Background and Objectives: Patients with atherosclerotic cardiovascular disease (ASCVD) remain at high risk of recurrent events. REALITY aims to analyse the actual levels of low-density lipoprotein cholesterol (LDL-C), the modalities of lipid-lowering therapies (LLT) used, and ASCVD patient outcomes in a real-world setting in Spain. Methods: REALITY is a retrospective observational study conducted using a healthcare database of 1.8 million patients representative of the Spanish population. The study included 26,976 patients with new or recurrent ASCVD events recruited from 2017 to 2019 and followed up for two years. Results: Management of ASCVD involved the utilisation of high-intensity (53%) or very high-intensity (36%) LLT. After two years, a decrease in total cholesterol (from 228.7 to 176.7 mg/dL), LDL-C (from 126.4 to 99.0 mg/dL), and triglycerides (from 216.7 to 163.7 mg/dL), accompanied by a moderate increase in HDL-C levels was observed. However, LDL-C goals of ESC/EAS guidelines were only reached by a minority of patients. Less than 15% of ASCVD patients achieved their LDL-C goals of <70, as stated in contemporary guidelines (3% if the present <55 mg/dL threshold in the ESC/EAS guidelines is considered). During the follow-up period, 9% of ASCVD patients died and 25% experienced a new ASCVD event. Conclusions: In the REALITY study, most patients did not achieve their target LDL-C goals despite receiving high- or very high-intensity LLT. Increasing the utilisation of extreme LLT is crucial to reducing recurrent ASCVD events and mitigating these patients’ high morbidity and mortality risk.

Severe aortic stenosis has increased exponentially as a result of the aging of the population. Transcatheter aortic valve replacement (TAVR) procedures increase by 20%-30% per year in Spain. Referred patients are increasingly older, have comorbidities, and frailty. TAVR cardiac rehabilitation (CR) programs significantly improve both functional capacity and quality of life of patients. However, there are no guidelines on how to carry out them and few elderly patients are referred to CR. Furthermore, mortality in women who undergo TAVR is higher than in men and even fewer are referred to CR programs. Multidisciplinary patient care, including comorbidities and frailty, is essential. It is necessary to ensure exquisite continuity of care during TAVR, CR, and the rest of the patient's life. Telerehabilitation could be an option in some lower-risk patients to include more patients in CR programs after TAVR, given the high demand. This article reviews the evidence on why CR should be performed in post-TAVR patients and proposes a practical and novel approach to the care process and the recommended aspects and components of the CR program.

Background/Objectives: Contemporary data on patients attending cardiology outpatient clinics in Spain are scarce. We aimed to characterise cardiovascular conditions, cardiometabolic burden, risk-factor control and treatment patterns. Methods: RIESCAR is a national, multicentre, observational study. This analysis included 2808 adults evaluated in 50 general cardiology outpatient clinics. Results: Hypertension was present in 60.3%, dyslipidaemia in 58.9%, type 2 diabetes mellitus in 24.7%, obesity in 32.4%, and central obesity in 48.7%. Established cardiovascular disease was documented in 59.7%, with coronary artery disease (30.0%), atrial fibrillation (18.2%) and heart failure (11.7%) being the most frequent conditions. Among hypertensive patients, 42.6% had blood pressure ≥ 140/90 mmHg. In patients with established atherosclerotic cardiovascular disease (ASCVD), 37.2% achieved LDL-C < 55 mg/dL. Patients received a high number of cardiovascular drugs (mean 3.9). Among patients with a potential clinical indication for contemporary cardiometabolic therapies, SGLT2 inhibitors and GLP-1 receptor agonists were used in 35.4% and 8.6%, respectively. Conclusions: Patients attending cardiology clinics in Spain have a high cardiometabolic burden, with important gaps in blood-pressure and LDL-C target attainment. Use of contemporary cardiometabolic therapies remains variable, highlighting opportunities to strengthen cardiovascular prevention in routine practice.