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The TgLOX<span class="elsevierStyleSup">VSMC</span> mice (black bars) and control (WT; white bars) received a single injection of AAV-PCSK9<span class="elsevierStyleSup">D374Y</span> or saline solution and were fed an atherogenic diet for 20 weeks. Levels of mRNA of genes indicative of ECM remodelling (<span class="elsevierStyleItalic">Lox and Col1a1</span>) and oxidative stress (<span class="elsevierStyleItalic">Nox2</span>) (A), inflammation (<span class="elsevierStyleItalic">Il1β, Il6, and Mcp1</span>) (B), and calcification markers (<span class="elsevierStyleItalic">Runx2, Opn, and Alpl</span>) (C) in each experimental group. 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class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Paula" "apellidos" => "Gómez-Turégano" ] 2 => array:2 [ "nombre" => "María" "apellidos" => "Beltrán Moreno" ] 3 => array:2 [ "nombre" => "Ana Isabel" "apellidos" => "Fernández-Chamorro" ] 4 => array:2 [ "nombre" => "Benjamín" "apellidos" => "Roque Rodríguez" ] 5 => array:2 [ "nombre" => "Zineb" "apellidos" => "Kounka" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Departamento de Cardiología, Hospital Universitario San Pedro de Alcántara, Cáceres, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Lipoproteína (a) es un factor predictor de no consecución de objetivos de C-LDL en pacientes con cardiopatía isquémica crónica" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1348 "Ancho" => 2341 "Tamanyo" => 263995 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0040" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Summary of the study that includes the most relevant results in patients with Lp(a) levels in excess of >50 mg/dl and Lp(a) values of ≤50 mg/dl.</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">LDL-C: low-density lipoprotein cholesterol; Lp(a)-C: cholesterol bound to lipoprotein (a); CAD: coronary artery disease; OR: odds ratio; LLT: lipid-lowering treatment.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Lipoprotein (a) [Lp(a)] is a molecule that resembles low density lipoprotein (LDL) covalently bound by a disulphide bond from apolipoprotein B100 to apolipoprotein (a).<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Lp(a) has proatherogenic, proinflammatory, and prothrombotic properties, and several studies have demonstrated that it is involved in the pathophysiological process of atherosclerosis of the coronary arteries, as well as of other vascular territories.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a> There is ample scientific evidence from both epidemiological and genetic studies of the association between cardiovascular risk and elevated Lp(a) levels<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5–8</span></a> that shows that it is a continuous and independent risk factor for coronary artery disease (CAD) and that elevated Lp(a) levels predict the occurrence of cardiovascular events.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Genetics accounts for more than 90% of plasma Lp(a) levels, while environmental factors have little influence,<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10,11</span></a> and in the general population the distribution is skewed to the left, with 35% of all people presenting values >30 mg/dl.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> Other genetic dyslipidaemias, such as familial hypercholesterolaemia, are associated with a higher prevalence of elevated Lp(a).<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Whilst CAD mortality has declined in recent years, a percentage of patients do not meet guideline-recommended low-density lipoprotein cholesterol (LDL-C) reduction targets,<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14,15</span></a> even with intensive treatment strategies,<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> and those subjects who fail to attain the recommended targets continue to be at high risk for cardiovascular morbidity and mortality.</p><p id="par0025" class="elsevierStylePara elsevierViewall">There is little evidence as to the role of high Lp(a) levels in not reaching the strict LDL-C targets of the latest guidelines,<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17–19</span></a> and, inasmuch as Lp(a) levels are often not determined in people with CAD, the correlation between Lp(a) and successful achievement of LDL-C goals in these patients has been scarcely explored.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The objective of the present study was to investigate the prevalence of elevated Lp(a) levels in a population of patients with CAD and how they impact LDL-C concentrations and the achievement of the LDL-C goals set forth in the guidelines for very high-risk CAD patients.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Patients and method</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Study population</span><p id="par0035" class="elsevierStylePara elsevierViewall">The study population consisted of 870 consecutive cases with CAD seen at a cardiology clinic at a Spanish tertiary hospital between September 2016 until March 2020.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Two Lp(a) categories were established based on the threshold proposed by the European Atherosclerosis Society for Lp(a),<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> setting a limit of 50 mg/dl, thereby dividing cases into one group with Lp(a) concentrations of ≤50 and another one with values of >50 mg/dl.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Using our centre’s computerised analytical system, we collected the highest LDL-C recorded in said system (baseline LDL-C), which comprised 72.5%, prior to commencing with lipid-lowering treatment (LLT) and then distributed the patients according to whether their baseline LDL-C was ≤ or >130 mg/dl.</p><p id="par0050" class="elsevierStylePara elsevierViewall">In those subjects who had already started LLT prior to the implementation of our hospital's computerised analysis registry (240 patients), we inferred pre-LLT LDL-C concentrations using the published conversion factors.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">All the participants signed an informed consent form and that had been previously approved by the local ethics committee.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Clinical and biochemical determinations</span><p id="par0060" class="elsevierStylePara elsevierViewall">The diagnosis of CAD was established by coronariographic proof of at least one coronary stenosis of 50% or more in an epicardiac coronary artery.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Clinical parameters were chosen that were related with the presence of hyperlipidaemia and the use of LLT.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Lp(a) concentrations (in mg/ dl) were determined by means of immunoturbidimetry on the Hitachi 917 analyser (Roche Diagnostics, Indianapolis, IN, USA), using calibrators, controls, and reagents from the same brand.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Total cholesterol, high-density lipoprotein cholesterol (HDL-C) and triglyceride values were quantified in the laboratory; LDL-C values were determined by means of the Friedewald formula when triglyceride levels were less than 200 mg/dl and by direct method when they were higher.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> The LDL-C corrected for the cholesterol content of Lp(a) [C-Lp(a)] was obtained by using Dahlen’s equation (corrected LDL-C = LDL-C − Lp(a) mass × 0.3).<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">High potency statins were deemed [appropriate], such as rosuvastatin at doses of 20−40 mg/day or atorvastatin at doses of 40−80 mg/day.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Statistical analysis</span><p id="par0085" class="elsevierStylePara elsevierViewall">All statistical analyses were performed using the SPSS 25.0 software package (IBM Corporation, Armonk, NY, USA) for Windows.</p><p id="par0090" class="elsevierStylePara elsevierViewall">The Kolmogorov-Smirnov test was applied to determine that the Lp(a) concentrations followed no normal pattern of distribution (p < .0001).</p><p id="par0095" class="elsevierStylePara elsevierViewall">The categorical variables are presented as frequencies with percentages and were compared using the Chi-squared test. The continuous variables are expressed as the mean and standard deviation, except for Lp(a) levels, which are presented as the median and interquartile range (IQR), and were compared with Student’s t-test for independent samples when the distribution is normal, or with the Mann-Whitney U test when the data are not normally distributed.</p><p id="par0100" class="elsevierStylePara elsevierViewall">The odds ratio (OR) and 95% confidence Interval were calculated using multivariate logistic regression.</p><p id="par0105" class="elsevierStylePara elsevierViewall">Statistical significance was set at a p value < .05.</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Baseline population characteristics</span><p id="par0110" class="elsevierStylePara elsevierViewall">A total of 870 outpatient subjects with CAD were enrolled. Just over 43% (43.2%) (376 participants) had Lp(a) levels > 30 mg/dl and 30.8% (268 subjects) displayed concentrations of >50 mg/dl. The median Lp(a) value was 22.10 mg/dl (IQR 8.28–60.70).</p><p id="par0115" class="elsevierStylePara elsevierViewall">We divided the study population into two groups – those with Lp(a) concentrations of ≤50 mg/dl and Lp(a) >50 mg/dl. The main clinical and biochemical characteristics can be found on <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">There were no differences in terms of age or sex of the individuals with Lp(a) > and those with Lp(a) ≤50 mg/dl, or with respect to family history of premature CAD.</p><p id="par0125" class="elsevierStylePara elsevierViewall">Hyperlipemia was reported more often among the participants in the higher Lp(a) level group. LLT was similar in both groups, although the use of high-potency statins was higher in those with Lp(a) >50 mg/dl; patients on high-potency statin treatment had significantly higher Lp(a) levels than those not receiving such treatment: 24.35 mg/dl (IQR 8.63–62.55) vs. 18.55 mg/dl (IQR 7.40–52.38) (p = 0.019 as per Mann–Whitney U).</p><p id="par0130" class="elsevierStylePara elsevierViewall">Combination LLT with ezetimibe was more common in participants with Lp(a) >50 mg/dl, and those who took ezetimibe exhibited significantly higher Lp(a) values than those who did not: 31.80 mg/dl (IQR 10.90–76.85) vs. 18.15 mg/dl (IQR 7.50–54.13) (p = .0001 on the basis of the Mann-Whitney U test).</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Association between Lp(a) and LDL-C</span><p id="par0135" class="elsevierStylePara elsevierViewall">We have analysed both groups of patients: those with a baseline LDL-C concentration of  ≤ 130 mg/dl and those who started off with a baseline LDL-C value > 130 mg/dl (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0140" class="elsevierStylePara elsevierViewall">The subjects with baseline LDL-C levels of >130 mg/dl and Lp(a) >50 mg/dl exhibited significantly higher concentrations of LDL-C at baseline, as well as LDL-C values at present, in comparison with those in the Lp(a) ≤50 mg/dl group.</p><p id="par0145" class="elsevierStylePara elsevierViewall">Participants with baseline LDL-C values ≤130 mg/dl displayed similar baseline LDL-C concentrations, regardless of whether it was > or ≤50 mg/dl; that being said, their current LDL-C levels were significantly greater when Lp(a) was >50 mg/dl.</p><p id="par0150" class="elsevierStylePara elsevierViewall">The percentage of LDL-C decrease was similar in individuals with baseline LDL-C >130 mg/dl, irrespective of Lp(a); among those with baseline LDL-C of ≤130 mg/dl, the ones having Lp(a) concentrations of >50 mg/dl revealed significantly smaller decreases than those with Lp(a) values ≤50 mg/dl.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Lp(a) concentrations and LDL-C target values achieved</span><p id="par0155" class="elsevierStylePara elsevierViewall">The percentage of participants who attained the target LDL-C levels established in the European dyslipidaemia guidelines<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> (both below 70 mg/dl, as well as 55 mg/dl) was lower among the individuals with Lp(a) >50 mg/dl, despite the greater use of high-potency statins and combination LLT in combination with ezetimibe in these cases (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><p id="par0160" class="elsevierStylePara elsevierViewall">When we corrected LDL-C in accordance with Lp(a) concentration levels using Dahlen's formula, the percentage of participants achieving LDL-C targets improves with respect to the LDL-C calculated. An LDL-C value of <70 mg/dl was achieved by 76.1 vs. 59.1% (p = .0001) of the subjects and an LDL-C value of <55 mg/dl was obtained by 54.4 vs. 31.8% (p = .0001).</p><p id="par0165" class="elsevierStylePara elsevierViewall">Target LDL-C <70 mg/ dl is improved when corrected LDL-C was considered both in patients with Lp(a) ≤50 mg/dl (71.6 vs. 62.9%; p = .0001) and those with Lp(a) >50 mg/dl (86.3 vs. 50.6%; p = 0.0001), albeit the magnitude is greater in the latter group. Likewise, the target level of LDL-C of <55 mg/dl was better among individuals with Lp(a) ≤50 mg/dl (46.9 vs. 36.3%; p = .0001), but, especially, among those with Lp(a) > 50 mg/dl (71.4 vs. 21.7%; p = .0001).</p><p id="par0170" class="elsevierStylePara elsevierViewall">Median Lp(a) values differed depending on the LDL-C level achieved: individuals who achieved LDL-C ≤55 mg/dl had significantly lower Lp(a) values than those who attained LDL-C values of between 55−70 mg/dl and >70 mg/dl. Consequently, it would appear that elevated Lp(a) values hamper the achievement of the targets set out in the clinical practice guidelines (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Variables independently associated with elevated Lp(a) concentrations</span><p id="par0175" class="elsevierStylePara elsevierViewall">In the multivariate analysis, the clinical variables independently associated with elevated Lp(a) (>50 mg/dl) were LLT with high-potency statins (OR 1.5, 95% CI 1.1–2.1, p = .017), combined LLT with ezetimibe (OR 2.0, 95% CI 2.5–2.7, p = 0.0001), and failure to achieve the LDL-C target (OR 1.5–2.7, 95% CI 1.5–2.7, p = 0.0001); 95% CI 1.5–2.7; p = 0.0001), and failure to achieve the LDL-C target of <55 mg/dl set forth in the ESC/EAS 2019 dyslipidaemia guidelines<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> for patients at very high cardiovascular risk (OR 2.3; 95% CI 1.6–3.2; p = .0001) (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a><a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>).</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Discussion</span><p id="par0180" class="elsevierStylePara elsevierViewall">The results of this study reveal that a high percentage of individuals with CAD and elevated Lp(a) levels are less likely to achieve guideline-recommended lipid targets despite the use of intensive LLT with high-potency statins or LLT in combination with ezetimibe.</p><p id="par0185" class="elsevierStylePara elsevierViewall">The EAS proposed that the optimal level of Lp(a) is <50 mg/dl; this corresponds to the 80th percentile of the Caucasian population, which accounts for 20% of the population with the highest values.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> In the present study, we detected a 30.8% prevalence of elevated Lp(a) levels (>50 mg/dl) among CAD patients. This prevalence is similar to that reported in other studies of individuals with CAD and higher than in the general population, which indicates that elevated Lp(a) is an important risk factor for developing CAD. We have also established that Lp(a) appears to be strongly positively associated with hyperlipidaemia. Participants in the PRAXY study of premature acute coronary syndrome had a higher prevalence of high Lp(a) relative to the general population (20 vs. 31%; p < 0.001), in line with the findings of our study. Compared to patients with lower Lp(a) (≤50 mg/dl), subjects with high Lp(a) levels (>50 mg/dl) had a higher prevalence of hyperlipidaemia.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> In our country data from the registry of Arrobas Velilla et al.,<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> 29.58% of the samples analysed were found to have Lp(a) concentrations of >50 mg/dl and 1.52% of them displayed values of >180 mg/dl.</p><p id="par0190" class="elsevierStylePara elsevierViewall">LDL-C determination includes Lp(a)-C, which can potentially contribute approximately 30–45% to the measured LDL-C.26 Thus, when the total mass of Lp(a) is high, the contribution of Lp(a)-C to LDL-C is substantial.<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">26,27</span></a> Thus, high levels of genetically generated Lp(a) falsely increase the amount of LDL-C calculated and, independently, the risk of CAD.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> Consequently, the calculated LDL-C should be modified to factor in the cholesterol associated with Lp(a) using Dalhen’s formula.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a></p><p id="par0195" class="elsevierStylePara elsevierViewall">The LLT routinely used to treat hypercholesterolaemia (statins and ezetimibe) do not lower Lp(a) levels; as a result, lowering LDL-C to the values recommended by the current ESC/ EAS guidelines (<55 mg/dl) may be more difficult in patients with cardiovascular disease and high Lp(a) levels.</p><p id="par0200" class="elsevierStylePara elsevierViewall">In our study, participants with Lp(a) >50 mg/dl had a more unfavourable lipid profile than those with Lp(a) ≤50 mg/dl; total cholesterol and LDL-C levels were higher in the former. This reflects the fact that the LDL-C calculated also gauges Lp(a). None of the methods used to quantify LDL-C enable us to discern between LDL particulate cholesterol and Lp(a); consequently, both should be reported together as LDL-C, which includes «LDL-C + Lp(a)-C».<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> In cases in which Lp(a) is very low, this limitation is not clinically relevant, however, as Lp(a) increases so too does its contribution to LDL-C, and limits the accurate interpretation of the contribution of each. Biochemical studies have evidenced that the Lp(a)-C content as a percentage of Lp(a) mass ranges from 20 to 45% depending on the individual and their baseline Lp(a),<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">26,29</span></a> such that in patients with extreme Lp(a) elevations and controlled LDL-C, the latter may consist predominantly or almost entirely of Lp(a)-C. Thus, in patients treated with high doses of statins and in whom we do not achieve an ‘expected’ LDL-C reduction, their true LDL-C may be very low and they are less sensitive to further LDL-C reduction given that a significant proportion of their LDL-C is in the form of Lp(a) particles. In these individuals with elevated Lp(a), a major fraction of LDL-C, both current and at baseline, may be transported by Lp(a) particles and contribute substantially to the calculated LDL-C, and in these cases statins and ezetimibe only lower LDL-C, not Lp(a)-C.</p><p id="par0205" class="elsevierStylePara elsevierViewall">A recent study<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> found a strong positive correlation between serum Lp(a) concentrations and the percentage of overestimation of LDL-C, and that as Lp(a) levels went up, there was no significant variation in the percentage of corrected LDL-C decline during treatment with atorvastatin.</p><p id="par0210" class="elsevierStylePara elsevierViewall">We observed that in the subgroup of patients with a baseline LDL-C level of >130 mg/dl and who also presented Lp(a) values of >50 mg/dl, we achieved smaller LDL-C reductions than in those in whom the concentration of Lp(a) was ≤50 mg/dl, despite more intensive use of LLT. These observations may bear implications for both treatment and LDL-C treatment targets. In our study, the use of combination LLT was significantly more frequent in people with higher Lp(a) levels. Despite this, LDL-C levels achieved in subjects with Lp(a) >50 mg/dl were significantly higher than among those with Lp(a) ≤50 mg/dl, which reflects a certain «resistance» in achieving targets in patients with elevated Lp(a) values. This «resistance» to high-intensity LLT that we have verified in our study had already been demonstrated in the FOURIER trial, in which the participants with the highest baseline Lp(a) levels were unable to achieve very low LDL-C levels (<20 mg/dl).<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> In the study by Verbeek et al., the authors highlight the clinical significance of this fact,<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a> inasmuch as for the same given LDL-C level, the risk of CAD increased by 40–50% when Lp(a) values were ≥50 mg/dl. Moreover, they noted that high Lp(a) levels are also closely associated with adverse clinical outcomes in subjects with low LDL-C values.</p><p id="par0215" class="elsevierStylePara elsevierViewall">This indicates that it will be extremely challenging for current LLTs to be able to achieve the targets in subjects with elevated Lp(a) and CAD, and that new drugs that also lower Lp(a) levels will be needed.</p><p id="par0220" class="elsevierStylePara elsevierViewall">In our study, although a larger percentage of participants with elevated Lp(a) levels (>50 mg/dl) were treated with high-potency statins and LLT in combination with ezetimibe, we did not achieve a reduction to target LDL-C levels compared to those with lower Lp(a) levels (≤50 mg/dl). This leads us to promote the use of drugs that can lower Lp(a).</p><p id="par0225" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> illustrates a summary of the leading conclusions of the study.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conclusions</span><p id="par0230" class="elsevierStylePara elsevierViewall">The prevalence of elevated concentrations of Lp(a) (>50 mg/dl) is greater among people with CAD than among the general population.</p><p id="par0235" class="elsevierStylePara elsevierViewall">High Lp(a) values are associated with higher levels of LDL-C and, in these patients, achieving optimal LDL-C levels as stipulated in clinical guidelines is challenging.</p><p id="par0240" class="elsevierStylePara elsevierViewall">In the context of very high cardiovascular risk and elevated Lp(a), the use of drugs specifically targeting Lp(a) are needed, given that high-potency statin therapy and ezetimibe is not efficacious in lowering Lp(a) and, consequently, reaching the LDL-C targets as per clinical guidelines is a challenge.</p><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Strengths and limitations of the study</span><p id="par0245" class="elsevierStylePara elsevierViewall">One of the primary strengths of the study is how well the study population was characterised, with angiographic evidence of CAD and comprehensive lipid profiles. One limitation is the absence of baseline LDL-C values prior to initiating lipid-lowering therapy in 27.5% of individuals, which had to be calculated without prior treatment using published conversion factors.<elsevierMultimedia ident="tb0005"></elsevierMultimedia></p></span></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Funding</span><p id="par0295" class="elsevierStylePara elsevierViewall">This work has not received funding of any kind.</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Conflict of interests</span><p id="par0300" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres2268251" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction and objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1891537" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres2268250" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción y objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1891538" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Patients and method" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Study population" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Clinical and biochemical determinations" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Statistical analysis" ] ] ] 6 => array:3 [ "identificador" => "sec0030" "titulo" => "Results" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0035" "titulo" => "Baseline population characteristics" ] 1 => array:2 [ "identificador" => "sec0040" "titulo" => "Association between Lp(a) and LDL-C" ] 2 => array:2 [ "identificador" => "sec0045" "titulo" => "Lp(a) concentrations and LDL-C target values achieved" ] 3 => array:2 [ "identificador" => "sec0050" "titulo" => "Variables independently associated with elevated Lp(a) concentrations" ] ] ] 7 => array:2 [ "identificador" => "sec0055" "titulo" => "Discussion" ] 8 => array:3 [ "identificador" => "sec0060" "titulo" => "Conclusions" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0065" "titulo" => "Strengths and limitations of the study" ] ] ] 9 => array:2 [ "identificador" => "sec0070" "titulo" => "Funding" ] 10 => array:2 [ "identificador" => "sec0075" "titulo" => "Conflict of interests" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2023-10-26" "fechaAceptado" => "2024-01-17" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1891537" "palabras" => array:4 [ 0 => "LDL-cholesterol" 1 => "Lipoprotein (a)" 2 => "Coronary artery disease" 3 => "Lipid-lowering treatment" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1891538" "palabras" => array:4 [ 0 => "Colesterol-LDL" 1 => "Lipoproteína (a)" 2 => "Enfermedad arterial coronaria" 3 => "Tratamiento hipolipemiante" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction and objectives</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Lipoprotein (a) [Lp(a)] concentration influences serum low-density lipoprotein cholesterol (LDL-C) levels. How it influences the achievement of LDL-C targets established in the guidelines is not well studied. Our aim was to know the prevalence of elevated Lp(a) levels in patients with coronary artery disease (CAD), and to assess its influence on the achievement of LDL-C targets.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Method</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">We conducted a cross-sectional study in a Cardiology department in Spain. A total of 870 patients with stable CAD had their lipid profile determined, including Lp(a). Patients were stratified into two groups according to Lp(a) >50 mg/dL and Lp(a) ≤50 mg/dL. The association of Lp(a) >50 mg/dL with achievement of LDL-C targets was assessed by logistic regression analysis.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">The prevalence of Lp(a) >50 mg/dL was 30.8%. Patients with Lp(a) >50 mg/dL had higher baseline (142.30 ± 47.54 mg/dL vs 130.47 ± 40.75 mg/dL; p = 0.0001) and current (72.91 ± 26.44 mg/dL vs 64.72 ± 25.30 mg/dL; p = 0.0001), despite the fact that they were treated with more high-potency statins (77.2% vs 70.9%; p = 0.058) and more combination lipid-lowering therapy (LLT) (37.7% vs 25.7%; p = 0.001). The proportion of patients achieving target LDL-C was lower in those with Lp(a) >50 mg/dL. Independent predictors of having elevated Lp(a) levels >50 mg/dL were the use of high-potency statins (OR 1.5; 95% CI 1.08−2.14), combination LLT with ezetimibe (OR 2.0; 95% CI 1.45−2.73) and failure to achieve a LDL-C ≤55 mg/dL (OR 2.3; 95% CI 1.63−3.23).</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Elevated Lp(a) levels influence LDL-C levels and hinder the achievement of targets in patients at very high cardiovascular risk. New drugs that act directly on Lp(a) are needed in these patients.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction and objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "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">Introducción y objetivos</span><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">La concentración de lipoproteína (a) [Lp(a)] influye en los niveles séricos de colesterol de las lipoproteínas de baja densidad (C-LDL). Cómo influye en la consecución de objetivos de C-LDL establecidos en las guías no está bien estudiado. Nuestro objetivo fue conocer la prevalencia de niveles elevados de Lp(a) en pacientes con enfermedad arterial coronaria (EAC), y evaluar su influencia en la consecución de objetivos de C-LDL.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Método</span><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Realizamos un estudio transversal en un servicio de Cardiología en España. A un total de 870 pacientes con EAC estable les determinamos el perfil lipídico, incluida Lp(a). Los pacientes se estratificaron en dos grupos según Lp(a) >50 mg/dL y Lp(a) ≤50 mg/dL. La asociación de Lp(a) >50 mg/dL con la consecución de objetivos de C-LDL se evaluó mediante análisis de regresión logística.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">La prevalencia de Lp(a) >50 mg/dL fue de 30,8%. Los pacientes con Lp(a) >50 mg/dL tenían un C-LDL más elevado, tanto basal (142,30 ± 47,54 mg/dL vs 130,47 ± 40,75 mg/dL; p = 0,0001) como actual (72,91 ± 26,44 mg/dL vs 64,72 ± 25,30 mg/dL; p = 0,0001), a pesar de que estaban tratados con más estatinas de alta potencia (77,2% vs 70,9%; p = 0,058) y más tratamiento hipolipemiante (THL) de combinación (37,7% vs 25,7%; p = 0,001). La proporción de pacientes que alcanzaron el objetivo de C-LDL fue menor en aquellos con Lp(a) >50 mg/dL. Fueron predictores independientes de tener niveles elevados de Lp(a) >50 mg/dL, la utilización de estatinas de alta potencia (OR 1.5; 95% CI 1.08–2,14), el THL de combinación con ezetimiba (OR 2,0; 95% CI 1,45−2,73) y la no consecución de un C-LDL ≤55 mg/dL (OR 2,3; 95% CI 1,63−3,23).</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Los niveles elevados de Lp(a) influyen en los niveles de LDL-C y dificultan la consecución de objetivos en pacientes de muy alto riesgo cardiovascular. En estos pacientes son necesarios nuevos fármacos que actúen directamente sobre Lp(a).</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción y objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "multimedia" => array:6 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1348 "Ancho" => 2341 "Tamanyo" => 263995 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0040" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Summary of the study that includes the most relevant results in patients with Lp(a) levels in excess of >50 mg/dl and Lp(a) values of ≤50 mg/dl.</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">LDL-C: low-density lipoprotein cholesterol; Lp(a)-C: cholesterol bound to lipoprotein (a); CAD: coronary artery disease; OR: odds ratio; LLT: lipid-lowering treatment.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0045" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Quantitative variables are expressed as the mean ± standard deviation. Qualitative variables are expressed as percentages (n).</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">HDL-C: high density lipoprotein cholesterol; LDL-C: low density lipoprotein cholesterol; Lp(a): lipoprotein (a).</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="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Patients (N = 870) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Lp(a) ≤50 mg/dl (n = 602) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Lp(a) >50 mg/dl (n = 268) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Clinical parameters</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Age (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">64.34 ± 11.93 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">64.73 ± 11.80 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">63.47 ± 12.19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.150 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Females \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17.90 (156) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16.6 (100) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20.9 (56) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.151 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Family history \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">52.00 (452) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">51.5 (310) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">53.0 (142) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.713 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hyperlipidaemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">67.7 (588) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">65.1 (392) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">73.4 (196) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.018 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Statins \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">96.00 (835) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">95.7 (576) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">96.6 (259) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.579 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>High-potency statins \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">72.9 (634) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">70.9 (427) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">77.2 (207) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.058 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ezetimibe \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30.3 (264) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26.6 (160) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38.8 (104) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.000 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Combination therapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">29.4 (256) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25.7 (155) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">37.7 (101) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Biochemical parameters</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Current cholesterol \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">137.92 ± 32.69 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">135.48 ± 32.16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">143.40 ± 33.28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Current LDL-C \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">67.24 ± 25.92 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">64.72 ± 25.30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">72.91 ± 26.44 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.000 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Baseline LDL-C \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">134.11 ± 43.27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">130.47 ± 40.75 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">142.30 ± 47.54 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.000 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>HDL-C \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">46.78 ± 13.64 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">46.51 ± 14.14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">47.40 ± 12.45 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.378 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Triglycerides \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">120.84 ± 73.31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">122.98 ± 78.93 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">116.02 ± 58.54 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.197 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Non-HDL cholesterol \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">91.17 ± 30.05 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">89.01 ± 29.33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">96.01 ± 31.14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.002 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>LDL-C <70 mg/dl \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">59.1 (511) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">62.9 (376) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50.6 (135) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>LDL-C <55 mg/dl \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">31.8 (275) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36.3 (217) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21.7 (58) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.000 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3684997.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Baseline characteristics of the study subjects.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0050" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">LDL-C: low density lipoprotein cholesterol; Lp(a): lipoprotein (a).</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="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Baseline LDL-C  > 130 mg/dl</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Baseline LDL-C ≤ 130 mg/dl</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lp(a) ≤50 mg/dl \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lp(a) >50 mg/dl \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">p<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lp(a) ≤50 mg/dl \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lp(a) >50 mg/dl \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">p<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Baseline LDL-C \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">164.37 ± 29.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">176.18 ± 37.27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.0001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">98.71 ± 19.40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">101.80 ± 18.18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.135 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Current LDL-C \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">70.06 ± 29.04 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">76.85 ± 30.83 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.028 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">60.28 ± 20.40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">68.18 ± 19.38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Percentage reduction of LDL-C \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">56.90 ± 17.76 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">55.29 ± 18.29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.383 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">37.85 ± 20.52 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">31.28 ± 19.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.003 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3684998.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Student’s t.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Baseline and currently levels of LDL-C in individuals with baseline LDL-C values of > and ≤130 mg/dl, according to Lp(a) concentrations.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0055" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Mann–Whitney U test.</p><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">LDL-C: low density lipoprotein cholesterol; Lp(a): lipoprotein (a); IQR: interquartile range.</p><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">1 and 2 = 0.0001; 1 and 3 = 0.000; 2 and 3 = 0.160.</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="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">LDL-C levels achieved \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><55 mg/dl \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">55−69.9 mg/dl \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">>70 mg/dl \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Median Lp(a) (IQR) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15.9 (6.0−40.9) (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23.8 (8.1−62.9) (2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30.1 (10.62−67.3) (3) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3684996.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Lp(a) values according to LDL-C target achieved.</p>" ] ] 4 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0060" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">LDL-C: low density lipoprotein cholesterol; 95% CI: 95% confidence interval; OR: odds ratio.</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="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">OR \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">95% CI \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">(1.08−2.14) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.017 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ezetimibe \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">(1.45−2.73) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">LDL-C ≤55 mg/dl \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">(1.63−3.23) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3684995.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Clinical predictors of Lp(a) > 50 mg/dl in the multivariate analysis.</p>" ] ] 5 => array:5 [ "identificador" => "tb0005" "tipo" => "MULTIMEDIATEXTO" "mostrarFloat" => false "mostrarDisplay" => true "texto" => array:1 [ "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0250" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">What is known about the subject?</span><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">•</span><p id="par0255" class="elsevierStylePara elsevierViewall">LDL-C determination includes the cholesterol that is transported by LDL and Lp(a).</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">•</span><p id="par0260" class="elsevierStylePara elsevierViewall">The concentration of Lp(a) impacts LDL-C levels.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">•</span><p id="par0265" class="elsevierStylePara elsevierViewall">Little is known about how Lp(a) concentrations affect achieving LDL-C targets in high-risk patients as established by current clinical practice guidelines.</p></li></ul></p><p id="par0270" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">What does it contribute?</span><ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">•</span><p id="par0275" class="elsevierStylePara elsevierViewall">Patients with Lp(a) concentrations exceeding 50 mg/ dl present higher LDL-C values.</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">•</span><p id="par0280" class="elsevierStylePara elsevierViewall">In subjects with coronary artery disease and Lp(a) values of >50 mg/dl, it is more difficult to attain target LDL-C levels of <55 mg/dl as set forth in the guidelines.</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">•</span><p id="par0285" class="elsevierStylePara elsevierViewall">These individuals with elevated Lp(a) have more potent LLT, with high-potency statins and combination treatment with ezetimibe.</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">•</span><p id="par0290" class="elsevierStylePara elsevierViewall">If a target concentration of LDL-C levels of <55 mg/dl are to be achieved in people with Lp(a) values of >50 mg/dl, new drugs are needed, such as PCSK9 inhibitors or anti-RNA.</p></li></ul></p></span>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:32 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lipoprotein(a): an update on a marker of residual risk and associated clinical manifestations" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N.P. 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Original article
Lipoprotein (a) is a predictor of non-achievement of LDL-C goals in patients with chronic heart disease
Lipoproteína (a) es un factor predictor de no consecución de objetivos de C-LDL en pacientes con cardiopatía isquémica crónica
José Javier Gómez-Barrado
, Paula Gómez-Turégano, María Beltrán Moreno, Ana Isabel Fernández-Chamorro, Benjamín Roque Rodríguez, Zineb Kounka
Corresponding author
Departamento de Cardiología, Hospital Universitario San Pedro de Alcántara, Cáceres, Spain