[Statement of the Spanish Interdisciplinary Vascular Prevention Committee on the updated European Guidelines on Cardiovascular Disease Prevention]. / Comentario del CEIPV a las nuevas Guías Europeas de Prevención Cardiovascular 2021.

Statement of the Spanish Interdisciplinary Vascular Prevention Committee on the updated European Guidelines on Cardiovascular Disease Prevention. We present the Spanish adaptation of the 2021 European Guidelines on Cardiovascular Disease (CVD) prevention in clinical practice. The current guidelines besides the individual approach greatly emphasize on the importance of population level approaches to the prevention of cardiovascular diseases. Systematic global CVD risk assessment is recommended in individuals with any major vascular risk factor. Regarding LDL-Cholesterol, blood pressure, and glycemic control in patients with diabetes mellitus, goals and targets remain as recommended in previous guidelines. However, it is proposed a new, stepwise approach (Step 1 and 2) to treatment intensification as a tool to help physicians and patients pursue these targets in a way that fits patient profile. After Step 1, considering proceeding to the intensified goals of Step 2 is mandatory, and this intensification will be based on 10-year CVD risk, lifetime CVD risk and treatment benefit, comorbidities and patient preferences. The updated SCORE algorithm-SCORE2, SCORE-OP- is recommended in these guidelines, which estimates an individual's 10-year risk of fatal and non-fatal CVD events (myocardial infarction, stroke) in healthy men and women aged 40-89 years. Another new and important recommendation is the use of different categories of risk according different age groups (< 50, 50-69 ≥ 70 years). Different flow charts of CVD risk and risk factor treatment in apparently healthy persons, in patients with established atherosclerotic CVD, and in diabetic patients are recommended. Patients with chronic kidney disease are considered high risk or very high-risk patients according to the levels of glomerular filtration rate and albumin-to-creatinine ratio. New lifestyle recommendations adapted to the ones published by the Spanish Ministry of Health as well as recommendations focused on the management of lipids, blood pressure, diabetes and chronic renal failure are included.

Acute changes in serum gonadotrophins and steroids following orchidectomy in the rat: role of the adrenal gland.

Orchidectomy in male rats leads to a) an increase in serum LH and FSH within 9 h; b) a decrease in serum testosterone to baseline levels by 30 min; c) an increase in serum progesterone (for 30 to 120 min), in the presence of the adrenals. If adrenalectomy is performed simultaneously with orchidectomy, the LH and FSH rises at 9 and 12 h are abolished, and the rises at 24 h are attenuated or abolished. By 48 h, the orchidectomized-adrenalectomized rat has achieved a rise in serum LH and FSH equal to that found in gonadectomy alone. Two hypotheses are offered to explain the abolition of the early gonadotrophin rises after combined orchidectomy-adrenalectomy treatment: a) the early responses are due to increased serum progesterone, on a background of decreased testosterone; b) the early responses are abolished because of the missing corticosterone, which either forces competition between pituitary secretion of ACTH and LH/FSH, or is necessary for rapid gonadotroph-secretory response. The differences and similarities between male and female rats, in the response of LH and FSH to gonadectomy, in the presence or absence of the adrenals, are discussed.