Electrocardiographic changes in adults living in a southern Brazilian city: A population-based studyElectrocardiographic changes in adults living in a southern Brazilian city: A population-based study | Revista Portuguesa de Cardiologia (English edition)

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(A) Distribution of cardiovascular causes of sudden death in 1435 young competitive athletes. From the Minneapolis Heart Institute Foundation Registry, 1980–2005 (adapted from Maron et al.<a class="elsevierStyleCrossRefs" href="#bib0425">12,20</a>). (B) Causes of sudden death in athletes in the Veneto region, Italy, 1979–1999 (adapted from Corrado et al.<a class="elsevierStyleCrossRef" href="#bib0430">13</a>). 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"titulo" => "Alterações eletrocardiográficas na população adulta de cidade do sul do Brasil: estudo populacional" ] ] "textoCompleto" => "IntroductionCardiovascular disease (CVD) is associated with high rates of morbidity and mortality in developed countries, and has been the leading cause of mortality in Brazil since the 1960s. In 2008 CVD accounted for 31.8% of mortality in the country as a whole and 38% of deaths recorded in the municipality of Tubarão, Santa Catarina.<a class="elsevierStyleCrossRef" href="#bib0170">1</a>CVD is responsible for high health costs and affects a large proportion of the working population. Its economic impact in Brazil is demonstrated by the following figures: it accounts for 65% of deaths in adults aged 30–69 years, 14% of hospital admissions in this age-group (1150000 hospitalizations/year) and 40% of early retirements.<a class="elsevierStyleCrossRef" href="#bib0175">2</a> The causes of CVD are multifactorial and its prevention depends on control of cardiovascular risk factors, including smoking, obesity, dyslipidemia, systemic hypertension, sedentary life styles and diabetes.<a class="elsevierStyleCrossRefs" href="#bib0180">3–5</a>Abnormalities on the resting electrocardiogram (ECG) are an independent predictor of the development of coronary artery disease (CAD) and are associated with increased mortality and cardiovascular risk.<a class="elsevierStyleCrossRefs" href="#bib0195">6–10</a> Abnormal Q waves on the ECG may indicate a silent or unrecognized myocardial infarction. In the Framingham study, a quarter of non-fatal infarctions were only detected through ECG changes.<a class="elsevierStyleCrossRefs" href="#bib0220">11–13</a>Against this background, besides patient history and clinical examination, the ECG is also useful in cardiovascular epidemiology, due to its low cost, accessibility, safety, and ability to predict cardiovascular risk.<a class="elsevierStyleCrossRefs" href="#bib0205">8,10</a>The aim of this study was to estimate the prevalence of major and minor ECG abnormalities and their association with the main risk factors for CAD in the adult population of Tubarão, Santa Catarina.MethodsThe study was approved by the Ethics and Research Committee of the University of Southern Santa Catarina (UNISUL). It was sponsored by the Foundation for Research and Innovation of the State of Santa Catarina (FAPESC), and is part of the Tubarão Adult Health Study (ESATU), in a partnership between the Center for Clinical Research of Hospital Nossa Senhora da Conceição, UNISUL and the Municipal Health Secretariat.We performed an epidemiological, cross-sectional, population-based study between November 2011 and June 2012 in adults aged 19–59 years of both sexes living in the municipality of Tubarão, Santa Catarina, Brazil. Pregnant women, individuals unable to travel to the data collection point, and those unable to freely decide on their participation were excluded, as were those who did not undergo ECG or laboratory testing.To calculate the sample size, we used an estimate of 36% of ECG abnormalities<a class="elsevierStyleCrossRef" href="#bib0205">8</a> with a level of significance of 5% and a margin of error of 1%, which resulted in a minimum sample of 353 individuals for a 95% confidence interval, based on an adult population in Tubarão of 62537 (2010 census).The participants were selected through simple random sampling based on house numbers in each of the 250 micro areas of the municipality registered in 27 family health units. Each micro area has a community health worker who carries out regular home visits, and the service is estimated to cover 90% of the resident population. The randomly selected house numbers were 4, 36, 27, 10 and 32. Community health workers visited the first house selected (number 4) in their area and invited the resident to participate in the study in accordance with the inclusion and exclusion criteria. If there were no adults at home or if they refused to participate in the study, the health workers proceeded to the next selected house (number 10) until each had recruited one or two participants per micro area.Data collection took place on Saturday mornings in outpatient consultations arranged with the participants in branches of Hospital Nossa Senhora da Conceição. Participating individuals were requested to fast for 12 hours and to abstain from alcohol in the 72 hours prior to the consultation.After their informed consent was obtained, the participants were interviewed, with the following data being recorded: sociodemographic (age, gender and level of education, as indicated by number of years of schooling), behavioral (sedentarism, alcohol consumption and smoking) and clinical (history of CVD and medications). Individuals who had smoked at least 100 cigarettes in their lives were considered smokers.<a class="elsevierStyleCrossRef" href="#bib0235">14</a> The CAGE questionnaire was applied in those who stated they drank alcohol.<a class="elsevierStyleCrossRef" href="#bib0240">15</a> The short-form International Physical Activity Questionnaire was used to assess the level of exercise.<a class="elsevierStyleCrossRefs" href="#bib0245">16,17</a>Height and weight were measured to determine body mass index (BMI), individuals with BMI ≥30 kg/m2 being considered obese; 10 ml of peripheral venous blood was collected for assessment of total, HDL and LDL cholesterol (HDL-C and LDL-C), triglycerides (TG), blood glucose and creatinine.A diagnosis of dyslipidemia was based on changes in one or more of the four parameters measured: isolated hypercholesterolemia (LDL-C ≥160 mg/dl); isolated hypertriglyceridemia (TG ≥150 mg/dl); mixed hyperlipidemia (LDL-C ≥160 mg/dl and TG ≥150 mg/dl); and low HDL-C (<40 mg/dl in men and <50 mg/dl in women), either isolated or associated with increased LDL-C or TG.<a class="elsevierStyleCrossRef" href="#bib0180">3</a>Systemic hypertension was assessed in accordance with the 2010 guidelines of the Brazilian Society of Cardiology, with three blood pressure (BP) measurements being taken at one-minute intervals,<a class="elsevierStyleCrossRef" href="#bib0255">18</a> using an Omron HEM-742INT automatic sphygmomanometer. Patients were classified as hypertensive if they presented mean systolic or diastolic BP ≥140 or ≥90 mmHg, respectively, or were under antihypertensive therapy. Patients with a previous diagnosis of diabetes or taking hypoglycemic medication and those with fasting glucose >126 mg/dl were considered diabetic. The participants were categorized according to their Framingham risk score as low (<10%), intermediate (10%–20%) or high risk (>20%).<a class="elsevierStyleCrossRef" href="#bib0260">19</a>The ECG was performed using a C10+ digital electrocardiograph, with the patient at rest in dorsal decubitus. The recordings were sent to a cardiologist, who established the diagnoses in accordance with the guidelines of the Brazilian Society of Cardiology on analyzing and issuing electrocardiographic reports.<a class="elsevierStyleCrossRef" href="#bib0265">20</a> The results were divided into major and minor abnormalities or no changes, as in previous studies.<a class="elsevierStyleCrossRefs" href="#bib0195">6–10</a>Abnormalities of ventricular repolarization were defined as significant changes in the polarity, duration or morphology of the J point, ST segment, T wave or U wave in the absence of alterations that met the definition of ischemic waves or other specific diagnostic features such as chamber overload or intraventricular block. Increased corrected QT interval was considered separately from the above alterations. Subepicardial ischemia was diagnosed in the presence of negative, symmetrical and sharp T waves.<a class="elsevierStyleCrossRef" href="#bib0265">20</a>OpenEpi software, version 2.3.1, was used to calculate the sample size. The data were entered into EpiData, version 3.1 (EpiData Association, Odense, Denmark) and SPSS for Windows, version 19 (Chicago, IL, USA) was used for the statistical analysis. Descriptive statistics with frequencies and measures of central tendency and dispersion were used to summarize the data. Pearson's chi-square test and one-way ANOVA were used to analyze the association between the variables under study, with a 95% confidence interval.ResultsA total of 361 participants were studied. Mean age was 40.4±12.2 years, 232 (64.3%) were women and 312 (86.4%) were white.Minor abnormalities were found in 61 individuals (16.9%), major abnormalities in 12 (3.3%), and 288 (79.8%) had no abnormalities. <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the ECG changes observed among the participants.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the sociodemographic and clinical characteristics of the study population according to ECG results.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>The results show that major and minor abnormalities were mainly associated with female gender, smoking, alcohol consumption, hypertension and diabetes, as well as intermediate or high Framingham risk score.DiscussionIn our study minor ECG abnormalities were more prevalent than major ones (16.9% vs. 3.3%, respectively). These percentages are lower than in population studies in the US<a class="elsevierStyleCrossRefs" href="#bib0205">8–10</a>; an American study of 14749 women aged 40–55 years found 27.8% had minor abnormalities and 6.3% major abnormalities.<a class="elsevierStyleCrossRef" href="#bib0215">10</a> Another American study, involving 2192 individuals aged 70–79 years, found 13% had minor abnormalities and 23% major abnormalities. The different prevalences can be explained by age differences, since the present study assessed individuals aged 18–59, with a mean age of 40.4 years.Women presented a higher prevalence of minor abnormalities, while men had a higher prevalence of major abnormalities. A study of adult outpatients in basic health care units in São Paulo, Brazil, also found a higher proportion of ECG changes among men.<a class="elsevierStyleCrossRef" href="#bib0270">21</a>Smokers and former smokers showed a positive correlation with the presence of ECG abnormalities, as demonstrated in other studies.<a class="elsevierStyleCrossRefs" href="#bib0215">10,22,23</a> Oliveira et al. showed that adults aged 45 or under who smoked more than 25 cigarettes/day had a higher risk of myocardial infarction than those who had never smoked.<a class="elsevierStyleCrossRef" href="#bib0285">24</a>In our study 37.7% of the population were hypertensive, while other Brazilian studies have reported prevalences between 20% and 45%.<a class="elsevierStyleCrossRefs" href="#bib0290">25–28</a> Hypertension is the risk factor most commonly associated with ECG alterations, mainly ST-T abnormalities.<a class="elsevierStyleCrossRefs" href="#bib0205">8,9</a> Greenland et al. showed that the risk of CAD rises from 38% to 67% at five years if the abnormalities persist.<a class="elsevierStyleCrossRef" href="#bib0210">9</a>Only 5% of our study population were in the intermediate or high risk groups according to their Framingham score, and 38.9% of these had minor or major ECG abnormalities. A US study found ECG abnormalities in 54.7% of patients with high Framingham risk scores, which demonstrates that the score is a good predictor of cardiovascular risk in adults.<a class="elsevierStyleCrossRef" href="#bib0205">8</a>Among diabetic individuals in our study, 31.8% had major or minor ECG abnormalities. Brollo et al. assessed 1042 Japanese-Brazilians and found no statistically significant difference in infarction scar area on ECG between diabetic and non-diabetic individuals. However, among those born in Brazil there was a tendency for ECG abnormalities to be found and infarction scars were present in 7.5% of those with diabetes, a finding that corroborates the results of the study.<a class="elsevierStyleCrossRef" href="#bib0310">29</a>In the present study there was an association between alcohol consumption and ECG abnormalities, although other studies have found no such association.<a class="elsevierStyleCrossRefs" href="#bib0200">7,8,10</a> This discrepancy may be due to the difficulty in quantifying alcohol consumption. We used the CAGE questionnaire, which is a practical and validated method of screening for alcohol abuse in population studies, but its simplicity means it is unsuitable for assessing the degree of alcoholism.<a class="elsevierStyleCrossRef" href="#bib0240">15</a>There was no association in our study between dyslipidemia and ECG abnormalities, although this has been demonstrated in other studies in various countries.<a class="elsevierStyleCrossRefs" href="#bib0205">8,10,30</a> A US study reported that 25.7% of individuals with ECG alterations and 24.7% of those with no alterations had high LDL-C, with no statistically significant difference.<a class="elsevierStyleCrossRef" href="#bib0320">31</a> However, Denes et al. found a correlation with ECG abnormalities in women treated for dyslipidemia.<a class="elsevierStyleCrossRef" href="#bib0215">10</a>One limitation of the study is that the sample population was not designed to enable analysis of subgroups, which would have allowed assessment of risk factors for CAD and specific ECG abnormalities. Furthermore, we have compared our results with studies that used different methods for interpreting and classifying ECGs; for example, in one US study ECG abnormalities were classified according to the Minnesota code.<a class="elsevierStyleCrossRefs" href="#bib0205">8,32</a> Finally, the records were analyzed by a single cardiologist, and there was therefore no assessment of intra- or interobserver agreement. Previous studies have shown variations in interpretation between individuals, which may affect the accuracy of ECG reports.<a class="elsevierStyleCrossRef" href="#bib0330">33</a>Nevertheless, there are few Brazilian studies on the prevalence of ECG abnormalities in the general population, and the study thus makes an important contribution to public health; the ECG is a simple and widely available exam and is extremely valuable in screening for cardiac abnormalities, thus enabling early detection and intervention to prevent a fatal outcome.ConclusionsOf the 361 adults studied, 61 (16.9%) had minor and 12 (3.3%) had major ECG changes.The results showed that female gender, smoking, alcohol consumption, hypertension, diabetes and intermediate or high Framingham risk score were positively associated with ECG abnormalities, and some of these factors are modifiable.The safety, low cost and wide availability of electrocardiography makes it useful for predicting cardiovascular risk in the general population.Ethical responsibilitiesProtection of people and animalsThe authors state that the procedures followed were in accordance with regulations established by the heads of the Clinical and Research Ethics Commission and according to the World Medical Association and the Declaration of Helsinki.Data confidentialityThe authors declare that they have followed the protocols of their work center on the publication of patient data.Right to privacy and informed consentThe authors declare having received written consent from patients and/or subjects mentioned in the article. The corresponding author must be in possession of this document.FinancingThis study was funded by the Foundation for Research and Innovation of the State of Santa Catarina (FAPESC).Conflicts of interestThe authors have no conflicts of interest to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:14 [ 0 => array:3 [ "identificador" => "xres823903" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction and Objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec820494" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres823904" "titulo" => "Resumo" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introdução e objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusões" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec820493" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusions" ] 9 => array:3 [ "identificador" => "sec0030" "titulo" => "Ethical responsibilities" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0035" "titulo" => "Protection of people and animals" ] 1 => array:2 [ "identificador" => "sec0040" "titulo" => "Data confidentiality" ] 2 => array:2 [ "identificador" => "sec0045" "titulo" => "Right to privacy and informed consent" ] ] ] 10 => array:2 [ "identificador" => "sec0050" "titulo" => "Financing" ] 11 => array:2 [ "identificador" => "sec0055" "titulo" => "Conflicts of interest" ] 12 => array:2 [ "identificador" => "xack276354" "titulo" => "Acknowledgments" ] 13 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-02-20" "fechaAceptado" => "2015-07-01" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec820494" "palabras" => array:3 [ 0 => "Risk factors" 1 => "Cardiovascular disease" 2 => "Electrocardiography" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec820493" "palabras" => array:3 [ 0 => "Fatores de risco" 1 => "Doenças cardiovasculares" 2 => "Eletrocardiografia" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "Introduction and ObjectivesAbnormalities on the resting electrocardiogram (ECG) are predictors of mortality and cardiovascular events among asymptomatic adults. The aim of this study was to estimate the prevalence of ECG abnormalities in adults and their association with cardiovascular risk factors. MethodsWe performed a cross-sectional analysis of ECGs in adults aged 19–59 years, living in Tubarão, Santa Catarina, Brazil. Data were collected between November 2011 and July 2012. Electrocardiographic findings were classified according to the guidelines of the Brazilian Society of Cardiology on analyzing and issuing electrocardiographic reports, and were divided into major abnormalities, minor abnormalities and no changes, as in previous studies. Pearson's chi-square test and ANOVA were used to analyze the association of ECG parameters with traditional cardiovascular risk factors. ResultsA total of 361 participants were studied. Mean age was 40.4±12.2 years; 232 (64.3%) were women. Minor abnormalities were found in 16.9% and major abnormalities in 3.3%. Among the risk factors examined, gender, smoking, alcohol consumption, systemic hypertension, diabetes, and high Framingham risk score were significantly associated with major and minor ECG changes. ConclusionsThe prevalence of electrocardiographic changes was 20.2% in the population surveyed, the majority being minor. Both major and minor electrocardiographic abnormalities showed significant associations with risk of coronary artery disease, and may predict cardiovascular risk in asymptomatic adults." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction and Objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "pt" => array:3 [ "titulo" => "Resumo" "resumen" => "Introdução e objetivosAnormalidades em um eletrocardiograma (ECG) de repouso são fatores preditores de mortalidade e eventos cardiovasculares entre adultos assintomáticos. Estimar a prevalência de anormalidades eletrocardiográficas em adultos e possível associação com fatores de risco. MétodosEstudo transversal que avaliou adultos com idade entre 19-59 anos, provenientes do município de Tubarão (SC). A colheita dos dados ocorreu entre novembro de 2011 a julho de 2012. Os laudos eletrocardiográficos foram classificados de acordo com a diretriz da Sociedade Brasileira de Cardiologia sobre Análise e Emissão de Laudos Eletrocardiográficos e divididos em anormalidades maiores, anormalidades menores e sem alterações, conforme estudos anteriores. Para a associação do ECG com os tradicionais fatores de risco cardiovasculares foi utilizado o método qui-quadrado de Pearson ou ANOVA. ResultadosForam estudados 361 participantes, a média de idade foi de 40,4 (DP=12,2) anos e 232 (64,3%) eram mulheres. Verificou-se 16,9% de anormalidades menores e 3,3% de anormalidades maiores. Dentre os fatores de risco estudados, sexo, tabagismo, alcoolismo, hipertensão arterial sistémica, diabetes mellitus, e maior score de risco de Framingham (ERF) estiveram associados significativamente às alterações maiores e menores do ECG. ConclusõesHouve prevalência de 20,2% de alterações eletrocardiográficas na população estudada, sendo a maioria de anormalidades menores. As anormalidades eletrocardiográficas maiores e menores tiveram associações significativas com fatores de risco de doença arterial coronária, podendo este exame predizer risco cardiovascular em populações adultas assintomáticas." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introdução e objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusões" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Sebold FJG, Schuelter-Trevisol F, Nakashima L, Possamai Della Júnior A, Pereira MR, Trevisol DJ. Alterações eletrocardiográficas na população adulta de cidade do sul do Brasil: estudo populacional. Rev Port Cardiol. 2015;34:745–751." ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "WPW: Wolff-Parkinson-White." "tablatextoimagen" => array:2 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Minor abnormalities \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">n=61 \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Alterations in ventricular repolarization \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Right bundle branch conduction disturbances \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sinus bradycardia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Left anterior fascicular block \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Early repolarization \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Left axis deviation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Junctional rhythm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Isolated monomorphic ventricular extrasystoles \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">First-degree atrioventricular block \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1385245.png" ] ] 1 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Major abnormalities \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">n=12 \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Inferior subepicardial ischemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Short PR and delta wave suggestive of WPW syndrome \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Inferior infarction scar \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Anteroseptal infarction scar \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Septal infarction scar \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Early repolarization in V1 and V6, possible biatrial overload \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Anterior superior fascicular block, right bundle branch block \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Anteroseptal subepicardial ischemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Infarction scar and inferior subepicardial ischemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1385247.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Changes found in electrocardiographic reports (n=73)." ] ] 1 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "ECG: electrocardiogram; SD: standard deviation." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Characteristics \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">ECG</th><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total n=361 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Normal n=288 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Minor abnormalities n=61 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Major abnormalities n=12 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p<a class="elsevierStyleCrossRef" href="#tblfn0005">*</a> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age, years (mean ± SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40.4±12.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40.0±12.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41.0±13.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">47.2±10.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.133 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top"></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gender, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.037 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">232 (64.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">194 (67.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33 (54.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (41.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">129 (35.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">94 (32.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28 (45.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (58.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top"></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Years of study, mean ± SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.8±4.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.0±4.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.4±4.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.6±3.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.403 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top"></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Smoking, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.002 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">112 (31.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">82 (28.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21 (34.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 (75.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">249 (69.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">206 (71.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40 (65.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (25.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top"></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Alcohol consumption, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29 (8.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 (6.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (6.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (41.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">332 (92.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">268 (93.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">57 (93.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (58.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top"></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Physical activity, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.842 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sedentary \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">219 (60.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">173 (60.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">39 (63.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (58.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Active \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">142 (39.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">115 (39.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22 (36.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (41.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top"></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Systemic hypertension, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.044 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">136 (37.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">101 (35.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27 (44.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (66.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">225 (62.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">187 (64.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34 (55.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (33.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top"></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diabetes, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.019 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22 (6.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 (5.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (6.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (25.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">339 (93.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">273 (94.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">57 (93.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 (75.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top"></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Obesity, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.552 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">98 (27.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">75 (26.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 (32.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (25.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">263 (72.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">213 (74.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41 (67.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 (75.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top"></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dyslipidemia, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.753 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">233 (64.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">185 (64.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">39 (63.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 (75.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">126 (35.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">101 (35.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22 (36.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (25.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top"></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Framingham risk score, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.004 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Intermediate or high \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 (5.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 (3.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (6.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (25.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Low \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">335 (94.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">269 (96.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">57 (93.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 (75.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1385246.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "*" "nota" => "Chi-square test or ANOVA." ] ] ] "descripcion" => array:1 [ "en" => "Sociodemographic and clinical characteristics according to electrocardiographic results." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:33 [ 0 => array:3 [ "identificador" => "bib0170" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "SIM/DATASUS. 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Electrocardiographic changes in adults living in a southern Brazilian city: A population-based studyElectrocardiographic changes in adults living in a southern Brazilian city: A population-based study

Alterações eletrocardiográficas na população adulta de cidade do sul do Brasil: estudo populacional

Fábio Jean Goulart Sebolda, Fabiana Schuelter-Trevisolb,c, Leandro Nakashimaa, Afonso Possamai Della Júniora, Márcia Regina Pereiraa, Daisson José Trevisolb,c,

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daissont@uol.com.br

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a Curso de Medicina da Universidade do Sul de Santa Catarina, Florianópolis, Brazil

b Programa de Pós-Graduação em Ciências da Saúde da Universidade do Sul de Santa Catarina, Florianópolis, Brazil

c Centro de Pesquisas Clínicas do Hospital Nossa Senhora da Conceição e da Universidade do Sul de Santa Catarina, Florianópolis, Brazil

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Cardiovascular disease &#40;CVD&#41; is associated with high rates of morbidity and mortality in developed countries&#44; and has been the leading cause of mortality in Brazil since the 1960s&#46; In 2008 CVD accounted for 31&#46;8&#37; of mortality in the country as a whole and 38&#37; of deaths recorded in the municipality of Tubar&#227;o&#44; Santa Catarina&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">CVD is responsible for high health costs and affects a large proportion of the working population&#46; Its economic impact in Brazil is demonstrated by the following figures&#58; it accounts for 65&#37; of deaths in adults aged 30&#8211;69 years&#44; 14&#37; of hospital admissions in this age-group &#40;1<span class="elsevierStyleHsp" style=""></span>150<span class="elsevierStyleHsp" style=""></span>000 hospitalizations&#47;year&#41; and 40&#37; of early retirements&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">2</span></a> The causes of CVD are multifactorial and its prevention depends on control of cardiovascular risk factors&#44; including smoking&#44; obesity&#44; dyslipidemia&#44; systemic hypertension&#44; sedentary life styles and diabetes&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">3&#8211;5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Abnormalities on the resting electrocardiogram &#40;ECG&#41; are an independent predictor of the development of coronary artery disease &#40;CAD&#41; and are associated with increased mortality and cardiovascular risk&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">6&#8211;10</span></a> Abnormal Q waves on the ECG may indicate a silent or unrecognized myocardial infarction&#46; In the Framingham study&#44; a quarter of non-fatal infarctions were only detected through ECG changes&#46;<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">11&#8211;13</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Against this background&#44; besides patient history and clinical examination&#44; the ECG is also useful in cardiovascular epidemiology&#44; due to its low cost&#44; accessibility&#44; safety&#44; and ability to predict cardiovascular risk&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">8&#44;10</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The aim of this study was to estimate the prevalence of major and minor ECG abnormalities and their association with the main risk factors for CAD in the adult population of Tubar&#227;o&#44; Santa Catarina&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0030" class="elsevierStylePara elsevierViewall">The study was approved by the Ethics and Research Committee of the University of Southern Santa Catarina &#40;UNISUL&#41;&#46; It was sponsored by the Foundation for Research and Innovation of the State of Santa Catarina &#40;FAPESC&#41;&#44; and is part of the Tubar&#227;o Adult Health Study &#40;ESATU&#41;&#44; in a partnership between the Center for Clinical Research of Hospital Nossa Senhora da Concei&#231;&#227;o&#44; UNISUL and the Municipal Health Secretariat&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">We performed an epidemiological&#44; cross-sectional&#44; population-based study between November 2011 and June 2012 in adults aged 19&#8211;59 years of both sexes living in the municipality of Tubar&#227;o&#44; Santa Catarina&#44; Brazil&#46; Pregnant women&#44; individuals unable to travel to the data collection point&#44; and those unable to freely decide on their participation were excluded&#44; as were those who did not undergo ECG or laboratory testing&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">To calculate the sample size&#44; we used an estimate of 36&#37; of ECG abnormalities<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">8</span></a> with a level of significance of 5&#37; and a margin of error of 1&#37;&#44; which resulted in a minimum sample of 353 individuals for a 95&#37; confidence interval&#44; based on an adult population in Tubar&#227;o of 62<span class="elsevierStyleHsp" style=""></span>537 &#40;2010 census&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The participants were selected through simple random sampling based on house numbers in each of the 250 micro areas of the municipality registered in 27 family health units&#46; Each micro area has a community health worker who carries out regular home visits&#44; and the service is estimated to cover 90&#37; of the resident population&#46; The randomly selected house numbers were 4&#44; 36&#44; 27&#44; 10 and 32&#46; Community health workers visited the first house selected &#40;number 4&#41; in their area and invited the resident to participate in the study in accordance with the inclusion and exclusion criteria&#46; If there were no adults at home or if they refused to participate in the study&#44; the health workers proceeded to the next selected house &#40;number 10&#41; until each had recruited one or two participants per micro area&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Data collection took place on Saturday mornings in outpatient consultations arranged with the participants in branches of Hospital Nossa Senhora da Concei&#231;&#227;o&#46; Participating individuals were requested to fast for 12 hours and to abstain from alcohol in the 72 hours prior to the consultation&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">After their informed consent was obtained&#44; the participants were interviewed&#44; with the following data being recorded&#58; sociodemographic &#40;age&#44; gender and level of education&#44; as indicated by number of years of schooling&#41;&#44; behavioral &#40;sedentarism&#44; alcohol consumption and smoking&#41; and clinical &#40;history of CVD and medications&#41;&#46; Individuals who had smoked at least 100 cigarettes in their lives were considered smokers&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">14</span></a> The CAGE questionnaire was applied in those who stated they drank alcohol&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">15</span></a> The short-form International Physical Activity Questionnaire was used to assess the level of exercise&#46;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">16&#44;17</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Height and weight were measured to determine body mass index &#40;BMI&#41;&#44; individuals with BMI &#8805;30 kg&#47;m<span class="elsevierStyleSup">2</span> being considered obese&#59; 10 ml of peripheral venous blood was collected for assessment of total&#44; HDL and LDL cholesterol &#40;HDL-C and LDL-C&#41;&#44; triglycerides &#40;TG&#41;&#44; blood glucose and creatinine&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">A diagnosis of dyslipidemia was based on changes in one or more of the four parameters measured&#58; isolated hypercholesterolemia &#40;LDL-C &#8805;160 mg&#47;dl&#41;&#59; isolated hypertriglyceridemia &#40;TG &#8805;150 mg&#47;dl&#41;&#59; mixed hyperlipidemia &#40;LDL-C &#8805;160 mg&#47;dl and TG &#8805;150 mg&#47;dl&#41;&#59; and low HDL-C &#40;&#60;40 mg&#47;dl in men and &#60;50 mg&#47;dl in women&#41;&#44; either isolated or associated with increased LDL-C or TG&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">3</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Systemic hypertension was assessed in accordance with the 2010 guidelines of the Brazilian Society of Cardiology&#44; with three blood pressure &#40;BP&#41; measurements being taken at one-minute intervals&#44;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">18</span></a> using an Omron HEM-742INT automatic sphygmomanometer&#46; Patients were classified as hypertensive if they presented mean systolic or diastolic BP &#8805;140 or &#8805;90 mmHg&#44; respectively&#44; or were under antihypertensive therapy&#46; Patients with a previous diagnosis of diabetes or taking hypoglycemic medication and those with fasting glucose &#62;126 mg&#47;dl were considered diabetic&#46; The participants were categorized according to their Framingham risk score as low &#40;&#60;10&#37;&#41;&#44; intermediate &#40;10&#37;&#8211;20&#37;&#41; or high risk &#40;&#62;20&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">19</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">The ECG was performed using a C10&#43; digital electrocardiograph&#44; with the patient at rest in dorsal decubitus&#46; The recordings were sent to a cardiologist&#44; who established the diagnoses in accordance with the guidelines of the Brazilian Society of Cardiology on analyzing and issuing electrocardiographic reports&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">20</span></a> The results were divided into major and minor abnormalities or no changes&#44; as in previous studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">6&#8211;10</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Abnormalities of ventricular repolarization were defined as significant changes in the polarity&#44; duration or morphology of the J point&#44; ST segment&#44; T wave or U wave in the absence of alterations that met the definition of ischemic waves or other specific diagnostic features such as chamber overload or intraventricular block&#46; Increased corrected QT interval was considered separately from the above alterations&#46; Subepicardial ischemia was diagnosed in the presence of negative&#44; symmetrical and sharp T waves&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">20</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">OpenEpi software&#44; version 2&#46;3&#46;1&#44; was used to calculate the sample size&#46; The data were entered into EpiData&#44; version 3&#46;1 &#40;EpiData Association&#44; Odense&#44; Denmark&#41; and SPSS for Windows&#44; version 19 &#40;Chicago&#44; IL&#44; USA&#41; was used for the statistical analysis&#46; Descriptive statistics with frequencies and measures of central tendency and dispersion were used to summarize the data&#46; Pearson&#39;s chi-square test and one-way ANOVA were used to analyze the association between the variables under study&#44; with a 95&#37; confidence interval&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0090" class="elsevierStylePara elsevierViewall">A total of 361 participants were studied&#46; Mean age was 40&#46;4&#177;12&#46;2 years&#44; 232 &#40;64&#46;3&#37;&#41; were women and 312 &#40;86&#46;4&#37;&#41; were white&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Minor abnormalities were found in 61 individuals &#40;16&#46;9&#37;&#41;&#44; major abnormalities in 12 &#40;3&#46;3&#37;&#41;&#44; and 288 &#40;79&#46;8&#37;&#41; had no abnormalities&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the ECG changes observed among the participants&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the sociodemographic and clinical characteristics of the study population according to ECG results&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">The results show that major and minor abnormalities were mainly associated with female gender&#44; smoking&#44; alcohol consumption&#44; hypertension and diabetes&#44; as well as intermediate or high Framingham risk score&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0110" class="elsevierStylePara elsevierViewall">In our study minor ECG abnormalities were more prevalent than major ones &#40;16&#46;9&#37; vs&#46; 3&#46;3&#37;&#44; respectively&#41;&#46; These percentages are lower than in population studies in the US<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">8&#8211;10</span></a>&#59; an American study of 14<span class="elsevierStyleHsp" style=""></span>749 women aged 40&#8211;55 years found 27&#46;8&#37; had minor abnormalities and 6&#46;3&#37; major abnormalities&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">10</span></a> Another American study&#44; involving 2192 individuals aged 70&#8211;79 years&#44; found 13&#37; had minor abnormalities and 23&#37; major abnormalities&#46; The different prevalences can be explained by age differences&#44; since the present study assessed individuals aged 18&#8211;59&#44; with a mean age of 40&#46;4 years&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Women presented a higher prevalence of minor abnormalities&#44; while men had a higher prevalence of major abnormalities&#46; A study of adult outpatients in basic health care units in S&#227;o Paulo&#44; Brazil&#44; also found a higher proportion of ECG changes among men&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">21</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">Smokers and former smokers showed a positive correlation with the presence of ECG abnormalities&#44; as demonstrated in other studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">10&#44;22&#44;23</span></a> Oliveira et al&#46; showed that adults aged 45 or under who smoked more than 25 cigarettes&#47;day had a higher risk of myocardial infarction than those who had never smoked&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">24</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">In our study 37&#46;7&#37; of the population were hypertensive&#44; while other Brazilian studies have reported prevalences between 20&#37; and 45&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">25&#8211;28</span></a> Hypertension is the risk factor most commonly associated with ECG alterations&#44; mainly ST-T abnormalities&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">8&#44;9</span></a> Greenland et al&#46; showed that the risk of CAD rises from 38&#37; to 67&#37; at five years if the abnormalities persist&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">9</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">Only 5&#37; of our study population were in the intermediate or high risk groups according to their Framingham score&#44; and 38&#46;9&#37; of these had minor or major ECG abnormalities&#46; A US study found ECG abnormalities in 54&#46;7&#37; of patients with high Framingham risk scores&#44; which demonstrates that the score is a good predictor of cardiovascular risk in adults&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">8</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">Among diabetic individuals in our study&#44; 31&#46;8&#37; had major or minor ECG abnormalities&#46; Brollo et al&#46; assessed 1042 Japanese-Brazilians and found no statistically significant difference in infarction scar area on ECG between diabetic and non-diabetic individuals&#46; However&#44; among those born in Brazil there was a tendency for ECG abnormalities to be found and infarction scars were present in 7&#46;5&#37; of those with diabetes&#44; a finding that corroborates the results of the study&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">29</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">In the present study there was an association between alcohol consumption and ECG abnormalities&#44; although other studies have found no such association&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">7&#44;8&#44;10</span></a> This discrepancy may be due to the difficulty in quantifying alcohol consumption&#46; We used the CAGE questionnaire&#44; which is a practical and validated method of screening for alcohol abuse in population studies&#44; but its simplicity means it is unsuitable for assessing the degree of alcoholism&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">15</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">There was no association in our study between dyslipidemia and ECG abnormalities&#44; although this has been demonstrated in other studies in various countries&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">8&#44;10&#44;30</span></a> A US study reported that 25&#46;7&#37; of individuals with ECG alterations and 24&#46;7&#37; of those with no alterations had high LDL-C&#44; with no statistically significant difference&#46;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">31</span></a> However&#44; Denes et al&#46; found a correlation with ECG abnormalities in women treated for dyslipidemia&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">10</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">One limitation of the study is that the sample population was not designed to enable analysis of subgroups&#44; which would have allowed assessment of risk factors for CAD and specific ECG abnormalities&#46; Furthermore&#44; we have compared our results with studies that used different methods for interpreting and classifying ECGs&#59; for example&#44; in one US study ECG abnormalities were classified according to the Minnesota code&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">8&#44;32</span></a> Finally&#44; the records were analyzed by a single cardiologist&#44; and there was therefore no assessment of intra- or interobserver agreement&#46; Previous studies have shown variations in interpretation between individuals&#44; which may affect the accuracy of ECG reports&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">33</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">Nevertheless&#44; there are few Brazilian studies on the prevalence of ECG abnormalities in the general population&#44; and the study thus makes an important contribution to public health&#59; the ECG is a simple and widely available exam and is extremely valuable in screening for cardiac abnormalities&#44; thus enabling early detection and intervention to prevent a fatal outcome&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusions</span><p id="par0160" class="elsevierStylePara elsevierViewall">Of the 361 adults studied&#44; 61 &#40;16&#46;9&#37;&#41; had minor and 12 &#40;3&#46;3&#37;&#41; had major ECG changes&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">The results showed that female gender&#44; smoking&#44; alcohol consumption&#44; hypertension&#44; diabetes and intermediate or high Framingham risk score were positively associated with ECG abnormalities&#44; and some of these factors are modifiable&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">The safety&#44; low cost and wide availability of electrocardiography makes it useful for predicting cardiovascular risk in the general population&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Ethical responsibilities</span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Protection of people and animals</span><p id="par0175" class="elsevierStylePara elsevierViewall">The authors state that the procedures followed were in accordance with regulations established by the heads of the Clinical and Research Ethics Commission and according to the World Medical Association and the Declaration of Helsinki&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Data confidentiality</span><p id="par0180" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Right to privacy and informed consent</span><p id="par0185" class="elsevierStylePara elsevierViewall">The authors declare having received written consent from patients and&#47;or subjects mentioned in the article&#46; The corresponding author must be in possession of this document&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Financing</span><p id="par0190" class="elsevierStylePara elsevierViewall">This study was funded by the Foundation for Research and Innovation of the State of Santa Catarina &#40;FAPESC&#41;&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflicts of interest</span><p id="par0195" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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          "titulo" => "Conclusions"
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          "titulo" => "Ethical responsibilities"
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              "titulo" => "Right to privacy and informed consent"
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    "fechaRecibido" => "2014-02-20"
    "fechaAceptado" => "2015-07-01"
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          "clase" => "keyword"
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            0 => "Risk factors"
            1 => "Cardiovascular disease"
            2 => "Electrocardiography"
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        0 => array:4 [
          "clase" => "keyword"
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          "identificador" => "xpalclavsec820493"
          "palabras" => array:3 [
            0 => "Fatores de risco"
            1 => "Doen&#231;as cardiovasculares"
            2 => "Eletrocardiografia"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction and Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Abnormalities on the resting electrocardiogram &#40;ECG&#41; are predictors of mortality and cardiovascular events among asymptomatic adults&#46; The aim of this study was to estimate the prevalence of ECG abnormalities in adults and their association with cardiovascular risk factors&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We performed a cross-sectional analysis of ECGs in adults aged 19&#8211;59 years&#44; living in Tubar&#227;o&#44; Santa Catarina&#44; Brazil&#46; Data were collected between November 2011 and July 2012&#46; Electrocardiographic findings were classified according to the guidelines of the Brazilian Society of Cardiology on analyzing and issuing electrocardiographic reports&#44; and were divided into major abnormalities&#44; minor abnormalities and no changes&#44; as in previous studies&#46; Pearson&#39;s chi-square test and ANOVA were used to analyze the association of ECG parameters with traditional cardiovascular risk factors&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A total of 361 participants were studied&#46; Mean age was 40&#46;4&#177;12&#46;2 years&#59; 232 &#40;64&#46;3&#37;&#41; were women&#46; Minor abnormalities were found in 16&#46;9&#37; and major abnormalities in 3&#46;3&#37;&#46; Among the risk factors examined&#44; gender&#44; smoking&#44; alcohol consumption&#44; systemic hypertension&#44; diabetes&#44; and high Framingham risk score were significantly associated with major and minor ECG changes&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The prevalence of electrocardiographic changes was 20&#46;2&#37; in the population surveyed&#44; the majority being minor&#46; Both major and minor electrocardiographic abnormalities showed significant associations with risk of coronary artery disease&#44; and may predict cardiovascular risk in asymptomatic adults&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction and Objectives"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
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          2 => array:2 [
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            "titulo" => "Results"
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        "titulo" => "Resumo"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introdu&#231;&#227;o e objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Anormalidades em um eletrocardiograma &#40;ECG&#41; de repouso s&#227;o fatores preditores de mortalidade e eventos cardiovasculares entre adultos assintom&#225;ticos&#46; Estimar a preval&#234;ncia de anormalidades eletrocardiogr&#225;ficas em adultos e poss&#237;vel associa&#231;&#227;o com fatores de risco&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudo transversal que avaliou adultos com idade entre 19-59 anos&#44; provenientes do munic&#237;pio de Tubar&#227;o &#40;SC&#41;&#46; A colheita dos dados ocorreu entre novembro de 2011 a julho de 2012&#46; Os laudos eletrocardiogr&#225;ficos foram classificados de acordo com a diretriz da Sociedade Brasileira de Cardiologia sobre An&#225;lise e Emiss&#227;o de Laudos Eletrocardiogr&#225;ficos e divididos em anormalidades maiores&#44; anormalidades menores e sem altera&#231;&#245;es&#44; conforme estudos anteriores&#46; Para a associa&#231;&#227;o do ECG com os tradicionais fatores de risco cardiovasculares foi utilizado o m&#233;todo qui-quadrado de Pearson ou ANOVA&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Foram estudados 361 participantes&#44; a m&#233;dia de idade foi de 40&#44;4 &#40;DP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>12&#44;2&#41; anos e 232 &#40;64&#44;3&#37;&#41; eram mulheres&#46; Verificou-se 16&#44;9&#37; de anormalidades menores e 3&#44;3&#37; de anormalidades maiores&#46; Dentre os fatores de risco estudados&#44; sexo&#44; tabagismo&#44; alcoolismo&#44; hipertens&#227;o arterial sist&#233;mica&#44; diabetes <span class="elsevierStyleItalic">mellitus</span>&#44; e maior <span class="elsevierStyleItalic">score</span> de risco de Framingham &#40;ERF&#41; estiveram associados significativamente &#224;s altera&#231;&#245;es maiores e menores do ECG&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#245;es</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Houve preval&#234;ncia de 20&#44;2&#37; de altera&#231;&#245;es eletrocardiogr&#225;ficas na popula&#231;&#227;o estudada&#44; sendo a maioria de anormalidades menores&#46; As anormalidades eletrocardiogr&#225;ficas maiores e menores tiveram associa&#231;&#245;es significativas com fatores de risco de doen&#231;a arterial coron&#225;ria&#44; podendo este exame predizer risco cardiovascular em popula&#231;&#245;es adultas assintom&#225;ticas&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as&#58; Sebold FJG&#44; Schuelter-Trevisol F&#44; Nakashima L&#44; Possamai Della J&#250;nior A&#44; Pereira MR&#44; Trevisol DJ&#46; Altera&#231;&#245;es eletrocardiogr&#225;ficas na popula&#231;&#227;o adulta de cidade do sul do Brasil&#58; estudo populacional&#46; Rev Port Cardiol&#46; 2015&#59;34&#58;745&#8211;751&#46;</p>"
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">n&#61;61&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Alterations in ventricular repolarization&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Right bundle branch conduction disturbances&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sinus bradycardia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Left anterior fascicular block&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Early repolarization&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Left axis deviation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Junctional rhythm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Isolated monomorphic ventricular extrasystoles&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">First-degree atrioventricular block&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Major abnormalities&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">n&#61;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Inferior subepicardial ischemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Short PR and delta wave suggestive of WPW syndrome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Inferior infarction scar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Anteroseptal infarction scar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Septal infarction scar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Early repolarization in V1 and V6&#44; possible biatrial overload&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Anterior superior fascicular block&#44; right bundle branch block&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Anteroseptal subepicardial ischemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Infarction scar and inferior subepicardial ischemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Changes found in electrocardiographic reports &#40;n&#61;73&#41;&#46;</p>"
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          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">ECG&#58; electrocardiogram&#59; SD&#58; standard deviation&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Characteristics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">ECG</th><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total<br>n&#61;361&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Normal<br>n&#61;288&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Minor abnormalities<br>n&#61;61&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Major abnormalities<br>n&#61;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Age&#44; years &#40;mean &#177; SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40&#46;4&#177;12&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40&#46;0&#177;12&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">41&#46;0&#177;13&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47&#46;2&#177;10&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;133&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Gender&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;037&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">232 &#40;64&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">194 &#40;67&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33 &#40;54&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;41&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">129 &#40;35&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">94 &#40;32&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28 &#40;45&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;58&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Years of study&#44; mean &#177; SD</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;8&#177;4&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;0&#177;4&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;4&#177;4&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;6&#177;3&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;403&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Smoking&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">112 &#40;31&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">82 &#40;28&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21 &#40;34&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;75&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">249 &#40;69&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">206 &#40;71&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40 &#40;65&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;25&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Alcohol consumption&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29 &#40;8&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20 &#40;6&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;6&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;41&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">332 &#40;92&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">268 &#40;93&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57 &#40;93&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;58&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Physical activity&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;842&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sedentary&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">219 &#40;60&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">173 &#40;60&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39 &#40;63&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;58&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Active&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">142 &#40;39&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">115 &#40;39&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22 &#40;36&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;41&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Systemic hypertension&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;044&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">136 &#40;37&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">101 &#40;35&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27 &#40;44&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;66&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">225 &#40;62&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">187 &#40;64&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34 &#40;55&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;33&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Diabetes&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;019&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22 &#40;6&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15 &#40;5&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;6&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;25&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">339 &#40;93&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">273 &#40;94&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57 &#40;93&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;75&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Obesity&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;552&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">98 &#40;27&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">75 &#40;26&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20 &#40;32&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;25&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">213 &#40;74&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">41 &#40;67&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;75&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Dyslipidemia&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;753&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">233 &#40;64&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">185 &#40;64&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39 &#40;63&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;75&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">101 &#40;35&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;25&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Low&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">335 &#40;94&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
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                  "referenciaCompleta" => "IV Diretriz Brasileira Sobre Dislipidemias e Preven&#231;&#227;o de Aterosclerose Departamento de Aterosclerose da Sociedade Brasileira de Cardiologia&#44; RAB Cia&#44; volume 88&#44; suplemento I&#44; Abril de 2007&#46;"
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Article information

ISSN: 21742049
Original language: English

DOI:10.1016/j.repce.2015.11.003

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Year/Month	Html	Pdf	Total

2024 November	5	4	9
2024 October	28	50	78
2024 September	26	30	56
2024 August	38	26	64
2024 July	30	28	58
2024 June	24	24	48
2024 May	36	29	65
2024 April	29	25	54
2024 March	31	23	54
2024 February	26	22	48
2024 January	21	23	44
2023 December	22	33	55
2023 November	23	24	47
2023 October	16	15	31
2023 September	25	21	46
2023 August	23	18	41
2023 July	18	12	30
2023 June	20	15	35
2023 May	43	26	69
2023 April	13	5	18
2023 March	29	28	57
2023 February	28	25	53
2023 January	17	13	30
2022 December	47	24	71
2022 November	58	34	92
2022 October	42	20	62
2022 September	78	29	107
2022 August	78	27	105
2022 July	68	44	112
2022 June	22	25	47
2022 May	26	27	53
2022 April	32	31	63
2022 March	29	46	75
2022 February	14	32	46
2022 January	27	26	53
2021 December	21	35	56
2021 November	38	34	72
2021 October	31	35	66
2021 September	18	27	45
2021 August	30	41	71
2021 July	18	28	46
2021 June	27	22	49
2021 May	41	32	73
2021 April	37	77	114
2021 March	43	24	67
2021 February	62	14	76
2021 January	30	25	55
2020 December	31	19	50
2020 November	33	22	55
2020 October	25	22	47
2020 September	53	13	66
2020 August	34	10	44
2020 July	36	21	57
2020 June	40	12	52
2020 May	42	7	49
2020 April	45	23	68
2020 March	46	11	57
2020 February	132	29	161
2020 January	38	9	47
2019 December	44	13	57
2019 November	34	16	50
2019 October	28	8	36
2019 September	25	9	34
2019 August	30	6	36
2019 July	37	10	47
2019 June	30	15	45
2019 May	44	5	49
2019 April	31	21	52
2019 March	80	14	94
2019 February	62	10	72
2019 January	52	6	58
2018 December	119	7	126
2018 November	105	12	117
2018 October	330	14	344
2018 September	76	16	92
2018 August	36	6	42
2018 July	18	7	25
2018 June	31	8	39
2018 May	35	10	45
2018 April	72	2	74
2018 March	98	10	108
2018 February	88	5	93
2018 January	46	7	53
2017 December	109	8	117
2017 November	52	9	61
2017 October	31	7	38
2017 September	18	10	28
2017 August	30	12	42
2017 July	21	10	31
2017 June	33	12	45
2017 May	34	14	48
2017 April	22	11	33
2017 March	31	50	81
2017 February	20	1	21
2017 January	21	11	32
2016 December	31	9	40
2016 November	26	6	32
2016 October	36	9	45
2016 September	16	7	23
2016 August	9	3	12
2016 July	17	4	21
2016 June	15	4	19
2016 May	13	3	16
2016 April	28	2	30
2016 March	21	23	44
2016 February	43	42	85
2016 January	92	46	138

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