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puesto que el tratamiento farmacol&#243;gico lip&#237;dico est&#225; limitado por el riesgo teratog&#233;nico y la experiencia con af&#233;resis terap&#233;utica es reducida&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Presentamos el caso de una mujer de 33 a&#241;os con HFH diagnosticada en el a&#241;o 2019 &#40;mutaci&#243;n gen RLDL&#41;&#44; con arco corneal y xantoma aqu&#237;leo izquierdo&#46; Como antecedentes familiares destaca padre fallecido a los 50 a&#241;os por infarto de miocardio y hermana con accidente cerebrovascular a los 29 a&#241;os&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Prosegu&#237;a controles habituales en Endocrinolog&#237;a con buen control lip&#237;dico con ezetimiba y atorvastatina&#46; Ante deseo gen&#233;sico&#44; se modific&#243; tratamiento a colestiramina con cifras de colesterol total de 516<span class="elsevierStyleHsp" style=""></span>mg&#47;dl y cLDL de 402<span class="elsevierStyleHsp" style=""></span>mg&#47;dl durante el segundo trimestre de gestaci&#243;n por lo que se nos consulta para inicio de LDL af&#233;resis&#44; tras valoraci&#243;n multidisciplinar&#46; La paciente presentaba diabetes gestacional concomitante&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Previa obtenci&#243;n de consentimiento informado&#44; bajo control ecogr&#225;fico y fluorosc&#243;pico &#40;con 1 segundo de tiempo de fluoroscopia&#41;&#44; se implanta cat&#233;ter tunelizado yugular derecho en la semana 26 de gestaci&#243;n y se inicia LDL af&#233;resis&#44; con t&#233;cnica de doble filtraci&#243;n&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Utilizamos el monitor Plasauto &#931;&#8482; indic&#225;ndose 1<span class="elsevierStyleHsp" style=""></span>l como volumen objetivo de plasma a tratar&#44; 30&#37; de relaci&#243;n plasma&#47;sangre&#44; 10&#37; de drenaje&#47;plasma y 10&#37; de reemplazo&#47;plasma&#44; con el fin de evitar alteraciones hemodin&#225;micas y primar el bienestar fetal&#46; Tras cada sesi&#243;n&#44; se realiz&#243; control ecogr&#225;fico gestacional&#44; sin observarse alteraciones en el feto y cantidad preservada de l&#237;quido amni&#243;tico&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">La periodicidad de las sesiones se bas&#243; en el c&#225;lculo de cLDL medio o Cave &#40;conocido como cLDL promediado en el tiempo&#41;&#44; siendo el Cave objetivo<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>250 con cLDL m&#225;ximo de 300<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#46; El flujo de sangre empleado fue de 100<span class="elsevierStyleHsp" style=""></span>ml&#47;min y se administr&#243; bolo inicial de heparina s&#243;dica como tratamiento anticoagulante necesario para la t&#233;cnica&#46; El sellado del cat&#233;ter se realiz&#243; con heparina al 1&#37;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Se llevaron a cabo un total de 6 sesiones durante la gestaci&#243;n y 6 sesiones durante el per&#237;odo de lactancia&#44; observ&#225;ndose tras todas las sesiones descenso en colesterol total y cLDL hasta valores objetivos consensuados con el servicio de Endocrinolog&#237;a &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46; Las sesiones fueron bien toleradas cl&#237;nica y hemodin&#225;micamente&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">En la semana 35<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>3 de gestaci&#243;n la paciente present&#243; rotura prematura de membranas&#44; con parto eut&#243;cico y reci&#233;n nacido var&#243;n&#44; con peso de 2565<span class="elsevierStyleHsp" style=""></span>g&#44; talla 47<span class="elsevierStyleHsp" style=""></span>cm y Apgar de 9 y 10 en el minuto 1 y 5&#44; respectivamente&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">En las sesiones realizadas durante el per&#237;odo de lactancia el volumen de plasma tratado fue mayor &#40;2500-2800<span class="elsevierStyleHsp" style=""></span>cc por sesi&#243;n&#41; con resto de par&#225;metros similares a la pauta descrita&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Tras finalizar sesiones&#44; se retir&#243; el cat&#233;ter tunelizado&#44; sin incidencias&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Durante el embarazo es necesario realizar una valoraci&#243;n pormenorizada del metabolismo lip&#237;dico en pacientes con diagn&#243;stico previo de HFH&#44; no solo por las complicaciones agudas que pueden conllevar&#44; sino tambi&#233;n por la morbimortalidad cardiovascular futura en el reci&#233;n nacido&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">A pesar de los nuevos f&#225;rmacos hipolipidemiantes que consiguen un control lip&#237;dico &#243;ptimo&#44; su utilizaci&#243;n durante la gestaci&#243;n no dispone de un perfil de seguridad adecuado por el riesgo de teratog&#233;nesis<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6&#44;7</span></a>&#44; consider&#225;ndose en la actualidad en los diferentes consensos la LDL af&#233;resis dentro del arsenal terap&#233;utico de los pacientes con HFH durante la gestaci&#243;n&#46; Se desconocen con exactitud valores de referencia de colesterol durante el embarazo&#44; siendo las indicaciones para iniciar af&#233;resis terap&#233;utica en poblaci&#243;n general de cLDL<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>300<span class="elsevierStyleHsp" style=""></span>mg&#47;dl sin enfermedad cardiovascular y cLDL<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>200<span class="elsevierStyleHsp" style=""></span>mg&#47;dl en presencia de enfermedad cardiovascular<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">8&#44;9</span></a>&#44;</p><p id="par0070" class="elsevierStylePara elsevierViewall">La doble filtraci&#243;n es un procedimiento extracorp&#243;reo que utiliza&#44; despu&#233;s de una plasmaseparaci&#243;n&#44; un tratamiento del plasma con un segundo filtro con el fin de eliminar componentes seg&#250;n su peso molecular&#44; como lipoprote&#237;nas circulantes que contiene ApoB&#44; principalmente cLDL y Lp&#40;a&#41;&#46; Las gu&#237;as ASFA<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> no describen cu&#225;l debe de ser la pauta id&#243;nea a utilizar durante la gestaci&#243;n&#44; siendo importante individualizar a cada paciente y adecuar la t&#233;cnica utilizada&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Los efectos secundarios son poco frecuentes y de car&#225;cter leve&#44; destacando hipotensi&#243;n&#44; cefalea&#44; n&#225;useas o problemas con el acceso vascular&#44; que no present&#243; la paciente&#44; quiz&#225;s en relaci&#243;n con los vol&#250;menes utilizados durante la gestaci&#243;n&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; reportamos un caso de una gestante con HFH controlada con LDL af&#233;resis&#44; que implic&#243; un abordaje multidisciplinar y un reto terap&#233;utico dada la ausencia de documentos de consenso del uso de esta t&#233;cnica en el embarazo&#46; Se describe la pauta terap&#233;utica empleada la cual result&#243; exitosa en nuestra experiencia con un adecuado perfil de seguridad&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic"><span class="elsevierStyleBold">Puntos destacados&#58;</span></span><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0090" class="elsevierStylePara elsevierViewall">La hipercolesterolemia familiar puede implicar un reto en el manejo terap&#233;utico en una gestante&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0095" class="elsevierStylePara elsevierViewall">La doble filtraci&#243;n es un procedimiento extracorp&#243;reo que elimina selectivamente los componentes aterog&#233;nicos del plasma con un adecuado perfil de seguridad&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0100" class="elsevierStylePara elsevierViewall">La af&#233;resis terap&#233;utica de l&#237;pidos se puede considerar dentro del arsenal terap&#233;utico en el manejo de la hipercolesterolemia familiar en la gestante&#46;</p></li></ul></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicto de intereses</span><p id="par0105" class="elsevierStylePara elsevierViewall">La presente investigaci&#243;n no ha recibido ayudas espec&#237;ficas provenientes de agencias del sector p&#250;blico&#44; 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          "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">cLDL&#58; colesterol LDL &#40;mg&#47;dl&#41;&#59; CT&#58; colesterol total &#40;mg&#47;dl&#41;&#59; IgG&#58; inmunoglobulina G &#40;mg&#47;dl&#41;&#59; TG&#58; triglic&#233;ridos &#40;mg&#47;dl&#41;&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">C&#225;lculo de LDL colesterol medio &#40;Cave&#41;&#58; Cave<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>Cm&#237;n<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>K &#40;Cm&#225;x-Cm&#237;n&#41;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Cm&#237;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>cLDL inmediatamente despu&#233;s de la af&#233;resis Cm&#225;x<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>cLDL inmediatamente anterior a la af&#233;resis K o coeficiente de rebote<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;73 heterocigotos&#46;</p>"
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Carta al Director
Aféresis terapéutica en gestante con hipercolesterolemia familiar heterocigota
Therapeutic apheresis in a pregnant woman with heterozygous familial hypercholesterolemia
Zoila Stany Albines Fiestasa,
Autor para correspondencia
zoilastany@gmail.com

Autora para correspondencia.
, María Victoria Rubio Rubioa, José Antonio Gimeno Ornab, Ana Belén Mañas Martínezb, Virginia Arroyo Espallargasa, Jordi Bosch Melguizoc, Beatriz María Rojas Pérez-Ezquerrad, Carmen Criado Mainara, Fernando Anaya-Fernández Lomanae,, Pablo Iñigo Gila
a Servicio de Nefrología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
b Servicio de Endocrinología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
c Servicio de Radiología Intervencionista, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
d Servicio de Ginecología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
e Servicio de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, España
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">El embarazo supone un perfil lip&#237;dico aterog&#233;nico impulsado por el aumento a la resistencia a la insulina&#44; estr&#243;genos&#44; progesterona y lact&#243;geno placentario<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#44;2</span></a>&#46; Este aumento puede empeorar la hipercolesterolemia de base en pacientes gestantes con hipercolesterolemia familiar heterocigota &#40;HFH&#41;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a>&#46; El colesterol total aumenta en un 25-50&#37; y el colesterol LDL &#40;cLDL&#41; un 50&#37;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> con una predisposici&#243;n al da&#241;o endotelial en el feto&#44; que comienza durante la vida intrauterina&#44; y susceptibilidad posnatal a la arteriosclerosis<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">El manejo terap&#233;utico y el alcance de objetivos son complejos&#44; puesto que el tratamiento farmacol&#243;gico lip&#237;dico est&#225; limitado por el riesgo teratog&#233;nico y la experiencia con af&#233;resis terap&#233;utica es reducida&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Presentamos el caso de una mujer de 33 a&#241;os con HFH diagnosticada en el a&#241;o 2019 &#40;mutaci&#243;n gen RLDL&#41;&#44; con arco corneal y xantoma aqu&#237;leo izquierdo&#46; Como antecedentes familiares destaca padre fallecido a los 50 a&#241;os por infarto de miocardio y hermana con accidente cerebrovascular a los 29 a&#241;os&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Prosegu&#237;a controles habituales en Endocrinolog&#237;a con buen control lip&#237;dico con ezetimiba y atorvastatina&#46; Ante deseo gen&#233;sico&#44; se modific&#243; tratamiento a colestiramina con cifras de colesterol total de 516<span class="elsevierStyleHsp" style=""></span>mg&#47;dl y cLDL de 402<span class="elsevierStyleHsp" style=""></span>mg&#47;dl durante el segundo trimestre de gestaci&#243;n por lo que se nos consulta para inicio de LDL af&#233;resis&#44; tras valoraci&#243;n multidisciplinar&#46; La paciente presentaba diabetes gestacional concomitante&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Previa obtenci&#243;n de consentimiento informado&#44; bajo control ecogr&#225;fico y fluorosc&#243;pico &#40;con 1 segundo de tiempo de fluoroscopia&#41;&#44; se implanta cat&#233;ter tunelizado yugular derecho en la semana 26 de gestaci&#243;n y se inicia LDL af&#233;resis&#44; con t&#233;cnica de doble filtraci&#243;n&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Utilizamos el monitor Plasauto &#931;&#8482; indic&#225;ndose 1<span class="elsevierStyleHsp" style=""></span>l como volumen objetivo de plasma a tratar&#44; 30&#37; de relaci&#243;n plasma&#47;sangre&#44; 10&#37; de drenaje&#47;plasma y 10&#37; de reemplazo&#47;plasma&#44; con el fin de evitar alteraciones hemodin&#225;micas y primar el bienestar fetal&#46; Tras cada sesi&#243;n&#44; se realiz&#243; control ecogr&#225;fico gestacional&#44; sin observarse alteraciones en el feto y cantidad preservada de l&#237;quido amni&#243;tico&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">La periodicidad de las sesiones se bas&#243; en el c&#225;lculo de cLDL medio o Cave &#40;conocido como cLDL promediado en el tiempo&#41;&#44; siendo el Cave objetivo<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>250 con cLDL m&#225;ximo de 300<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#46; El flujo de sangre empleado fue de 100<span class="elsevierStyleHsp" style=""></span>ml&#47;min y se administr&#243; bolo inicial de heparina s&#243;dica como tratamiento anticoagulante necesario para la t&#233;cnica&#46; El sellado del cat&#233;ter se realiz&#243; con heparina al 1&#37;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Se llevaron a cabo un total de 6 sesiones durante la gestaci&#243;n y 6 sesiones durante el per&#237;odo de lactancia&#44; observ&#225;ndose tras todas las sesiones descenso en colesterol total y cLDL hasta valores objetivos consensuados con el servicio de Endocrinolog&#237;a &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46; Las sesiones fueron bien toleradas cl&#237;nica y hemodin&#225;micamente&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">En la semana 35<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>3 de gestaci&#243;n la paciente present&#243; rotura prematura de membranas&#44; con parto eut&#243;cico y reci&#233;n nacido var&#243;n&#44; con peso de 2565<span class="elsevierStyleHsp" style=""></span>g&#44; talla 47<span class="elsevierStyleHsp" style=""></span>cm y Apgar de 9 y 10 en el minuto 1 y 5&#44; respectivamente&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">En las sesiones realizadas durante el per&#237;odo de lactancia el volumen de plasma tratado fue mayor &#40;2500-2800<span class="elsevierStyleHsp" style=""></span>cc por sesi&#243;n&#41; con resto de par&#225;metros similares a la pauta descrita&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Tras finalizar sesiones&#44; se retir&#243; el cat&#233;ter tunelizado&#44; sin incidencias&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Durante el embarazo es necesario realizar una valoraci&#243;n pormenorizada del metabolismo lip&#237;dico en pacientes con diagn&#243;stico previo de HFH&#44; no solo por las complicaciones agudas que pueden conllevar&#44; sino tambi&#233;n por la morbimortalidad cardiovascular futura en el reci&#233;n nacido&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">A pesar de los nuevos f&#225;rmacos hipolipidemiantes que consiguen un control lip&#237;dico &#243;ptimo&#44; su utilizaci&#243;n durante la gestaci&#243;n no dispone de un perfil de seguridad adecuado por el riesgo de teratog&#233;nesis<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6&#44;7</span></a>&#44; consider&#225;ndose en la actualidad en los diferentes consensos la LDL af&#233;resis dentro del arsenal terap&#233;utico de los pacientes con HFH durante la gestaci&#243;n&#46; Se desconocen con exactitud valores de referencia de colesterol durante el embarazo&#44; siendo las indicaciones para iniciar af&#233;resis terap&#233;utica en poblaci&#243;n general de cLDL<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>300<span class="elsevierStyleHsp" style=""></span>mg&#47;dl sin enfermedad cardiovascular y cLDL<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>200<span class="elsevierStyleHsp" style=""></span>mg&#47;dl en presencia de enfermedad cardiovascular<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">8&#44;9</span></a>&#44;</p><p id="par0070" class="elsevierStylePara elsevierViewall">La doble filtraci&#243;n es un procedimiento extracorp&#243;reo que utiliza&#44; despu&#233;s de una plasmaseparaci&#243;n&#44; un tratamiento del plasma con un segundo filtro con el fin de eliminar componentes seg&#250;n su peso molecular&#44; como lipoprote&#237;nas circulantes que contiene ApoB&#44; principalmente cLDL y Lp&#40;a&#41;&#46; Las gu&#237;as ASFA<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> no describen cu&#225;l debe de ser la pauta id&#243;nea a utilizar durante la gestaci&#243;n&#44; siendo importante individualizar a cada paciente y adecuar la t&#233;cnica utilizada&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Los efectos secundarios son poco frecuentes y de car&#225;cter leve&#44; destacando hipotensi&#243;n&#44; cefalea&#44; n&#225;useas o problemas con el acceso vascular&#44; que no present&#243; la paciente&#44; quiz&#225;s en relaci&#243;n con los vol&#250;menes utilizados durante la gestaci&#243;n&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; reportamos un caso de una gestante con HFH controlada con LDL af&#233;resis&#44; que implic&#243; un abordaje multidisciplinar y un reto terap&#233;utico dada la ausencia de documentos de consenso del uso de esta t&#233;cnica en el embarazo&#46; Se describe la pauta terap&#233;utica empleada la cual result&#243; exitosa en nuestra experiencia con un adecuado perfil de seguridad&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic"><span class="elsevierStyleBold">Puntos destacados&#58;</span></span><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0090" class="elsevierStylePara elsevierViewall">La hipercolesterolemia familiar puede implicar un reto en el manejo terap&#233;utico en una gestante&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0095" class="elsevierStylePara elsevierViewall">La doble filtraci&#243;n es un procedimiento extracorp&#243;reo que elimina selectivamente los componentes aterog&#233;nicos del plasma con un adecuado perfil de seguridad&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0100" class="elsevierStylePara elsevierViewall">La af&#233;resis terap&#233;utica de l&#237;pidos se puede considerar dentro del arsenal terap&#233;utico en el manejo de la hipercolesterolemia familiar en la gestante&#46;</p></li></ul></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicto de intereses</span><p id="par0105" class="elsevierStylePara elsevierViewall">La presente investigaci&#243;n no ha recibido ayudas espec&#237;ficas provenientes de agencias del sector p&#250;blico&#44; sector comercial o entidades sin &#225;nimo de lucro&#46;</p></span></span>"
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          "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">cLDL&#58; colesterol LDL &#40;mg&#47;dl&#41;&#59; CT&#58; colesterol total &#40;mg&#47;dl&#41;&#59; IgG&#58; inmunoglobulina G &#40;mg&#47;dl&#41;&#59; TG&#58; triglic&#233;ridos &#40;mg&#47;dl&#41;&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">C&#225;lculo de LDL colesterol medio &#40;Cave&#41;&#58; Cave<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>Cm&#237;n<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>K &#40;Cm&#225;x-Cm&#237;n&#41;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Cm&#237;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>cLDL inmediatamente despu&#233;s de la af&#233;resis Cm&#225;x<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>cLDL inmediatamente anterior a la af&#233;resis K o coeficiente de rebote<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;73 heterocigotos&#46;</p>"
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Idioma original: Español
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