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Generalitat Valenciana","award":["CB16\/11\/00360"],"award-info":[{"award-number":["CB16\/11\/00360"]}]},{"name":"Conselleria de Educaci\u00f3n of the Generalitat Valenciana","award":["CM21\/00175"],"award-info":[{"award-number":["CM21\/00175"]}]},{"name":"Conselleria de Educaci\u00f3n of the Generalitat Valenciana","award":["CM23\/00246"],"award-info":[{"award-number":["CM23\/00246"]}]},{"name":"Conselleria de Educaci\u00f3n of the Generalitat Valenciana","award":["PROMETEO\/2021\/008"],"award-info":[{"award-number":["PROMETEO\/2021\/008"]}]},{"name":"Conselleria de Educaci\u00f3n of the Generalitat Valenciana","award":["JR23\/00032"],"award-info":[{"award-number":["JR23\/00032"]}]},{"name":"Conselleria de Educaci\u00f3n of the Generalitat Valenciana","award":["CIAPOS\/2023\/247"],"award-info":[{"award-number":["CIAPOS\/2023\/247"]}]},{"name":"Conselleria de Educaci\u00f3n of the Generalitat 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Carlos III and co-funding from Fondo Social Europeo Plus (FSE+)","award":["CM23\/00246"],"award-info":[{"award-number":["CM23\/00246"]}]},{"name":"the Instituto de Salud Carlos III and co-funding from Fondo Social Europeo Plus (FSE+)","award":["PROMETEO\/2021\/008"],"award-info":[{"award-number":["PROMETEO\/2021\/008"]}]},{"name":"the Instituto de Salud Carlos III and co-funding from Fondo Social Europeo Plus (FSE+)","award":["JR23\/00032"],"award-info":[{"award-number":["JR23\/00032"]}]},{"name":"the Instituto de Salud Carlos III and co-funding from Fondo Social Europeo Plus (FSE+)","award":["CIAPOS\/2023\/247"],"award-info":[{"award-number":["CIAPOS\/2023\/247"]}]},{"name":"the Instituto de Salud Carlos III and co-funding from Fondo Social Europeo Plus (FSE+)","award":["CIAPOS2023\/248"],"award-info":[{"award-number":["CIAPOS2023\/248"]}]},{"name":"the Conselleria de Educaci\u00f3n\u2014Generalitat Valenciana and co-funding from Fondo Social Europeo Plus","award":["PI23\/01150"],"award-info":[{"award-number":["PI23\/01150"]}]},{"name":"the Conselleria de Educaci\u00f3n\u2014Generalitat Valenciana and co-funding from Fondo Social Europeo Plus","award":["CB16\/11\/00486"],"award-info":[{"award-number":["CB16\/11\/00486"]}]},{"name":"the Conselleria de Educaci\u00f3n\u2014Generalitat Valenciana and co-funding from Fondo Social Europeo Plus","award":["CB16\/11\/00420"],"award-info":[{"award-number":["CB16\/11\/00420"]}]},{"name":"the Conselleria de Educaci\u00f3n\u2014Generalitat Valenciana and co-funding from Fondo Social Europeo Plus","award":["CB16\/11\/00360"],"award-info":[{"award-number":["CB16\/11\/00360"]}]},{"name":"the Conselleria de Educaci\u00f3n\u2014Generalitat Valenciana and co-funding from Fondo Social Europeo Plus","award":["CM21\/00175"],"award-info":[{"award-number":["CM21\/00175"]}]},{"name":"the Conselleria de Educaci\u00f3n\u2014Generalitat Valenciana and co-funding from Fondo Social Europeo Plus","award":["CM23\/00246"],"award-info":[{"award-number":["CM23\/00246"]}]},{"name":"the Conselleria de Educaci\u00f3n\u2014Generalitat Valenciana and co-funding from Fondo Social Europeo Plus","award":["PROMETEO\/2021\/008"],"award-info":[{"award-number":["PROMETEO\/2021\/008"]}]},{"name":"the Conselleria de Educaci\u00f3n\u2014Generalitat Valenciana and co-funding from Fondo Social Europeo Plus","award":["JR23\/00032"],"award-info":[{"award-number":["JR23\/00032"]}]},{"name":"the Conselleria de Educaci\u00f3n\u2014Generalitat Valenciana and co-funding from Fondo Social Europeo Plus","award":["CIAPOS\/2023\/247"],"award-info":[{"award-number":["CIAPOS\/2023\/247"]}]},{"name":"the Conselleria de Educaci\u00f3n\u2014Generalitat Valenciana and co-funding from Fondo Social Europeo Plus","award":["CIAPOS2023\/248"],"award-info":[{"award-number":["CIAPOS2023\/248"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: A significant proportion of post-myocardial infarction (MI) patients do not reach target low-density lipoprotein cholesterol (LDL-C) levels. Suboptimal LDL-C reduction is often attributed to poor adherence to pharmacological therapy and lifestyle recommendations. Methods: In a prospective registry of 179 post-MI patients who completed a Phase 2 Cardiac Rehabilitation Program (CRP), we evaluated the characteristics and predictors of suboptimal LDL-C reduction. Key indicators were assessed before and after CRP: adherence to the Mediterranean diet (using the PREDIMED questionnaire), weekly physical activity (via the IPAQ questionnaire), therapeutic adherence (using the Morisky\u2013Green questionnaire), and peak oxygen consumption (VO2) on exercise testing. Lipid-lowering therapy (LLT) and LDL-C were recorded prior to MI and both before and after Phase 2 CRP. At the end of Phase 2, we analyzed the difference between measured and theoretical LDL-C (basal LDL-C minus expected LDL-C reduction by LLT), which was defined as \u201cresidual difference in LDL-C\u201d (RD-LDL-C). We analyzed the predictors of positive RD-LDL-C (lower than theoretically expected). Results: After CRP, 54 (30.2%) patients exhibited positive RD-LDL-C. Within this subgroup, LLT was uptitrated, and patients received more potent LLT at the conclusion of CRP (theoretical potency: 69.81 \u00b1 7.07 vs. 66.41 \u00b1 7.48%, p = 0.005). However, they were less likely to reach the target LDL-C level &lt;55 mg\/dL (66.7% vs. 93.6%, p &lt; 0.001). Male sex (HR 17.96 [2.15, 149.92], p = 0.008) and higher lipoprotein (a) levels (HR 1.02 [1.01, 1.03] per mg\/dL, p = 0.001) were associated with a positive RD-LDL-C. Conversely, diabetes mellitus (HR 0.17 [0.06, 0.51], p = 0.002), higher corrected basal LDL-C levels (HR 0.98 [0.97, 0.99] per mg\/dL, p = 0.001), and supervised in-hospital training during CRP (HR 0.28 [0.09, 0.86], p = 0.03) were associated with a reduced probability of positive RD-LDL-C. No association was found with adherence to the Mediterranean diet (88.1%), therapeutic adherence (89.1%), reported weekly physical activity (median 3545 [1980, 6132] metabolic equivalents per week), or change in peak VO2. Conclusions: More than one-third of post-MI patients demonstrated lower than expected LDL-C reduction (positive RD-LDL-C) following CRP, a finding that could not be attributed to poor adherence to pharmacological therapy or lifestyle recommendations. These findings suggest that a personalized approach to prescribing and uptitrating LLT may help achieve LDL-C targets, particularly in MI patients with healthy lifestyle habits who exhibit a lower response to LLT.<\/jats:p>","DOI":"10.3390\/jcm14124242","type":"journal-article","created":{"date-parts":[[2025,6,16]],"date-time":"2025-06-16T06:40:27Z","timestamp":1750056027000},"page":"4242","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Low-Density Lipoprotein Cholesterol Reduction and Therapeutic Adherence During Cardiac Rehabilitation After Myocardial Infarction"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4751-5859","authenticated-orcid":false,"given":"Carlos","family":"Bertol\u00edn-Boronat","sequence":"first","affiliation":[{"name":"Department of Cardiology, Hospital Clinico Universitario de Valencia, 46010 Valencia, Spain"},{"name":"INCLIVA Health Research Institute, 46010 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1734-0381","authenticated-orcid":false,"given":"H\u00e9ctor","family":"Merenciano-Gonz\u00e1lez","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hospital Clinico Universitario de Valencia, 46010 Valencia, Spain"},{"name":"INCLIVA Health Research Institute, 46010 Valencia, Spain"},{"name":"Network Biomedical Research Center for Cardiovascular Diseases (CIBER-CV), 28029 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5565-5547","authenticated-orcid":false,"given":"V\u00edctor","family":"Marcos-Garc\u00e9s","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hospital Clinico Universitario de Valencia, 46010 Valencia, Spain"},{"name":"INCLIVA Health Research Institute, 46010 Valencia, Spain"},{"name":"Network Biomedical Research Center for Cardiovascular Diseases (CIBER-CV), 28029 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda Luz","family":"Mart\u00ednez Mas","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hospital Clinico Universitario de Valencia, 46010 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josefa In\u00e9s","family":"Climent Alberola","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation, Hospital Clinico Universitario de Valencia, 46010 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 Manuel","family":"Civera","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hospital Clinico Universitario de Valencia, 46010 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda","family":"Valls Reig","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hospital Clinico Universitario de Valencia, 46010 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Ruiz Hueso","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hospital Clinico Universitario de Valencia, 46010 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia","family":"Castro Carmona","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hospital Clinico Universitario de Valencia, 46010 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3527-0337","authenticated-orcid":false,"given":"Nerea","family":"Perez","sequence":"additional","affiliation":[{"name":"INCLIVA Health Research Institute, 46010 Valencia, Spain"},{"name":"Network Biomedical Research Center for Cardiovascular Diseases (CIBER-CV), 28029 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4024-0418","authenticated-orcid":false,"given":"Laura","family":"L\u00f3pez-Bueno","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation, Hospital Clinico Universitario de Valencia, 46010 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3410-5831","authenticated-orcid":false,"given":"Beatriz","family":"D\u00edaz D\u00edaz","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation, Hospital Clinico Universitario de Valencia, 46010 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabel","family":"Mi\u00f1ano Mart\u00ednez","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation, Hospital Clinico Universitario de Valencia, 46010 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfonso","family":"Pay\u00e1 Rubio","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation, Hospital Clinico Universitario de Valencia, 46010 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6405-6279","authenticated-orcid":false,"given":"C\u00e9sar","family":"R\u00edos-Navarro","sequence":"additional","affiliation":[{"name":"INCLIVA Health Research Institute, 46010 Valencia, Spain"},{"name":"Network Biomedical Research Center for Cardiovascular Diseases (CIBER-CV), 28029 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"de Dios","sequence":"additional","affiliation":[{"name":"Network Biomedical Research Center for Cardiovascular Diseases (CIBER-CV), 28029 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3483-7066","authenticated-orcid":false,"given":"Jose","family":"Gavara","sequence":"additional","affiliation":[{"name":"Network Biomedical Research Center for Cardiovascular Diseases (CIBER-CV), 28029 Madrid, Spain"},{"name":"Centre for Biomaterials and Tissue Engineering, Universitat Polit\u00e8nica de Val\u00e8ncia, 46022 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuel F.","family":"Jim\u00e9nez-Navarro","sequence":"additional","affiliation":[{"name":"Network Biomedical Research Center for Cardiovascular Diseases (CIBER-CV), 28029 Madrid, Spain"},{"name":"Servicio de Cardiolog\u00eda y Cirug\u00eda Cardiovascular-\u00c1rea del Coraz\u00f3n, Hospital Universitario Virgen de la Victoria, 29010 M\u00e1laga, Spain"},{"name":"Instituto de Investigaci\u00f3n Biom\u00e9dica de M\u00e1laga y Plataforma en Nanomedicina (IBIMA Plataforma BIONAND), 29590 M\u00e1laga, Spain"},{"name":"Departamento de Medicina y Dermatolog\u00eda, Facultad de Medicina, Universidad de M\u00e1laga, 29010 M\u00e1laga, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0797-8709","authenticated-orcid":false,"given":"Juan","family":"Sanchis","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hospital Clinico Universitario de Valencia, 46010 Valencia, Spain"},{"name":"INCLIVA Health Research Institute, 46010 Valencia, Spain"},{"name":"Network Biomedical Research Center for Cardiovascular Diseases (CIBER-CV), 28029 Madrid, Spain"},{"name":"Department of Medicine, Faculty of Medicine and Odontology, University of Valencia, 46010 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vicente","family":"Bodi","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hospital Clinico Universitario de Valencia, 46010 Valencia, Spain"},{"name":"INCLIVA Health Research Institute, 46010 Valencia, Spain"},{"name":"Network Biomedical Research Center for Cardiovascular Diseases (CIBER-CV), 28029 Madrid, Spain"},{"name":"Department of Medicine, Faculty of Medicine and Odontology, University of Valencia, 46010 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3227","DOI":"10.1093\/eurheartj\/ehab484","article-title":"2021 ESC Guidelines on Cardiovascular Disease Prevention in Clinical Practice","volume":"42","author":"Visseren","year":"2021","journal-title":"Eur. 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