Cardiovascular diseases (CVD) remain the leading cause of death worldwide and pharmacotherapy of most of them is still suboptimal, in spite of the improvement of care in the past decades. Thus, there is a clear need to identify new pharmacological targets, to develop new pharmacological treatments and re-purpose ‘old’ drugs in new contexts. This review summarizes the most recent and relevant advances in cardiovascular pharmacology including the approval of first-in-class drugs that open new avenues for the treatment of cardiomyopathies, diabetes, heart failure. Fixed dose drug combinations repurposing "old" drugs have also recently been tested and showed an improved safety and efficacy at affordable prices for the health system, especially of low-income countries were CVD are impressively raising. The near future will also disclose whether FXI(a) blockade keeps the promise of being a bleeding-free antithrombotic strategy.