Praktisches Vorgehen bei Hyperlipidämien

Abstract

Cardiovascular disease due to atherosclerosis is an important cause of premature mortality and morbidity in Europe. There are many causes for developing cardiovascular disease. One important risk factor is hyperlipidemia, i. e. an increased concentration of total cholesterol, LDL-cholesterol and triglycerides. This update will focus on the treatment of hypercholesterinemia and hypertriglyceridemia. General strategies for the treatment of hypercholesterinemia are: the total CV risk of the subject by using a SCORE model should be estimated. The LDL-C target should be defined depending on that risk. In patients at high CV risk a LDL-C goal of less than about 100 mg/dl, at very high risk (e. g. patients with diabetes and coronary heart disease) of less than about 70 mg/dl should be considered. Drug of choice is a statin which can lower LDL-C approximately 40 – 50 %. Statin induced myopathies are common (10 – 20 % of patients). Possible solutions of this problem are discussed. General strategies for the treatment of hypertriglyceridemia are lifestyle inventions such as weight loss, regular exercise and dietary changes including alcohol avoidance, measures that are especially important for patients with obesity, metabolic syndrome and type 2 diabetes. In subject at high total CV risk with triglycerides more than ~ 200 mg/dl who cannot lower them by lifestyle interventions, drug treatment may be considered. Since the effects of statins on mortality and morbidity have been proven, they are the drugs of choice for the treatment of hypertriglyceridemia. Further options are fibrates and omega-3-fatty acids, but not nicotinic acid which has been withdrawn from the market.

• Literatur

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