My dear friend Eduardo Meaney, editor of this magnificent journal, has invited me to write about the importance of inter-American cardiological cooperation, which has made me go back a few years ago, during my time as president in the Inter-American Society of Cardiology (SIAC, for its acronym in Spanish) and evaluate from the historical and critical point of view, my role in it, I am a faithful believer that a log does not burn alone, under this concept, I am totally convinced that the growth we have experienced in SIAC is due to the impressive work of each of the members that make up its different councils, which also constitute its scientific arm, being a core made up of extraordinary cardiologists from the continent, who have raised the Latin American cardiovascular presence on par with others in the world.

In 2009, Fernando Alonso of the Spanish Society of Cardiology invited the editors of the cardiology journals of the different Latin American societies to evaluate the concept of scientific participation and its impact on Latin American publications, an experience that remained written. In the Spanish Journal of Cardiology in 2009 «Ibero-American Cardiovascular Journals. Proposals for a much-needed cooperation», in the introduction of this publication, the authors conclude that the Ibero-American collaboration was due to the close contact that until now exists between the different societies, their scientific, academic and social initiatives, which are based on the deep common cultural roots between nations, which identify and unite us, whose best exponent are the languages we share (Spanish and Portuguese).¹

Another aspect of great importance to emphasize is the teaching link and the great participation of great speakers of international renown who are present in the different national congresses that take place in Latin America and proudly also in other continents.

In recent years, Latin America has formed working groups, which have published guidelines and positions, which have marked the road map that many countries now take as a reference, which denotes the importance of inter-American cardiological cooperation and which I summarize below, not chronological order, but trying to give a perspective of historical, scientific impact.

In 2017, the Latin American Society of Hypertension (LASH) published updated guidelines for «Arterial hypertension and its associated comorbidities in Latin America» in the Journal of Hypertension,² which emphasize the importance of implementing a common policy for cardiovascular prevention in Latin America. Among the challenges common to all parts of the world is the growing global burden of morbidity and premature mortality associated with Non-Communicable Diseases (NCDs) and the financial limitations and inefficiencies that traditional models of health care have for coping with chronic diseases. Specific challenges arise from the fact that Latin America is one of the world regions with the greatest disparities in socioeconomic conditions and the availability of health care. A working group of 50 Latin American experts on hypertension speaks for the first time of this importance and establishes appropriate guidelines in our low-income countries.² SIAC in 2020, in its position with 25 experts,³ published that they are convinced of the need to standardize the steps in which it goes from the diagnosis to the control of hypertension, establishing guidelines and standards that must be adopted in all Latin American countries. In the same way, the management of cardiovascular (CV) risk in order to achieve a substantial decrease in CV events based on the publication of LASH of the 2017.² Which later resulted in the creation of the SIAC program, «Cardiometabolic Prevention Units (CMPU)», which currently has more than 500 units accredited throughout Latin America with more than 800 participants.⁴

The most important participation as a Latin American unit has been carried out in the May Measurement Month (MMM), started in 2017 and led by the International Society of Hypertension (ISH), recruiting until the year 2021, almost five million people, in the Latin American survey of 2017 and published in 2020, a total of 105,246 were analyzed, reporting a prevalence of hypertension (HBP) in Latin America of 40%, which gives us a very clear idea of the current situation of the disease.⁵

Published in the Spanish Clinical Journal «Latin American Registry of Ambulatory Blood Pressure Monitoring (MAPA-LATAM):⁵ an urgent need» once again unites Spain and Latin America, the use of ambulatory blood pressure monitoring (ABPM) is recommended to helping a better diagnosis, in making therapeutic decisions, and represents a better prognostic estimate than the measurements in consultation. It makes the clarification that, unfortunately, there is no global prospective ABPM registry for all Latin American countries that analyzes the prevalence of HBP, the degree of its knowledge, its percentage of treatment and the degree of control. Consequently, the authors of this article consider its implementation a priority.⁶

Undoubtedly, cardiovascular mortality, higher in our poor countries, has motivated us to learn about our differences in relation to Cardiovascular Risk Factors (CVRF) and the differences with other continents, in «The Consensus on Atherogenic Dyslipidemia: Prevalence, Causes and Treatment»⁷,⁸ met the Latin American Lipid Association (ALALIP), SIAC and the Pan-American College of Endothelium (PACE), carrying out with a perfect modified Delphi methodology, the best consensus on the subject and which also results in two publications both in Spanish and English.⁷,⁸

This task force meets again in the «Consensus for Residual Risk Management»⁹ giving strong conclusions and oriented to in the reduction of residual risk, therapeutic options adapted to the specific needs of the patient should be considered, based on five objectives of treatment: triglyceride-rich lipoproteins, inflammation, glucose metabolism, high blood pressure, and prothrombotic state. Comprehensive control of all cardiometabolic risk factors should be a priority to address this important public health problem and prevent premature deaths.⁹

SIAC analyzed the relationship between influenza, cardiovascular disease, and the importance of vaccination in risk groups and published it in its position published in Global Heart «Influenza Vaccination for the Prevention of Cardiovascular Disease in the Americas: Consensus document of the Inter-American Society of Cardiology and the World Heart Federation» with extraordinary conclusions and recommendations for all Latin America.¹⁰ One of the SIAC proposals to improve the control of secondary prevention and, as far as possible, primary prevention has been the use of the polypill, recommendations that were published in the consensus and that were adapted to the Latin American reality.¹¹

In order not to expand further, I must point out that Latin American cooperation in the current pandemic has made important scientific contributions: «Hydroxychloroquine, Messages from Cardiology in times of Pandemic»,¹² «Personal Safety during the COVID-19 Pandemic: Realities and Perspectives of Healthcare Workers in Latin America»,¹³ Ambulatory Patients with Cardiometabolic Disease and Without Evidence of COVID-19 During the Pandemic. The CorCOVID LATAM Study (five publications now)¹⁴-¹⁸ where topics related to psychological impact, vaccination and cardiometabolic disease were addressed, in addition to the Latin American registry of COVID and Cardiovascular Disease, whose rationale we have published, and we are waiting for the results obtained from many Latin American research centers to give us a clear idea of the impact of the pandemic in Latin America.¹⁹

The future of cardiology is in the hands of young cardiologists, who are beginning their professional life, including those medical students, who from their early years give an idea of the professionals they will become. I think my best program was the SIAC Emerging Leaders, a group of at least 30 young people under 35 years old, from all over Latin America, who have shown that cooperation, research and science are guaranteed, all of them have created, together with their mentors, the NET-Heart Project «Neglected tropical diseases and their impact on cardiovascular health» with a total of 19 scientific publications, whose rationale I will cite in this editorial²⁰ and culminating in a book sponsored by Elsevier, is the icing on the cake of two years of intense cooperative work in Latin America.

What is my vision Eduardo? of a Latin America without borders, without differences, united by the passion of our lives «Cardiology», showing the rest of the world what we are capable of doing and, of course, showing where we are going, the answer after more than more than 30 scientific publications, the blue book (SIAC’s Cardiology textbook, with more than 250 Latin American authors) and others, have shown that Latin American cooperation today is an indestructible reality and that it will surely give us great satisfaction.