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–Green 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 “residual difference in LDL-C” (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 ± 7.07 vs. 66.41 ± 7.48%, p = 0.005). However, they were less likely to reach the target LDL-C level <55 mg/dL (66.7% vs. 93.6%, p < 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.

Introducción: A nivel mundial los cambios en la estructura demográfica van marcando en la población una tendencia al envejecimiento. Proyecciones de Naciones Unidas establecen que la cantidad de personas mayores entre 1950 y 2000 aumentó en algo más del 141%. La población de mayor edad muchas veces fallece por evitables. En el presente estudio se compararon las tasas de mortalidad por causas evitables entre la adultez posterior y la senectud en las cuatro regiones naturales del país. Material y métodos: Se realizó un estudio ecológico exploratorio en el que se compararon las tasas de mortalidad por cien mil habitantes entre la adultez posterior y la senectud por causas evitables y por regiones naturales en el Ecuador entre 1990 y 2014. Resultados: La tasa de mortalidad en la adultez posterior (entre 60 y 74 años) pasó de 410,84 en 1990 a 429,8 en 2014 por cada cien mil habitantes, en tanto que, en la senectud, es decir, en mayores de 75 años la tasa fue de 8.845,94 en 1990 y 6.861,79 en 2104. Tasas más altas se observaron en la senectud, por causas evitables con diagnóstico y tratamiento precoz, seguidas de evitables con medidas mixtas, con medidas de saneamiento y con vacunación y tratamiento preventivo(p<0.01). Las tasas de mortalidad en la senectud fueron más altas comparadas con las tasas de la adultez posterior (p<0.01). Conclusiones: Las tasas de mortalidad en la senectud fueron más altas que en la adultez posterior sobre todo por causas evitables con diagnóstico y tratamiento precoz.

To synthesize evidence on the effects of balance-based interventions in patients undergoing total knee (TKR) or hip replacement (THR) on self-reported functionality and balance outcomes. A systematic review with meta-analysis evaluated the effects of balance-based interventions on self-reported functionality and balance, as well as on pain and quality of life. Databases (MEDLINE, Embase, Cochrane, PEDro, Scopus) were searched up to 15th February 2025. Methodological quality and risk of bias were assessed (PEDro scale and Cochrane tool). A standardized mean differences (SMD) meta-analysis was conducted with 95% CI. Certainty of evidence was cataloged with GRADE. Twenty studies with 1118 participants were included. Balance-based interventions showed greater self-reported functionality (SMD95% = 0.42 [0.03, 1.12]) and significant improvements in dynamic, static, and global balance (SMD95% = 1.18 [0.40, 1.96], 1.01 [0.31, 1.72], 1.42 [0.1, 2.73]) compared to controls for the immediate term. Evidence quality ranged from low to moderate. Similar trends were observed in the other outcomes. Balance and proprioceptive interventions may improve short-term balance and self-reported function in TKR and THR rehab when added to conventional care. However, their impact on health status and performance measures is inconsistent, and more high-quality research is needed to assess long-term effectiveness.