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Different primary and secondary prevention studies have documented that a greater degree of reduction in low-density lipoprotein cholesterol (LDL-C) levels is associated with a greater decrease in cardiovascular event rates. PCSK9 inhibitors achieve important, rapid and sustained decreases in LDL-C. New clinical practice guidelines for the management of dyslipidemia establish reduced target levels of LDL-C. These goals are hardly achievable with a statin-only treatment, even in combination with ezetimibe. The addition of PCSK9 inhibitors can play a determining role in achieving these recommendations. However, it is important to identify the patient subgroups that can most benefit from this marked reduction in LDL-C levels. This document describes the profiles of patients with cardiovascular disease in which the maximum decrease in LDL-C levels should be a priority objective, considering strategies to achieve these levels and to facilitate the judicious use of these new drugs.

Resumen El embarazo es predictor de riesgo cardiovascular futuro que puede desenmascarar trastornos metabolicos o vasculares latentes. El retraso en la edad reproductiva y su asociacion a otros factores de riesgo han incrementado los embarazos con complicaciones medicas. Actualmente existe un excelente protocolo nacional de atencion continuada a las mujeres que desarrollan estas complicaciones durante el embarazo. Pero tras el parto se inicia este periodo llamado «cuarto trimestre», que hace referencia al resto de la vida de la mujer tras el embarazo y donde disminuye el seguimiento. El objetivo de este documento es establecer recomendaciones en el «cuarto trimestre», avaladas por la Sociedad Espanola de Obstetricia y Ginecologia (SEGO), la Sociedad Espanola de Medicos de Atencion Primaria (SEMERGEN), la Sociedad Espanola de Medicina de Familia y Comunitaria (semFYC) y la Sociedad Espanola de Cardiologia (SEC), para asegurar el seguimiento de los factores de riesgo y potenciales complicaciones cardiovasculares que puedan desarrollarse a partir del «cuarto trimestre».

This document has been endorsed by the Diabetes and Obesity Working Group of the Spanish Society of Cardiology and the Diabetic Nephropathy Group of the Spanish Society of Nephrology. In this document on the management of patients with type 2 diabetes mellitus (T2DM) and cardiovascular disease or very high cardiovascular risk, it is intended to cover all aspects that should be considered in the treatment of these patients in order to reduce their cardiovascular risk and improve their clinical outcome. A new paradigm is being witnessed in the treatment of T2DM. The reduction of cardiovascular complications and mortality in patients with T2DM and cardiovascular disease, or high cardiovascular risk, goes beyond blood glucose control, and seems to be related more to the specific benefit provided by the new drugs. These include the group of sodium-glucose co-transporter type 2 inhibitors and the group of agonists of the glucagon-like peptide-1 receptor. The objective of this work is to update the document published by this working group at the beginning of 2018, and to provide information to specialties such, as cardiology and nephrology, on these new families of drugs that improve cardiovascular and renal prognosis

Resumen 2020 es el ano de la pandemia de COVID-19, durante la cual los pacientes con enfermedad cardiovascular o factores de riesgo han tenido mayor morbimortalidad. Por ello, la prevencion cardiovascular y la rehabilitacion cardiaca (RC) se hacen mas imprescindibles que nunca. El tratamiento con farmacos protectores cardiovasculares y renales en diabetes es imparable y se actualiza en un nuevo algoritmo. El abandono del tabaco, control de la hipertension, dislipemia, sedentarismo y obesidad se consideran prioritarios. La e-medicina se ha implementado como nunca en prevencion; para llegar al maximo de pacientes, los programas de RC dejan de ser mayoritariamente presenciales para hacerse online y e-supervisados. La pandemia se convierte en una oportunidad para impulsar la prevencion y la RC, mas necesarias que nunca y para todos.