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Prevalencia de hipertrigliceridemia en adultos y factores cardiometabólicos asociados. Estudio SIMETAP-HTG
Prevalence of hypertriglyceridemia in adults and related cardiometabolic factors. SIMETAP-HTG study
Antonio Ruiz-Garcíaa,
Autor para correspondencia
antoniodoctor@gmail.com

Autor para correspondencia.
, Ezequiel Arranz-Martínezb, Beatriz López-Uriartec, Montserrat Rivera-Teijidod, David Palacios-Martínezd, Gema M. Dávila-Blázqueze, Antonio Rosillo-Gonzálezf, José Antonio González-Posada Delgadog, José Enrique Mariño-Suárezg, Enrique Revilla-Pascualg, José Luis Quintana-Gómezg, Ignacio Íscar-Valenzuelag, Rafael Alonso-Rocah, Ana Pilar Javierre-Mirandai, Rosa Ana Escrivá-Ferrairój, Isabel Tello-Mecok, Ana María Ibarra-Sánchezl, M. Isabel Gutiérrez Sánchezm, Juan Ramón Iglesias Quintanan, M. Inmaculada Hernández-Beltránn..., Montserrat Pérez Fernándezo, Elena Barrios-Ruedap, Raúl Pérez Muñozq, Miguel Prieto Marcosr, Santiago Delgado Rodríguezr, Raquel Pleite Raposos, Rafael Rodríguez-Cabanillast, M. Rosario Morales-Chicou, Diana Fernández-Pacheco Vilau, Beatriz Remón-Pérezu, M. Jesús del Villar Redondou, Joaquina Reguillo-Díazu, Paloma Aguilera Reijav, Ana Olga Rodríguez Rodríguezw, Ofelia Gómez-Fernándezx, M. del Carmen Antón-Sanzy, Antonio Sánchez-Calsoz, Norma Alejandra Doria-Carlinaa, Manuel J. Frías-Vargasbb, en representación del Grupo de Investigación del Estudio SIMETAP Ver más
a Centro de Salud Universitario Pinto, Unidad de Lípidos y Prevención Cardiovascular, Pinto, Madrid, España
b Centro de Salud San Blas, Parla, Madrid, España
c Centro de Salud Humanes, Humanes de Madrid, Madrid, España
d Centro de Salud Universitario Isabel II, Parla, Madrid, España
e Centro de Salud Universitario Las Américas, Parla, Madrid, España
f Centro de Salud Tres Cantos II, Tres Cantos, Madrid, España
g Centro de Salud El Greco, Getafe, Madrid, España
h Centro de Salud Mar Báltico, Madrid, España
i Centro de Salud Montesa, Madrid, España
j Centro de Salud Santa Isabel, Leganés, Madrid, España
k Centro de Salud Los Alperchines, San Fernando de Henares, Madrid, España
l Centro de Salud Buenos Aires, Madrid, España
m Centro de Salud Guayaba, Madrid, España
n Centro de Salud Pavones, Madrid, España
o Centro de Salud Reyes Magos, Alcalá de Henares, Madrid, España
p Centro de Salud Vicente Soldevilla, Madrid, España
q Centro de Salud Huerta de los Frailes, Leganés, Madrid, España
r Centro de Salud Ntra. Sra. de Fátima, Madrid, España
s Centro de Salud Juncal, Torrejón de Ardoz, Madrid, España
t Centro de Salud Arroyo de la Media Legua, Madrid, España
u Centro de Salud Valdemoro, Valdemoro, Madrid, España
v Centro de Salud Miraflores, Alcobendas, Madrid, España
w Centro de Salud Margaritas, Getafe, Madrid, España
x Centro de Salud Daroca, Madrid, España
y Consultorio Alpedrete, Alpedrete, Madrid, España
z Centro de Salud Galapagar, Galapagar, Madrid, España
aa Centro de Salud Los Cármenes, Madrid, España
bb Centro de Salud Comillas, Madrid, España
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">La importancia de la hipertrigliceridemia &#40;HTG&#41; se justifica por su elevada prevalencia y por su relevancia cl&#237;nica al asociarse con un aumento del riesgo de la enfermedad cardiovascular arterioscler&#243;tica &#40;ECVA&#41;&#46; El incremento de la prevalencia de HTG en las &#250;ltimas d&#233;cadas ha sido similar al de la diabetes mellitus &#40;DM&#41; tipo 2 y la obesidad<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">1</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">La mayor&#237;a de los triglic&#233;ridos &#40;TG&#41; circulantes son transportados por las lipoprote&#237;nas ricas en TG&#44; que incluyen quilomicrones&#44; lipoprote&#237;nas de muy baja densidad y sus remanentes&#46; La medici&#243;n de l&#237;pidos y lipoprote&#237;nas se usa para estimar el riesgo cardiovascular &#40;RCV&#41; y ayudar al manejo terap&#233;utico de las enfermedades cardiovasculares&#46; Las concentraciones de TG superiores a 150<span class="elsevierStyleHsp" style=""></span>mg&#47;dL indican un RCV m&#225;s elevado y obligan a buscar otros factores de riesgo cardiovascular &#40;FRCV&#41;<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">2&#8211;4</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Durante las &#250;ltimas d&#233;cadas&#44; la cardiopat&#237;a isqu&#233;mica y las enfermedades cerebrovasculares contin&#250;an siendo las primeras 2 causas de mortalidad en Espa&#241;a<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">5</span></a>&#46; Existen estudios epidemiol&#243;gicos que muestran una correlaci&#243;n entre la HTG y la morbimortalidad cardiovascular<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">2&#44;6&#44;7</span></a>&#46; Los sujetos con concentraciones plasm&#225;ticas de colesterol de baja densidad &#40;c-LDL&#41; similares pueden tener distinto riesgo de ECVA dependiendo de sus concentraciones de TG&#44; de forma que los individuos con HTG tienen mayor RCV<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">8</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">La HTG se asocia frecuentemente con concentraciones bajas de colesterol unido a lipoprote&#237;nas de alta densidad &#40;c-HDL&#41; y con una mayor concentraci&#243;n de part&#237;culas de c-LDL&#44; caracterizadas por ser peque&#241;as y densas&#46; Esta asociaci&#243;n&#44; conocida como dislipidemia aterog&#233;nica&#44; aumenta el riesgo de ECVA<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">3</span></a>&#46; Las determinaciones de TG y c-HDL son necesarias para estimar con mayor precisi&#243;n el RCV&#44; sobre todo en pacientes con DM&#44; s&#237;ndrome metab&#243;lico &#40;SM&#41; o enfermedad renal cr&#243;nica &#40;ERC&#41;&#44; en los que existe una mayor concentraci&#243;n de lipoprote&#237;nas aterog&#233;nicas que contienen apolipoprote&#237;na B &#40;ApoB&#41;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">4</span></a>&#46; La mayor concentraci&#243;n de part&#237;culas de c-LDL peque&#241;as y densas asociada a la HTG se puede revertir al disminuir la concentraci&#243;n de TG con tratamiento farmacol&#243;gico<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">9</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Aunque la HTG se asocia con un mayor riesgo de ECVA&#44; el ajuste por el c-HDL aten&#250;a esta relaci&#243;n<a class="elsevierStyleCrossRefs" href="#bib0355"><span class="elsevierStyleSup">8&#44;10</span></a>&#46; La evidencia cient&#237;fica ha confirmado que la retenci&#243;n dentro del endotelio arterial del c-LDL y de otras part&#237;culas plasm&#225;ticas que contienen ApoB son las causantes de la formaci&#243;n de la ECVA&#44; cuya concentraci&#243;n se asocia al colesterol no unido a lipoprote&#237;nas de alta densidad &#40;c-no-HDL&#41;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">11</span></a>&#44; y que puede ser incluso m&#225;s efectivo que el c-LDL para la predicci&#243;n de ECVA cuando existe HTG<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">12</span></a>&#46; El conjunto de lipoprote&#237;nas ricas en TG y sus remanentes est&#225; asociado con un riesgo de ECVA&#44; pero est&#225; m&#225;s determinado por la concentraci&#243;n de part&#237;culas que contienen ApoB que por el contenido de TG<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">2&#44;13&#44;14</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Los estudios de prevalencia de los FRCV son necesarios para mejorar la prevenci&#243;n de la ECVA&#44; planificar los recursos de salud&#44; y monitorizar y evaluar las estrategias establecidas en el Plan de acci&#243;n mundial para la prevenci&#243;n y el control de las enfermedades no transmisibles<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">15</span></a>&#46; La HTG severa &#40;TG<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>885<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#41; es poco frecuente y est&#225; m&#225;s asociada al aumento del riesgo de pancreatitis<a class="elsevierStyleCrossRefs" href="#bib0395"><span class="elsevierStyleSup">16&#8211;19</span></a>&#46; Sin embargo&#44; la prevalencia de la HTG leve a moderada &#40;TG entre 150 y 885<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#41; supera el 10&#37; de la poblaci&#243;n adulta&#44; con gran variabilidad entre pa&#237;ses<a class="elsevierStyleCrossRefs" href="#bib0365"><span class="elsevierStyleSup">10&#44;20&#44;21</span></a>&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">El presente estudio pretende determinar en la poblaci&#243;n adulta las tasas de prevalencia brutas y ajustadas por edad y sexo de HTG en el &#225;mbito de Atenci&#243;n Primaria&#44; y evaluar la asociaci&#243;n de la HTG con FRCV&#44; ERC y enfermedades cardiovasculares y metab&#243;licas&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material y m&#233;todos</span><p id="par0040" class="elsevierStylePara elsevierViewall">El estudio SIMETAP-HTG forma parte del proyecto SIMETAP&#44; aprobado por la Comisi&#243;n de Investigaci&#243;n de la Gerencia de Atenci&#243;n Primaria del Servicio de Salud de la Comunidad de Madrid &#40;SERMAS&#41;&#46; El presente estudio es una investigaci&#243;n observacional transversal&#44; realizada por 121 m&#233;dicos de familia interesados en participar en el proyecto de investigaci&#243;n SIMETAP&#44; cuyo objetivo era valorar las prevalencias de los FRCV&#44; SM y enfermedades cardiovasculares o metab&#243;licas relacionadas&#46; Los m&#233;dicos desempe&#241;aban su actividad laboral en 64 centros de Atenci&#243;n Primaria dependientes del SERMAS &#40;25&#37; de los centros de salud del SERMAS&#41;&#46; Los m&#233;dicos participantes fueron seleccionados competitivamente hasta conseguir el tama&#241;o muestral necesario&#46; El material y los m&#233;todos &#40;dise&#241;o&#44; muestreo&#44; selecci&#243;n&#44; criterios de inclusi&#243;n y exclusi&#243;n de los sujetos del estudio&#44; recogida de datos y an&#225;lisis estad&#237;stico&#41; del estudio SIMETAP se han detallado previamente en esta revista<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">22</span></a>&#46; La poblaci&#243;n de estudio se obtuvo mediante una muestra aleatoria simple de la poblaci&#243;n mayor de 18 a&#241;os asignada a los m&#233;dicos de Atenci&#243;n Primaria del SERMAS que participaban en el estudio&#46; Por protocolo de estudio&#44; se obtuvo el consentimiento informado de todos los participantes&#44; y se excluyeron aquellos de los que no se ten&#237;a informaci&#243;n de las variables bioqu&#237;micas&#44; y los pacientes terminales&#44; institucionalizados&#44; con deterioro cognitivo&#44; as&#237; como las mujeres en periodo de gestaci&#243;n&#46; La muestra final fue 10&#46;084 sujetos de estudio&#44; cuya tasa de respuesta fue del 65&#44;8&#37;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">El an&#225;lisis estad&#237;stico se realiz&#243; utilizando el programa <span class="elsevierStyleItalic">Statistical Package for the Social Sciences</span> &#40;IBM&#174; SPSS&#174; Statistics&#41;&#46; Se determinaron la media y la desviaci&#243;n est&#225;ndar &#40;DE&#41; para el an&#225;lisis de las variables continuas&#46; Se determinaron el rango&#44; la mediana y el rango intercuart&#237;lico &#40;percentil 25&#59; percentil 75&#41; de la variable edad&#44; y la media aritm&#233;tica &#40;DE&#41;&#44; mediana y media geom&#233;trica de la variable TG&#46; Las variables cualitativas se analizaron mediante tasas de prevalencia y porcentajes en cada categor&#237;a&#44; presentadas con l&#237;mites inferior y superior del intervalo de confianza del 95&#37; &#40;IC95&#37;&#41;&#46; Las prevalencias se determinaron como tasas brutas y tasas ajustadas por edad y sexo&#44; estandarizadas con la poblaci&#243;n espa&#241;ola mediante m&#233;todo directo<a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">23</span></a>&#46; Las distribuciones por edad y sexo de la poblaci&#243;n espa&#241;ola de enero de 2015 se obtuvieron de la base de datos del Instituto Nacional de Estad&#237;stica<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">24</span></a>&#46; Se decidi&#243; realizar el ajuste de tasas seg&#250;n la poblaci&#243;n espa&#241;ola en vez de la poblaci&#243;n de la Comunidad de Madrid&#44; porque no exist&#237;an diferencias significativas en los resultados de las tasas de prevalencia ajustadas entre ambas poblaciones y para facilitar la comparaci&#243;n de resultados con otras poblaciones&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Las comparaciones de las variables continuas se realizaron mediante la prueba t-Student o el an&#225;lisis de varianza&#46; El an&#225;lisis de las variables categ&#243;ricas se realiz&#243; mediante la prueba de chi-cuadrado&#46; Las <span class="elsevierStyleItalic">odds ratio</span>s &#40;OR&#41; se determinaron con IC95&#37;&#46; Todas las pruebas se consideraron estad&#237;sticamente significativas si el valor de p de 2 colas era inferior a 0&#44;05&#46; Se utiliz&#243; el an&#225;lisis multivariante de regresi&#243;n log&#237;stica con el m&#233;todo introducir para evaluar el efecto sobre la variable dependiente &#40;HTG&#41; de aquellas variables independientes &#40;FRCV y comorbilidades&#41; cuyo an&#225;lisis univariado realizado previamente hubiera mostrado asociaci&#243;n estad&#237;sticamente significativa con la variable dependiente&#44; excepto las variables edad y sexo&#44; por estar fuertemente relacionadas con otras variables cardiovasculares o metab&#243;licas&#46; Las variables CUN-BAE<a class="elsevierStyleCrossRefs" href="#bib0440"><span class="elsevierStyleSup">25&#44;26</span></a>&#44; SM&#44; dislipidemia aterog&#233;nica&#44; ECVA y ERC no se introdujeron en el an&#225;lisis multivariante por ser par&#225;metros complejos que contienen variables ya incluidas en el an&#225;lisis&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">En el presente estudio se consideraron las definiciones y criterios de las variables indicadas previamente en esta revista<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">22</span></a>&#46; Tambi&#233;n se consider&#243; que los sujetos de estudio padec&#237;an los s&#237;ndromes o enfermedades analizadas si sus respectivos diagn&#243;sticos o sus c&#243;digos relacionados de la Clasificaci&#243;n Internacional de Atenci&#243;n Primaria 2&#46;<span class="elsevierStyleSup">a</span> edici&#243;n<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">27</span></a> o de la Clasificaci&#243;n Internacional de Enfermedades 9&#46;<span class="elsevierStyleSup">a</span> revisi&#243;n&#44; Modificaci&#243;n Cl&#237;nica<a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">28</span></a>&#44; estaban registrados en sus historias cl&#237;nicas&#46; A efectos del presente estudio&#44; se consideraron espec&#237;ficamente los siguientes criterios&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0060" class="elsevierStylePara elsevierViewall">Obesidad abdominal o central&#58; per&#237;metro de cintura<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>102<span class="elsevierStyleHsp" style=""></span>cm en hombres o<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>88<span class="elsevierStyleHsp" style=""></span>cm en mujeres<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">29</span></a>&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0065" class="elsevierStylePara elsevierViewall">&#205;ndice de masa corporal &#40;IMC&#41;<a class="elsevierStyleCrossRef" href="#bib0465"><span class="elsevierStyleSup">30</span></a>&#58; peso &#40;kg&#41;&#47;altura &#40;m&#41;<span class="elsevierStyleSup">2</span>&#46; Sobrepeso&#58; IMC 25&#44;0-29&#44;9<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#46; Obesidad&#58; IMC<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0070" class="elsevierStylePara elsevierViewall">&#205;ndice cintura-talla aumentado<a class="elsevierStyleCrossRef" href="#bib0470"><span class="elsevierStyleSup">31</span></a>&#58; per&#237;metro de cintura &#40;cm&#41;&#47;talla &#40;cm&#41;<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>0&#44;6&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">-</span><p id="par0075" class="elsevierStylePara elsevierViewall">Adiposidad o &#237;ndice de grasa corporal determinado mediante la f&#243;rmula CUN-BAE &#40;Cl&#237;nica Universitaria de Navarra-<span class="elsevierStyleItalic">Body Adiposity Estimator</span>&#41;<a class="elsevierStyleCrossRefs" href="#bib0440"><span class="elsevierStyleSup">25&#44;26</span></a>&#58; sexo masculino &#40;&#37;&#41;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;44&#44;988<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>&#40;0&#44;503<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>edad&#41;<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>&#40;3&#44;172<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>IMC&#41;<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>&#40;0&#44;026<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>IMC<span class="elsevierStyleSup">2</span>&#41;<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>&#40;0&#44;02<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>IMC<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>edad&#41;<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>&#40;0&#44;00021<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>IMC<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>edad&#41;&#59; sexo femenino &#40;&#37;&#41;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;44&#44;988<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>&#40;0&#44;503<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>edad&#41;<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>10&#44;689<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>&#40;3&#44;353<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>IMC&#41;<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>&#40;0&#44;031<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>IMC<span class="elsevierStyleSup">2</span>&#41;<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>&#40;0&#44;02<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>IMC<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>edad&#41;<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>&#40;0&#44;00021<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>IMC<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>edad&#41;&#46; CUN-BAE-sobrepeso&#58; 20-25&#37; &#40;hombres&#41;&#59; 30-35&#37; &#40;mujeres&#41;&#59; CUN-BAE-obesidad&#58;<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>25&#37; &#40;hombres&#41;&#59;<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>35&#37; &#40;mujeres&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">-</span><p id="par0080" class="elsevierStylePara elsevierViewall">Hipercolesterolemia<a class="elsevierStyleCrossRef" href="#bib0475"><span class="elsevierStyleSup">32</span></a> &#40;Clasificaci&#243;n Internacional de Atenci&#243;n Primaria 2&#46;<span class="elsevierStyleSup">a</span> edici&#243;n&#58; T93&#46; Clasificaci&#243;n Internacional de Enfermedades 9&#46;<span class="elsevierStyleSup">a</span> revisi&#243;n&#44; Modificaci&#243;n Cl&#237;nica&#58; 272&#46;0&#59; 272&#46;2&#59; 272&#46;4&#41;&#58; concentraci&#243;n s&#233;rica de colesterol total &#40;CT&#41;<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>200<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#44; o si el paciente estaba tomando f&#225;rmacos para reducir el colesterol&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">-</span><p id="par0085" class="elsevierStylePara elsevierViewall">HTG<a class="elsevierStyleCrossRef" href="#bib0475"><span class="elsevierStyleSup">32</span></a> &#40;Clasificaci&#243;n Internacional de Enfermedades 9&#46;<span class="elsevierStyleSup">a</span> revisi&#243;n&#44; Modificaci&#243;n Cl&#237;nica&#58; 272&#46;1&#59; 272&#46;3&#41;&#58; concentraci&#243;n s&#233;rica de TG<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>150<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#44; o si el paciente estaba tomando f&#225;rmacos para reducir los TG&#46;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">-</span><p id="par0090" class="elsevierStylePara elsevierViewall">c-HDL bajo<a class="elsevierStyleCrossRef" href="#bib0480"><span class="elsevierStyleSup">33</span></a>&#58; concentraci&#243;n s&#233;rica<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>40<span class="elsevierStyleHsp" style=""></span>mg&#47;dL &#40;hombres&#41; o<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>50<span class="elsevierStyleHsp" style=""></span>mg&#47;dL &#40;mujeres&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">-</span><p id="par0095" class="elsevierStylePara elsevierViewall">c-no-HDL<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">4</span></a>&#58; diferencia entre las concentraciones s&#233;ricas de CT y c-HDL&#46;</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">-</span><p id="par0100" class="elsevierStylePara elsevierViewall">c-LDL<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">4</span></a>&#58; f&#243;rmula de Friedewald c-LDL<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>CT<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>c-HDL<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>TG&#47;5 &#40;mg&#47;dL&#41;&#46; No determinado si TG<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>400<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#46;</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">-</span><p id="par0105" class="elsevierStylePara elsevierViewall">Colesterol unido a lipoprote&#237;nas de muy baja densidad y remanentes de lipoprote&#237;nas ricas en TG&#58; CT<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>c-HDL<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>c-LDL&#46; No determinado si TG<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>400<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#46;</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">-</span><p id="par0110" class="elsevierStylePara elsevierViewall">Dislipidemia aterog&#233;nica<a class="elsevierStyleCrossRef" href="#bib0480"><span class="elsevierStyleSup">33</span></a>&#58; HTG con c-HDL bajo&#46;</p></li><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">-</span><p id="par0115" class="elsevierStylePara elsevierViewall">&#205;ndice Castelli-I<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">34</span></a>&#58; CT&#47;c-HDL&#46;</p></li><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">-</span><p id="par0120" class="elsevierStylePara elsevierViewall">&#205;ndice Castelli-II<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">34</span></a>&#58; c-LDL&#47;c-HDL&#46;</p></li><li class="elsevierStyleListItem" id="lsti0070"><span class="elsevierStyleLabel">-</span><p id="par0125" class="elsevierStylePara elsevierViewall">Coeficiente aterog&#233;nico&#58; c-no-HDL&#47;c-HDL&#46;</p></li><li class="elsevierStyleListItem" id="lsti0075"><span class="elsevierStyleLabel">-</span><p id="par0130" class="elsevierStylePara elsevierViewall">&#205;ndice TG&#47;c-HDL&#46;</p></li><li class="elsevierStyleListItem" id="lsti0080"><span class="elsevierStyleLabel">-</span><p id="par0135" class="elsevierStylePara elsevierViewall">&#205;ndice aterog&#233;nico de plasma<a class="elsevierStyleCrossRef" href="#bib0490"><span class="elsevierStyleSup">35</span></a>&#58; log &#40;TG&#47;c-HDL&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0085"><span class="elsevierStyleLabel">-</span><p id="par0140" class="elsevierStylePara elsevierViewall">&#205;ndice TG y glucosa<a class="elsevierStyleCrossRef" href="#bib0495"><span class="elsevierStyleSup">36</span></a>&#58; Ln &#91;TG &#40;mg&#47;dL&#41;<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>GPA &#40;mg&#47;dL&#41;&#47;2&#93;</p></li><li class="elsevierStyleListItem" id="lsti0090"><span class="elsevierStyleLabel">-</span><p id="par0145" class="elsevierStylePara elsevierViewall">Albuminuria<a class="elsevierStyleCrossRef" href="#bib0500"><span class="elsevierStyleSup">37</span></a>&#58; cociente alb&#250;mina-creatinina<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>mg&#47;g&#46;</p></li><li class="elsevierStyleListItem" id="lsti0095"><span class="elsevierStyleLabel">-</span><p id="par0150" class="elsevierStylePara elsevierViewall">Tasa de filtrado glomerular &#40;FGe&#41; bajo<a class="elsevierStyleCrossRef" href="#bib0500"><span class="elsevierStyleSup">37</span></a>&#58;<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#47;1&#44;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> estimado seg&#250;n <span class="elsevierStyleItalic">Chronic Kidney Disease EPIdemiology collaboration</span>&#46;</p></li><li class="elsevierStyleListItem" id="lsti0100"><span class="elsevierStyleLabel">-</span><p id="par0155" class="elsevierStylePara elsevierViewall">ERC<a class="elsevierStyleCrossRef" href="#bib0500"><span class="elsevierStyleSup">37</span></a>&#58; FGe bajo y&#47;o albuminuria&#46;</p></li><li class="elsevierStyleListItem" id="lsti0105"><span class="elsevierStyleLabel">-</span><p id="par0160" class="elsevierStylePara elsevierViewall">SM&#58; criterios del consenso 2009 IDF&#47;NHLBI&#47;AHA&#47;WHF&#47;IAS&#47;IASO<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">29</span></a>&#46;</p></li><li class="elsevierStyleListItem" id="lsti0110"><span class="elsevierStyleLabel">-</span><p id="par0165" class="elsevierStylePara elsevierViewall">ECVA&#58; incluye enfermedad coronaria&#44; ictus y enfermedad arterial perif&#233;rica&#46; La enfermedad coronaria incluye cardiopat&#237;a isqu&#233;mica&#44; infarto agudo de miocardio previo&#44; s&#237;ndromes coronarios agudos&#44; revascularizaci&#243;n coronaria y otros procedimientos de revascularizaci&#243;n arterial&#46; Ictus&#58; incluye accidente cerebrovascular&#44; isquemia cerebral o hemorragias intracraneales y ataque isqu&#233;mico transitorio&#46; Enfermedad arterial perif&#233;rica&#58; incluye claudicaci&#243;n intermitente o un &#237;ndice tobillo-brazo<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#44;9&#46;</p></li><li class="elsevierStyleListItem" id="lsti0115"><span class="elsevierStyleLabel">-</span><p id="par0170" class="elsevierStylePara elsevierViewall">RCV&#58; valoraci&#243;n seg&#250;n las recomendaciones de las Gu&#237;as Europeas<a class="elsevierStyleCrossRef" href="#bib0505"><span class="elsevierStyleSup">38</span></a>&#44; mediante los sistemas <span class="elsevierStyleItalic">Systematic Coronary Risk Estimation</span><a class="elsevierStyleCrossRef" href="#bib0505"><span class="elsevierStyleSup">38</span></a> y <span class="elsevierStyleItalic">Systematic Coronary Risk Estimation O&#46;P&#46;</span><a class="elsevierStyleCrossRef" href="#bib0510"><span class="elsevierStyleSup">39</span></a>&#46; RCV extremo<a class="elsevierStyleCrossRef" href="#bib0515"><span class="elsevierStyleSup">40</span></a>&#58; pacientes con ECVA y DM o ERC&#46;</p></li></ul></p><p id="par0175" class="elsevierStylePara elsevierViewall">Para comparar las tasas de prevalencia de HTG determinadas en el presente estudio&#44; se realiz&#243; una b&#250;squeda bibliogr&#225;fica en PubMed&#44; Medline&#44; Embase&#44; Google Scholar y Web of Science de los principales estudios publicados entre 2005 y 2015&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados</span><p id="par0180" class="elsevierStylePara elsevierViewall">El 55&#44;9&#37; &#40;IC95&#37;&#58; 54&#44;7-57&#44;1&#41; de la poblaci&#243;n de estudio eran mujeres&#46; La diferencia de las medias de edad entre hombres y mujeres &#40;0&#44;3 a&#241;os&#41; no era significativa&#46; La diferencia de las medias de edad &#40;5&#44;2 a&#241;os&#41; entre las poblaciones con y sin HTG era significativa &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; En la poblaci&#243;n con HTG&#44; la proporci&#243;n de mujeres fue del 44&#44;9&#37; &#40;IC95&#37;&#58; 42&#44;7-47&#44;2&#41;&#44; siendo significativa &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; la diferencia de las medias de edad &#40;6&#44;0 a&#241;os&#41; entre hombres y mujeres&#46; En la poblaci&#243;n sin HTG&#44; la proporci&#243;n de mujeres fue del 60&#44;5&#37; &#40;IC95&#37;&#58; 59&#44;1-61&#44;9&#41;&#44; siendo significativa &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; la diferencia de las medias de edad &#40;1&#44;8 a&#241;os&#41; entre hombres y mujeres &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0185" class="elsevierStylePara elsevierViewall">Las caracter&#237;sticas cl&#237;nicas y los perfiles lip&#237;dicos de las poblaciones de estudio global&#44; con HTG y sin HTG&#44; se muestran en la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#46; Todos los par&#225;metros evaluados fueron significativamente mayores en la poblaci&#243;n con HTG&#44; excepto el c-HDL y el FGe&#44; que eran significativamente mayores en la poblaci&#243;n sin HTG&#46; No hab&#237;a diferencia significativa en la media del tiempo de evoluci&#243;n de DM entre las poblaciones con y sin HTG &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0190" class="elsevierStylePara elsevierViewall">El 47&#44;1&#37; &#40;IC95&#37;&#58; 44&#44;9-49&#44;3&#41; de la poblaci&#243;n con HTG estaba con tratamiento farmacol&#243;gico hipolipidemiante&#46; El 63&#44;9&#37; &#40;IC95&#37;&#58; 61&#44;8-66&#44;1&#41; de la poblaci&#243;n con HTG ten&#237;a concentraciones de TG<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>200<span class="elsevierStyleHsp" style=""></span>mg&#47;dL y el 23&#44;3&#37; &#40;IC95&#37;&#58; 21&#44;4-25&#44;1&#41; ten&#237;a concentraciones de TG<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>150<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">En la poblaci&#243;n de estudio&#44; la media &#40;DE&#41; de TG fue significativamente m&#225;s alta &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; en hombres &#40;135&#44;7 &#91;100&#44;6&#93; mg&#47;dL&#41; que en mujeres &#40;108&#44;6 &#91;63&#44;8&#93; mg&#47;dL&#41;&#46; Las medias geom&#233;tricas y las medianas de TG fueron respectivamente&#58; 104&#44;2 y 101<span class="elsevierStyleHsp" style=""></span>mg&#47;dL en la poblaci&#243;n global&#59; 116&#44;0 y 111<span class="elsevierStyleHsp" style=""></span>mg&#47;dL en la poblaci&#243;n masculina&#59; y 95&#44;7 y 93<span class="elsevierStyleHsp" style=""></span>mg&#47;dL en la femenina&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">En la poblaci&#243;n con HTG&#44; la media &#40;DE&#41; de TG fue significativamente m&#225;s alta &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; en hombres &#40;210&#44;0 &#91;131&#44;6&#93; mg&#47;dL&#41; que en mujeres &#40;185&#44;6 &#91;82&#44;4&#93; mg&#47;dL&#41;&#46; Las medias geom&#233;tricas y las medianas de TG fueron respectivamente&#58; 180&#44;6 y 176<span class="elsevierStyleHsp" style=""></span>mg&#47;dL en la poblaci&#243;n global&#59; 187&#44;8 y 182<span class="elsevierStyleHsp" style=""></span>mg&#47;dL en la poblaci&#243;n masculina&#59; y 172&#44;2 y 169<span class="elsevierStyleHsp" style=""></span>mg&#47;dL en la femenina&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">En la poblaci&#243;n sin HTG&#44; la media &#40;DE&#41; de TG fue significativamente m&#225;s alta &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; en hombres &#40;92&#44;2&#44;0 &#91;28&#44;3&#93; mg&#47;dL&#41; que en mujeres &#40;84&#44;6&#44;6 &#91;28&#44;3&#93; mg&#47;dL&#41;&#46; Las medias geom&#233;tricas y las medianas de TG fueron respectivamente&#58; 82&#44;7 y 85<span class="elsevierStyleHsp" style=""></span>mg&#47;dL en la poblaci&#243;n global&#59; 87&#44;6 y 92<span class="elsevierStyleHsp" style=""></span>mg&#47;dL en la poblaci&#243;n masculina&#59; y 79&#44;7 y 82<span class="elsevierStyleHsp" style=""></span>mg&#47;dL en la femenina&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">Las tasas de prevalencia brutas y ajustadas por edad y sexo de los distintos tipos de HTG se muestran en la <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#46; La prevalencia bruta de HTG fue del 29&#44;6&#37; &#40;IC95&#37;&#58; 28&#44;4-30&#44;7&#41;&#44; siendo significativa &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; la diferencia entre hombres &#40;36&#44;9&#37; &#91;IC95&#37;&#58; 35&#44;2-38&#44;7&#93;&#41; y mujeres &#40;23&#44;8&#37; &#91;IC95&#37;&#58; 22&#44;4-25&#44;1&#93;&#41;&#46; Las tasas de prevalencia ajustadas por edad y sexo de HTG fueron ligeramente menores &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0215" class="elsevierStylePara elsevierViewall">La distribuci&#243;n de las tasas de prevalencia de HTG por grupos etarios decenales se ajustaba &#40;coeficiente de determinaci&#243;n R<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;93&#41; a la siguiente funci&#243;n polin&#243;mica&#58; y<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>0&#44;0147x<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>0&#44;1521x<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>0&#44;0333 &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46; La prevalencia de HTG aumentaba continuamente con la edad&#44; desde la tercera hasta la sexta d&#233;cada en el hombre y desde la tercera hasta la octava d&#233;cada en la mujer&#44; descendiendo posteriormente&#46; La poblaci&#243;n masculina ten&#237;a tasas de prevalencia de HTG significativamente mayores que la poblaci&#243;n femenina en todos los grupos etarios&#44; excepto en el tramo 70-79 a&#241;os&#44; en el que la diferencia no era significativa&#44; y en el tramo<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>80 a&#241;os&#44; en el que la prevalencia de HTG era ligeramente mayor en la poblaci&#243;n femenina&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0220" class="elsevierStylePara elsevierViewall">Las OR de las comorbilidades evaluadas entre las poblaciones con y sin HTG se muestran en la <a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#46; Todas las comorbilidades se asociaban significativamente con la HTG&#44; excepto el hipotiroidismo y la disfunci&#243;n er&#233;ctil&#46; Las variables que mostraban una mayor asociaci&#243;n con la HTG fueron CUN-BAE<a class="elsevierStyleCrossRefs" href="#bib0440"><span class="elsevierStyleSup">25&#44;26</span></a>&#44; DM&#44; SM<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">29</span></a>&#44; esteatosis hep&#225;tica&#44; hipercolesterolemia&#44; c-HDL bajo&#44; FGe bajo y albuminuria&#46; Los tratamientos hipoglucemiante&#44; hipolipidemiante y antihipertensivo&#44; y los RCV alto&#44; muy alto y extremo estaban m&#225;s asociados con la poblaci&#243;n con HTG&#46; El RCV bajo se asociaba significativamente m&#225;s con la poblaci&#243;n sin HTG&#46; El 42&#44;1&#37; &#40;IC95&#37;&#58; 39&#44;9-44&#44;3&#37;&#41; de los pacientes con HTG ten&#237;an un RCV muy alto o extremo &#40;OR&#58; 2&#44;0 &#91;IC95&#37; 1&#44;8-2&#44;3&#93;&#41;&#46; El resultado del an&#225;lisis multivariante de los factores independientes asociados significativamente con HTG se muestra en la <a class="elsevierStyleCrossRef" href="#tbl0025">tabla 5</a>&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><elsevierMultimedia ident="tbl0025"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discusi&#243;n</span><p id="par0225" class="elsevierStylePara elsevierViewall">El presente estudio actualiza la informaci&#243;n sobre la prevalencia de HTG y los valores medios de TG en la poblaci&#243;n adulta&#44; ofreciendo unos resultados intermedios entre los publicados por otros estudios nacionales e internacionales&#46; Algunos pa&#237;ses como los Estados Unidos&#44; Alemania o China prefirieron utilizar las medias geom&#233;tricas para mostrar la tendencia central de los valores de TG&#44; puesto que estos son menos sensibles a los valores extremos que las medias aritm&#233;ticas&#46; En el presente estudio&#44; la media geom&#233;trica de TG &#40;104<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#41; era m&#225;s baja que la media aritm&#233;tica de TG &#40;121<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#41;&#46; Las medias geom&#233;tricas de TG de la poblaci&#243;n adulta de los Estados Unidos<a class="elsevierStyleCrossRefs" href="#bib0320"><span class="elsevierStyleSup">1&#44;41</span></a> y Alemania<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">21</span></a> fueron 107 y 111<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#44; respectivamente&#44; siendo levemente superiores a las del estudio SIMETAP-HTG&#46; La media de TG en Francia<a class="elsevierStyleCrossRef" href="#bib0525"><span class="elsevierStyleSup">42</span></a> &#40;121<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#41; era similar a la del presente estudio&#46; La prevalencia ajustada de HTG<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>200<span class="elsevierStyleHsp" style=""></span>mg&#47;dL de Corea<a class="elsevierStyleCrossRefs" href="#bib0530"><span class="elsevierStyleSup">43&#44;44</span></a> &#40;9&#44;8&#37;&#41; fue similar a la del presente estudio&#46; Las tasas de prevalencia ajustada de HTG del estudio SIMETAP-HTG y sus concentraciones medias de TG fueron inferiores a las determinadas en los siguientes pa&#237;ses&#58; M&#233;xico<a class="elsevierStyleCrossRef" href="#bib0540"><span class="elsevierStyleSup">45</span></a>&#44; prevalencia 31&#44;5&#37;&#59; media de TG 140<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#59; China<a class="elsevierStyleCrossRef" href="#bib0545"><span class="elsevierStyleSup">46</span></a>&#44; media geom&#233;trica de TG 139<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#46; India<a class="elsevierStyleCrossRef" href="#bib0550"><span class="elsevierStyleSup">47</span></a>&#44; prevalencia 36&#44;9&#37;&#44; medias de TG 163<span class="elsevierStyleHsp" style=""></span>mg&#47;dL &#40;hombres&#41; y 144<span class="elsevierStyleHsp" style=""></span>mg&#47;dL &#40;mujeres&#41;&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">Las medias de TG y las tasas de prevalencia ajustada de HTG del presente estudio fueron ligeramente superiores a las de otras investigaciones realizadas en Espa&#241;a<a class="elsevierStyleCrossRefs" href="#bib0555"><span class="elsevierStyleSup">48&#8211;57</span></a>&#44; excepto el estudio CORSAIB<a class="elsevierStyleCrossRef" href="#bib0605"><span class="elsevierStyleSup">58</span></a>&#44; que mostr&#243; una media de TG de 131<span class="elsevierStyleHsp" style=""></span>mg&#47;dL en la poblaci&#243;n<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>35 a&#241;os de las Islas Baleares&#44; y la cohorte CDC de Canarias<a class="elsevierStyleCrossRef" href="#bib0610"><span class="elsevierStyleSup">59</span></a>&#44; que mostr&#243; unas medias de TG de 141<span class="elsevierStyleHsp" style=""></span>mg&#47;dL &#40;hombres&#41; y 108<span class="elsevierStyleHsp" style=""></span>mg&#47;dL &#40;mujeres&#41;&#46; El grupo GEVA<a class="elsevierStyleCrossRef" href="#bib0555"><span class="elsevierStyleSup">48</span></a> determin&#243; una media de TG de 117<span class="elsevierStyleHsp" style=""></span>mg&#47;dL en la poblaci&#243;n de Albacete&#44; y una prevalencia de HTG del 19&#44;3&#37;&#46; El proyecto DINO<a class="elsevierStyleCrossRef" href="#bib0560"><span class="elsevierStyleSup">49</span></a> determin&#243; una media de TG de 109<span class="elsevierStyleHsp" style=""></span>mg&#47;dL en la poblaci&#243;n de Murcia&#46; El estudio HERMEX<a class="elsevierStyleCrossRef" href="#bib0565"><span class="elsevierStyleSup">50</span></a> determin&#243; una media geom&#233;trica de TG de 96<span class="elsevierStyleHsp" style=""></span>mg&#47;dL en la poblaci&#243;n<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>25 a&#241;os de Badajoz&#46; En la poblaci&#243;n<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>35 a&#241;os de Navarra<a class="elsevierStyleCrossRef" href="#bib0570"><span class="elsevierStyleSup">51</span></a>&#44; las medias de TG fueron 132<span class="elsevierStyleHsp" style=""></span>mg&#47;dL &#40;hombres&#41; y 98<span class="elsevierStyleHsp" style=""></span>mg&#47;dL &#40;mujeres&#41;&#44; y las prevalencias de HTG fueron 22&#44;6 y 9&#44;1&#37;&#44; respectivamente&#46; En la poblaci&#243;n entre 35 y 74 a&#241;os de Gerona&#44; los investigadores de REGICOR<a class="elsevierStyleCrossRef" href="#bib0575"><span class="elsevierStyleSup">52</span></a> determinaron unas prevalencias de HTG<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>200<span class="elsevierStyleHsp" style=""></span>mg&#47;dL del 13&#44;6&#37; &#40;hombres&#41; y el 4&#44;6&#37; &#40;mujeres&#41;&#46; En poblaci&#243;n de la Comunidad de Madrid entre 30 y 74 a&#241;os&#44; el estudio PREDIMERC<a class="elsevierStyleCrossRef" href="#bib0580"><span class="elsevierStyleSup">53</span></a> mostr&#243; una prevalencia de HTG del 8&#44;8&#37;&#44; y el estudio MADRIC<a class="elsevierStyleCrossRef" href="#bib0585"><span class="elsevierStyleSup">54</span></a> mostr&#243; una prevalencia de HTG del 21&#44;0&#37; en la poblaci&#243;n entre 30 y 70 a&#241;os&#46; El estudio ENRICA<a class="elsevierStyleCrossRef" href="#bib0590"><span class="elsevierStyleSup">55</span></a> determin&#243; una prevalencia de HTG del 17&#44;4&#37; y una media de TG de 108<span class="elsevierStyleHsp" style=""></span>mg&#47;dL en la poblaci&#243;n espa&#241;ola&#44; excluyendo a los pacientes con TG<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>400<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#46; El estudio di&#64;bet&#46;es<a class="elsevierStyleCrossRef" href="#bib0595"><span class="elsevierStyleSup">56</span></a> mostr&#243; una prevalencia de HTG del 21&#44;5&#37; &#40;hombres&#58; 29&#44;5&#37;&#59; mujeres&#58; 15&#44;5&#37;&#41;&#46; El estudio DARIOS<a class="elsevierStyleCrossRef" href="#bib0600"><span class="elsevierStyleSup">57</span></a> analiz&#243; 11 estudios realizados en Espa&#241;a con poblaciones entre 35 y 74 a&#241;os&#44; mostrando unas medias de TG de 142<span class="elsevierStyleHsp" style=""></span>mg&#47;dL &#40;hombres&#41; y 108<span class="elsevierStyleHsp" style=""></span>mg&#47;dL &#40;mujeres&#41;&#44; similares a las del presente estudio &#40;136 y 109<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#44; respectivamente&#41;&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">Las diferencias socioecon&#243;micas o culturales&#44; el distinto concepto de HTG o la exclusi&#243;n de las poblaciones<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>35 a&#241;os o<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>70 a&#241;os&#44; o con TG<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>400<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#44; pueden justificar la variabilidad de los resultados expuestos&#46; Las diferencias disminuyen cuando se ampl&#237;a el estudio a toda la poblaci&#243;n adulta&#44; se ajustan las prevalencias o se ofrecen otras medidas de centralizaci&#243;n como medianas o medias geom&#233;tricas&#46; La prevalencia de HTG est&#225; muy influida por la edad y el sexo&#46; En el presente estudio&#44; la quinta parte de la poblaci&#243;n femenina padece HTG&#44; y m&#225;s de un tercio de la poblaci&#243;n masculina&#46; La prevalencia de HTG aumenta con la edad hasta la d&#233;cada de los 50&#44; descendiendo posteriormente&#46; Existen diferencias significativas a favor de la poblaci&#243;n masculina en todos los tramos etarios hasta la d&#233;cada de los 70&#44; donde se iguala&#44; siendo superior en la poblaci&#243;n femenina posteriormente&#46; Tambi&#233;n son importantes las prevalencias de HTG en las poblaciones<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>30 a&#241;os &#40;13&#37;&#41; y<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>80 a&#241;os &#40;30&#37;&#41;&#44; por lo que ser&#237;a recomendable incluirlas en los estudios de prevalencia de HTG&#46;</p><p id="par0240" class="elsevierStylePara elsevierViewall">Las tasas de prevalencia de HTG severa y muy severa mostradas en el presente estudio &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41; fueron similares a las publicadas en otros trabajos<a class="elsevierStyleCrossRefs" href="#bib0395"><span class="elsevierStyleSup">16&#8211;19</span></a>&#46;</p><p id="par0245" class="elsevierStylePara elsevierViewall">El &#237;ndice Castelli-I<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">34</span></a> &#40;CT&#47;c-HDL&#41; se ha considerado un &#237;ndice de riesgo de enfermedad coronaria m&#225;s sensible y espec&#237;fico que el CT en individuos con HTG&#46; Se ha asociado a mayor riesgo<a class="elsevierStyleCrossRef" href="#bib0615"><span class="elsevierStyleSup">60</span></a> cuando es<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>4&#46; En la poblaci&#243;n con HTG&#44; el &#237;ndice CT&#47;c-HDL era 4&#44;5&#44; lo que evidencia que el riesgo era alto&#46; El coeficiente aterog&#233;nico &#40;c-no-HDL&#47;c-HDL&#41; refleja el potencial aterog&#233;nico de las lipoprote&#237;nas que contienen ApoB<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">12</span></a>&#46; Este coeficiente era significativamente m&#225;s alto en la poblaci&#243;n con HTG&#44; lo que apunta a una mayor carga aterog&#233;nica&#46; Seg&#250;n Dobiasova<a class="elsevierStyleCrossRef" href="#bib0490"><span class="elsevierStyleSup">35</span></a>&#44; los valores del &#237;ndice aterog&#233;nico de plasma entre &#8722;0&#44;3 y 0&#44;11 est&#225;n asociados con riesgo de arterioesclerosis bajo&#59; entre 0&#44;1 y 0&#44;21&#44; con riesgo moderado&#59; y<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;21&#44; con riesgo alto<a class="elsevierStyleCrossRef" href="#bib0620"><span class="elsevierStyleSup">61</span></a>&#46; El &#237;ndice aterog&#233;nico de plasma de la poblaci&#243;n con HTG fue 0&#44;23&#44; lo que tambi&#233;n evidencia que el riesgo era alto&#46; El &#237;ndice de insulinorresistencia TG y glucosa<a class="elsevierStyleCrossRef" href="#bib0495"><span class="elsevierStyleSup">36</span></a> era significativamente m&#225;s elevado en la poblaci&#243;n con HTG&#44; al tener concentraciones m&#225;s altas de glucosa y TG &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46;</p><p id="par0250" class="elsevierStylePara elsevierViewall">El metabolismo lip&#237;dico puede justificar que la hipercolesterolemia y el c-HDL bajo estuvieran fuertemente asociados con la HTG&#46; El SM fue la comorbilidad con mayor asociaci&#243;n con la HTG&#44; por ser la HTG y el c-HDL bajo&#44; criterios que se incluyen en su definici&#243;n&#46; La esteatosis hep&#225;tica&#44; la DM&#44; la prediabetes y el etilismo tambi&#233;n se asociaban significativamente con la HTG&#44; tanto en el an&#225;lisis univariado como en el multivariante &#40;<a class="elsevierStyleCrossRefs" href="#tbl0020">tablas 4 y 5</a>&#41;&#44; probablemente debido a que el contenido de grasa hep&#225;tica y la glucosa plasm&#225;tica se correlacionan con la producci&#243;n de lipoprote&#237;nas de muy baja densidad&#44; TG y ApoB<a class="elsevierStyleCrossRef" href="#bib0625"><span class="elsevierStyleSup">62</span></a>&#46; La mayor asociaci&#243;n con esteatosis hep&#225;tica podr&#237;a justificar que las concentraciones de transaminasas estuvieran significativamente m&#225;s elevadas en la poblaci&#243;n con HTG &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46;</p><p id="par0255" class="elsevierStylePara elsevierViewall">Hipercolesterolemia&#44; hipertensi&#243;n arterial y DM estaban asociadas con la poblaci&#243;n con HTG&#44; lo que puede justificar que las terapias antidiab&#233;tica&#44; hipolipidemiante y antihipertensiva estuvieran m&#225;s asociadas en la poblaci&#243;n con HTG&#46; El &#237;ndice cintura-talla aumentado&#44; la obesidad abdominal&#44; el sobrepeso&#44; la obesidad y la adiposidad &#40;valorada por el &#237;ndice de grasa corporal CUN-BAE-obesidad<a class="elsevierStyleCrossRefs" href="#bib0440"><span class="elsevierStyleSup">25&#44;26</span></a>&#41; se asociaban significativamente con la HTG&#44; aunque solo obesidad y sobrepeso eran los factores independientes asociados con la HTG &#40;<a class="elsevierStyleCrossRefs" href="#tbl0020">tablas 4 y 5</a>&#41;&#46;</p><p id="par0260" class="elsevierStylePara elsevierViewall">Las variables de afectaci&#243;n de la funci&#243;n renal &#40;FGe disminuido&#44; albuminuria&#41; estaban asociadas significativamente con la HTG&#44; aunque no fueron significativas en el an&#225;lisis multivariante &#40;<a class="elsevierStyleCrossRefs" href="#tbl0020">tablas 4 y 5</a>&#41;&#46;</p><p id="par0265" class="elsevierStylePara elsevierViewall">El Registro de Hipertrigliceridemias de la Sociedad Espa&#241;ola de Arteriosclerosis<a class="elsevierStyleCrossRef" href="#bib0630"><span class="elsevierStyleSup">63</span></a> incluy&#243; a 1&#46;182 pacientes seleccionados en las Unidades de L&#237;pidos de dicha sociedad&#44; con HTG<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>200<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#46; Las medias de TG del Registro de la Sociedad Espa&#241;ola de Arteriosclerosis<a class="elsevierStyleCrossRef" href="#bib0630"><span class="elsevierStyleSup">63</span></a> eran mayores que las del presente estudio&#44; aunque las prevalencias de las comorbilidades asociadas con HTG &#40;hipertensi&#243;n arterial&#44; DM&#44; SM&#44; enfermedad coronaria&#41; eran bastante similares en ambos estudios&#46;</p><p id="par0270" class="elsevierStylePara elsevierViewall">El 66&#37; de la poblaci&#243;n con HTG del estudio SIMETAP-HTG ten&#237;a RCV alto o muy alto&#47;extremo&#46; La mayor asociaci&#243;n con HTG de la hipertensi&#243;n arterial&#44; el tabaquismo&#44; la DM&#44; la obesidad&#44; el SM&#44; la hipercolesterolemia y la ECVA puede justificar su estrecha asociaci&#243;n con el RCV alto &#40;OR&#58; 2&#44;3&#41; y con el RCV muy alto&#47;extremo &#40;OR&#58; 2&#44;0&#41;&#46;</p><p id="par0275" class="elsevierStylePara elsevierViewall">Las principales limitaciones del presente trabajo fueron la incapacidad de un estudio transversal para determinar la causalidad&#44; y el posible infradiagn&#243;stico al excluir por protocolo a mujeres en periodo de gestaci&#243;n y a pacientes terminales&#44; institucionalizados o con deterioro cognitivo&#46; Las variables edad y sexo no se utilizaron en el an&#225;lisis multivariante por estar fuertemente asociadas con FRCV&#44; enfermedades cardiovasculares o metab&#243;licas&#44; con el fin de destacar aquellas variables cardiometab&#243;licas independientes que pudieran estar asociadas con la HTG&#46; Por otra parte&#44; los investigadores deb&#237;an recoger la informaci&#243;n de los par&#225;metros bioqu&#237;micos m&#225;s recientes determinados en los an&#225;lisis realizados durante el &#250;ltimo a&#241;o&#44; por lo que la observaci&#243;n transversal realizada puede estar influida por las enfermedades que en dicho momento estuvieran padeciendo los participantes&#44; y por sus tratamientos&#46; Al comparar la variable tratamiento hipolipidemiante&#44; existe una diferencia significativa entre las poblaciones con y sin HTG&#44; por lo que es plausible que la prevalencia de HTG pudiera ser algo mayor si la poblaci&#243;n con HTG no estuviera bajo la influencia de la terapia hipolipidemiante&#44; circunstancia que &#233;ticamente no se puede evitar en este estudio observacional&#46;</p><p id="par0280" class="elsevierStylePara elsevierViewall">Una de las fortalezas del presente estudio fue la selecci&#243;n aleatoria de los sujetos de estudio con base poblacional&#44; una extensa muestra que incluy&#243; a personas entre 18 y 102 a&#241;os de edad&#44; mientras que otros estudios realizados en el mismo &#225;mbito excluyen a la poblaci&#243;n<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>35 a&#241;os o<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>70 a&#241;os&#46; Tambi&#233;n destacan la presentaci&#243;n de los valores de TG con varias medidas de centralizaci&#243;n&#44; unas escasas diferencias entre las prevalencias brutas y ajustadas de HTG &#40;del 2&#44;3&#37; en la poblaci&#243;n masculina y el 2&#44;4&#37; en la femenina&#41;&#44; y la evaluaci&#243;n de la posible asociaci&#243;n entre la HTG y numerosos FRCV&#44; ERC&#44; enfermedades metab&#243;licas y ECVA&#46; Dado que la HTG est&#225; influida por las variables sexo y edad&#44; otra fortaleza del presente estudio es la descripci&#243;n global y por sexo de las prevalencias de HTG en todos los tramos etarios decenales de adultos&#44; y la presentaci&#243;n con tasas ajustadas por edad y sexo para poder comparar con otras poblaciones&#46;</p><p id="par0285" class="elsevierStylePara elsevierViewall">La elevada prevalencia de HTG tiene graves consecuencias socioecon&#243;micas y sanitarias al aumentar la morbimortalidad cardiovascular&#46; La valoraci&#243;n de la prevalencia de HTG es muy importante para planificar mejor las pol&#237;ticas de intervenci&#243;n de prevenci&#243;n cardiovascular&#44; optimizar los recursos de salud disponibles y mejorar la atenci&#243;n m&#233;dica y la calidad de vida de los pacientes con HTG&#46; Dada la progresi&#243;n de la prevalencia de la obesidad&#44; la DM y&#44; simult&#225;neamente&#44; la HTG en los &#250;ltimos a&#241;os&#44; es comprensible la necesidad de realizar m&#225;s estudios epidemiol&#243;gicos dirigidos a toda la poblaci&#243;n&#44; y en este sentido&#44; es deseable que el presente estudio contribuya a mejorar el conocimiento epidemiol&#243;gico de la HTG y a valorar la importancia de la asociaci&#243;n entre HTG y ECVA&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusiones</span><p id="par0290" class="elsevierStylePara elsevierViewall">Los estudios realizados sobre las determinaciones de las concentraciones medias de TG y las tasas de prevalencia de HTG en la poblaci&#243;n adulta muestran unos resultados con una alta variabilidad&#46; El estudio SIMETAP-HTG confirma unos resultados intermedios con respecto a estudios previos&#46; Las medias de las concentraciones de TG en la poblaci&#243;n adulta del presente estudio fueron inferiores a las de M&#233;xico&#44; China y la India&#44; y similares a las de Estados Unidos&#44; Corea&#44; Alemania y Francia&#46; Las prevalencias ajustadas de HTG fueron inferiores a las obtenidas en las Islas Baleares y Canarias&#44; y ligeramente superiores a las de otros estudios realizados en Espa&#241;a&#46;</p><p id="par0295" class="elsevierStylePara elsevierViewall">El presente estudio tambi&#233;n refuerza la idea de que la prevalencia de HTG en la poblaci&#243;n adulta est&#225; muy influida por las variables sexo y edad&#44; por lo que es necesario ajustar los resultados por estas variables&#46; Muestra que la quinta parte de la poblaci&#243;n adulta femenina y m&#225;s de un tercio de la masculina presentaba HTG&#44; y que la prevalencia aumenta a lo largo de la vida hasta la d&#233;cada de los 50&#46; La prevalencia de HTG es mayor en la poblaci&#243;n masculina hasta la d&#233;cada de los 60&#44; igual&#225;ndose en la d&#233;cada de los 70&#44; y siendo mayor posteriormente en la poblaci&#243;n femenina&#46;</p><p id="par0300" class="elsevierStylePara elsevierViewall">El estudio SIMETAP-HTG muestra que los factores cardiometab&#243;licos relacionados con la HTG fueron DM&#44; prediabetes&#44; esteatosis hep&#225;tica&#44; sobrepeso y obesidad&#46; Tambi&#233;n muestra que la elevaci&#243;n de los &#237;ndices aterog&#233;nicos del perfil lip&#237;dico evidencia que la HTG est&#225; asociada con un mayor potencial aterog&#233;nico y un mayor riesgo de ECVA&#46; El presente estudio destaca que los par&#225;metros lip&#237;dicos m&#225;s fuertemente asociados con la HTG fueron la hipercolesterolemia y la concentraci&#243;n baja de c-HDL&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Financiaci&#243;n</span><p id="par0305" class="elsevierStylePara elsevierViewall">La financiaci&#243;n del estudio SIMETAP &#40;C&#243;digo Beca&#58; 05&#47;2010RS&#41; fue aprobada seg&#250;n la Orden 472&#47;2010&#44; de 16 de septiembre&#44; de la Consejer&#237;a de Sanidad&#44; por la que se aprueban las bases reguladoras y la convocatoria de ayudas para el a&#241;o 2010 de la Agencia Pedro La&#237;n Entralgo de Formaci&#243;n&#44; Investigaci&#243;n y Estudios Sanitarios de la Comunidad de Madrid&#44; para la realizaci&#243;n de proyectos de investigaci&#243;n en el campo de resultados en salud en Atenci&#243;n Primaria&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflicto de intereses</span><p id="par0310" class="elsevierStylePara elsevierViewall">Los autores no tienen ning&#250;n conflicto de intereses en relaci&#243;n con esta publicaci&#243;n&#46;</p></span></span>"
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          "palabras" => array:3 [
            0 => "Prevalence"
            1 => "Hypertriglyceridaemia"
            2 => "Adult"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Determinar en la poblaci&#243;n adulta las tasas de prevalencia brutas y ajustadas por edad y sexo de hipertrigliceridemia &#40;HTG&#41; y valorar su asociaci&#243;n con factores de riesgo cardiovascular&#44; enfermedad renal cr&#243;nica y enfermedades cardiovasculares y cardiometab&#243;licas&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional transversal realizado en Atenci&#243;n Primaria&#44; con 6&#46;588 sujetos de estudio adultos&#44; seleccionados aleatoriamente con base poblacional&#46; Los pacientes ten&#237;an HTG si la concentraci&#243;n de triglic&#233;ridos era<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>150<span class="elsevierStyleHsp" style=""></span>mg&#47;dL &#40;&#8805;<span class="elsevierStyleHsp" style=""></span>1&#44;7<span class="elsevierStyleHsp" style=""></span>mmol&#47;L&#41; o estaban en tratamiento hipolipidemiante para reducir los triglic&#233;ridos&#46; Se valoraron las asociaciones mediante an&#225;lisis univariado y multivariante&#44; y se determinaron las prevalencias brutas y ajustadas por edad y sexo&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Las medias aritm&#233;ticas y geom&#233;tricas de las concentraciones de triglic&#233;ridos fueron respectivamente 120&#44;5 y 104&#44;2<span class="elsevierStyleHsp" style=""></span>mg&#47;dL en la poblaci&#243;n global&#44; 135&#44;7 y 116&#44;0<span class="elsevierStyleHsp" style=""></span>mg&#47;dL en hombres&#44; y 108&#44;6 y 95&#44;7<span class="elsevierStyleHsp" style=""></span>mg&#47;dL en mujeres&#46; Las prevalencias brutas de HTG fueron 29&#44;6&#37; en poblaci&#243;n global&#44; 36&#44;9&#37; en hombres y 23&#44;8&#37; en mujeres&#46; Las prevalencias ajustadas por edad y sexo de HTG fueron 27&#44;0&#37; en poblaci&#243;n global&#44; 34&#44;6&#37; en hombres y 21&#44;4&#37; en mujeres&#46; Las variables independientes que m&#225;s se asociaban con la HTG fueron hipercolesterolemia &#40;OR&#58; 4&#44;6&#41;&#44; c-HDL bajo &#40;OR&#58; 4&#44;1&#41;&#44; esteatosis hep&#225;tica &#40;OR&#58; 2&#44;8&#41;&#44; diabetes &#40;OR&#58; 2&#44;0&#41; y obesidad &#40;OR&#58; 1&#44;9&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Las medias de triglic&#233;ridos y las prevalencias de HTG se encuentran intermedias entre las de otros estudios nacionales e internacionales&#46; La quinta parte de la poblaci&#243;n adulta femenina y m&#225;s de un tercio de la masculina presentaba HTG&#46; Los factores independientes asociados con HTG fueron hipercolesterolemia y c-HDL bajo&#44; y las variables cardiometab&#243;licas diabetes&#44; esteatosis hep&#225;tica y obesidad&#46;</p></span>"
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          2 => array:2 [
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            "titulo" => "Resultados"
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      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Aim</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To determine in the adult population the crude and the sex- and age-adjusted prevalence rates of hypertriglyceridaemia &#40;HTG&#41; and to assess its association with cardiovascular risk factors&#44; chronic kidney disease&#44; cardiovascular and cardiometabolic diseases&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Cross-sectional observational study conducted in Primary Care&#44; with 6&#44;588 adult study subjects&#44; randomly selected on base-population&#46; Patients had HTG if the triglyceride level was<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>150<span class="elsevierStyleHsp" style=""></span>mg&#47;dL &#40;&#8805;<span class="elsevierStyleHsp" style=""></span>1&#46;7<span class="elsevierStyleHsp" style=""></span>mmol&#47;L&#41;&#44; or were on lipid-lowering therapy to lower triglyceride&#46; Associations were assessed by univariate and multivariate analysis&#44; and crude and sex- and age-adjusted prevalence rates were determined&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The arithmetic and geometric means of triglyceride levels were respectively 120&#46;5 and 104&#46;2<span class="elsevierStyleHsp" style=""></span>mg&#47;dL in global population&#44; 135&#46;7 and 116&#46;0<span class="elsevierStyleHsp" style=""></span>mg&#47;dL in men&#44; and 108&#46;6 and 95&#46;7<span class="elsevierStyleHsp" style=""></span>mg&#47;dL in women&#46; The crude HTG prevalence rates were 29&#46;6&#37; in global population&#44; 36&#46;9&#37; in men and 23&#46;8&#37; in women&#46; The sex- and age-adjusted HTG prevalence rates were 27&#46;0&#37; in global population&#44; 34&#46;6&#37; in men and 21&#46;4&#37; in women&#46; The independent variables that were most associated with HTG were hypercholesterolemia &#40;OR&#58; 4&#46;6&#41;&#44; low HDL-<span class="elsevierStyleSmallCaps">C</span> &#40;OR&#58; 4&#46;1&#41;&#44; hepatic steatosis &#40;OR&#58; 2&#46;8&#41;&#44; diabetes &#40;OR&#58; 2&#46;0&#41;&#44; and obesity &#40;OR&#58; 1&#46;9&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The means of triglyceride levels and HTG prevalence rates are intermediate between those of other national and international studies&#46; A fifth of the female adult population and more than a third of the male population had HTG&#46; The independent factors associated with HTG were hypercholesterolemia and low HDL-C&#44; and the cardiometabolic variables diabetes&#44; hepatic steatosis and obesity&#46;</p></span>"
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                  \t\t\t\t">PAS &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">PAD &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">CT &#40;mg&#47;dL&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;641&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;82 &#40;0&#44;27&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;08&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></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">FGe &#40;mL&#47;min&#47;1&#44;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;588&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">90&#44;6 &#40;20&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;947&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">85&#44;9 &#40;20&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4&#46;641&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">92&#44;5 &#40;20&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;6&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Albuminuria &#40;mg&#47;g&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;451&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">14&#44;7 &#40;55&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#46;447&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">20&#44;3 &#40;77&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3&#46;004&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">12&#44;1 &#40;40&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">8&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
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            0 => array:3 [
              "identificador" => "tblfn0005"
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            1 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "b"
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            2 => array:3 [
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              "etiqueta" => "c"
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            3 => array:3 [
              "identificador" => "tblfn0020"
              "etiqueta" => "d"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Para convertir mg&#47;dL a mmol&#47;L&#44; multiplicar por 0&#44;01129&#46;</p>"
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          "es" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas cl&#237;nicas de la poblaci&#243;n de estudio</p>"
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          "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">IC95&#37;&#58; l&#237;mites inferior y superior del intervalo de confianza al 95&#37;&#59; TG&#58; triglic&#233;ridos&#46;</p>"
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                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">Concentraci&#243;n de TG&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Prevalencia bruta &#40;IC95&#37;&#41;&#44; &#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Prevalencia ajustada<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&#44; &#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8805;<span class="elsevierStyleHsp" style=""></span>150<span class="elsevierStyleHsp" style=""></span>mg&#47;dL &#40;&#8805;<span class="elsevierStyleHsp" style=""></span>1&#44;7<span class="elsevierStyleHsp" style=""></span>mmol&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#44;7 &#40;21&#44;7&#59; 23&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8805;<span class="elsevierStyleHsp" style=""></span>177<span class="elsevierStyleHsp" style=""></span>mg&#47;dL &#40;&#8805;<span class="elsevierStyleHsp" style=""></span>2&#44;0<span class="elsevierStyleHsp" style=""></span>mmol&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#44;7 &#40;13&#44;8&#59; 15&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8805;<span class="elsevierStyleHsp" style=""></span>200<span class="elsevierStyleHsp" style=""></span>mg&#47;dL &#40;&#8805;<span class="elsevierStyleHsp" style=""></span>2&#44;3<span class="elsevierStyleHsp" style=""></span>mmol&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#44;7 &#40;9&#44;9&#59; 11&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8805;<span class="elsevierStyleHsp" style=""></span>400<span class="elsevierStyleHsp" style=""></span>mg&#47;dL &#40;&#8805;<span class="elsevierStyleHsp" style=""></span>4&#44;5<span class="elsevierStyleHsp" style=""></span>mmol&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;94 &#40;0&#44;71&#59; 1&#44;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8805;<span class="elsevierStyleHsp" style=""></span>885<span class="elsevierStyleHsp" style=""></span>mg&#47;dL &#40;&#8805;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleHsp" style=""></span>mmol&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;09 &#40;0&#44;02&#59; 0&#44;16&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8805;<span class="elsevierStyleHsp" style=""></span>1&#46;770<span class="elsevierStyleHsp" style=""></span>mg&#47;dL &#40;&#8805;<span class="elsevierStyleHsp" style=""></span>20<span class="elsevierStyleHsp" style=""></span>mmol&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;015 &#40;&#8722;0&#44;01&#59; &#8722;0&#44;04&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;021&nbsp;\t\t\t\t\t\t\n
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              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0025">Prevalencia ajustada por edad y sexo a la poblaci&#243;n espa&#241;ola 2015&#46;</p> <p class="elsevierStyleNotepara" id="npar0030">Fuente&#58; Instituto Nacional de Estad&#237;stica<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">24</span></a>&#46;</p>"
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          "leyenda" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">ADA&#58; <span class="elsevierStyleItalic">American Diabetes Association&#59;</span> c-HDL&#58; colesterol unido a lipoprote&#237;nas de alta densidad&#59; CDA&#58; <span class="elsevierStyleItalic">Canadian Diabetes Association&#59;</span> CUN-BAE&#58; &#237;ndice de grasa corporal &#40;Cl&#237;nica Universitaria de Navarra-<span class="elsevierStyleItalic">Body Adiposity Estimator</span>&#41;&#59; EAP&#58; enfermedad arterial perif&#233;rica&#59; ECVA&#58; enfermedad cardiovascular arterioscler&#243;tica&#59; EPOC&#58; enfermedad pulmonar obstructiva cr&#243;nica&#59; FGe&#58; tasa de filtrado glomerular estimado seg&#250;n CKD-EPI&#59; HTG&#58; hipertrigliceridemia&#59; ICT&#58; &#237;ndice cintura-talla&#59; RCV&#58; riesgo cardiovascular&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Con HTG<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">a</span></a>&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sin HTG&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t">Hipertensi&#243;n arterial&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">EAP&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">82 &#40;1&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;0 &#40;1&#44;4-2&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">ECVA&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">250 &#40;12&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">365 &#40;7&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;7 &#40;1&#44;4-2&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Insuficiencia cardiaca&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">71 &#40;3&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">113 &#40;2&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;006&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;5 &#40;1&#44;1-2&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fibrilaci&#243;n auricular&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">95 &#40;4&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#44;003&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;5 &#40;1&#44;1-1&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Disfunci&#243;n er&#233;ctil&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">202 &#40;18&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">302 &#40;16&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;105&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;6 &#40;1&#44;4-2&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Albuminuria<a class="elsevierStyleCrossRef" href="#tblfn0115"><span class="elsevierStyleSup">r</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">164 &#40;11&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">FGe bajo<a class="elsevierStyleCrossRef" href="#tblfn0120"><span class="elsevierStyleSup">s</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Enfermedad renal cr&#243;nica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">286 &#40;27&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">470 &#40;8&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1&#44;5 &#40;1&#44;3-1&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tratamiento hipoglucemiante&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">442 &#40;22&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t">6&#44;2 &#40;5&#44;2-7&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tratamiento antihipertensivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">933 &#40;47&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1&#46;406 &#40;30&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#44;4 &#40;2&#44;1-2&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tratamiento hipolipidemiante&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">917 &#40;47&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">934 &#40;20&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3&#44;5 &#40;3&#44;2-4&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RCV bajo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">216 &#40;11&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1&#46;929 &#40;41&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;2 &#40;1&#44;0-1&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">OR Exp&#40;&#946;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0145"><span class="elsevierStyleSup">d</span></a>&nbsp;\t\t\t\t\t\t\n
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