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Kardiologie up2date 2018; 14(04): 331-342
DOI: 10.1055/a-0662-1062
Koronare Herzkrankheit (KHK)
Georg Thieme Verlag KG Stuttgart · New York

Prävention kardiovaskulärer Erkrankungen durch medikamentöse LDL-Cholesterin-Senkung

Corinna Lebherz
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Publication History

Publication Date:
11 December 2018 (online)

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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.
Kernaussagen

  • 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.

Schlüsselwörter

Hypercholesterinämie - kardiovaskuläres Risiko - medikamentöse Therapie - Statinunverträglichkeit - PCSK9-Inhibitoren
 

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