Reducing residual cardiovascular risk following acute coronary syndrome (ACS) remains a major unmet clinical need. Despite substantial advances in lipid-lowering therapies, the risk of recurrent major adverse cardiovascular events (MACEs) after ACS remains high, with an estimated incidence of approximately 33.4% at 5 years. Residual cardiovascular risk is driven by multiple mechanisms, including persistent inflammation, a prothrombotic status, metabolic disturbances, and the presence of atherogenic lipoproteins beyond low-density lipoprotein cholesterol (LDL-C). Lipoprotein(a) (Lp(a)) is a pro-inflammatory, prothrombotic, and pro-atherosclerotic lipoprotein that appears to play a major role in residual risk after ACS or ischemic stroke. Elevated Lp(a) is a well-established independent and causal risk factor for atherosclerotic cardiovascular disease (ASCVD). Nevertheless, evidence regarding its prognostic value specifically after ACS remains limited, with marked heterogeneity across studies, which complicates direct comparisons and interpretation. In addition, while Lp(a) levels are predominantly genetically determined, recent studies have reported intra-individual variability, although their clinical significance remains uncertain. Finally, current therapeutic options specifically targeting Lp(a) are limited. Novel RNA-based therapies, including antisense oligonucleotides, small interfering RNAs, and emerging gene-editing approaches, have demonstrated profound and sustained reductions in circulating Lp(a) levels. Yet, whether this biological effect translates into reductions in hard clinical endpoints is under evaluation in ongoing clinical trials. This review aims to synthesize current evidence on the role of Lp(a) as a major contributor to residual cardiovascular risk following ACS.

La adquisición de competencias resulta fundamental en ámbitos tan relevantes clínicamente como la patología cardiovascular. Este estudio pretende valorar la adquisición por parte de estudiantes de Medicina de las principales competencias respecto al sistema cardiovascular, así como su autopercepción y la relación con la asistencia presencial y el rendimiento académico. Para lograr este objetivo, se analizaron los datos obtenidos mediante la cumplimentación telemática por parte de 142 estudiantes de cuarto, quinto y sexto curso del Grado en Medicina de la Universidad de Málaga de un cuestionario de elaboración propia (0-15 puntos) con preguntas de elección múltiple basadas en situaciones clínicas y una autoevaluación sobre competencias. Analizando los resultados, las competencias consideradas como adquiridas por un mayor y menor número de estudiantes fueron, respectivamente, el manejo de los factores de riesgo cardiovascular (100%) y la auscultación cardiopulmonar (38,3%). Se obtuvieron mejores resultados en estudiantes que asistieron a clase (11,28±1,84 vs 9,54±2,45; p<0,01). Además, se demostró que la autopercepción de un correcto aprendizaje (odds ratio [OR]=1,26, intervalo de confianza al 95% [IC95%]=1,07-1,50), la asistencia a clase (OR=3,55; IC95%=1,64-7,7) y la nota media del expediente (OR=2,6; IC95%=1,46-4,63) son variables predictoras de calificaciones altas en el cuestionario (≥11 puntos). Esto nos permite inferir que la asistencia a clase se antoja fundamental en el aprendizaje. Además, la autopercepción podría utilizarse como herramienta para guiar la docencia. Por otro lado, se sugiere un insuficiente desarrollo de las competencias eminentemente prácticas, así como la importancia de interrelacionar conocimientos, pues un mejor rendimiento académico general durante el grado se refleja también en la especialidad estudiada en este trabajo

Background Continuous glucose monitoring (CGM) captures dysglycaemia and glycaemic variability after acute coronary syndrome (ACS), but patient-level trajectories from early recovery to mid-term follow-up—particularly in people without diabetes—remain insufficiently characterised. Methods In this prospective multicentre observational study (ORACLE programme), consecutive high-risk ACS patients wore a FreeStyle Libre 3/3 Plus sensor for 14–15 days near discharge and again at ~ 4 months. We quantified CGM time-in-range metrics (70–180 mg/dL and tight range 70–140 mg/dL), time above/below range, and variability/risk indices, including within-day profiles. Clinically relevant changes were categorised using pre-specified thresholds, and predictors of worsening were explored using multivariable models. Results Among 274 enrolled patients, 213 had analyzable baseline CGM recordings meeting quality criteria. Early post-ACS mean time-in-range 70–180 was 85.7 ± 21.4%, time in tight range 70–140 was 69.6 ± 27.7%, time above range > 180 was 12.8 ± 21.5%, and time below range < 70 was 1.5 ± 3.3% (mean glucose 131.4 ± 35.6 mg/dL; glucose management indicator 6.4 ± 0.8%). CGM demonstrated marked inter-individual heterogeneity and a reproducible late-morning (10:00–12:00) vulnerability window with lower range time and higher hyperglycaemic exposure, consistent across diabetes status and similar on weekdays and weekends; adverse CGM profiles were more prominent in patients with diabetes, older individuals, and women. Although CGM parameters improved modestly over the initial monitoring period, overall control deteriorated from baseline to ~ 4 months, including in patients without diabetes. Tight-range time decreased by 3.8% (95% CI − 6.67 to − 0.99; p = 0.0077) and mean glucose increased by 3.85 mg/dL (p = 0.035), accompanied by worsening variability and risk indices. Across CGM endpoints, ~ 20–40% of patients showed a worsening trajectory (20.2% by broad time-in-range thresholds); higher comorbidity burden clustered with deterioration, with hypertension and COPD independently associated with tight-range worsening. Conclusions After ACS, CGM reveals substantial inter-individual heterogeneity and a reproducible late-morning vulnerability window. From discharge to mid-term follow-up, deterioration—also affecting patients without diabetes—may be preferentially detected by tight-range and variability/risk metrics that traditional monitoring of blood glucose and static measures such as HbA1c may overlook, supporting CGM-informed phenotyping to refine post-ACS metabolic surveillance.

Medical education has evolved towards a focus on competencies and practical skills. In response to changing demands, medical faculties have adopted methodologies that promote active and participative learning, enhancing student motivation and performance. Tools such as Miller's Pyramid and Bloom's Taxonomy guide planning and evaluation, integrating levels of knowledge with practical skills and clinical competence. The aim of this investigation was to study more deeply the student perspective on the teaching methods applied in the "Diseases of the Circulatory System" subject. To achieve that objective, a questionnaire was designed to assess the evaluation of teaching methods in Cardiovascular Medicine and to identify statistical differences between variables. This was distributed online to students from the University of Malaga and included sections on sociodemographic variables, perception of acquired competencies, preferred teaching methods, and new teaching assumptions. The study involved 121 students (32.2% male and 67.8% female), with a median grade point average of 7.8. The majority were in their sixth year (57%), followed by fifth year (24.8%) and fourth year (18.2%). Knowledge of cardiovascular risk factors was acquired by 99.2% of students, while cardiopulmonary auscultation was acquired by only 43.8%. The most valued teaching methods were clinical practices, seminars and workshops, and problem-based learning. Notably, lectures with a more dynamic approach were widely welcomed. In conclussion, integrated teaching in Cardiology enhances learning; students perceive the need to implement dynamic and practical methods that reflect real clinical scenarios. La formación médica ha evolucionado a un enfoque en competencias y habilidades prácticas. En respuesta a las demandas cambiantes, las facultades de medicina han adoptado metodologías que promueven un aprendizaje activo y participativo, mejorando la motivación y el rendimiento de los estudiantes. Herramientas como la Pirámide de Miller y la Taxonomía de Bloom orientan la planificación y evaluación, integrando niveles de conocimiento con habilidades prácticas y competencia clínica. El objetivo de esta investigación era ahondar en la perspectiva estudiantil sobre los métodos docentes aplicados en la asignatura "Enfermedades del Sistema Circulatorio". Para ello, se diseñó un cuestionario para evaluar la valoración de métodos docentes en Medicina Cardiovascular e identificar diferencias estadísticas entre variables. Este fue distribuido de forma online a estudiantes de la Universidad de Málaga e incluyó secciones sobre variables sociodemográficas, percepción de competencias adquiridas, métodos docentes preferidos y nuevos supuestos de enseñanza. Finalmente, el estudio involucró a 121 estudiantes (32,2% hombres y 67,8% mujeres), con una mediana de 7,8 como nota media del expediente. La mayoría cursaba sexto (57%), seguido de quinto (24,8%) y cuarto (18,2%). El conocimiento de los factores de riesgo cardiovascular fue adquirido por el 99,2% de los estudiantes, mientras que la auscultación cardiopulmonar solo por el 43,8%. Los métodos docentes más valorados fueron las prácticas clínicas, los seminarios y talleres y el aprendizaje basado en problemas. Destaca la acogida global por clases magistrales con un enfoque más dinámico. En conclusión, la enseñanza integradora en Cardiología potencia el aprendizaje; percibiendo los estudiantes la necesidad de implementar métodos dinámicos y prácticos que reflejen escenarios clínicos reales