El tratamiento actual de la dislipidemia en el paciente con riesgo cardiovascular tiene tres preceptos bien definidos: la meta terapéutica primaria es el colesterol LDL (C-LDL), las metas terapéuticas según el nivel de riesgo se deben alcanzar lo antes posible, y las combinaciones de fármacos son cada vez más necesarias. El ácido bempedoico (AB) es un agente administrado por vía oral en forma de profármaco que se activa selectivamente en el hepatocito e inhibe la enzima adenosina trifosfato-citrato liasa, cuya actividad precede a la HMG-CoA reductasa en la cadena de biosíntesis del colesterol. Se realizó un análisis objetivo y con sentido costo-efectivo sobre el papel del AB en el esquema terapéutico de los pacientes con dislipidemia en Latinoamérica, así como una propuesta de algoritmos terapéuticos prácticos. El AB como monoterapia ha demostrado disminuir significativamente los eventos cardiovasculares mayores en pacientes intolerantes a las estatinas o que se niegan a recibirlas. Además, es una herramienta terapéutica útil para combinar con estatinas u otros fármacos para conseguir las metas de C-LDL. El AB es una opción terapéutica importante en la reducción del C-LDL en los pacientes con intolerancia a las estatinas y en aquellos que no han alcanzado las metas de C-LDL según su riesgo cardiovascular. El perfil de seguridad, la eficacia clínica y los beneficios metabólicos del AB lo posicionan como una herramienta valiosa en el manejo de la dislipidemia y la prevención de enfermedades cardiovasculares ateroscleróticas en diferentes escenarios clínicos.
The current treatment of dyslipidemia in patients with cardiovascular risk (CR) is based on three well-defined principles: First, given the extensive evidence demonstrating the association between elevated low-density lipoprotein cholesterol (LDL-C) levels and cardiovascular risk, the primary therapeutic target is LDL-C. Second, as current guidelines recommend LDL-C targets below 55 mg/dL for high-risk patients, therapeutic goals according to risk level should be achieved as early as possible, and combination therapy is increasingly necessary. Third evidence indicates that non-statin therapies—including ezetimibe, bempedoic acid, PCSK9 inhibitors (evolocumab and alirocumab), and inclisiran—provide substantial LDL-C reductions and reduce cardiovascular events. These agents are particularly effective in very high-risk and statin-intolerant populations, with bempedoic acid addressing both lipid and inflammatory pathways. Additionally, the fixed-dose combination of bempedoic acid and ezetimibe produces an approximately 36.2% reduction in LDL-C in high-risk patients. Risk-stratified guidelines recommend ezetimibe as first-line add-on therapy, followed by PCSK9 inhibitors or bempedoic acid based on residual LDL-C levels and tolerability. Alirocumab has demonstrated a significant reduction in the primary composite endpoint of major adverse cardiovascular events (MACE), with a favorable trend in all-cause mortality. Furthermore, inflammation (measured by hsCRP) provides complementary prognostic information beyond LDL-C. This expert position paper proposes practical algorithms for a precision medicine approach in Latin America, matching treatment intensity to individual risk profiles for the primary and secondary prevention of atherosclerotic cardiovascular disease.
Hypertension is the main risk factor for cardiovascular disease (CVD), affecting 20-40% of Latin American (LATAM) adults, and responsible for more than two million deaths annually due to CVD. The different ethnic, economic, geographic, and cultural characteristics of the LATAM population influence the high prevalence of all cardiovascular risk factors (CVRF), particularly metabolic disturbances such as type 2 diabetes (DM2), obesity and the metabolic syndrome. Their main determinants in LATAM includes environment, food quality, social inequity, low education, political aspects, contextual behaviour, and genetics. The prevalence of overweight and obesity in LATAM increased during the last four decades reaching figures of 10-20% in childhood, 30-40% in adolescence, and 60-70% in adults. Many studies in the region have reported the extremely low rates of awareness, treatment, and control of CVRF in the general population of LATAM, particularly in patients with metabolic disorders, and the consequent high cardiovascular morbidity and mortality. This 2026 LATAM consensus is developed by a large group of experts from different LATAM countries, the USA and Europe, representing areas of internal medicine, cardiology, nephrology, endocrinology, geriatrics, paediatrics, pharmacology, and epidemiology. A careful search for novel studies in LATAM, together with new evidence that has emerged since the 2019 LATAM consensus, support the statements and recommendations in the current report. This update aims to provide clear and useful recommendations for health professionals to improve awareness, treatment, and control of hypertension and associated CVRF in the region.
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Introduction:Immunization rates against influenza and pneumococcus in Latin America remain lower than expected, particularly in Andean region, Central America, Mexico, and Caribbean region. An incremental correlation between economic strata and educational level and vaccines uptake has been observed. This highlights the need for more comprehensive data to accurately characterize the current health landscape and develop strategies for improvement. Methods and Design:The Inter-American Registry of Influenza and Pneumococcal Vaccination (CorVacc Study) is a cross-sectional survey of the general population conducted across 19 Latin American countries. Adults aged 18 years and older completed a 34-question online survey. The pool was validated within the first 1000 responses. Data were grouped into seven categories: demographics, socioeconomic and educational level, cardiometabolic profile, cardiovascular interventions, medical follow-up and treatments, and COVID-19 vaccination status. Results:A total of 21,389 responses were obtained, distributed as follows: 8915 from the North, Central, and Caribbean region; 7492 from the Andean region; and 4801 from the Southern Cone region. Influenza vaccination rates were lower in the Andean region (OR: 0.62; 95% CI: 0.50-0.78), the Caribbean (OR: 0.30; 95% CI: 0.23-0.39), and Central America (OR: 0.59; 95% CI: 0.46-0.76) compared with the Southern Cone. Residing in Central America (OR: 3.06; 95% CI: 1.62-5.77) was associated with greater pneumococcal vaccination. The probability of being vaccinated against influenza was higher in men (OR: 1.3; 95% CI: 1.1-1.6) and in individuals with obesity (OR: 1.26; 95% CI: 1.13-1.40). COPD was associated with a lower probability of pneumococcal vaccination (OR: 0.51; 95% CI: 0.33-0.79). Conclusions:This study highlights the importance of targeted vaccination campaigns to improve coverage, particularly in regions with lower rates. It also underscores the need for enhanced education and awareness of the benefits of vaccination. Tackling barriers such as vaccine hesitancy and misinformation will be essential for raising vaccination rates and, ultimately, for reducing the burden of cardiovascular disease.
