Lipid and Vascular Risk Units. EROMOT study
Causas de no consecución del objetivo terapéutico del colesterol de las lipoproteínas de baja densidad en pacientes de alto y muy alto riesgo vascular controlados en Unidades de Lípidos y Riesgo Vascular. Estudio EROMOT
Clotilde Moralesa,
, Núria Planab, Anna Arnauc, Laia Matasd, Marta Maurie, Àlex Vilaf, Lluís Vilag, Cristina Solerh, Jesús Montesinosc, Lluís Masanab, Juan Pedro-Boteti, on behalf of the EROMOT-XULA research group ◊
Corresponding author
a Servei de Medicina Interna, Unitat de Lípids i Risc Vascular, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Barcelona, Spain
b Unitat de Medicina Vascular i Metabolisme (UVASMET), Hospital Universitari Sant Joan de Reus, Universitat Rovira i Virgili de Reus, Reus, Tarragona, Spain
c Unitat de Recerca i Innovació, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Barcelona, Spain
d Servei de Medicina Interna, Unitat de Risc Vascular i Lípids, Hospital de Sant Pau de Barcelona, Barcelona, Spain
e Servei de Medicina Interna, Unitat de Lípids, Consorci Sanitari de Terrassa-Hospital de Terrassa, Terrassa, Barcelona, Spain
f Servei de Medicina Interna, Unitat de Lípids, Hospital de Figueres, Figueres, Girona, Spain
g Servei d’Endocrinologia i Nutrició, Unitat de Lípids, Hospital Sant Joan Despí Moisès Broggi, Consorci Sanitari Integral, Sant Joan Despí, Barcelona, Spain
h Hospital de Santa Caterina de Salt, Parc Hospitalari Martí i Julià, Salt, Girona, Spain
i Unitat de Lípids i Risc Vascular, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
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