Patients with diabetes are at increased risk of developing cardiovascular disease (CVD) with its manifestations of coronary artery disease (CAD), heart failure (HF), atrial fibrillation (AF), and stroke, as well as aortic and peripheral artery diseases. In addition, diabetes is a major risk factor f...or developing chronic kidney disease (CKD), which in itself is associated with developing CVD. The combination of diabetes with these cardio-renal comorbidities enhances the risk not only for cardiovascular (CV) events but also for CV and all-cause mortality. The current European Society of Cardiology (ESC) Guidelines on the management of cardiovascular disease in patients with diabetes are designed to guide prevention and management of the manifestations of CVD in patients with diabetes based on data published until end of January 2023. Over the last decade, the results of various large cardiovascular outcome trials (CVOTs) in patients with diabetes at high CV risk with novel glucose- lowering agents, such as sodium–glucose co-transporter-2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists (RAs), but also novel non-steroidal mineralocorticoid receptor antagonists (MRAs), such as finerenone have substantially expanded available therapeutic op- tions, leading to numerous evidence-based recommendations for the management of this patient population. more

The document is structured into five sections. The first presents the key experiences and challenges that justify a renewal of the EPHFs. The second section updates the groundwork for the exercise of public health and provides a framework to inform the exercise of the new essential functions. The th...ird section proposes a new integrated approach for implementing the EPHFs. The fourth section presents a new list of 11 EPHFs related to each stage of this integrated approach. Finally, in the last section, considerations are put forth to guide EPHF implementation as a means of strengthening the health sector. more

Este documento apresenta um marco conceitual renovado das funções essenciais de saúde pública (FESP) para a Região das Américas, com o qual se pretende dar maior clareza conceitual e operacionalidade ao novo campo de atuação da saúde pública e preencher uma lacuna nas propostas conceituais... sobre o fortalecimento dos sistemas de saúde. O marco proposto apresenta um novo paradigma para a saúde pública, baseado em quatro pilares orientados para a ação: a necessidade de incorporar a abordagem dos direitos humanos às políticas públicas de saúde; a necessidade de a saúde pública ampliar seu enfoque para ter uma abordagem mais ampla dos determinantes sociais da saúde; o papel da saúde pública para garantir de forma integral e integrada o acesso a intervenções de base populacional e atenção individual de qualidade; e a necessidade de as autoridades de saúde atuarem em colaboração com outros setores e com a sociedade civil no desempenho das funções de saúde pública. more