Hypertriglyceridämie: prognostische Bedeutung und Therapiemöglichkeiten

Zusammenfassung

Eine erhöhte Plasmakonzentration triglyceridreicher Lipoproteine ist mit einem erhöhten kardiovaskulären Risiko und überdies bei vielen Patienten auch mit weiteren kardiovaskulären Risikofaktoren wie Adipositas, arterieller Hypertonie und pathologischer Glukosetoleranz vergesellschaftet. Entscheidend für die Beurteilung des individuellen Risikos eines Patienten mit erhöhten Triglyceridwerten ist nicht allein die Höhe der Triglyceride sondern neben LDL- und HDL-Cholesterin auch das Vorliegen von Begleiterkrankungen, die Zusammensetzung der triglyceridreichen Lipoproteine und eine positive Familienanamnese für eine frühzeitige koronare Herzerkrankung. Vorrangige Therapieziele bei der Behandlung sind die Reduktion des kardiovaskulären Risikos und die Prävention Triglycerid-assoziierter Komplikationen wie des Chylomikronämiesyndroms. Die wesentliche Maßnahme zur Behandlung einer Hypertriglyceridämie besteht in einer dauerhaften Umstellung des Lebensstils (kalorien- und fettreduzierte Ernährung, Verzicht auf Alkohol, vermehrte körperliche Aktivität, Gewichtsreduktion, Rauchverzicht). Wenn Allgemein- und Lebensstilmaßnahmen keine ausreichende Triglyceridsenkung bewirken, muss eine medikamentöse Therapie erwogen werden. Hierfür stehen Nicotinsäure, Fibrate und Omega-3-Säurenethylester zur Verfügung. Zusätzlich zur Senkung der Triglyceridwerte ist eine Senkung des Non-HDL-Cholesterins durch Statine zur Risikoreduktion indiziert.

Abstract

Elevated Triglyceride levels are associated with increased risk for atherosclerotic disease and additional vascular risk factors such as obesity, hypertension and impaired glucose tolerance. To estimate the individual cardiovascular risk of a patient with elevated triglycerides LDL- and HDL-cholesterol levels, concomitant diseases, composition of triglyceride rich lipoproteins and a family history for premature coronary heart disease are important. Primary goals for the management of hypertriglyceridemia are a reduction of cardiovascular risk and prevention of triglyceride associated complications such as the chylomicronemia syndrome. The basis of treatment are lifestyle changes: dietary intervention, alcohol avoidance, regular physical activity, weight loss and smoking cessation to modify risk factors. If triglyceride levels can not be sufficiently reduced by lifestyle intervention pharmacotherapy (nicotinic acid, fibrates and omega-3-acid ethyl esters) is indicated. Beyond reduction of triglyceride levels optimization of non-HDL-cholesterol by statin treatment is warranted to reduce vascular risk.

Schlüsselwörter

Hypertriglyceridämie - kardiovaskuläres Risiko - Lebensstilmaßnahmen - Pharmakotherapie

Keywords

hypertriglyceridemia - cardiovascular risk - lifestyle intervention - pharmacotherapy

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