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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0070" class="elsevierStylePara elsevierViewall">Cardiovascular &#40;CV&#41; disease is the leading cause of morbidity and mortality in Portugal&#44; which highlights the impact of atherosclerosis on public health and the need to implement primary and secondary prevention measures&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Cardiac rehabilitation programs &#40;CRPs&#41; were established to promote early recovery after an acute event and were designed to fully reintegrate patients into society&#46; Their aims are to inform patients about their condition and to educate them on ways to prevent recurrence by controlling CV risk factors and prescribing physical exercise based on CV risk stratification in order to improve their functional capacity and quality of life&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">The last 10 years have seen growing evidence of the benefits of CRPs in coronary artery disease &#40;CAD&#41;&#44; 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with assessment by the specialist in physical medicine and rehabilitation in the CVPRU&#46; The educational process continues and an overall clinical evaluation is performed that includes the patient&#39;s medical history and cardiorespiratory&#44; neurological and musculoskeletal exams&#44; as well as functional assessment&#46; Diagnostic exams are then scheduled &#40;exercise testing and laboratory tests&#41; for stratification of CV risk&#44; on which an exercise program is based according to the current guidelines&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Patients are also referred for other consultations at the CVPRU depending on clinical indications&#44; such as nutrition&#44; psychiatry&#44; smoking cessation&#44; urology and vascular surgery&#46; This stage usually lasts 8 weeks but can vary between 6 and 12 weeks depending on clinical needs and the patient&#39;s response to exercise&#46; It consists of weekly educational sessions on subjects related to CV risk factors and disease&#44; and therapeutic exercise sessions&#46; The latter are held twice weekly under the supervision of the physiatrist and cardiologist&#44; in accordance with international guidelines on the level of supervision and monitoring appropriate to each case&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> In addition&#44; patients are advised to exercise during the rest of the week&#44; based on the general principles of the program&#44; and are encouraged to increase their level of activity in a safe manner&#46; Each session lasts between 60 and 90<span class="elsevierStyleHsp" style=""></span>minutes&#59; the exercise protocol includes a warm-up period&#44; aerobic training &#40;treadmill and arm and leg ergometers&#41;&#44; strength training &#40;using dumbbells&#44; exercise balls and other strength training equipment&#41;&#44; a cool-down period and flexibility exercises&#46; The intensity of each exercise component is determined for each individual patient based on their exercise heart rate calculated by the Karvonen formula<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> using the data obtained from exercise testing&#59; 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and at 3&#44; 6 and 12 months&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Cardiovascular risk factors</span><p id="par0120" class="elsevierStylePara elsevierViewall">CV risk factors were defined in accordance with the European Society of Cardiology guidelines on cardiovascular disease prevention&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Determination of lipid profile included measurement of total cholesterol &#40;TC&#41;&#44; low density lipoprotein cholesterol &#40;LDL-C&#41;&#44; high density lipoprotein cholesterol &#40;HDL-C&#41; and triglycerides &#40;TG&#41;&#44; based on the following references values<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>&#58; TC &#60;175<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; LDL-C &#60;100<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; HDL-C &#62;45<span class="elsevierStyleHsp" style=""></span>mg&#47;dl and TG &#60;150<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#46; Laboratory tests were performed on blood samples collected after 12<span class="elsevierStyleHsp" style=""></span>hours&#8217; fasting&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Body composition was assessed by weight&#44; waist circumference &#40;WC&#41; and body mass index &#40;BMI&#41;&#46; Obesity was defined according to the internationally recognized classification of BMI &#8805;30 &#40;weight in kilograms&#47;height in meters squared&#41;&#44; and those with BMI 25&#8211;29&#46;9<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span> were classified as overweight or pre-obese&#46; WC was considered high if &#62;80<span class="elsevierStyleHsp" style=""></span>cm in women and &#62;94<span class="elsevierStyleHsp" style=""></span>cm in men&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Blood pressure &#40;BP&#41; values were recorded and considered high if &#62;130&#47;80<span class="elsevierStyleHsp" style=""></span>mmHg in two consecutive assessments&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">With regard to diabetic patients&#44; capillary blood glucose and HbA1c were used to assess diabetes control&#44; fasting blood glucose &#8805;110<span class="elsevierStyleHsp" style=""></span>mg&#47;dl and HbA1c &#8805;6&#46;5&#37; being considered abnormal&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Patients&#8217; smoking habits were recorded&#44; those who did not smoke at all being considered non-smokers&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Levels of physical activity were assessed using the International Physical Activity Questionnaire &#40;IPAQ&#41;&#44; which has been validated in the Portuguese population&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> This is designed to quantify &#40;in METs&#47;min&#47;week&#41; the amount of exercise taken in a week performing various activities &#40;including household chores&#44; employment&#44; sport and recreation&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Statistical analysis</span><p id="par0155" class="elsevierStylePara elsevierViewall">The data from this prospective study were recorded and analyzed using SPSS version 17&#46;0&#46; Qualitative variables are presented as percentages and quantitative variables as means<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation&#46; Quantitative variables were compared using the Student&#39;s t-test and qualitative variables by the McNemar test&#46; Values of p&#60;0&#46;05 were considered statistically significant&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Results</span><p id="par0160" class="elsevierStylePara elsevierViewall">Of a total of 329 patients&#44; 73 were lost to follow-up&#46; The study population thus included 256 patients&#44; most of whom &#40;81&#46;6&#37;&#41; were referred for CRP during hospitalization in the cardiology ward&#46; The majority were men &#40;76&#46;2&#37;&#41;&#44; and mean age was 61&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;6 years &#40;30&#8211;83&#41;&#46; The most common admission diagnosis &#40;65&#46;3&#37;&#41; was acute coronary syndrome &#40;ACS&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0165" class="elsevierStylePara elsevierViewall">The prevalence and changes in CV risk factors over the study period are presented in <a class="elsevierStyleCrossRefs" href="#tbl0010">Tables 2&#8211;4</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Dyslipidemia</span><p id="par0170" class="elsevierStylePara elsevierViewall">At admission&#44; dyslipidemia was the most prevalent CV risk factor &#40;74&#46;2&#37;&#41; in the study population&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">At the end of phase II of the CRP &#40;at 3 months&#41;&#44; there were mean reductions of 18<span class="elsevierStyleHsp" style=""></span>mg&#47;dl in TC &#40;10&#46;2&#37;&#44; p&#60;0&#46;001&#41;&#44; 19<span class="elsevierStyleHsp" style=""></span>mg&#47;dl in LDL-C &#40;17&#46;6&#37;&#44; p&#60;0&#46;001&#41; and 19<span class="elsevierStyleHsp" style=""></span>mg&#47;dl in TG &#40;17&#46;6&#37;&#44; p&#60;0&#46;001&#41;&#46; As a result&#44; the number of patients with TC &#62;190<span class="elsevierStyleHsp" style=""></span>mg&#47;dl almost halved &#40;from 26&#46;2&#37; to 12&#46;5&#37;&#44; p&#60;0&#46;001&#41;&#44; and the number with LDL-C &#62;100<span class="elsevierStyleHsp" style=""></span>mg&#47;dl fell from 55&#46;1&#37; to 32&#37; &#40;p&#60;0&#46;001&#41;&#46; Statistically significant reductions were maintained at 6 and 12 months in TC &#40;6&#46;8&#37; and 5&#46;1&#37;&#44; respectively&#44; p&#60;0&#46;001&#41;&#44; LDL-C &#40;13&#46;9&#37; and 12&#37;&#44; p&#60;0&#46;001&#41; and TG &#40;14&#46;1&#37; and 16&#46;7&#37;&#44; p&#60;0&#46;001&#41;&#44; compared to the initial assessment values&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">There was also a statistically significant increase in HDL-C levels at 3 months&#44; the proportion of patients with HDL-C &#60;45<span class="elsevierStyleHsp" style=""></span>mg&#47;dl decreasing from 71&#46;9&#37; to 38&#46;2&#37; &#40;p&#60;0&#46;001&#41;&#44; as well as at 6 and 12 months&#44; an increase being maintained throughout the study period&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Obesity</span><p id="par0185" class="elsevierStylePara elsevierViewall">BMI &#62;25<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span> was the second most common risk factor &#40;71&#46;5&#37;&#41; in the study population&#44; 19&#46;9&#37; of patients being classified as obese &#40;BMI &#8805;30<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&#46; At 3 months&#44; there was a mean reduction of 2&#46;5<span class="elsevierStyleHsp" style=""></span>kg in weight &#40;3&#46;3&#37;&#44; p&#60;0&#46;001&#41;&#44; 3&#46;5&#37; in BMI &#40;p&#60;0&#46;001&#41; and 3<span class="elsevierStyleHsp" style=""></span>cm in WC &#40;3&#46;7&#37;&#44; p&#60;0&#46;001&#41; in the overall population&#46; Thus&#44; the number of obese patients decreased by 19&#46;9&#37; to 15&#46;2&#37; &#40;p&#61;0&#46;002&#41; and the number of those with BMI &#8805;25<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span> decreased from 71&#46;5&#37; to 60&#46;6&#37; &#40;p&#61;0&#46;003&#41;&#46; However&#44; although a statistically significant reduction in weight was observed at all assessments&#44; the greatest weight loss was seen at the 3-month assessment&#44; with only small reductions at subsequent assessments &#40;2&#46;8&#37; at 6 months and 2&#46;5&#37; at 12 months in the overall population compared to initial values&#41;&#46; With regard to BMI&#44; the significant decrease observed at 3 months was virtually nonexistent at 6 months &#40;0&#46;3&#37;&#44; p&#61;0&#46;92&#41;&#44; the change in BMI compared to initial values no longer being significant&#46; However&#44; there was a further statistically significant reduction at 12 months &#40;2&#46;4&#37;&#44; p&#60;0&#46;001&#41;&#44; the number of patients with BMI &#8805;25<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span> decreasing from 71&#46;5&#37; to 61&#46;3&#37; &#40;p&#60;0&#46;001&#41; and the proportion of obese patients from 19&#46;9&#37; to 16&#46;4&#37; &#40;p&#61;0&#46;049&#41;&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Initial assessment revealed that 78&#46;7&#37; of women had WC &#62;88<span class="elsevierStyleHsp" style=""></span>cm and 32&#46;3&#37; of men had WC &#62;102<span class="elsevierStyleHsp" style=""></span>cm&#46; At 3 months&#44; there was a statistically significant reduction in WC of 3<span class="elsevierStyleHsp" style=""></span>cm &#40;3&#46;7&#37;&#44; p&#60;0&#46;001&#41;&#44; which was less pronounced at 6- and 12-month assessment&#44; although still statistically significant compared to initial values&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Hypertension</span><p id="par0195" class="elsevierStylePara elsevierViewall">Of the total population&#44; 62&#46;5&#37; had a history of hypertension and initial assessment showed that 25&#46;8&#37; had high BP&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">At 3 months&#44; only 4&#46;3&#37; had uncontrolled hypertension &#40;p&#60;0&#46;001&#41;&#44; this figure rising to 9&#46;8&#37; &#40;p&#60;0&#46;001&#41; at 6 months and 7&#46;8&#37; &#40;p&#60;0&#46;001&#41; at 12 months&#46; Thus&#44; although the change was most pronounced at the end of phase II&#44; statistical significance was maintained throughout follow-up&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Diabetes</span><p id="par0205" class="elsevierStylePara elsevierViewall">In the study population&#44; 34&#46;4&#37; of patients were diabetic and 55&#46;7&#37; of these had HbA1C &#62;6&#46;5&#37; on initial assessment&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">At 3 months&#44; there was a mean reduction of 0&#46;8&#37; in HbA1C &#40;11&#46;3&#37;&#44; p&#60;0&#46;001&#41; and the number of patients with HbA1C &#62;6&#46;5&#37; almost halved &#40;from 55&#46;7&#37; to 30&#46;7&#37;&#44; p&#60;0&#46;001&#41;&#46; There was a mean reduction of 0&#46;5&#37; in HbA1c &#40;7&#46;6&#37;&#44; p&#60;0&#46;001&#41; at 6 months&#44; and a further 0&#46;5&#37; &#40;7&#46;1&#37;&#44; p&#60;0&#46;001&#41; at 12 months&#44; still statistically significant changes&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Smoking</span><p id="par0215" class="elsevierStylePara elsevierViewall">Of the study population&#44; 28&#46;5&#37; were smokers&#46; At 3 months&#44; only 3&#46;9&#37; of patients still smoked &#40;p&#60;0&#46;001&#41;&#44; an 86&#46;3&#37; reduction in the proportion of current smokers&#46; At 6 months&#44; 7&#37; were smokers &#40;p&#60;0&#46;001&#41;&#44; with a similar percentage at 12 months &#40;p&#60;0&#46;001&#41;&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Sedentary lifestyle</span><p id="par0220" class="elsevierStylePara elsevierViewall">At the start of the study&#44; 46&#46;5&#37; of individuals were sedentary&#44; based on the scores obtained on the IPAQ&#46; At 3 months&#44; an increase of over 200&#37; was observed in levels of weekly physical activity &#40;2852&#46;7 METs&#47;min&#47;week&#41;&#44; as reported on the IPAQ&#44; resulting in a reduction from 46&#46;5&#37; to 11&#37; in the number of sedentary individuals &#40;p&#60;0&#46;001&#41;&#46; A mean increase of 174&#37; &#40;p&#60;0&#46;001&#41; in weekly physical activity levels compared to the initial assessment was seen at 6- and 12-month assessments&#44; the proportion classified as sedentary being 8&#46;6&#37; &#40;p&#60;0&#46;001&#41; and 9&#46;8&#37; &#40;p&#60;0&#46;001&#41;&#44; respectively&#46;</p></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0225" class="elsevierStylePara elsevierViewall">The main aim of this study was to assess the long-term effects of an exercise-based CRP in CAD patients with regard to the modifiable CV risk factors of obesity&#44; waist circumference&#44; hypertension&#44; dyslipidemia&#44; diabetes&#44; smoking and sedentary lifestyle&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">A high proportion of our study population had dyslipidemia at admission &#40;74&#46;2&#37;&#41;&#44; which is in agreement with the literature&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;13</span></a> The relationship between TC&#44; LDL-C and HDL-C levels and atherosclerosis is based on solid evidence&#46; Triglycerides are also linked to greater risk of CAD&#44; although their role in atherosclerotic CV disease is less well established&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;14</span></a> The risk associated with hypercholesterolemia is progressive and reducing TC by 10&#37; lowers the incidence of CAD by 25&#37; at five years&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> At the end of phase II of the CRP &#40;3 months&#41;&#44; the mean reduction in TC was over 10&#37; and hence a significant reduction in CV risk can be assumed&#46; However&#44; there are conflicting results in the literature on the long-term effects of CRPs on lipid profile&#59; some studies report that the benefits are not statistically significant in the long term&#44;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> while others are in agreement with our results&#44; with statistically significant benefits being maintained&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> Among the explanations that have been put forward for successful outcomes is the fact that some programs include nutritional support and educational sessions&#44; leading to more consistent benefits&#46; Both components were included in our CRP&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">The prevalence of obesity is so high worldwide that the World Health Organization &#40;WHO&#41; considers it to be the global epidemic of the 21st century&#46; The latest data for Portugal<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> indicate a prevalence of overweight and obesity of 53&#46;6&#37;&#46; The study population presented an even higher prevalence&#44; reflecting their greater risk&#46; Our results are in agreement with other studies that have also found a high rate of overweight and obesity in CAD patients&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p><p id="par0240" class="elsevierStylePara elsevierViewall">Various studies have shown that obesity alone increases CV mortality<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> and that a 5&#37; reduction in body weight reduces CV risk factors&#44; while a 10&#37; reduction has significant effects on lipid profile&#44; hypertension control&#44; insulin resistance and coagulation profile&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17&#44;18</span></a></p><p id="par0245" class="elsevierStylePara elsevierViewall">It is now recognized that body fat&#44; particularly visceral fat&#44; is a metabolically active organ that synthesizes and releases into the bloodstream a variety of compounds that play an important role in cardiovascular hemostasis&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> In Portugal&#44; most women have WC &#62;88<span class="elsevierStyleHsp" style=""></span>cm&#44; while the proportion of men at similar risk is considerably lower &#40;38&#37; have WC &#62;102<span class="elsevierStyleHsp" style=""></span>cm&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> The data from our study follow the same pattern of a predominance of women with high WC&#46;</p><p id="par0250" class="elsevierStylePara elsevierViewall">At the end of phase II of the program&#44; there had been a statistically significant reduction in weight-related parameters&#46; Similar results are found in the literature&#44;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#44;22</span></a> which confirms the efficacy of these programs in reducing risk factors&#44; although the benefits obtained were significantly less at 6 and 12 months&#46; Some studies have reported no statistically significant improvement in these parameters in the long term<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>&#59; one possible reason is the absence of specific weight-loss components in CRPs&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#44;22</span></a> Our program included dietary advice by a nutritionist for all patients but no specific measures were adopted for obese patients in the exercise component&#46;</p><p id="par0255" class="elsevierStylePara elsevierViewall">As in most countries&#44; hypertension is a major public health issue in Portugal&#44; given its high prevalence &#40;42&#37;&#41;&#44; low treatment rate &#40;39&#37;&#41; and low percentage of controlled patients &#40;11&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0260" class="elsevierStylePara elsevierViewall">In our patient population&#44; 62&#46;5&#37; had hypertension as a CV risk factor and on initial assessment 25&#46;8&#37; had high BP&#46; Thus&#44; most patients had controlled BP at the start of the CRP&#44; which may be explained by the fact that most were under optimized antihypertensive therapy&#44; having been referred following hospitalization in the cardiology department&#46;</p><p id="par0265" class="elsevierStylePara elsevierViewall">There is strong evidence of the clinical benefits of BP lowering in hypertensive patients&#44;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;11</span></a> and the benefits of exercise-based CRPs in BP control are well established&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">23&#8211;25</span></a> The CRP had a positive impact in reducing hypertension throughout the study period&#44; which was statistically significant at all assessments&#44; and at 12 months only 7&#46;8&#37; had uncontrolled hypertension&#46;</p><p id="par0270" class="elsevierStylePara elsevierViewall">The WHO estimates that 300 million people worldwide will suffer from diabetes by 2025&#46; In Portugal&#44; 6&#46;5&#37; of the adult population has diabetes &#40;over 300<span class="elsevierStyleHsp" style=""></span>000 individuals&#41;&#44; and this figure is undoubtedly an underestimate&#44; since it does not include undiagnosed individuals&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Diabetes is a well-established risk factor for CV disease&#59; although diabetic patients are likely to have other conventional CV risk factors such as hypertension and dyslipidemia&#44; the 3-5-fold increase in CV risk associated with diabetes appears to be independent of other risk factors&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0275" class="elsevierStylePara elsevierViewall">At the start of the study&#44; 34&#46;4&#37; of patients had a history of diabetes&#44; which was poorly controlled in over half &#40;HbA1C &#62;6&#46;5&#37;&#41;&#46; This figure is well above that published for Portugal&#44; which could reflect a higher prevalence of this risk factor in CAD patients or underdiagnosis of the disease in the general population&#46; The benefits of exercise and CRPs on blood glucose levels are well documented in the literature<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">26&#44;27</span></a> and our study showed a reduction in almost half of the patients with poor glycemic control&#46;</p><p id="par0280" class="elsevierStylePara elsevierViewall">Smoking is the main factor in reduced life expectancy and is responsible for over 50&#37; of avoidable deaths&#44; half of which are due to atherothrombotic disease&#46; In Portugal&#44; 19&#46;6&#37; of the population over the age of 10 are daily smokers&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> The link between active and passive smoking and risk of developing CAD&#44; cerebrovascular disease or peripheral vascular disease is well established&#46; The incidence of myocardial infarction is six times higher in women and three times higher in men who smoke 20 cigarettes a day than in those who have never smoked&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> The harmful effects are cumulative&#44; in terms of both daily consumption and duration of the habit &#40;exposure time&#41;&#46; The INTERHEART study<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> showed a strong correlation between the number of cigarettes and risk of ACS &#8211; five cigarettes a day increases the risk by 38&#37;&#44; while 40 a day increases it by 900&#37; &#8211; and halving daily consumption also halves ACS risk&#46; Smoking cessation is thus a priority in cardiac rehabilitation&#44; and is even more important in the presence of atherothrombotic disease and in patients undergoing invasive procedures such as coronary bypass surgery&#44; angioplasty or vascular surgery&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> CRPs therefore represent an excellent opportunity to stress the importance of smoking cessation&#46;</p><p id="par0285" class="elsevierStylePara elsevierViewall">In our study&#44; the percentage of smokers had fallen by more than half at the end of follow-up&#46; These results are in agreement with other studies showing higher rates of smoking cessation among individuals participating in CRPs&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a></p><p id="par0290" class="elsevierStylePara elsevierViewall">Exercise is crucial for primary&#44; secondary and tertiary prevention of most of the common chronic and&#47;or degenerative diseases found in contemporary societies&#44; especially those with western lifestyles&#44; particularly with regard to the causes and consequences of atherosclerosis&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> In 1997&#44; Portugal had the highest prevalence of sedentary lifestyles &#40;87&#46;8&#37;&#41; of 15 European Union countries&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a></p><p id="par0295" class="elsevierStylePara elsevierViewall">The number of sedentary patients fell dramatically over the course of our study and at 12-month follow-up&#44; only 9&#46;8&#37; maintained a sedentary lifestyle&#59; levels of weekly physical activity increased by 174&#37;&#46; These results are a further illustration of the importance of CRPs in these patients&#46;</p><p id="par0300" class="elsevierStylePara elsevierViewall">On assessment at the end of phase II&#44; a considerable and statistically significant improvement was seen in all CV risk factors&#44; which is in agreement with the results reported in the literature<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">31&#8211;35</span></a> that show consistent benefits in these patients from exercise-based CRPs&#46;</p><p id="par0305" class="elsevierStylePara elsevierViewall">There was an overall improvement in the parameters related to control of CV risk factors&#44; which remained statistically significant throughout the 12 months of follow-up&#44; albeit with some reduction in the benefits obtained&#46; This reduction was mainly seen at the 6-month assessment&#44; which may be due to a waning of the initial level of motivation associated with the acute event&#46; The relative improvement observed at 12 months may have resulted from the reinforcement of healthy behaviors and preventive measures &#40;particularly in terms of diet and exercise&#41; that took place at the 6-month assessment in view of the worsening of parameters compared to the favorable changes seen at the end of phase II&#46;</p><p id="par0310" class="elsevierStylePara elsevierViewall">The difficulty in maintaining such benefits is particularly evident in anthropometric data&#44; since BMI was the parameter that showed the least change&#44; the improvement seen in the first 3 months being virtually cancelled out in subsequent assessments&#46; These results are similar to other studies that have reported greater difficulty in maintaining statistically significant differences for these parameters&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> The main reason suggested&#44; as pointed out above&#44; is the lack of specific preventive measures when prescribing exercise for obese patients&#46;</p><p id="par0315" class="elsevierStylePara elsevierViewall">We feel the study is important in that it assesses the long-term effects of CRPs in a sizable patient population&#44; including changes in CV risk factors&#46; There are few works in the literature presenting similar research&#44; and most assess risk factors over a shorter time period and analyze a narrower range of parameters&#46; This is also the first study in Portugal reporting CRP results at 12 months in a population of this size&#46;</p><p id="par0320" class="elsevierStylePara elsevierViewall">The lack of a control group is a limitation of the study&#44; but since studies comparing usual care versus cardiac rehabilitation have consistently demonstrated the benefits of CRPs&#44;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a> we are confident that our results can be attributed specifically to participation in a CRP&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conclusion</span><p id="par0325" class="elsevierStylePara elsevierViewall">CRPs are thus successful in treating patients with coronary disease&#44; with benefits being maintained in subsequent months&#46; Nevertheless&#44; there is a reduction in these benefits once the hospital-supervised stage has ended&#44; and it is therefore important to implement new strategies that will encourage patient compliance throughout the various phases of the program&#46; It should be explained to patients that the benefits are often lost after phase II unless they adhere strictly to the preventive measures prescribed&#46; Other interventions could be implemented&#44; including a 3-monthly supervised exercise session accompanied by an educational component&#44; in order to reinforce the basic concepts underlying prevention and health promotion&#44; and monthly telephone calls and online communication to promote closer contact between the patient and the CRP team&#46; It is also essential to make patients aware that they are responsible for their treatment and rehabilitation&#44; since the latter will mainly depend on their own actions&#46;</p><p id="par0330" class="elsevierStylePara elsevierViewall">In our opinion&#44; this study highlights the importance of these programs for secondary prevention of atherosclerotic disease and supports their applicability in clinical practice&#46; There is thus a need to increase the referral rate to the CRPs currently available in Portugal and to establish new centers&#44; in order to provide the care that is essential for full recovery after an acute event and for prevention of cardiovascular disease&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Ethical responsibilities</span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Protection of human and animal subjects</span><p id="par0335" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Confidentiality of data</span><p id="par0340" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data and that all the patients included in the study received sufficient information and gave their written informed consent to participate in the study&#46;</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Right to privacy and informed consent</span><p id="par0345" class="elsevierStylePara elsevierViewall">The authors have obtained the written informed consent of the patients or subjects mentioned in the article&#46; The corresponding author is in possession of this document&#46;</p></span></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicts of interest</span><p id="par0350" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2012-05-15"
    "fechaAceptado" => "2012-08-02"
    "PalabrasClave" => array:2 [
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          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec166330"
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            0 => "Cardiac rehabilitation"
            1 => "Coronary disease"
            2 => "Cardiovascular risk factors"
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          "titulo" => "Palavras-chave"
          "identificador" => "xpalclavsec166331"
          "palabras" => array:3 [
            0 => "Reabilita&#231;&#227;o Card&#237;aca"
            1 => "Doen&#231;a card&#237;aca isqu&#233;mica"
            2 => "Fatores de risco cardiovascular"
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    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Cardiac rehabilitation programs are designed to improve patients&#8217; functional capacity&#44; as well as to educate them and to monitor their cardiovascular risk factors&#46;</p> <span class="elsevierStyleSectionTitle">Aim</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The study aims to evaluate the effects of cardiac rehabilitation programs in patients with coronary disease over a 12-month follow-up period with regard to control of cardiovascular risk factors&#46;</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">This was a prospective study of patients diagnosed with coronary disease who completed an exercise-based cardiac rehabilitation program between January 2008 and December 2009 and who were not lost to follow-up&#46; Patients were evaluated at an early stage &#40;first medical consultation in phase II of the program&#41; and 3&#44; 6 and 12 months later&#44; the following parameters being assessed&#58; weight and body mass index&#44; waist circumference&#44; lipid profile&#44; HbA1c in diabetic patients&#44; blood pressure&#44; smoking status and physical activity &#40;using the International Physical Activity Questionnaire&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">In the sample of 256 patients &#40;76&#46;2&#37; male&#44; mean age 67 years&#41;&#44; dyslipidemia proved to be the most prevalent risk factor &#40;74&#46;2&#37;&#41;&#44; followed by overweight &#40;71&#46;5&#37;&#41;&#46; There was a statistically significant improvement &#40;p&#60;0&#46;05&#41; in all risk factors studied at the end of phase II of the program&#44; which was maintained at 6 and 12 months of follow-up&#44; with the exception of body mass index &#40;loss of statistical significance at 6-month assessment&#44; p&#61;0&#46;92&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusion</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">This study highlights the need for cardiac rehabilitation programs in the context of secondary prevention of cardiovascular disease and the importance of implementing strategies that promote long-term maintenance of their benefits&#46;</p>"
      ]
      "pt" => array:2 [
        "titulo" => "Resumo"
        "resumen" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Os Programas de Reabilita&#231;&#227;o Card&#237;aca visam melhorar a capacidade funcional do doente com patologia card&#237;aca assim como educar e acompanhar no controlo dos seus fatores de risco cardiovasculares&#46;</p> <span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Avaliar os efeitos de um programa de Reabilita&#231;&#227;o Card&#237;aca em doentes com doen&#231;a card&#237;aca isqu&#233;mica ao longo de 12 meses de <span class="elsevierStyleItalic">follow-up</span> no que se refere ao controlo dos fatores de risco cardiovascular&#46;</p> <span class="elsevierStyleSectionTitle">M&#233;todos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Estudo prospetivo que inclui doentes com diagn&#243;stico de doen&#231;a card&#237;aca isqu&#233;mica que completaram programa de Reabilita&#231;&#227;o Card&#237;aca baseado no exerc&#237;cio entre janeiro de 2008 a dezembro de 2009&#44; sem perda de dados no <span class="elsevierStyleItalic">follow-up</span>&#46; Foram avaliados num momento inicial &#40;primeira consulta da Fase II&#41; aos 3&#44; 6 e 12 meses depois&#44; com registo dos seguintes par&#226;metros&#58; &#237;ndice de massa corporal&#44; circometria abdominal&#44; perfil lip&#237;dico&#44; HbA1c nos doentes diab&#233;ticos&#44; tens&#227;o arterial&#44; tabagismo e n&#237;vel de atividade f&#237;sica &#40;atrav&#233;s do <span class="elsevierStyleItalic">International Physical Activity Questionnaire&#41;</span>&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Amostra de 256 doentes &#40;76&#44;2&#37;&#59; idade m&#233;dia&#58; 67 anos&#41;&#59; a dislipidemia revelou-se o fator de risco mais prevalente &#40;74&#44;2&#37;&#41; seguido de excesso ponderal &#40;71&#44;5&#37;&#41;&#46; No final da Fase II ocorreu uma melhoria estatisticamente significativa &#40;p&#60;0&#44;05&#41; em todos os fatores de risco estudados&#44; que se manteve aos 6 e 12 meses de <span class="elsevierStyleItalic">follow-up</span>&#44; com a exce&#231;&#227;o do IMC &#40;perda do significado estat&#237;stico na avalia&#231;&#227;o dos 6 meses&#59; p&#61;0&#44;92&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclus&#227;o</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Este estudo salienta a necessidade de programas de Reabilita&#231;&#227;o Card&#237;aca no contexto da preven&#231;&#227;o secund&#225;ria da doen&#231;a cardiovascular e a import&#226;ncia de implementar estrat&#233;gias que potenciem a manuten&#231;&#227;o dos benef&#237;cios a longo prazo&#46;</p>"
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        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara">Please cite this article as&#58; Magalh&#227;es&#44; S&#44; et al&#46;&#44; Efeitos a longo prazo de um programa de reabilita&#231;&#227;o card&#237;aca no controlo dos fatores de risco cardiovasculares&#46; Rev Port Cardiol 2013&#46; <span class="elsevierStyleInterRef" href="doi:10.1016/j.repc.2012.08.005">http&#58;&#47;&#47;dx&#46;doi&#46;org&#47;10&#46;1016&#47;j&#46;repc&#46;2012&#46;08&#46;005</span>&#46;</p>"
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        "titulo" => "<span class="elsevierStyleSectionTitle">Abbreviations</span>"
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              0 => array:2 [
                "termino" => "ACS"
                "descripcion" => "<p id="par0005" class="elsevierStylePara elsevierViewall">acute coronary syndrome</p>"
              ]
              1 => array:2 [
                "termino" => "BMI"
                "descripcion" => "<p id="par0010" class="elsevierStylePara elsevierViewall">body mass index</p>"
              ]
              2 => array:2 [
                "termino" => "BP"
                "descripcion" => "<p id="par0015" class="elsevierStylePara elsevierViewall">blood pressure</p>"
              ]
              3 => array:2 [
                "termino" => "CAD"
                "descripcion" => "<p id="par0020" class="elsevierStylePara elsevierViewall">coronary artery disease</p>"
              ]
              4 => array:2 [
                "termino" => "CRP"
                "descripcion" => "<p id="par0025" class="elsevierStylePara elsevierViewall">cardiac rehabilitation program</p>"
              ]
              5 => array:2 [
                "termino" => "CV"
                "descripcion" => "<p id="par0030" class="elsevierStylePara elsevierViewall">cardiovascular</p>"
              ]
              6 => array:2 [
                "termino" => "CVPRU"
                "descripcion" => "<p id="par0035" class="elsevierStylePara elsevierViewall">Cardiovascular Prevention and Rehabilitation Unit</p>"
              ]
              7 => array:2 [
                "termino" => "HDL-C"
                "descripcion" => "<p id="par0040" class="elsevierStylePara elsevierViewall">high-density lipoprotein cholesterol</p>"
              ]
              8 => array:2 [
                "termino" => "IPAQ"
                "descripcion" => "<p id="par0045" class="elsevierStylePara elsevierViewall">international physical activity questionnaire</p>"
              ]
              9 => array:2 [
                "termino" => "LDL-C"
                "descripcion" => "<p id="par0050" class="elsevierStylePara elsevierViewall">low density lipoprotein cholesterol</p>"
              ]
              10 => array:2 [
                "termino" => "TC"
                "descripcion" => "<p id="par0055" class="elsevierStylePara elsevierViewall">total cholesterol</p>"
              ]
              11 => array:2 [
                "termino" => "TG"
                "descripcion" => "<p id="par0060" class="elsevierStylePara elsevierViewall">triglycerides</p>"
              ]
              12 => array:2 [
                "termino" => "WC"
                "descripcion" => "<p id="par0065" class="elsevierStylePara elsevierViewall">waist circumference</p>"
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                  \t\t\t\t">1&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Gender</span></td></tr><tr title="table-row"><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"><span class="elsevierStyleHsp" style=""></span>Male&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">195&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">76&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Female&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Diagnosis</span></td></tr><tr title="table-row"><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"><span class="elsevierStyleHsp" style=""></span>ACS&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">167&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">65&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Post-angioplasty&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Post-ICD implantation&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Post-CABG&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Angina&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Heart failure&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Post-CRT implantation&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" 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"><span class="elsevierStyleItalic">Total</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">256&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab272108.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Patient characteristics&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">BMI&#58; body mass index&#59; F&#58; female&#59; M&#58; male&#59; WC&#58; waist circumference&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><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">BMI &#8804;25<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">183&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BMI &#62;25 to &#60;30<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">131&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BMI &#8805;30<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">WC 94&#8211;102<span class="elsevierStyleHsp" style=""></span>cm &#40;M&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">76&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">WC &#62;102<span class="elsevierStyleHsp" style=""></span>cm &#40;M&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">WC 80&#8211;88<span class="elsevierStyleHsp" style=""></span>cm &#40;F&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">WC &#62;88<span class="elsevierStyleHsp" style=""></span>cm &#40;F&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dyslipidemia&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">190&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">74&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hypertension&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">160&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Smoking&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">73&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Diabetes&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">88&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sedentary lifestyle&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">119&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab272106.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Prevalence of cardiovascular risk factors&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">F&#58; females&#59; HDL-C&#58; high density lipoprotein cholesterol&#59; LDL-C&#58; low density lipoprotein cholesterol&#59; M&#58; males&#59; TC&#58; total cholesterol&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td 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" style="border-bottom: 2px solid black">Risk factor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Initial &#37; &#40;n&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">3-month &#37; &#40;n&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">6-month &#37; &#40;n&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">12-month &#37; &#40;n&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><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">BMI &#8805;25<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71&#46;5 &#40;183&#47;256&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&#46;6 &#40;155&#47;256&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59 &#40;151&#47;256&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61&#46;3 &#40;157&#47;256&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Obesity&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#46;9 &#40;51&#47;256&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;2 &#40;39&#47;256&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;002&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;41&#47;256&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;013&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#46;4 &#40;42&#47;256&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;049&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">WC &#62;88<span class="elsevierStyleHsp" style=""></span>cm &#40;F&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">78&#46;7 &#40;48&#47;61&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72&#46;1 &#40;44&#47;61&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;125&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">67&#46;2 &#40;41&#47;61&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;016&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63&#46;9 &#40;39&#47;61&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">WC &#62;102<span class="elsevierStyleHsp" style=""></span>cm &#40;M&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&#46;3 &#40;63&#47;195&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20 &#40;39&#47;195&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&#46;1 &#40;47&#47;195&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;006&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&#46;6 &#40;48&#47;195&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hypertension&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#46;8 &#40;66&#47;256&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;3 &#40;11&#47;256&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;8 &#40;25&#47;256&#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\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;8 &#40;20&#47;256&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TC &#8805;175<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#46;2 &#40;67&#47;256&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">12&#46;5 &#40;32&#47;256&#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\ttop\n
                  \t\t\t\t">&#60;0&#46;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="char" valign="\n
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                  \t\t\t\t">18&#46;8 &#40;48&#47;256&#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\ttop\n
                  \t\t\t\t">0&#46;069&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&#46;4 &#40;47&#47;256&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;047&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">LDL-C &#8805;100<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55&#46;1 &#40;141&#47;256&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32 &#40;82&#47;256&#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">HbA1c &#8805;6&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Sedentary lifestyle&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">9&#46;8 &#40;25&#47;256&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
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                  """
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          "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">BMI&#58; body mass index&#59; diff&#46;&#58; difference&#59; HDL-C&#58; high density lipoprotein cholesterol&#59; IPAQ&#58; International Physical Activity Questionnaire&#59; LDL-C&#58; low density lipoprotein cholesterol&#59; METs&#58; metabolic equivalents&#59; SD&#58; standard deviation&#59; TC&#58; total cholesterol&#59; TG&#58; triglycerides&#46;</p>"
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                  \t\t\t\t\tvoid\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">0&#8211;3 months</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">0&#8211;6 months</td><td class="td" title="\n
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                  \t\t\t\t  " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">0&#8211;12 months</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Mean diff&#46; &#40;&#177; SD&#41;&nbsp;\t\t\t\t\t\t\n
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                  \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" style="border-bottom: 2px solid black">Mean diff&#46; &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Mean diff&#46; &#40;&#177; SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Mean diff&#46; &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Mean diff&#46; &#40;&#177; SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Mean diff&#46; &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;5 &#40;&#177;2&#46;8&#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">&#8595; 3&#46;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;1 &#40;&#177;4&#46;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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8595; 2&#46;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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Original article
Long-term effects of a cardiac rehabilitation program in the control of cardiovascular risk factors
Efeitos a longo prazo de um programa de reabilitação cardíaca no controlo dos fatores de risco cardiovasculares
Sandra Magalhãesa,
Corresponding author
mag.sandra@gmail.com

Corresponding author.
, Maria Miguel Ribeiroa, Ana Barreirab, Preza Fernandesb, Severo Torresb, José Lopes Gomesb, Sofia Viamontea
a Serviço de Medicina Física e de Reabilitação, Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal
b Serviço de Cardiologia, Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal
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and therapeutic exercise sessions&#46; The latter are held twice weekly under the supervision of the physiatrist and cardiologist&#44; in accordance with international guidelines on the level of supervision and monitoring appropriate to each case&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> In addition&#44; patients are advised to exercise during the rest of the week&#44; based on the general principles of the program&#44; and are encouraged to increase their level of activity in a safe manner&#46; Each session lasts between 60 and 90<span class="elsevierStyleHsp" style=""></span>minutes&#59; the exercise protocol includes a warm-up period&#44; aerobic training &#40;treadmill and arm and leg ergometers&#41;&#44; strength training &#40;using dumbbells&#44; exercise balls and other strength training equipment&#41;&#44; a cool-down period and flexibility exercises&#46; The intensity of each exercise component is determined for each individual patient based on their exercise heart rate calculated by the Karvonen formula<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> using the data obtained from exercise testing&#59; 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and at 3&#44; 6 and 12 months&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Cardiovascular risk factors</span><p id="par0120" class="elsevierStylePara elsevierViewall">CV risk factors were defined in accordance with the European Society of Cardiology guidelines on cardiovascular disease prevention&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Determination of lipid profile included measurement of total cholesterol &#40;TC&#41;&#44; low density lipoprotein cholesterol &#40;LDL-C&#41;&#44; high density lipoprotein cholesterol &#40;HDL-C&#41; and triglycerides &#40;TG&#41;&#44; based on the following references values<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>&#58; TC &#60;175<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; LDL-C &#60;100<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; HDL-C &#62;45<span class="elsevierStyleHsp" style=""></span>mg&#47;dl and TG &#60;150<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#46; Laboratory tests were performed on blood samples collected after 12<span class="elsevierStyleHsp" style=""></span>hours&#8217; fasting&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Body composition was assessed by weight&#44; waist circumference &#40;WC&#41; and body mass index &#40;BMI&#41;&#46; Obesity was defined according to the internationally recognized classification of BMI &#8805;30 &#40;weight in kilograms&#47;height in meters squared&#41;&#44; and those with BMI 25&#8211;29&#46;9<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span> were classified as overweight or pre-obese&#46; WC was considered high if &#62;80<span class="elsevierStyleHsp" style=""></span>cm in women and &#62;94<span class="elsevierStyleHsp" style=""></span>cm in men&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Blood pressure &#40;BP&#41; values were recorded and considered high if &#62;130&#47;80<span class="elsevierStyleHsp" style=""></span>mmHg in two consecutive assessments&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">With regard to diabetic patients&#44; capillary blood glucose and HbA1c were used to assess diabetes control&#44; fasting blood glucose &#8805;110<span class="elsevierStyleHsp" style=""></span>mg&#47;dl and HbA1c &#8805;6&#46;5&#37; being considered abnormal&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Patients&#8217; smoking habits were recorded&#44; those who did not smoke at all being considered non-smokers&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Levels of physical activity were assessed using the International Physical Activity Questionnaire &#40;IPAQ&#41;&#44; which has been validated in the Portuguese population&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> This is designed to quantify &#40;in METs&#47;min&#47;week&#41; the amount of exercise taken in a week performing various activities &#40;including household chores&#44; employment&#44; sport and recreation&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Statistical analysis</span><p id="par0155" class="elsevierStylePara elsevierViewall">The data from this prospective study were recorded and analyzed using SPSS version 17&#46;0&#46; Qualitative variables are presented as percentages and quantitative variables as means<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation&#46; Quantitative variables were compared using the Student&#39;s t-test and qualitative variables by the McNemar test&#46; Values of p&#60;0&#46;05 were considered statistically significant&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Results</span><p id="par0160" class="elsevierStylePara elsevierViewall">Of a total of 329 patients&#44; 73 were lost to follow-up&#46; The study population thus included 256 patients&#44; most of whom &#40;81&#46;6&#37;&#41; were referred for CRP during hospitalization in the cardiology ward&#46; The majority were men &#40;76&#46;2&#37;&#41;&#44; and mean age was 61&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;6 years &#40;30&#8211;83&#41;&#46; The most common admission diagnosis &#40;65&#46;3&#37;&#41; was acute coronary syndrome &#40;ACS&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0165" class="elsevierStylePara elsevierViewall">The prevalence and changes in CV risk factors over the study period are presented in <a class="elsevierStyleCrossRefs" href="#tbl0010">Tables 2&#8211;4</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Dyslipidemia</span><p id="par0170" class="elsevierStylePara elsevierViewall">At admission&#44; dyslipidemia was the most prevalent CV risk factor &#40;74&#46;2&#37;&#41; in the study population&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">At the end of phase II of the CRP &#40;at 3 months&#41;&#44; there were mean reductions of 18<span class="elsevierStyleHsp" style=""></span>mg&#47;dl in TC &#40;10&#46;2&#37;&#44; p&#60;0&#46;001&#41;&#44; 19<span class="elsevierStyleHsp" style=""></span>mg&#47;dl in LDL-C &#40;17&#46;6&#37;&#44; p&#60;0&#46;001&#41; and 19<span class="elsevierStyleHsp" style=""></span>mg&#47;dl in TG &#40;17&#46;6&#37;&#44; p&#60;0&#46;001&#41;&#46; As a result&#44; the number of patients with TC &#62;190<span class="elsevierStyleHsp" style=""></span>mg&#47;dl almost halved &#40;from 26&#46;2&#37; to 12&#46;5&#37;&#44; p&#60;0&#46;001&#41;&#44; and the number with LDL-C &#62;100<span class="elsevierStyleHsp" style=""></span>mg&#47;dl fell from 55&#46;1&#37; to 32&#37; &#40;p&#60;0&#46;001&#41;&#46; Statistically significant reductions were maintained at 6 and 12 months in TC &#40;6&#46;8&#37; and 5&#46;1&#37;&#44; respectively&#44; p&#60;0&#46;001&#41;&#44; LDL-C &#40;13&#46;9&#37; and 12&#37;&#44; p&#60;0&#46;001&#41; and TG &#40;14&#46;1&#37; and 16&#46;7&#37;&#44; p&#60;0&#46;001&#41;&#44; compared to the initial assessment values&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">There was also a statistically significant increase in HDL-C levels at 3 months&#44; the proportion of patients with HDL-C &#60;45<span class="elsevierStyleHsp" style=""></span>mg&#47;dl decreasing from 71&#46;9&#37; to 38&#46;2&#37; &#40;p&#60;0&#46;001&#41;&#44; as well as at 6 and 12 months&#44; an increase being maintained throughout the study period&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Obesity</span><p id="par0185" class="elsevierStylePara elsevierViewall">BMI &#62;25<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span> was the second most common risk factor &#40;71&#46;5&#37;&#41; in the study population&#44; 19&#46;9&#37; of patients being classified as obese &#40;BMI &#8805;30<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&#46; At 3 months&#44; there was a mean reduction of 2&#46;5<span class="elsevierStyleHsp" style=""></span>kg in weight &#40;3&#46;3&#37;&#44; p&#60;0&#46;001&#41;&#44; 3&#46;5&#37; in BMI &#40;p&#60;0&#46;001&#41; and 3<span class="elsevierStyleHsp" style=""></span>cm in WC &#40;3&#46;7&#37;&#44; p&#60;0&#46;001&#41; in the overall population&#46; Thus&#44; the number of obese patients decreased by 19&#46;9&#37; to 15&#46;2&#37; &#40;p&#61;0&#46;002&#41; and the number of those with BMI &#8805;25<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span> decreased from 71&#46;5&#37; to 60&#46;6&#37; &#40;p&#61;0&#46;003&#41;&#46; However&#44; although a statistically significant reduction in weight was observed at all assessments&#44; the greatest weight loss was seen at the 3-month assessment&#44; with only small reductions at subsequent assessments &#40;2&#46;8&#37; at 6 months and 2&#46;5&#37; at 12 months in the overall population compared to initial values&#41;&#46; With regard to BMI&#44; the significant decrease observed at 3 months was virtually nonexistent at 6 months &#40;0&#46;3&#37;&#44; p&#61;0&#46;92&#41;&#44; the change in BMI compared to initial values no longer being significant&#46; However&#44; there was a further statistically significant reduction at 12 months &#40;2&#46;4&#37;&#44; p&#60;0&#46;001&#41;&#44; the number of patients with BMI &#8805;25<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span> decreasing from 71&#46;5&#37; to 61&#46;3&#37; &#40;p&#60;0&#46;001&#41; and the proportion of obese patients from 19&#46;9&#37; to 16&#46;4&#37; &#40;p&#61;0&#46;049&#41;&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Initial assessment revealed that 78&#46;7&#37; of women had WC &#62;88<span class="elsevierStyleHsp" style=""></span>cm and 32&#46;3&#37; of men had WC &#62;102<span class="elsevierStyleHsp" style=""></span>cm&#46; At 3 months&#44; there was a statistically significant reduction in WC of 3<span class="elsevierStyleHsp" style=""></span>cm &#40;3&#46;7&#37;&#44; p&#60;0&#46;001&#41;&#44; which was less pronounced at 6- and 12-month assessment&#44; although still statistically significant compared to initial values&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Hypertension</span><p id="par0195" class="elsevierStylePara elsevierViewall">Of the total population&#44; 62&#46;5&#37; had a history of hypertension and initial assessment showed that 25&#46;8&#37; had high BP&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">At 3 months&#44; only 4&#46;3&#37; had uncontrolled hypertension &#40;p&#60;0&#46;001&#41;&#44; this figure rising to 9&#46;8&#37; &#40;p&#60;0&#46;001&#41; at 6 months and 7&#46;8&#37; &#40;p&#60;0&#46;001&#41; at 12 months&#46; Thus&#44; although the change was most pronounced at the end of phase II&#44; statistical significance was maintained throughout follow-up&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Diabetes</span><p id="par0205" class="elsevierStylePara elsevierViewall">In the study population&#44; 34&#46;4&#37; of patients were diabetic and 55&#46;7&#37; of these had HbA1C &#62;6&#46;5&#37; on initial assessment&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">At 3 months&#44; there was a mean reduction of 0&#46;8&#37; in HbA1C &#40;11&#46;3&#37;&#44; p&#60;0&#46;001&#41; and the number of patients with HbA1C &#62;6&#46;5&#37; almost halved &#40;from 55&#46;7&#37; to 30&#46;7&#37;&#44; p&#60;0&#46;001&#41;&#46; There was a mean reduction of 0&#46;5&#37; in HbA1c &#40;7&#46;6&#37;&#44; p&#60;0&#46;001&#41; at 6 months&#44; and a further 0&#46;5&#37; &#40;7&#46;1&#37;&#44; p&#60;0&#46;001&#41; at 12 months&#44; still statistically significant changes&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Smoking</span><p id="par0215" class="elsevierStylePara elsevierViewall">Of the study population&#44; 28&#46;5&#37; were smokers&#46; At 3 months&#44; only 3&#46;9&#37; of patients still smoked &#40;p&#60;0&#46;001&#41;&#44; an 86&#46;3&#37; reduction in the proportion of current smokers&#46; At 6 months&#44; 7&#37; were smokers &#40;p&#60;0&#46;001&#41;&#44; with a similar percentage at 12 months &#40;p&#60;0&#46;001&#41;&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Sedentary lifestyle</span><p id="par0220" class="elsevierStylePara elsevierViewall">At the start of the study&#44; 46&#46;5&#37; of individuals were sedentary&#44; based on the scores obtained on the IPAQ&#46; At 3 months&#44; an increase of over 200&#37; was observed in levels of weekly physical activity &#40;2852&#46;7 METs&#47;min&#47;week&#41;&#44; as reported on the IPAQ&#44; resulting in a reduction from 46&#46;5&#37; to 11&#37; in the number of sedentary individuals &#40;p&#60;0&#46;001&#41;&#46; A mean increase of 174&#37; &#40;p&#60;0&#46;001&#41; in weekly physical activity levels compared to the initial assessment was seen at 6- and 12-month assessments&#44; the proportion classified as sedentary being 8&#46;6&#37; &#40;p&#60;0&#46;001&#41; and 9&#46;8&#37; &#40;p&#60;0&#46;001&#41;&#44; respectively&#46;</p></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0225" class="elsevierStylePara elsevierViewall">The main aim of this study was to assess the long-term effects of an exercise-based CRP in CAD patients with regard to the modifiable CV risk factors of obesity&#44; waist circumference&#44; hypertension&#44; dyslipidemia&#44; diabetes&#44; smoking and sedentary lifestyle&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">A high proportion of our study population had dyslipidemia at admission &#40;74&#46;2&#37;&#41;&#44; which is in agreement with the literature&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;13</span></a> The relationship between TC&#44; LDL-C and HDL-C levels and atherosclerosis is based on solid evidence&#46; Triglycerides are also linked to greater risk of CAD&#44; although their role in atherosclerotic CV disease is less well established&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;14</span></a> The risk associated with hypercholesterolemia is progressive and reducing TC by 10&#37; lowers the incidence of CAD by 25&#37; at five years&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> At the end of phase II of the CRP &#40;3 months&#41;&#44; the mean reduction in TC was over 10&#37; and hence a significant reduction in CV risk can be assumed&#46; However&#44; there are conflicting results in the literature on the long-term effects of CRPs on lipid profile&#59; some studies report that the benefits are not statistically significant in the long term&#44;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> while others are in agreement with our results&#44; with statistically significant benefits being maintained&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> Among the explanations that have been put forward for successful outcomes is the fact that some programs include nutritional support and educational sessions&#44; leading to more consistent benefits&#46; Both components were included in our CRP&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">The prevalence of obesity is so high worldwide that the World Health Organization &#40;WHO&#41; considers it to be the global epidemic of the 21st century&#46; The latest data for Portugal<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> indicate a prevalence of overweight and obesity of 53&#46;6&#37;&#46; The study population presented an even higher prevalence&#44; reflecting their greater risk&#46; Our results are in agreement with other studies that have also found a high rate of overweight and obesity in CAD patients&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p><p id="par0240" class="elsevierStylePara elsevierViewall">Various studies have shown that obesity alone increases CV mortality<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> and that a 5&#37; reduction in body weight reduces CV risk factors&#44; while a 10&#37; reduction has significant effects on lipid profile&#44; hypertension control&#44; insulin resistance and coagulation profile&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17&#44;18</span></a></p><p id="par0245" class="elsevierStylePara elsevierViewall">It is now recognized that body fat&#44; particularly visceral fat&#44; is a metabolically active organ that synthesizes and releases into the bloodstream a variety of compounds that play an important role in cardiovascular hemostasis&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> In Portugal&#44; most women have WC &#62;88<span class="elsevierStyleHsp" style=""></span>cm&#44; while the proportion of men at similar risk is considerably lower &#40;38&#37; have WC &#62;102<span class="elsevierStyleHsp" style=""></span>cm&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> The data from our study follow the same pattern of a predominance of women with high WC&#46;</p><p id="par0250" class="elsevierStylePara elsevierViewall">At the end of phase II of the program&#44; there had been a statistically significant reduction in weight-related parameters&#46; Similar results are found in the literature&#44;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#44;22</span></a> which confirms the efficacy of these programs in reducing risk factors&#44; although the benefits obtained were significantly less at 6 and 12 months&#46; Some studies have reported no statistically significant improvement in these parameters in the long term<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>&#59; one possible reason is the absence of specific weight-loss components in CRPs&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#44;22</span></a> Our program included dietary advice by a nutritionist for all patients but no specific measures were adopted for obese patients in the exercise component&#46;</p><p id="par0255" class="elsevierStylePara elsevierViewall">As in most countries&#44; hypertension is a major public health issue in Portugal&#44; given its high prevalence &#40;42&#37;&#41;&#44; low treatment rate &#40;39&#37;&#41; and low percentage of controlled patients &#40;11&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0260" class="elsevierStylePara elsevierViewall">In our patient population&#44; 62&#46;5&#37; had hypertension as a CV risk factor and on initial assessment 25&#46;8&#37; had high BP&#46; Thus&#44; most patients had controlled BP at the start of the CRP&#44; which may be explained by the fact that most were under optimized antihypertensive therapy&#44; having been referred following hospitalization in the cardiology department&#46;</p><p id="par0265" class="elsevierStylePara elsevierViewall">There is strong evidence of the clinical benefits of BP lowering in hypertensive patients&#44;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;11</span></a> and the benefits of exercise-based CRPs in BP control are well established&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">23&#8211;25</span></a> The CRP had a positive impact in reducing hypertension throughout the study period&#44; which was statistically significant at all assessments&#44; and at 12 months only 7&#46;8&#37; had uncontrolled hypertension&#46;</p><p id="par0270" class="elsevierStylePara elsevierViewall">The WHO estimates that 300 million people worldwide will suffer from diabetes by 2025&#46; In Portugal&#44; 6&#46;5&#37; of the adult population has diabetes &#40;over 300<span class="elsevierStyleHsp" style=""></span>000 individuals&#41;&#44; and this figure is undoubtedly an underestimate&#44; since it does not include undiagnosed individuals&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Diabetes is a well-established risk factor for CV disease&#59; although diabetic patients are likely to have other conventional CV risk factors such as hypertension and dyslipidemia&#44; the 3-5-fold increase in CV risk associated with diabetes appears to be independent of other risk factors&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0275" class="elsevierStylePara elsevierViewall">At the start of the study&#44; 34&#46;4&#37; of patients had a history of diabetes&#44; which was poorly controlled in over half &#40;HbA1C &#62;6&#46;5&#37;&#41;&#46; This figure is well above that published for Portugal&#44; which could reflect a higher prevalence of this risk factor in CAD patients or underdiagnosis of the disease in the general population&#46; The benefits of exercise and CRPs on blood glucose levels are well documented in the literature<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">26&#44;27</span></a> and our study showed a reduction in almost half of the patients with poor glycemic control&#46;</p><p id="par0280" class="elsevierStylePara elsevierViewall">Smoking is the main factor in reduced life expectancy and is responsible for over 50&#37; of avoidable deaths&#44; half of which are due to atherothrombotic disease&#46; In Portugal&#44; 19&#46;6&#37; of the population over the age of 10 are daily smokers&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> The link between active and passive smoking and risk of developing CAD&#44; cerebrovascular disease or peripheral vascular disease is well established&#46; The incidence of myocardial infarction is six times higher in women and three times higher in men who smoke 20 cigarettes a day than in those who have never smoked&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> The harmful effects are cumulative&#44; in terms of both daily consumption and duration of the habit &#40;exposure time&#41;&#46; The INTERHEART study<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> showed a strong correlation between the number of cigarettes and risk of ACS &#8211; five cigarettes a day increases the risk by 38&#37;&#44; while 40 a day increases it by 900&#37; &#8211; and halving daily consumption also halves ACS risk&#46; Smoking cessation is thus a priority in cardiac rehabilitation&#44; and is even more important in the presence of atherothrombotic disease and in patients undergoing invasive procedures such as coronary bypass surgery&#44; angioplasty or vascular surgery&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> CRPs therefore represent an excellent opportunity to stress the importance of smoking cessation&#46;</p><p id="par0285" class="elsevierStylePara elsevierViewall">In our study&#44; the percentage of smokers had fallen by more than half at the end of follow-up&#46; These results are in agreement with other studies showing higher rates of smoking cessation among individuals participating in CRPs&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a></p><p id="par0290" class="elsevierStylePara elsevierViewall">Exercise is crucial for primary&#44; secondary and tertiary prevention of most of the common chronic and&#47;or degenerative diseases found in contemporary societies&#44; especially those with western lifestyles&#44; particularly with regard to the causes and consequences of atherosclerosis&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> In 1997&#44; Portugal had the highest prevalence of sedentary lifestyles &#40;87&#46;8&#37;&#41; of 15 European Union countries&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a></p><p id="par0295" class="elsevierStylePara elsevierViewall">The number of sedentary patients fell dramatically over the course of our study and at 12-month follow-up&#44; only 9&#46;8&#37; maintained a sedentary lifestyle&#59; levels of weekly physical activity increased by 174&#37;&#46; These results are a further illustration of the importance of CRPs in these patients&#46;</p><p id="par0300" class="elsevierStylePara elsevierViewall">On assessment at the end of phase II&#44; a considerable and statistically significant improvement was seen in all CV risk factors&#44; which is in agreement with the results reported in the literature<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">31&#8211;35</span></a> that show consistent benefits in these patients from exercise-based CRPs&#46;</p><p id="par0305" class="elsevierStylePara elsevierViewall">There was an overall improvement in the parameters related to control of CV risk factors&#44; which remained statistically significant throughout the 12 months of follow-up&#44; albeit with some reduction in the benefits obtained&#46; This reduction was mainly seen at the 6-month assessment&#44; which may be due to a waning of the initial level of motivation associated with the acute event&#46; The relative improvement observed at 12 months may have resulted from the reinforcement of healthy behaviors and preventive measures &#40;particularly in terms of diet and exercise&#41; that took place at the 6-month assessment in view of the worsening of parameters compared to the favorable changes seen at the end of phase II&#46;</p><p id="par0310" class="elsevierStylePara elsevierViewall">The difficulty in maintaining such benefits is particularly evident in anthropometric data&#44; since BMI was the parameter that showed the least change&#44; the improvement seen in the first 3 months being virtually cancelled out in subsequent assessments&#46; These results are similar to other studies that have reported greater difficulty in maintaining statistically significant differences for these parameters&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> The main reason suggested&#44; as pointed out above&#44; is the lack of specific preventive measures when prescribing exercise for obese patients&#46;</p><p id="par0315" class="elsevierStylePara elsevierViewall">We feel the study is important in that it assesses the long-term effects of CRPs in a sizable patient population&#44; including changes in CV risk factors&#46; There are few works in the literature presenting similar research&#44; and most assess risk factors over a shorter time period and analyze a narrower range of parameters&#46; This is also the first study in Portugal reporting CRP results at 12 months in a population of this size&#46;</p><p id="par0320" class="elsevierStylePara elsevierViewall">The lack of a control group is a limitation of the study&#44; but since studies comparing usual care versus cardiac rehabilitation have consistently demonstrated the benefits of CRPs&#44;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a> we are confident that our results can be attributed specifically to participation in a CRP&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conclusion</span><p id="par0325" class="elsevierStylePara elsevierViewall">CRPs are thus successful in treating patients with coronary disease&#44; with benefits being maintained in subsequent months&#46; Nevertheless&#44; there is a reduction in these benefits once the hospital-supervised stage has ended&#44; and it is therefore important to implement new strategies that will encourage patient compliance throughout the various phases of the program&#46; It should be explained to patients that the benefits are often lost after phase II unless they adhere strictly to the preventive measures prescribed&#46; Other interventions could be implemented&#44; including a 3-monthly supervised exercise session accompanied by an educational component&#44; in order to reinforce the basic concepts underlying prevention and health promotion&#44; and monthly telephone calls and online communication to promote closer contact between the patient and the CRP team&#46; It is also essential to make patients aware that they are responsible for their treatment and rehabilitation&#44; since the latter will mainly depend on their own actions&#46;</p><p id="par0330" class="elsevierStylePara elsevierViewall">In our opinion&#44; this study highlights the importance of these programs for secondary prevention of atherosclerotic disease and supports their applicability in clinical practice&#46; There is thus a need to increase the referral rate to the CRPs currently available in Portugal and to establish new centers&#44; in order to provide the care that is essential for full recovery after an acute event and for prevention of cardiovascular disease&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Ethical responsibilities</span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Protection of human and animal subjects</span><p id="par0335" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Confidentiality of data</span><p id="par0340" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data and that all the patients included in the study received sufficient information and gave their written informed consent to participate in the study&#46;</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Right to privacy and informed consent</span><p id="par0345" class="elsevierStylePara elsevierViewall">The authors have obtained the written informed consent of the patients or subjects mentioned in the article&#46; The corresponding author is in possession of this document&#46;</p></span></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicts of interest</span><p id="par0350" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2012-05-15"
    "fechaAceptado" => "2012-08-02"
    "PalabrasClave" => array:2 [
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          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec166330"
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            0 => "Cardiac rehabilitation"
            1 => "Coronary disease"
            2 => "Cardiovascular risk factors"
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          "titulo" => "Palavras-chave"
          "identificador" => "xpalclavsec166331"
          "palabras" => array:3 [
            0 => "Reabilita&#231;&#227;o Card&#237;aca"
            1 => "Doen&#231;a card&#237;aca isqu&#233;mica"
            2 => "Fatores de risco cardiovascular"
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    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Cardiac rehabilitation programs are designed to improve patients&#8217; functional capacity&#44; as well as to educate them and to monitor their cardiovascular risk factors&#46;</p> <span class="elsevierStyleSectionTitle">Aim</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The study aims to evaluate the effects of cardiac rehabilitation programs in patients with coronary disease over a 12-month follow-up period with regard to control of cardiovascular risk factors&#46;</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">This was a prospective study of patients diagnosed with coronary disease who completed an exercise-based cardiac rehabilitation program between January 2008 and December 2009 and who were not lost to follow-up&#46; Patients were evaluated at an early stage &#40;first medical consultation in phase II of the program&#41; and 3&#44; 6 and 12 months later&#44; the following parameters being assessed&#58; weight and body mass index&#44; waist circumference&#44; lipid profile&#44; HbA1c in diabetic patients&#44; blood pressure&#44; smoking status and physical activity &#40;using the International Physical Activity Questionnaire&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">In the sample of 256 patients &#40;76&#46;2&#37; male&#44; mean age 67 years&#41;&#44; dyslipidemia proved to be the most prevalent risk factor &#40;74&#46;2&#37;&#41;&#44; followed by overweight &#40;71&#46;5&#37;&#41;&#46; There was a statistically significant improvement &#40;p&#60;0&#46;05&#41; in all risk factors studied at the end of phase II of the program&#44; which was maintained at 6 and 12 months of follow-up&#44; with the exception of body mass index &#40;loss of statistical significance at 6-month assessment&#44; p&#61;0&#46;92&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusion</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">This study highlights the need for cardiac rehabilitation programs in the context of secondary prevention of cardiovascular disease and the importance of implementing strategies that promote long-term maintenance of their benefits&#46;</p>"
      ]
      "pt" => array:2 [
        "titulo" => "Resumo"
        "resumen" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Os Programas de Reabilita&#231;&#227;o Card&#237;aca visam melhorar a capacidade funcional do doente com patologia card&#237;aca assim como educar e acompanhar no controlo dos seus fatores de risco cardiovasculares&#46;</p> <span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Avaliar os efeitos de um programa de Reabilita&#231;&#227;o Card&#237;aca em doentes com doen&#231;a card&#237;aca isqu&#233;mica ao longo de 12 meses de <span class="elsevierStyleItalic">follow-up</span> no que se refere ao controlo dos fatores de risco cardiovascular&#46;</p> <span class="elsevierStyleSectionTitle">M&#233;todos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Estudo prospetivo que inclui doentes com diagn&#243;stico de doen&#231;a card&#237;aca isqu&#233;mica que completaram programa de Reabilita&#231;&#227;o Card&#237;aca baseado no exerc&#237;cio entre janeiro de 2008 a dezembro de 2009&#44; sem perda de dados no <span class="elsevierStyleItalic">follow-up</span>&#46; Foram avaliados num momento inicial &#40;primeira consulta da Fase II&#41; aos 3&#44; 6 e 12 meses depois&#44; com registo dos seguintes par&#226;metros&#58; &#237;ndice de massa corporal&#44; circometria abdominal&#44; perfil lip&#237;dico&#44; HbA1c nos doentes diab&#233;ticos&#44; tens&#227;o arterial&#44; tabagismo e n&#237;vel de atividade f&#237;sica &#40;atrav&#233;s do <span class="elsevierStyleItalic">International Physical Activity Questionnaire&#41;</span>&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Amostra de 256 doentes &#40;76&#44;2&#37;&#59; idade m&#233;dia&#58; 67 anos&#41;&#59; a dislipidemia revelou-se o fator de risco mais prevalente &#40;74&#44;2&#37;&#41; seguido de excesso ponderal &#40;71&#44;5&#37;&#41;&#46; No final da Fase II ocorreu uma melhoria estatisticamente significativa &#40;p&#60;0&#44;05&#41; em todos os fatores de risco estudados&#44; que se manteve aos 6 e 12 meses de <span class="elsevierStyleItalic">follow-up</span>&#44; com a exce&#231;&#227;o do IMC &#40;perda do significado estat&#237;stico na avalia&#231;&#227;o dos 6 meses&#59; p&#61;0&#44;92&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclus&#227;o</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Este estudo salienta a necessidade de programas de Reabilita&#231;&#227;o Card&#237;aca no contexto da preven&#231;&#227;o secund&#225;ria da doen&#231;a cardiovascular e a import&#226;ncia de implementar estrat&#233;gias que potenciem a manuten&#231;&#227;o dos benef&#237;cios a longo prazo&#46;</p>"
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        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara">Please cite this article as&#58; Magalh&#227;es&#44; S&#44; et al&#46;&#44; Efeitos a longo prazo de um programa de reabilita&#231;&#227;o card&#237;aca no controlo dos fatores de risco cardiovasculares&#46; Rev Port Cardiol 2013&#46; <span class="elsevierStyleInterRef" href="doi:10.1016/j.repc.2012.08.005">http&#58;&#47;&#47;dx&#46;doi&#46;org&#47;10&#46;1016&#47;j&#46;repc&#46;2012&#46;08&#46;005</span>&#46;</p>"
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        "titulo" => "<span class="elsevierStyleSectionTitle">Abbreviations</span>"
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              0 => array:2 [
                "termino" => "ACS"
                "descripcion" => "<p id="par0005" class="elsevierStylePara elsevierViewall">acute coronary syndrome</p>"
              ]
              1 => array:2 [
                "termino" => "BMI"
                "descripcion" => "<p id="par0010" class="elsevierStylePara elsevierViewall">body mass index</p>"
              ]
              2 => array:2 [
                "termino" => "BP"
                "descripcion" => "<p id="par0015" class="elsevierStylePara elsevierViewall">blood pressure</p>"
              ]
              3 => array:2 [
                "termino" => "CAD"
                "descripcion" => "<p id="par0020" class="elsevierStylePara elsevierViewall">coronary artery disease</p>"
              ]
              4 => array:2 [
                "termino" => "CRP"
                "descripcion" => "<p id="par0025" class="elsevierStylePara elsevierViewall">cardiac rehabilitation program</p>"
              ]
              5 => array:2 [
                "termino" => "CV"
                "descripcion" => "<p id="par0030" class="elsevierStylePara elsevierViewall">cardiovascular</p>"
              ]
              6 => array:2 [
                "termino" => "CVPRU"
                "descripcion" => "<p id="par0035" class="elsevierStylePara elsevierViewall">Cardiovascular Prevention and Rehabilitation Unit</p>"
              ]
              7 => array:2 [
                "termino" => "HDL-C"
                "descripcion" => "<p id="par0040" class="elsevierStylePara elsevierViewall">high-density lipoprotein cholesterol</p>"
              ]
              8 => array:2 [
                "termino" => "IPAQ"
                "descripcion" => "<p id="par0045" class="elsevierStylePara elsevierViewall">international physical activity questionnaire</p>"
              ]
              9 => array:2 [
                "termino" => "LDL-C"
                "descripcion" => "<p id="par0050" class="elsevierStylePara elsevierViewall">low density lipoprotein cholesterol</p>"
              ]
              10 => array:2 [
                "termino" => "TC"
                "descripcion" => "<p id="par0055" class="elsevierStylePara elsevierViewall">total cholesterol</p>"
              ]
              11 => array:2 [
                "termino" => "TG"
                "descripcion" => "<p id="par0060" class="elsevierStylePara elsevierViewall">triglycerides</p>"
              ]
              12 => array:2 [
                "termino" => "WC"
                "descripcion" => "<p id="par0065" class="elsevierStylePara elsevierViewall">waist circumference</p>"
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                  \t\t\t\t">1&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Gender</span></td></tr><tr title="table-row"><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"><span class="elsevierStyleHsp" style=""></span>Male&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">195&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">76&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Female&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Diagnosis</span></td></tr><tr title="table-row"><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"><span class="elsevierStyleHsp" style=""></span>ACS&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">167&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">65&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Post-angioplasty&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Post-ICD implantation&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Post-CABG&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Angina&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Heart failure&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Post-CRT implantation&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" 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"><span class="elsevierStyleItalic">Total</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">256&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab272108.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Patient characteristics&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">BMI&#58; body mass index&#59; F&#58; female&#59; M&#58; male&#59; WC&#58; waist circumference&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><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">BMI &#8804;25<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">183&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BMI &#62;25 to &#60;30<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">131&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BMI &#8805;30<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">WC 94&#8211;102<span class="elsevierStyleHsp" style=""></span>cm &#40;M&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">76&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">WC &#62;102<span class="elsevierStyleHsp" style=""></span>cm &#40;M&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">WC 80&#8211;88<span class="elsevierStyleHsp" style=""></span>cm &#40;F&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">WC &#62;88<span class="elsevierStyleHsp" style=""></span>cm &#40;F&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dyslipidemia&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">190&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">74&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hypertension&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">160&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Smoking&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">73&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Diabetes&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">88&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sedentary lifestyle&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">119&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab272106.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Prevalence of cardiovascular risk factors&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">F&#58; females&#59; HDL-C&#58; high density lipoprotein cholesterol&#59; LDL-C&#58; low density lipoprotein cholesterol&#59; M&#58; males&#59; TC&#58; total cholesterol&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td 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" style="border-bottom: 2px solid black">Risk factor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Initial &#37; &#40;n&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">3-month &#37; &#40;n&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">6-month &#37; &#40;n&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">12-month &#37; &#40;n&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><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">BMI &#8805;25<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71&#46;5 &#40;183&#47;256&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&#46;6 &#40;155&#47;256&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59 &#40;151&#47;256&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61&#46;3 &#40;157&#47;256&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Obesity&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#46;9 &#40;51&#47;256&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;2 &#40;39&#47;256&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;002&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;41&#47;256&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;013&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#46;4 &#40;42&#47;256&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;049&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">WC &#62;88<span class="elsevierStyleHsp" style=""></span>cm &#40;F&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">78&#46;7 &#40;48&#47;61&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72&#46;1 &#40;44&#47;61&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;125&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">67&#46;2 &#40;41&#47;61&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;016&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63&#46;9 &#40;39&#47;61&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">WC &#62;102<span class="elsevierStyleHsp" style=""></span>cm &#40;M&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&#46;3 &#40;63&#47;195&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20 &#40;39&#47;195&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&#46;1 &#40;47&#47;195&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;006&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&#46;6 &#40;48&#47;195&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hypertension&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#46;8 &#40;66&#47;256&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;3 &#40;11&#47;256&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;8 &#40;25&#47;256&#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\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;8 &#40;20&#47;256&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TC &#8805;175<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#46;2 &#40;67&#47;256&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">12&#46;5 &#40;32&#47;256&#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\ttop\n
                  \t\t\t\t">&#60;0&#46;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="char" valign="\n
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                  \t\t\t\t">18&#46;8 &#40;48&#47;256&#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\ttop\n
                  \t\t\t\t">0&#46;069&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&#46;4 &#40;47&#47;256&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;047&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">LDL-C &#8805;100<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55&#46;1 &#40;141&#47;256&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32 &#40;82&#47;256&#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">HbA1c &#8805;6&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Sedentary lifestyle&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">9&#46;8 &#40;25&#47;256&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
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                  """
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          "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">BMI&#58; body mass index&#59; diff&#46;&#58; difference&#59; HDL-C&#58; high density lipoprotein cholesterol&#59; IPAQ&#58; International Physical Activity Questionnaire&#59; LDL-C&#58; low density lipoprotein cholesterol&#59; METs&#58; metabolic equivalents&#59; SD&#58; standard deviation&#59; TC&#58; total cholesterol&#59; TG&#58; triglycerides&#46;</p>"
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                  \t\t\t\t\tvoid\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">0&#8211;3 months</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">0&#8211;6 months</td><td class="td" title="\n
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                  \t\t\t\t  " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">0&#8211;12 months</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Mean diff&#46; &#40;&#177; SD&#41;&nbsp;\t\t\t\t\t\t\n
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                  \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" style="border-bottom: 2px solid black">Mean diff&#46; &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Mean diff&#46; &#40;&#177; SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Mean diff&#46; &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Mean diff&#46; &#40;&#177; SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Mean diff&#46; &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;5 &#40;&#177;2&#46;8&#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">&#8595; 3&#46;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;1 &#40;&#177;4&#46;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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8595; 2&#46;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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ISSN: 21742049
Original language: English
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2021 January 52 11 63
2020 December 42 6 48
2020 November 44 15 59
2020 October 25 10 35
2020 September 58 8 66
2020 August 31 10 41
2020 July 36 9 45
2020 June 47 4 51
2020 May 46 3 49
2020 April 56 13 69
2020 March 47 5 52
2020 February 41 26 67
2020 January 22 4 26
2019 December 21 1 22
2019 November 22 4 26
2019 October 30 3 33
2019 September 14 12 26
2019 August 30 5 35
2019 July 35 13 48
2019 June 15 7 22
2019 May 37 7 44
2019 April 29 15 44
2019 March 41 9 50
2019 February 53 7 60
2019 January 24 7 31
2018 December 43 4 47
2018 November 59 12 71
2018 October 144 18 162
2018 September 55 15 70
2018 August 28 5 33
2018 July 24 2 26
2018 June 42 8 50
2018 May 37 13 50
2018 April 34 1 35
2018 March 44 9 53
2018 February 23 4 27
2018 January 21 4 25
2017 December 48 5 53
2017 November 49 8 57
2017 October 32 12 44
2017 September 41 4 45
2017 August 37 13 50
2017 July 25 12 37
2017 June 30 5 35
2017 May 54 7 61
2017 April 33 3 36
2017 March 44 32 76
2017 February 37 7 44
2017 January 22 5 27
2016 December 28 12 40
2016 November 31 11 42
2016 October 31 10 41
2016 September 29 9 38
2016 August 9 0 9
2016 July 20 8 28
2016 June 16 3 19
2016 May 12 11 23
2016 April 52 2 54
2016 March 81 10 91
2016 February 103 23 126
2016 January 67 13 80
2015 December 68 14 82
2015 November 69 13 82
2015 October 75 16 91
2015 September 56 15 71
2015 August 61 17 78
2015 July 64 15 79
2015 June 37 7 44
2015 May 48 7 55
2015 April 54 14 68
2015 March 43 11 54
2015 February 51 7 58
2015 January 58 15 73
2014 December 78 15 93
2014 November 55 14 69
2014 October 98 15 113
2014 September 71 13 84
2014 August 41 13 54
2014 July 54 18 72
2014 June 62 8 70
2014 May 56 15 71
2014 April 59 10 69
2014 March 84 15 99
2014 February 64 11 75
2014 January 56 16 72
2013 December 53 17 70
2013 November 68 22 90
2013 October 66 22 88
2013 September 62 17 79
2013 August 66 32 98
2013 July 73 28 101
2013 June 56 24 80
2013 May 101 32 133
2013 April 14 11 25
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Revista Portuguesa de Cardiologia (English edition)
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