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La enfermedad cardiovascular sigue siendo la primera causa de mortalidad. La pandemia de COVID-19 ha empeorado el control de factores de riesgo y la atención a las patologías crónicas. Por ello urge optimizar la prevención y la rehabilitación cardiaca. En el siguiente documento se repasa el impacto en morbimortalidad, las novedades en manejo del riesgo cardiovascular y la nueva era en diabetes. También la rehabilitación cardiaca intensificada y mucho más digital y las nuevas recomendaciones en las guías de prevención cardiovascular europeas 2021.

BackgroundAtherosclerotic cardiovascular diseases (ASCVD) and dyslipidemia are associated to a higher risk of cardiovascular events, mortality, use of healthcare resources and costs. In Spain, the evidence about the administration of lipid-lowering treatments in clinical practice, and their clinical effectiveness in patients with ASCVD and hypercholesterolemia and patients with FH is scarce. Therefore, a multidisciplinary working group of cardiologists, family physicians, internal medicine specialists and neurologists was gathered for the Reality study. The aim of this study is to describe the demographic and clinical characteristics, comorbidities, and concomitant medication of patients with ASCVD and hypercholesterolemia and of patients with familial hypercholesterolemia (FH). The use of healthcare resources and costs associated to the management of these diseases after their diagnosis were also considered.MethodsThis is an observational and retrospective study, based on the BIG-PAC® database, which includes the electronic medical registries (EMRs) of 1.8 million people from 7 Autonomous Communities in Spain (including public primary care centers and hospitals). The study includes patients who had a new or recurrent episode of ASCVD during the recruitment period (from 01/01/2017 to 31/12/2018). The index date will be defined as the date of the ASCVD event, and the follow-up period will be 24 months. According to their first diagnosis in the database, patients will be classified as ASCVD (5 groups: stable/unstable angina, acute myocardial infarction, ischemic stroke, transient ischemic attack, and peripheral arterial disease) or FH.DiscussionThis study aims to analyze the treatment patterns and use of healthcare resources of ASCVD and FH in Spain. The prevalence of these disorders will also be estimated. Due to the high morbidity and mortality associated with these diseases, it is expected that our study will provide useful information for healthcare systems and decision makers to improve the management of these disabling diseases.

Purpose: Albumin serum levels and N-terminal pro-brain natriuretic peptide (NT proBNP) have shown to be useful in predicting outcome in patients with heart failure (HF) and systolic dysfunction. Carbohydrate antigen 125 (CA 125) has also been associated to a higher risk of mortality and rehospitalization in patients with HF and impaired left ventricular systolic function. The aim of this study was to evaluate the prognostic role of these biomarkers among acute decompensated HF with preserved ejection fraction (HFpEF) elderly patients. Methods and results: Data were collected prospectively from 154 consecutive patients with HFpEF admitted to our institution between 2011 and 2012. They were followed for one year after hospital discharge. Average age was 81 years (SD 9) and 63% were female. During follow-up, 37 patients died (mortality rate: 24%). In the multivariable analysis, NT proBNP > 2086 ng/l was identified as an independent predictor of mortality (OR 5.36; 1.84-15.65, CI 95%, p = 0.002). In the same way, hypoalbuminaemia (RR 2.57; 1.46-4.52, CI 95%, p = 0.001) and CA 125 plasmatic concentrations > 31 U/ml (RR 2.58; 1.23-5.43, CI 95%, p = 0.008) also were related to a higher risk of death in the univariable analysis. Finally, we found that the combination of NT proBNP plasmatic concentrations > 2086 ng/l, albuminaemia < 3.5 g/dl and CA 125 > 31 U/ml was associated to a worse outcome among acute decompensated HFpEF patients (RR 3.32; 1.91-5.78, CI 95%, p < 0.0001). Conclusion: NT proBNP, albuminaemia, and CA 125 could be used as filtering tools to select those with the highest clinical risk among hospitalized HFpEF patients. Sí