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Background: Decision tree algorithms, obtained by machine learning, provide clusters of patients with similar clinical patterns by the identification of variables that best merge with a given dependent variable., Methods: We performed a multicenter registry, with 7 hospitals form Spain, of patients with, or high-risk of having, coronary heart disease (CHD). Elevated Lp(a) was defined as >50 mg/dl. Machine learning based decision trees were obtained by Chi-square automatic interaction detection., Results: We analyzed 2301 patients. Median Lp(a) was 26.7 (9.3-79.9) mg/dl and 887 (38.6 %) patients had Lp(a) >50 mg/dl. The machine learning algorithm identified 6 clusters based on LDLc, CHD, FH of premature CHD and age (Fig. 1). Clusters 1 (LDLc <100 mg/dl, no CHD and, no FH of CHD) and 3 (LDLc <100 mg/dl, CHD and, no FH and, age < 50 yo) had the lowest Lp(a) values (Fig. 2); patients classified in cluster 5 (LDLc >100 mg/dl, CHD and, FH of CHD) and 6 (LDLc >100 mg/dl) had the highest values. We collapsed clusters in 3 groups: group 1 with clusters 1 and 3; group 2 with clusters 2 and 4; group 3 with clusters 5 and 6. The 3 groups have significantly different (p < 0.001) and progressively higher Lp(a) values. The prevalence of Lp(a) >50 mg/dl was 15.4 % in group 1, 29.2 % in group 2 and 91.1 % in group 3; similarly, the prevalence of Lp(a) >180 mg/dl was 1.0 %, 3.0 % and 7.6 % respectively., Conclusions: A decision tree algorithm, performed by machine learning, identified patients with, or at high risk of having, CHD have higher probabilities of having elevated Lp(a)., Competing Interests: Declaration of competing interest Alberto Cordero reports a) honoraria for lectures from AstraZeneca, AMGEN, Bristol-Myers Squibb, Ferrer, Boehringer Ingelheim, MSD, Daiichy Sankio, Novartis, Novo Nordisk, Sanofi and Amarin; b) consulting fees from AstraZeneca, Ferrer, Sanofi, AMGEN, Novartis, Lilly, Novo Nordisk and Amarin., (Copyright © 2024 Elsevier B.V. All rights reserved.)

In the course of the last year, a number of important clinical trials on cardiovascular disease, principally in hypertensive and diabetic patients, have published their results. The findings, some of which were unexpected, have enabled us, in certain instances, to confirm what already we knew about controlling these risk factors, but they have also led to active discussion about well-established topics, such as: To what extent should blood pressure and glycemia levels be reduced in patients with cardiovascular disease? In addition, up-to-date information has become available about treating hypertension with new drugs or new combinations of existing drugs. This article contains a review of all these topics and also summarizes the findings of some observational studies carried out by the working group on hypertension of the Spanish Society of Cardiology that have been reported in the last year.

During 2006, new evidence supporting the need to adopt a global approach to the treatment of cardiovascular risk in hypertensive patients has been reported. It is increasingly clear that it is not sufficient to aim for optimum blood pressure control, which in any case is not easy to achieve, and that it is essential to treat all cardiovascular risk factors by using drugs with proven benefits, even when those benefits are supplementary to the drug's principal effects. In addition, drugs that could have a detrimental effect or that are, merely, less beneficial should be avoided or kept as a last resort. This appears to have happened with atenolol, and with beta-blockers in general, which have been withdrawn as first-line treatment in the recommendations of some professional societies. To lower cardiovascular risk, it is essential to prevent the development of conditions like diabetes, which are known to have drastic effect on the patient's prognosis. Recently, the results of the DREAM study, which are discussed in detail in this article, have been reported. They could lead to a change in therapeutic strategy in patients who are expected to develop diabetes. In addition, this year has seen the publication of substantial data on a new antihypertensive agent, aliskiren, the first oral renin inhibitor. It is awaiting approval by the international medicine agencies (i.e., the FDA and the EMEA), but should provide a very promising tool in the difficult area of high blood pressure management. Despite numerous advances in the pharmacologic treatment of high blood pressure, control is very difficult to achieve, principally in the elderly, in whom the prevalence of hypertension is high. In these patients, social factors and difficulties with treatment compliance also have an influence and must be dealt with by public health measures aimed at improving blood pressure control.