Subscribe to RSS
DOI: 10.1055/a-0662-1062
Prävention kardiovaskulärer Erkrankungen durch medikamentöse LDL-Cholesterin-Senkung
Publication History
Publication Date:
11 December 2018 (online)
![](https://www.thieme-connect.de/media/kardiologie-u2d/201804/lookinside/thumbnails/10-1055-a-0662-1062_kd6621062_lebherz-1.jpg)
Die Hypercholesterinämie ist ein entscheidender Risikofaktor für die Entstehung einer Makroangiopathie. Die Risikostratifizierung sowie die aktuellen Behandlungsmöglichkeiten der Hypercholesterinämie mit Fokus auf die Primär- und Sekundärprophylaxe kardiovaskulärer Erkrankungen werden in diesem Beitrag erläutert.
-
Die Senkung des LDL-Cholesterins stellt weiterhin einen zentralen Baustein in der kardiovaskulären Primär- und Sekundärprophylaxe dar.
-
Da neben dem kausalen auch ein kumulativer Zusammenhang zwischen LDL-Cholesterin und kardiovaskulären Erkrankungen besteht, muss eine dauerhafte Therapie angestrebt werden.
-
Die Therapie basiert auf einem Stufenschema, bei dem hochpotente Statine als Basistherapie eingesetzt und zielwertorientiert durch Ezetimib und/oder PCSK9-Inhibitoren ergänzt werden sollten.
-
Aufgrund der hohen Kosten der PCSK9-Inhibitoren sollten diese primär in der Sekundärprävention individualisiert anhand für diese Medikamentengruppe speziell entwickelter Richtlinien eingesetzt werden.
-
Die Lipidapherese kann in therapierefraktären Fällen als „Ultima Ratio“ angeboten werden.
-
Literatur
- 1 Langlois MR, Chapman MJ, Cobbaert C. et al. Quantifying Atherogenic Lipoproteins: Current and Future Challenges in the Era of Personalized Medicine and Very Low Concentrations of LDL Cholesterol. A Consensus Statement from EAS and EFLM. Clin Chem 2018; 64: 1006-1033
- 2 Ference BA, Ginsberg HN, Graham I. et al. Low-density lipoproteins cause atherosclerotic cardiovascular disease. 1. Evidence from genetic, epidemiologic, and clinical studies. A consensus statement from the European Atherosclerosis Society Consensus Panel. Eur Heart J 2017; 38: 2459-2472
- 3 Scheidt-Nave C. et al. Verbreitung von Fettstoffwechselstörungen bei Erwachsenen in Deutschland. Robert Koch-Institut: Epidemiologie und Gesundheitsberichterstattung; 2013
- 4 Wang J, Dron JS, Ban MR. et al. Polygenic Versus Monogenic Causes of Hypercholesterolemia Ascertained Clinically. Arterioscler Thromb Vasc Biol 2016; 36: 2439-2445
- 5 Catapano AL, Graham I, De Backer G. et al. 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias: The Task Force for the Management of Dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS) Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Atherosclerosis 2016; 253: 281-344
- 6 Nordestgaard BG, Chapman MJ, Humphries SE. et al. Familial hypercholesterolaemia is underdiagnosed and undertreated in the general population: guidance for clinicians to prevent coronary heart disease: consensus statement of the European Atherosclerosis Society. Eur Heart J 2013; 34: 3478-3490a
- 7 Landmesser U, Chapman MJ, Stock JK. et al. 2017 Update of ESC/EAS Task Force on practical clinical guidance for proprotein convertase subtilisin/kexin type 9 inhibition in patients with atherosclerotic cardiovascular disease or in familial hypercholesterolaemia. Eur Heart J 2018; 39: 1131-1143
- 8 Catapano AL, Graham I, De Backer G. et al. 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias. Rev Esp Cardiol 2017; 70: 115
- 9 Baigent C, Keech A, Kearney PM. et al. Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins. Lancet 2005; 366: 1267-1278
- 10 Mihaylova B, Emberson J, Blackwell L. et al. The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: meta-analysis of individual data from 27 randomised trials. Lancet 2012; 380: 581-590
- 11 Ford I, Murray H, McCowan C. et al. Long-Term Safety and Efficacy of Lowering Low-Density Lipoprotein Cholesterol With Statin Therapy: 20-Year Follow-Up of West of Scotland Coronary Prevention Study. Circulation 2016; 133: 1073-1080
- 12 Chodick G, Shalev V, Gerber Y. et al. Long-term persistence with statin treatment in a not-for-profit health maintenance organization: a population-based retrospective cohort study in Israel. Clin Ther 2008; 30: 2167-2179
- 13 El-Salem K, Ababneh B, Rudnicki S. et al. Prevalence and risk factors of muscle complications secondary to statins. Muscle Nerve 2011; 44: 877-881
- 14 Stroes ES, Thompson PD, Corsini A. et al. Statin-associated muscle symptoms: impact on statin therapy-European Atherosclerosis Society Consensus Panel Statement on Assessment, Aetiology and Management. Eur Heart J 2015; 36: 1012-1022
- 15 Laufs U, Scharnagl H, Halle M. et al. Treatment Options for Statin-Associated Muscle Symptoms. Dtsch Arztebl Int 2015; 112: 748-755
- 16 Sattar N, Preiss D, Murray HM. et al. Statins and risk of incident diabetes: a collaborative meta-analysis of randomised statin trials. Lancet 2010; 375: 735-742
- 17 Spinar J, Spinarova L, Vitovec J. [IMProved Reduction of Outcomes: Vytorin Efficacy International Trial (studie IMPROVE-IT)]. Vnitr Lek 2014; 60: 1095-1101
- 18 Bohula EA, Morrow DA, Giugliano RP. et al. Atherothrombotic Risk Stratification and Ezetimibe for Secondary Prevention. J Am Coll Cardiol 2017; 69: 911-921
- 19 Landmesser U, Chapman MJ, Stock JK. et al. 2017 Update of ESC/EAS Task Force on practical clinical guidance for proprotein convertase subtilisin/kexin type 9 inhibition in patients with atherosclerotic cardiovascular disease or in familial hypercholesterolaemia. Eur Heart J 2018; 39: 1131-1143
- 20 Sabatine MS, Giugliano RP, Keech AC. et al. Evolocumab and Clinical Outcomes in Patients with Cardiovascular Disease. N Engl J Med 2017; 376: 1713-1722
- 21 Sabatine MS, De Ferrari GM, Giugliano RP. et al. Clinical Benefit of Evolocumab by Severity and Extent of Coronary Artery Disease: An Analysis from FOURIER. Circulation 2018; 138: 756-766
- 22 Bonaca MP, Nault P, Giugliano RP. et al. Low-Density Lipoprotein Cholesterol Lowering With Evolocumab and Outcomes in Patients With Peripheral Artery Disease: Insights From the FOURIER Trial (Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Subjects With Elevated Risk). Circulation 2018; 137: 338-350