Lipid-Management 2020 – medikamentöse Therapie und Lipidapherese im Kontext

Was ist neu?

Medikamentöse Therapie Die aktualisierte Dyslipidämie-Leitlinie der European Society of Cardiology senkt nochmals die LDL-Cholesterinzielwerte. Zur Erreichung dieser Zielwerte werden hochpotente Statine und vermehrt Kombinationspartner wie Ezetimib und PCSK9-Hemmer nötig werden.

Lipidapherese Die Bestimmung von Lipoprotein(a) zur kardiovaskulären Risikostratifizierung ist nun eine Klasse-II(a)-Empfehlung. Momentan steht lediglich die Lipidapherese zur Senkung von Lipoprotein(a) zur Verfügung, neue medikamentöse Therapieansätze sind allerdings in der klinischen Erprobung.

Abstract

The recently updated 2019 European Society of Cardiology/European Atherosclerosis Society Guidelines for the management of dyslipidaemias set new, ambitious goals for lipid lowering based on recently generated evidence from large outcome trials. Noninvasive imaging as well as measurement of lipoprotein(a) as a non-traditional risk factor is advocated for the refinement of risk stratification. A highly potent statin – defined as a drug that lowers LDL-cholesterol by 50 % from baseline – is recommended as the standard choice of treatment, whenever medical lipid lowering is indicated. Combining different therapeutic strategies such as a statin with ezetimibe and/or a Proproteinkonvertase Subtilisin Kexin Type 9 inhibitor allows to achieve the new treatment targets. If needed, lipid apheresis can complement the medical armamentarium. Moreover, lipid apheresis remains the only approved treatment modality for lowering lipoprotein(a), however medical treatments are under current investigation.

Schlüsselwörter

Lipoprotein(a) - Lipidapherese - PCSK9

Key words

lipoprotein(a) - lipid apheresis - PCSK9

Publication History

Article published online:
01 April 2020

• Literatur

• 1 Mach F, Baigent C, Catapano AL. et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J 2020; 41: 111-188
• 2 Schwartz GG, Steg PG, Szarek M. et al. Alirocumab and Cardiovascular Outcomes after Acute Coronary Syndrome. N Engl J Med 2018; 379: 2097-2107
• 3 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
• 4 Cannon CP, Blazing MA, Giugliano RP. et al. Ezetimibe Added to Statin Therapy after Acute Coronary Syndromes. N Engl J Med 2015; 372: 2387-2397
• 5 Weng TC, Yang YH, Lin SJ. et al. A systematic review and meta-analysis on the therapeutic equivalence of statins. J Clin Pharm Ther 2010; 35: 139-151
• 6 Spitzenverband Bund der Krankenkassen, Kassenärztliche Bundesvereinigung. Rahmenvertrag nach § 84 Abs. 6 SGB V – Arzneimittel – für das Jahr 2020. https://www.kbv.de/media/sp/Rahmenvorgaben_Arzneimittel.pdf . Stand: 12.2.2020
• 7 Deutsche Gesellschaft für Nephrologie. Der Apherese-Standard der Deutschen Gesellschaft für Nephrologie. https://www.dgfn.eu/apherese-standard.html . Stand: 12.2.2020
• 8 Waldmann E, Parhofer KG. Lipoprotein apheresis to treat elevated lipoprotein (a). J Lipid Res 2016; 57: 1751-1757
• 9 Leebmann J, Roeseler E, Julius U. et al. Lipoprotein apheresis in patients with maximally tolerated lipid-lowering therapy, lipoprotein(a)-hyperlipoproteinemia, and progressive cardiovascular disease: prospective observational multicenter study. Circulation 2013; 128: 2567-2576
• 10 Schettler VJJ, Neumann CL, Peter C. et al. The German Lipoprotein Apheresis Registry (GLAR) – almost 5 years on. Clin Res Cardiol Suppl 2017; 12: 44-49
• 11 Thompson G, Parhofer KG. Current Role of Lipoprotein Apheresis. Curr Atheroscler Rep 2019; 21: 26
• 12 Reddy YNV, Obokata M, Dean PG. et al. Long-term cardiovascular changes following creation of arteriovenous fistula in patients with end stage renal disease. Eur Heart J 2017; 38: 1913-1923
• 13 Ray KK, Bays HE, Catapano AL. et al. Safety and Efficacy of Bempedoic Acid to Reduce LDL Cholesterol. N Engl J Med 2019; 380: 1022-1032
• 14 Laufs U, Banach M, Mancini GBJ. et al. Efficacy and Safety of Bempedoic Acid in Patients With Hypercholesterolemia and Statin Intolerance. J Am Heart Assoc 2019; 8: e011662
• 15 Ballantyne CM, Banach M, Mancini GBJ. et al. Efficacy and safety of bempedoic acid added to ezetimibe in statin-intolerant patients with hypercholesterolemia: A randomized, placebo-controlled study. Atherosclerosis 2018; 277: 195-203
• 16 O’Donoghue ML, Fazio S, Giugliano RP. et al. Lipoprotein(a), PCSK9 Inhibition, and Cardiovascular Risk. Circulation 2019; 139: 1483-1492
• 17 Ray KK, Vallejo-Vaz AJ, Ginsberg HN. et al. Lipoprotein(a) reductions from PCSK9 inhibition and major adverse cardiovascular events: Pooled analysis of alirocumab phase 3 trials. Atherosclerosis 2019; 288: 194-202
• 18 Stiekema LCA, Stroes ESG, Verweij SL. et al. Persistent arterial wall inflammation in patients with elevated lipoprotein(a) despite strong low-density lipoprotein cholesterol reduction by proprotein convertase subtilisin/kexin type 9 antibody treatment. Eur Heart J 2019; 40: 2775-2781
• 19 Madsen CM, Kamstrup PR, Langsted A. et al. Lp(a) (Lipoprotein[a])-Lowering by 50 mg/dL (105 nmol/L) May Be Needed to Reduce Cardiovascular Disease 20% in Secondary Prevention: A Population-Based Study. Arterioscler Thromb Vasc Biol 2020; 40: 255-266
• 20 Viney NJ, van Capelleveen JC, Geary RS. et al. Antisense oligonucleotides targeting apolipoprotein(a) in people with raised lipoprotein(a): two randomised, double-blind, placebo-controlled, dose-ranging trials. Lancet 2016; 388: 2239-2253