BACKGROUND:Advanced interatrial block (IAB) is found in about 10% of subjects ≥75 years and is associated with atrial fibrillation and stroke. It is unclear if IAB association with cardiovascular events is a casual or non-causal association. OBJECTIVES:To determine the association of advanced IAB with left atrial (LA) imaging parameters and cerebral microemboli. METHODS:Prospective multicenter study that included 190 subjects ≥75 years without significant structural heart disease, including 83 patients with advanced IAB and 107 controls with normal P-wave (matched by age and cardiovascular risk factors). Electrocardiogram and transthoracic echocardiography were performed in all subjects. Cardiac and brain magnetic resonance imaging (MRI) were done in a exploratory subgroup of 23 and 26 subjects, respectively. RESULTS:Mean age was 80.9 years old (81.5 in advanced IAB vs. 80.5 in controls, p = 0.14) and 48.9% were females. There were no significant differences between patients with advanced IAB and controls in LA imaging parameters: reservoir strain (22.5 vs. 22.8%, p = 0.88), conduit strain (-12.6 vs. -11.4%, p = 0.41), contraction strain (-13.1 vs. -14.1%, p = 0.59), maximal 3D volume index (29.2 vs. 30.8 ml/m2, p = 0.48), ejection fraction (45.7 vs. 43.6%, p = 0.50), fibrosis burden assessed by Late Gadolinium Enhancement (7.4 vs. 8.8% of myocardium, p = 0.67). In a small brain MRI subgroup, patients with advanced IAB showed a numerically higher prevalence of silent brain lesions than controls; however, this difference was not statistically significant (p = 0.25). CONCLUSIONS:When compared to controls with normal P wave, matched by age and cardiovascular risk factors, advanced IAB is not associated with abnormal LA imaging parameters. Within the limitations of this underpowered study, advanced IAB may have a non-causal association with clinical events, although a causal relationship cannot be excluded.

Abstract Introduction The primary cause of sudden cardiac death is ischemic heart disease, but often we evaluate patients where this is excluded. Initial evaluation with echocardiogram may overlook certain morphological or functional alterations. Cardiac magnetic resonance (CMR) is recommended for survivors of cardiac arrest (CA) without a clear underlying cause (class I, level B). There is a lack of data from multicenter studies. Our aim is to assess whether CMR helps to clarify the aetiology of CA in our setting. Methods Retrospective observational study of survivors of CA with good neurological outcome with suspected cardiac cause admitted to Cardiology from October 2016 to April 2024. The patients did not show significant coronary lesions or those considered to be responsible for the arrest. CMR was performed for aetiological study and, on an individual basis, electrophysiology study, provocation test and/or genetics. Baseline characteristics and results of complementary tests were recorded. Results Thirty-two patients were included (figure 1). The average age was 50±9 years, over half were men (62,5%), and the majority had a shockable rhythm (87.5%). Genetic testing revealed a variant of uncertain significance or pathogenic in 40.6%. CMR found left ventricular (LV) systolic dysfunction in 31.3%, dilation in 18.8%, hypertrophy in 9.4%, and nonspecific morphological alterations in 9.4%. Similarly, right ventricular (RV) systolic dysfunction was observed in 9.4%, dilation in 6.3%, and morphological alterations in 6.3%. Diffuse fibrosis or interstitial disease was noted in 21.9%, edema in 18.8%, and late gadolinium enhancement in LV and/or RV in 40.6%. Figure 2 shows CMR diagnosis and final diagnosis based on initial suspicion. CMR reclassified 37.5% of patients and provided the diagnosis in 62.5% of patients. Conclusions CMR is a non-invasive test that constitutes a valuable tool in the context of initially non-ischemic CA, providing a comprehensive evaluation of cardiac structure, function, and tissue characterization. Routine use of CMR after CA decreases the percentage of patients classified as idiopathic ventricular fibrillation and reclassifies the diagnosis in more than a third, with consequences for the management and prognosis of the patient and their families. Demographic data and complementary tests Initial, CMR and final diagnosis

The Coronavirus Disease 2019, commonly referred to as COVID-19, is responsible for one of the deadliest pandemics in human history. The direct, indirect and lasting repercussions of the COVID-19 pandemic on individuals and public health, as well as health systems can still be observed, even today. In the midst of the initial chaos, the role of tobacco as a prognostic factor for unfavourable COVID-19 outcomes was largely neglected. As of 2023, numerous studies have confirmed that use of tobacco, a leading risk factor for cardiovascular and other diseases, is strongly associated with increased risks of severe COVID-19 complications (e.g., hospitalisation, ICU admission, need for mechanical ventilation, long COVID, etc.) and deaths from COVID-19. In addition, evidence suggests that COVID-19 directly affects multiple organs beyond the respiratory system, disproportionately impacting individuals with comorbidities. Notably, people living with cardiovascular disease are more prone to experiencing worse outcomes, as COVID-19 often inherently manifests as thrombotic cardiovascular complications. As such, the triad of tobacco, COVID-19 and cardiovascular disease constitutes a dangerous cocktail. The lockdowns and social distancing measures imposed by governments have also had adverse effects on our lifestyles (e.g., shifts in diets, physical activity, tobacco consumption patterns, etc.) and mental well-being, all of which affect cardiovascular health. In particular, vulnerable populations are especially susceptible to tobacco use, cardiovascular disease and the psychological fallout from the pandemic. Therefore, national pandemic responses need to consider health equity as well as the social determinants of health. The pandemic has also had catastrophic impacts on many health systems, bringing some to the brink of collapse. As a result, many health services, such as services for cardiovascular disease or tobacco cessation, were severely disrupted due to fears of transmission and redirection of resources for COVID-19 care. Unfortunately, the return to pre-pandemic levels of cardiovascular disease care activity has stagnated. Nevertheless, digital solutions, such as telemedicine and apps, have flourished, and may help reduce the gaps. Advancing tobacco control was especially challenging due to interference from the tobacco industry. The industry exploited lingering uncertainties to propagate misleading information on tobacco and COVID-19 in order to promote its products. Regrettably, the links between tobacco use and risk of SARS-CoV-2 infection remain inconclusive. However, a robust body of evidence has, since then, demonstrated that tobacco use is associated with more severe COVID-19 illness and complications. Additionally, the tobacco industry also repeatedly attempted to forge partnerships with governments under the guise of corporate social responsibility. The implementation of the WHO Framework Convention on Tobacco Control could address many of the aforementioned challenges and alleviate the burden of tobacco, COVID-19, and cardiovascular disease. In particular, the implementation of Article 5.3 could protect public health policies from the vested interests of the industry. The world can learn from the COVID-19 pandemic to better prepare for future health emergencies of international concern. In light of the impact of tobacco on the COVID-19 pandemic, it is imperative that tobacco control remains a central component in pandemic preparedness and response plans.

Objetivo: Analizar la incidencia y el riesgo de eventos adversos cardiovasculares mayores (MACE) recurrentes, el nivel de control de factores de riesgo, la persistencia al tratamiento y el coste de la versión de la polipíldora CNIC que contiene 100 mg de ácido acetilsalicílico (AAS), 20 mg de atorvastatina (A20) y 2.5/5.0 ó 10 mg de ramipril en pacientes en prevención cardiovascular secundaria.Método: Subanálisis del estudio observacional, retrospectivo y multicéntrico NEPTUNO en pacientes tratados durante 2 años con la polipíldora CNIC A20, los mismos monocomponentes por separado, medicamentos equipotentes u otras terapias.Resultados: Se incluyeron 922 pacientes en cada grupo.El riesgo de sufrir un MACE recurrente en el grupo de polipíldora CNIC A20 fue menor que en todas las demás cohortes (21%, 23% y 26% de aumento del riesgo en las cohortes de monocomponentes, equipotentes u otras terapias, respectivamente; p < 0.05).La magnitud del cambio en el colesterol unido a lipoproteínas de baja densidad y la presión arterial, así como el incremento en la proporción de pacientes que alcanzaron los objetivos establecidos, fueron mayores en los pacientes tratados con la polipíldora CNIC A20 que en cualquiera de las otras cohortes (p < 0.001).La persistencia al tratamiento fue mayor en los pacientes tratados con la polipíldora CNIC A20 (p < 0.001) y esta estrategia resultó ser menos costosa que cualquier otra opción terapéutica.Conclusiones: En pacientes en prevención cardiovascular secundaria, la polipíldora CNIC A20 (AAS 100 mg; atorvastatina 20 mg; ramipril 2.5/5.0 ó 10 mg) constituye una opción terapéutica válida con beneficios y resultados similares a la versión de la polipíldora con 40 mg de atorvastatina.

Objective: To analyse the incidence and risk of recurrent major adverse cardiovascular events (MACE), level of risk factor control, treatment persistence and cost of the CNIC polypill version containing acetylsalicylic acid (ASA) 100 mg, atorvastatin 20 mg (A20), and ramipril 2.5, 5.0 or 10 mg in secondary cardiovascular prevention patients. Method: Subanalysis of the observational, retrospective, multicentre, NEPTUNO study in patients treated for two years with the CNIC polypill A20, the same monocomponents as single drugs, equipotent drugs, and other therapies. Results: 922 patients were included in each group. The risk of recurrent MACE was lower among CNIC A20 polypill users than all others (21%, 23% and 26% increased risk among the monocomponents, equipotent or other therapy cohorts, respectively; p < 0.05). The magnitude of the mean change in low -density lipoprotein cholesterol and blood pressure, as well as the increase in the proportion of patients achieving target goals, was also greater among patients treated with the CNIC A20 polypill than in any of the other cohorts (all p < 0.001). Treatment persistence was significantly higher in patients treated with the CNIC A20 polypill (p < 0.001) and was a less costly strategy than any other therapeutic option. Conclusions: In patients in secondary cardiovascular prevention, the CNIC A20 polypill (ASA 100 mg, atorvastatin 20 mg, and ramipril 2.5, 5.0 or 10 mg) constitutes a valid therapeutic option with similar benefits and outcomes to the version of the polypill with atorvastatin 40 mg.

Nicotine is universally recognized as the primary addictive substance fuelling the continued use of tobacco products, which are responsible for over 8 million deaths annually. In recent years, the popularity of newer recreational nicotine products has surged drastically in many countries, raising health and safety concerns. For decades, the tobacco industry has promoted the myth that nicotine is as harmless as caffeine. Nonetheless, evidence shows that nicotine is far from innocuous, even on its own. In fact, numerous studies have demonstrated that nicotine can harm multiple organs, including the respiratory and cardiovascular systems. Tobacco and recreational nicotine products are commercialized in various types and forms, delivering varying levels of nicotine along with other toxic compounds. These products deliver nicotine in profiles that can initiate and perpetuate addiction, especially in young populations. Notably, some electronic nicotine delivery systems (ENDS) and heated tobacco products (HTP) can deliver concentrations of nicotine that are comparable to those of traditional cigarettes. Despite being regularly advertised as such, ENDS and HTP have demonstrated limited effectiveness as tobacco cessation aids in real-world settings. Furthermore, ENDS have also been associated with an increased risk of cardiovascular disease. In contrast, nicotine replacement therapies (NRT) are proven to be safe and effective medications for tobacco cessation. NRTs are designed to release nicotine in a slow and controlled manner, thereby minimizing the potential for abuse. Moreover, the long-term safety of NRTs has been extensively studied and documented. The vast majority of tobacco and nicotine products available in the market currently contain nicotine derived from tobacco leaves. However, advancements in the chemical synthesis of nicotine have introduced an economically viable alternative source. The tobacco industry has been exploiting synthetic nicotine to circumvent existing tobacco control laws and regulations. The emergence of newer tobacco and recreational nicotine products, along with synthetic nicotine, pose a tangible threat to established tobacco control policies. Nicotine regulations need to be responsive to address these evolving challenges. As such, governments should regulate all tobacco and non-medical nicotine products through a global, comprehensive, and consistent approach in order to safeguard tobacco control progress in past decades.

BACKGROUND:Patients with type 2 DM (T2DM) and established cardiovascular disease (CVD) are at high risk of recurrent CV events. We analysed the use of the CNIC-polypill (acetylsalicylic acid, ramipril, and atorvastatin) compared with other therapeutic strategies in patients with T2DM and CVD from the retrospective NEPTUNO study. METHODS:Patients were stratified into four therapeutic approaches: CNIC-polypill, its monocomponents as loose medications, equipotent medications, and other therapies. Outcomes included the 2-year cumulative incidence and risk of recurrent major adverse CV events (MACE) and CV death, risk factors control, medication persistence, and utilisation of healthcare resources and costs. RESULTS:After two years, T2DM patients treated with Monocomponents, Equipotent drugs, or Other therapies had increased recurrent MACE risk compared to CNIC-polypill (11 %, 23 %, and 44 %, respectively; P < 0.05) and shorter median time to CV events (305-377 vs. 396 days; P < 0.05). The CNIC-polypill group achieved a significant 11.2 % increase in patients reaching LDL-c targets <70 mg/dL, outperforming other strategies. It also exhibited superior triglyceride control and a higher proportion achieving the <130/80 mmHg blood pressure goal. The CNIC-polypill cohort displayed significantly higher 24-month persistence (71.5 % vs. 54.7 %-58.3 %, p < 0.05) and lower mean adjusted costs per patient (€5083 vs. €6000-€6523; p < 0.05). In a comparative analysis, T2DM patients had lower baseline LDL-c and total cholesterol levels than non-T2DM counterparts yet experienced a higher incidence of recurrent MACE over two years. CONCLUSION:The CNIC-polypill (ASA, atorvastatin and ramipril) emerged as a promising treatment for patients with CVD, particularly those with T2DM, offering improved clinical outcomes and economic efficiency.

Aims:The retrospective NEPTUNO study evaluated the effectiveness of the Centro Nacional de Investigaciones Cardiovasculares (CNIC)-polypill (including acetylsalicylic acid, ramipril, and atorvastatin) vs. other therapeutic approaches in secondary prevention for cardiovascular (CV) disease. In this substudy, the focus was on the subgroup of patients with ischaemic heart disease (IHD).Methods and results:Patients on four strategies: CNIC-polypill, its monocomponents as loose medications, equipotent medications, and other therapies. The primary endpoint was the incidence of recurrent major adverse CV events (MACEs) after 2 years. After matching, 1080 patients were included in each cohort. The CNIC-polypill cohort had a significantly lower incidence of recurrent MACE compared with monocomponents, equipotent drugs, and other therapies cohorts (16.1 vs. 24, 24.4, and 24.3%, respectively; P < 0.001). The hazard ratios (HRs) for recurrent MACE were higher in monocomponents (HR = 1.12; P = 0.042), equipotent drugs (HR = 1.14; P = 0.031), and other therapies cohorts (HR = 1.17; P = 0.016) compared with the CNIC-polypill, with a number needed to treat of 12 patients to prevent a MACE. The CNIC-polypill demonstrated a greater reduction in LDL cholesterol (LDL-c; -56.1 vs. -43.6, -33.3, and -33.2% in the monocomponents, equipotent drugs, and other therapies, respectively; P < 0.001) and systolic blood pressure (-13.7 vs. -11.5, -10.6, and -9.1% in the CNIC-polypill, monocomponents, equipotent drugs, and other therapies, respectively; P < 0.001) compared with other cohorts. The CNIC-polypill intervention was less costly and more effective than any other therapeutic option, with €2317-€2407 cost savings per event prevented.Conclusion:In IHD, the CNIC-polypill exemplifies a guideline-recommended secondary prevention treatment linked to better outcomes and cost saving compared with other therapeutic options.

Purpose:The aim of this study was to estimate health-care resources utilization, costs and cost-effectiveness associated with the treatment with CNIC-Polypill as secondary prevention of atherosclerotic cardiovascular disease (ASCVD) compared to other treatments, in clinical practice in Spain. Patients and Methods:An observational, retrospective study was performed using medical records (economic results [healthcare perspective], NEPTUNO-study; BIG-PAC-database) of patients who initiated secondary prevention between 2015 and 2018. Patients were followed up to 2 years (maximum). Four cohorts were balanced with a propensity-score-matching (PSM): 1) CNIC-Polypill (aspirin+atorvastatin+ramipril), 2) Monocomponents (same separate drugs), 3) Equipotent (equipotent drugs) and 4) Other therapies ([OT], other cardiovascular drugs). Incidence of cardiovascular events, health-care resources utilization and healthcare and non-healthcare costs (2020 Euros) were compared. Incremental cost-effectiveness ratios per cardiovascular event avoided were estimated. Results:After PSM, 1614 patients were recruited in each study cohort. The accumulated incidence of cardiovascular events during the 24-month follow-up was lower in the CNIC-Polypill cohort vs the other cohorts (19.8% vs Monocomponents: 23.3%, Equipotent: 25.5% and OT: 26.8%; p<0.01). During the follow-up period, the CNIC-Polypill cohort also reduced the health-care resources utilization per patient compared to the other cohorts, particularly primary care visits (16.6 vs Monocomponents: 18.7, Equipotent: 18.9 and OT: 21.0; p<0.001) and hospitalization days (2.3 vs Monocomponents: 3.4, Equipotent: 3.7 and OT: 4.0; p<0.001). The treatment cost in the CNIC-Polypill cohort was lower than that in the other cohorts (€4668 vs Monocomponents: €5587; Equipotent: €5682 and OT: €6016; p<0.001) (Difference: -€919, -€1014 and -€1348, respectively). Due to the reduction of cardiovascular events and costs, the CNIC-Polypill is a dominant alternative compared to the other treatments. Conclusion:CNIC-Polypill reduces recurrent major cardiovascular events and costs, being a cost-saving strategy as secondary prevention of ASCVD.

INTRODUCTION AND OBJECTIVES:Exposure to environmental tobacco smoke (ETS) is associated with increased mortality and morbidity. The objective of this study was to estimate the impact of ETS exposure in Spain on mortality in 2020 in the population aged 35 years and over. METHODS:A method of estimating attributable mortality (AM) based on the prevalence of ETS exposure was applied. Prevalence data were obtained from a representative study conducted in Spain and the relative risks were derived from a meta-analysis. AM point estimates are presented along with 95% confidence intervals (95% CI), calculated using a bootstrap naive procedure. AM, both overall and by smoking habit, was estimated for each combination of sex, age group, and cause of death (lung cancer and ischemic heart disease). A sensitivity analysis was performed. RESULTS:A total of 747 (95% CI 676-825) deaths were attributable to ETS exposure, of which 279 (95% CI 256-306) were caused by lung cancer, and 468 (95% CI 417-523) by ischemic heart disease. Three-quarters (75.1%) of AM occurred in men and 60.9% in non-smokers. When chronic obstructive pulmonary disease and cerebrovascular disease are included, the burden of AM is estimated at 2242 deaths. CONCLUSIONS:ETS exposure is associated with 1.5% of all deaths from lung cancer and ischemic heart disease in the population aged 35 and over. These data underline the need for health authorities to focus on reducing exposure to ETS in all settings and environments.

Introduction Exposure to secondhand smoke (SHS) is associated with an increase in mortality and morbidity. The aim of this work is to estimate the impact of the exposure to SHS on mortality in Spain in the population aged 35 and over in the year 2020. Material and Methods Attributable mortality (AM) to SHS was estimated using a prevalence-dependent method. Prevalence of exposure was derived from a national representative crosssectional study and relative risks from metanalyses. AM estimations were accompanied by 95% confidence intervals (95%CI), which were calculated using a naive bootstrap procedure. AM, globally and by tobacco consumption, was estimated by sex, age group and cause of death. A sensitivity analysis was performed. Results In Spain, in 2020, 747 (95% CI 676-825) deaths in the population aged 35 and over were attributed to exposure to SHS, 279 (95%CI 256-306) due to lung cancer and 468 (95% CI 417-523) due to ischemic heart disease. 75.1% of the AM occurred in men, 561 deaths (95% CI 494-634). 60.9% of deaths attributed to SHS exposure occurred in non-smokers. Including Chronic Obstructive Pulmonary Disease and stroke in the estimation rose the mortality burden to 2,242 deaths. Conclusions Exposure to SHS is an important cause of death in Spain, associated with 1.5% of all deaths from lung cancer and ischemic heart disease in the population aged 35 and over. Most of the AM to SHS occurs in non-smokers. These data reinforce the need for health authorities to commit to reducing the exposure to SHS in any type of context and location.

Background: To evaluate the effectiveness of a cardiovascular polypill including aspirin, ramipril and atorvastatin (CNIC-Polypill), on the incidence of recurrent major cardiovascular events (MACE) and risk factor control in patients with established atherosclerotic cardiovascular disease (ASCVD) vs different pharmacological therapeutic strategies. Methods: Retrospective, observational study using data from electronic-health records. Patients were distributed into 4 different cohorts: CNIC-Polypill (case cohort) vs 3 control cohorts: same monocomponents taken separately (Monocomponents), equipotent drugs (Equipotent) and other drugs not included in the previous cohorts (Other therapies). Patients were followed for 2 years or until MACE or death. Results: After propensity score matching, a total of 6456 patients (1614 patients per cohort) were analysed. After 2 years, the risk of recurrent MACE was lower in the CNIC-Polypill cohort compared to the control groups (22%; p = 0.017, 25%; p = 0.002, 27%; p = 0.001, higher in the Monocomponents, Equipotent and Other therapies cohorts, respectively). The incremental proportion of patients who achieved blood pressure (BP) and low-density lipoprotein cholesterol (LDLc) control from baseline was higher in the CNIC-Polypill cohort vs control cohorts (BP controlled patients: +12.5% vs + 6.3%; p < 0.05, +2.2%; p < 0.01, +2.4%; p < 0.01, LDLc controlled patients: +10.3% vs + 4.9%; p < 0.001, +5.7%; p < 0.001, +4.9%; p < 0.001, respectively). Medication persistence was higher in patients treated with the CNIC-Polypill (72.1% vs 62.2%, 60.0% and 54.2%, respectively; p < 0.001) at study end. Conclusions: In secondary prevention patients, compared with control groups, treatment with the CNIC-Polypill was associated with significant reductions in the accumulated incidence of recurrent MACE, improved BP and LDLc control rates, and increased medication persistence.

El control lipídico tiene especial relevancia en la mejora del pronóstico de los pacientes tras un síndrome coronario agudo. Un adecuado engranaje de las rutas asistenciales es esencial a la hora de optimizar el tratamiento hipolipemiante. Una de las situaciones que aborda el proyecto ACS-Europath (#RutaSCA) es el de derivación a atención primaria. Mantener una comunicación fluida entre cardiología y atención primaria y consensuar protocolos de actuación son pasos esenciales para mejorar la consecución de objetivos lipídicos en el menor tiempo posible y facilitar el acceso a terapias avanzadas a pacientes seleccionados.

espanolFundamentos: Durante el estado de alarma y una vez finalizado el confinamiento decretado por la pandemia por COVID-19, en Espana se realizo, entre el 4 y el 22 de mayo de 2020, un estudio transversal en voluntarios aplicando una encuesta autocumplimentada online. El objetivo de este estudio fue conocer como afecto el periodo de confinamiento al consumo de tabaco y relacionados en la poblacion adulta espanola. Metodos: El cuestionario constaba de 18 preguntas e incluia caracteristicas sociodemograficas, el consumo de tabaco y otros productos relacionados, exposicion al humo ambiental de tabaco y percepcion del riesgo de enfermedad por COVID-19 asociada a su consumo. La encuesta fue completada por 17.017 personas. El analisis de la asociacion entre variables cuantitativas, fue realizado mediante el test de la T de Student y el de frecuencias de las variables categoricas mediante el test de χ². Resultados: Se observo reduccion en la prevalencia de fumadores diarios de tabaco (6,73%) y no se observaron cambios en los productos consumidos. La prevalencia de exposicion al humo ambiental en casa durante el confinamiento entre personas no fumadoras disminuyo (61,83%). Los encuestados declararon que el consumo de tabaco y de cigarrillos electronicos aumentaba el riesgo de contraer la enfermedad del COVID-19 y sufrir complicaciones (39,09% y 31,80% respectivamente). Conclusiones: Durante el periodo de confinamiento en Espana debido al COVID-19, se produjo una reduccion en el consumo de tabaco y similares. Ademas de observo una reduccion a la exposicion al humo ambiental. EnglishBackground: During the state of alarm and once the confinement decreed by the COVID-19 pandemic ended, a cross-sectorial study was carried out in Spain between May 4th and 22nd, 2020 by volunteers who completed a self-administered online survey. The objective of this study was to know how the confinement period affected the consumption of tobacco and other related products in the adult Spanish population. Methods: The survey consisted of 18 questions concerning sociodemographic characteristics, the consumption of tobacco and other related products, exposure to secondhand smoke and perception of COVID-19 risk associated with consumption. Questions about tobacco and other related products were posed in order to compare consumption prior to and during confinement. The survey was completed by 17,017 people. The analysis of association of variables was carried out with T-student. Variable frequency analysis was performed with χ². Results: There was a reduction in the prevalence of daily tobacco smoking and no changes were observed in the products consumed in either period (6.73%). The prevalence of exposure to secondhand smoke at home during confinement among non-smokers decreased (61.83%). Most of survey respondents reported that tobacco and ecigarette consumption increased the risk of contracting COVID-19 and suffering severe complications (39.09% and 31.80% respectively). Conclusions: During the COVID-19 lockdown in Spain, the tobacco consumption decreased. Also, secondhand smoke exposition reduces in Spain during this period.

OBJECTIVE During the state of alarm and once the confinement decreed by the COVID-19 pandemic ended, a cross-sectorial study was carried out in Spain between May 4th and 22nd, 2020 by volunteers who completed a self-administered online survey. The objective of this study was to know how the confinement period affected the consumption of tobacco and other related products in the adult Spanish population. METHODS The survey consisted of 18 questions concerning sociodemographic characteristics, the consumption of tobacco and other related products, exposure to secondhand smoke and perception of COVID-19 risk associated with consumption. Questions about tobacco and other related products were posed in order to compare consumption prior to and during confinement. The survey was completed by 17,017 people. The analysis of association of variables was carried out with T-student. Variable frequency analysis was performed with χ2. RESULTS There was a reduction in the prevalence of daily tobacco smoking and no changes were observed in the products consumed in either period (6.73%). The prevalence of exposure to secondhand smoke at home during confinement among non-smokers decreased (61.83%). Most of survey respondents reported that tobacco and e-cigarette consumption increased the risk of contracting COVID-19 and suffering severe complications (39.09% and 31.80% respectively). CONCLUSIONS During the COVID-19 lockdown in Spain, the tobacco consumption decreased. Also, secondhand smoke exposition reduces in Spain during this period.

El incremento de la supervivencia del enfermo con cáncer, junto con el desarrollo de nuevas terapias antitumorales, han puesto de relieve el impacto negativo que las complicaciones vasculares asociadas con el tratamiento oncohematológico tienen en la salud cardiovascular del paciente con cáncer. El objetivo de este documento de consenso, promovido por el Grupo de Trabajo de Cardio-oncología de la Sociedad Española de Cardiología (SEC) y elaborado conjuntamente con diferentes áreas de conocimiento de la SEC junto con la Sociedad Española de Hematología y Hemoterapia (SEHH), la Sociedad Española de Oncología Médica (SEOM), la Sociedad Española de Oncología Radioterápica (SEOR), la Sociedad Española de Médicos Generales y de Familia (SEMG), la Asociación Española de Especialistas en Medicina del Trabajo (AEEMT), la Asociación Española de Enfermería Cardiovascular (AEEC), la Fundación Española del Corazón (FEC) y la Asociación Española contra el Cáncer (AECC), es proporcionar un enfoque coordinado, multidisciplinar y práctico para la estratificación, la monitorización y el tratamiento del riesgo cardiovascular de los pacientes con cáncer.

Tobacco is widely recognized as a leading cause of cardiovascular morbidity and mortality, accounting for approximately seventeen percent of all cardiovascular disease deaths globally. Electronic nicotine delivery systems such as e-cigarettes have been developed and advertised as safer alternatives to traditional tobacco cigarettes. Aggressive marketing strategies, as well as misleading claims by manufacturers, have largely contributed to the belief that e-cigarettes are harmless. In reality, e-cigarettes are far from innocuous. E-cigarette solutions and aerosols generally contain harmful substances that are commonly found in tobacco cigarette emissions. A growing body of literature suggests that e-cigarettes are associated with an increased risk of cardiovascular morbidity and mortality. In addition, the effectiveness of e-cigarettes as smoking cessation tools has yet to be determined. Concerningly, most smokers do not give up on tobacco cigarettes and eventually become dual users. Unregulated, e-cigarettes constitute a serious threat to established tobacco control policies. Fortunately, many countries have demonstrated that strong regulations were effective in protecting their populations from the dangers of e-cigarettes. The World Heart Federation recommends applying the precautionary principle and a set of measures to protect vulnerable populations, prevent exposure to second-hand smoking, and address misleading claims. In this regard, we recommend that governments, policymakers, and other relevant stakeholders enact or support the following measures, among others: Prohibit the sale and distribution of e-cigarettes to minors, as well as the use of flavouring agents.Prohibit the use of e-cigarettes anywhere tobacco cigarettes have been banned.Prohibit marketing, advertising, and misleading claims regarding e-cigarettes.Apply excise taxes on e-cigarettes.Conduct more research regarding the long-term effects of e-cigarettes on cardiovascular health. Lastly, countries that have banned the commercialization of e-cigarettes should maintain these measures.

Both cancer treatment and survival have significantly improved, but these advances have highlighted the deleterious effects of vascular complications associated with anticancer therapy. This consensus document aims to provide a coordinated, multidisciplinary and practical approach to the stratification, monitoring and treatment of cardiovascular risk in cancer patients. The document is promoted by the Working Group on Cardio Oncology of the Spanish Society of Cardiology (SEC) and was drafted in collaboration with experts from distinct areas of expertise of the SEC and the Spanish Society of Hematology and Hemotherapy (SEHH), the Spanish Society of Medical Oncology (SEOM), the Spanish Society of Radiation Oncology (SEOR), the Spanish Society of General and Family Physicians (SEMG), the Spanish Association of Specialists in Occupational Medicine (AEEMT), the Spanish Association of Cardiovascular Nursing (AEEC), the Spanish Heart Foundation (FEC), and the Spanish Cancer Association (AECC).