Die polyvaskuläre Erkrankung – eine Übersicht über die Datenlage und Managementstrategien

Zusammenfassung

Als die polyvaskuläre Erkrankung (PVE) wird eine relevante Atherosklerose in 2 oder mehr Gefäßregionen bezeichnet. Die möglichen Gefäßregionen sind die Koronarien, zerebrovaskuläre und periphere Gefäße, welche häufig gleichzeitig betroffen sind. Dieses Patientenkollektiv hat ein relevant erhöhtes Risiko für zukünftige kardiovaskuläre Ereignisse und Letalität und sollte eine intensive Primär- und Sekundärprävention erhalten. Neue individuelle Therapiestrategien beinhalten intensivierte antithrombotische und lipidsenkende Maßnahmen und die optimale Einstellung eines Diabetes mellitus. Zur interventionellen Versorgung bei häufig hohem OP-Risiko steht ein breites Spektrum in allen Gefäßgebieten zur Verfügung.

Abstract

Polyvascular disease (PVD) is defined as relevant atherosclerosis in two or more vascular regions. The possible vascular regions are the coronary, cerebrovascular and peripheral vessels, which are often affected simultaneously. This patient population has a relevant increased risk for future cardiovascular events and mortality and should receive intensive primary and secondary prevention. New individual therapeutic strategies include intensified antithrombotic and lipid-lowering measures and optimal management of diabetes mellitus. A broad spectrum of interventional care is available in all vascular areas, often with a high risk of surgery.

Was ist wichtig?

• Die Reduktion der Lebenserwartung von Patienten mit KHK oder PAVK ist besonders hoch, wenn atherosklerotische Läsionen in verschiedenen Gefäßregionen vorliegen (polyvaskuläre Erkrankung).

• Diese Patienten bedürfen gezielter präventiver Maßnahmen einschließlich einer präventiv wirksamen Medikation zur Einstellung der Risikofaktoren.

• Eine zentrale Rolle in der Therapie der polyvaskulären Erkrankung kommt dem intensivierten antithrombotischen, lipidsenkenden und antidiabetischen Management zu.

Schlüsselwörter

polyvaskuläre Erkrankung - kardiovaskuläre Prognose - präventive Maßnahmen - Risikofaktoren

Keywords

polyvascular disease - cardiovascular prognosis - preventative measures - risk factors

Publication History

Article published online:
12 April 2022

• Literatur

• 1 Aboyans V, Ricco JB, Bartelink MEL. et al. 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteriesEndorsed by: the European Stroke Organization (ESO)The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS). Eur Heart J 2018; 39: 763-816 DOI: 10.1093/eurheartj/ehx095. (PMID: 28886620)
• 2 Gutierrez JA, Aday AW, Patel MR. et al. Polyvascular Disease: Reappraisal of the Current Clinical Landscape. Circ Cardiovasc Interv 2019; 12: e007385 DOI: 10.1161/CIRCINTERVENTIONS.119.007385. (PMID: 31833412)
• 3 Alkhalil M, Kuzemczak M, Whitehead N. et al. Meta-Analysis of Intensive Lipid-Lowering Therapy in Patients With Polyvascular Disease. J Am Heart Assoc 2021; 10: e017948 DOI: 10.1161/JAHA.120.017948. (PMID: 33586467)
• 4 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 DOI: 10.1161/CIRCULATIONAHA.117.032235. (PMID: 29133605)
• 5 Gutierrez JA, Scirica BM, Bonaca MP. et al. Prevalence and Outcomes of Polyvascular (Coronary, Peripheral, or Cerebrovascular) Disease in Patients With Diabetes Mellitus (From the SAVOR-TIMI 53 Trial). Am J Cardiol 2019; 123: 145-152 DOI: 10.1016/j.amjcard.2018.09.014. (PMID: 30366601)
• 6 Verma S, Bhatt DL, Bain SC. et al. Effect of Liraglutide on Cardiovascular Events in Patients With Type 2 Diabetes Mellitus and Polyvascular Disease: Results of the LEADER Trial. Circulation 2018; 137: 2179-2183 DOI: 10.1161/CIRCULATIONAHA.118.033898. (PMID: 29760228)
• 7 Bonaca MP, Gutierrez JA, Cannon C. et al. Polyvascular disease, type 2 diabetes, and long-term vascular risk: a secondary analysis of the IMPROVE-IT trial. Lancet Diabetes Endocrinol 2018; 6: 934-943 DOI: 10.1016/S2213-8587(18)30290-0. (PMID: 30396865)
• 8 Colantonio LD, Hubbard D, Monda KL. et al. Atherosclerotic Risk and Statin Use Among Patients With Peripheral Artery Disease. J Am Coll Cardiol 2020; 76: 251-264 DOI: 10.1016/j.jacc.2020.05.048. (PMID: 32674789)
• 9 Dikilitas O, Satterfield BA, Kullo IJ. Risk Factors for Polyvascular Involvement in Patients With Peripheral Artery Disease: A Mendelian Randomization Study. J Am Heart Assoc 2020; 9: e017740 DOI: 10.1161/JAHA.120.017740. (PMID: 33287626)
• 10 Vlachopoulos C, Aznaouridis K, O’Rourke MF. et al. Prediction of cardiovascular events and all-cause mortality with central haemodynamics: a systematic review and meta-analysis. Eur Heart J 2010; 31: 1865-1871 DOI: 10.1093/eurheartj/ehq024. (PMID: 20197424)
• 11 Zhao B, Hong Z, Wei Y. et al. Erectile Dysfunction Predicts Cardiovascular Events as an Independent Risk Factor: A Systematic Review and Meta-Analysis. J Sex Med 2019; 16: 1005-1017 DOI: 10.1016/j.jsxm.2019.04.004. (PMID: 31104857)
• 12 Vlachopoulos CV, Terentes-Printzios DG, Ioakeimidis NK. et al. Prediction of cardiovascular events and all-cause mortality with erectile dysfunction: a systematic review and meta-analysis of cohort studies. Circ Cardiovasc Qual Outcomes 2013; 6: 99-109 DOI: 10.1161/CIRCOUTCOMES.112.966903. (PMID: 23300267)
• 13 van Engelen A, Wannarong T, Parraga G. et al. Three-dimensional carotid ultrasound plaque texture predicts vascular events. Stroke 2014; 45: 2695-2701 DOI: 10.1161/STROKEAHA.114.005752. (PMID: 25034714)
• 14 Aboyans V, Lacroix P. Indications for carotid screening in patients with coronary artery disease. Presse Med 2009; 38: 977-986 DOI: 10.1016/j.lpm.2009.02.015. (PMID: 19376684)
• 15 Hodis HN, Mack WJ, LaBree L. et al. The role of carotid arterial intima-media thickness in predicting clinical coronary events. Ann Intern Med 1998; 128: 262-269 DOI: 10.7326/0003-4819-128-4-199802150-00002. (PMID: 9471928)
• 16 Liu D, Du C, Shao W. et al. Diagnostic Role of Carotid Intima-Media Thickness for Coronary Artery Disease: A Meta-Analysis. Biomed Res Int 2020; 2020: 9879463 DOI: 10.1155/2020/9879463. (PMID: 32185231)
• 17 Bots ML, Baldassarre D, Simon A. et al. Carotid intima-media thickness and coronary atherosclerosis: weak or strong relations?. Eur Heart J 2007; 28: 398-406 DOI: 10.1093/eurheartj/ehl482. (PMID: 17277033)
• 18 Salonen JT, Salonen R. Ultrasonographically assessed carotid morphology and the risk of coronary heart disease. Arterioscler Thromb 1991; 11: 1245-1249 DOI: 10.1161/01.atv.11.5.1245. (PMID: 1911709)
• 19 Chambless LE, Heiss G, Folsom AR. et al. Association of coronary heart disease incidence with carotid arterial wall thickness and major risk factors: the Atherosclerosis Risk in Communities (ARIC) Study, 1987–1993. Am J Epidemiol 1997; 146: 483-494 DOI: 10.1093/oxfordjournals.aje.a009302. (PMID: 9290509)
• 20 Lorenz MW, Markus HS, Bots ML. et al. Prediction of clinical cardiovascular events with carotid intima-media thickness: a systematic review and meta-analysis. Circulation 2007; 115: 459-467 DOI: 10.1161/CIRCULATIONAHA.106.628875. (PMID: 17242284)
• 21 Knuuti J, Wijns W, Saraste A. et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J 2020; 41: 407-477 DOI: 10.1093/eurheartj/ehz425. (PMID: 31504439)
• 22 Perrone-Filardi P, Achenbach S, Möhlenkamp S. et al. Cardiac computed tomography and myocardial perfusion scintigraphy for risk stratification in asymptomatic individuals without known cardiovascular disease: a position statement of the Working Group on Nuclear Cardiology and Cardiac CT of the European Society of Cardiology. Eur Heart J 2011; 32: 1986-1993b DOI: 10.1093/eurheartj/ehq235.
• 23 Jönelid B, Kragsterman B, Berglund L. et al. Low Walking Impairment Questionnaire score after a recent myocardial infarction identifies patients with polyvascular disease. JRSM Cardiovasc Dis 2019; 8: 2048004019841971 DOI: 10.1177/2048004019841971. (PMID: 31019682)
• 24 Roffi M, Radovanovic D, Iglesias JF. et al. Multisite vascular disease in acute coronary syndromes: increased in-hospital mortality and no improvement over time. Eur Heart J Acute Cardiovasc Care 2020; 9: 748-757 DOI: 10.1177/2048872618814708. (PMID: 30516390)
• 25 Ferreira-González I, Permanyer Miralda G, Heras M. et al. Prognosis and management of patients with acute coronary syndrome and polyvascular disease. Rev Esp Cardiol 2009; 62: 1012-1021 DOI: 10.1016/s1885-5857(09)73267-0. (PMID: 19712622)
• 26 Frank U, Nikol S, Belch J. 5 Conservative treatment for PAD – Risk factor management. Vasa 2019; 48: 1-12 DOI: 10.1024/0301-1526/a000835. (PMID: 31578114)
• 27 Naylor AR, Ricco JB, de Borst GJ. et al. Editor’s Choice – Management of Atherosclerotic Carotid and Vertebral Artery Disease: 2017 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 2018; 55: 3-81 DOI: 10.1016/j.ejvs.2017.06.021. (PMID: 28851594)
• 28 Aday AW, Matsushita K. Epidemiology of Peripheral Artery Disease and Polyvascular Disease. Circ Res 2021; 128: 1818-1832 DOI: 10.1161/CIRCRESAHA.121.318535. (PMID: 34110907)
• 29 Chen ST, Hellkamp AS, Becker RC. et al. Impact of polyvascular disease on patients with atrial fibrillation: Insights from ROCKET AF. Am Heart J 2018; 200: 102-109 DOI: 10.1016/j.ahj.2018.02.013. (PMID: 29898836)
• 30 Eikelboom JW, Connolly SJ, Bosch J. et al. Rivaroxaban with or without Aspirin in Stable Cardiovascular Disease. N Engl J Med 2017; 377: 1319-1330 DOI: 10.1056/NEJMoa1709118. (PMID: 28844192)
• 31 Steffel J, Eikelboom JW, Anand SS. et al. The COMPASS Trial: Net Clinical Benefit of Low-Dose Rivaroxaban Plus Aspirin as Compared With Aspirin in Patients With Chronic Vascular Disease. Circulation 2020; 142: 40-48 DOI: 10.1161/CIRCULATIONAHA.120.046048. (PMID: 32436455)
• 32 Stoekenbroek RM, Boekholdt SM, Fayyad R. et al. High-dose atorvastatin is superior to moderate-dose simvastatin in preventing peripheral arterial disease. Heart 2015; 101: 356-362 DOI: 10.1136/heartjnl-2014-306906. (PMID: 25595417)
• 33 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 DOI: 10.1093/eurheartj/ehz455. (PMID: 31504418)
• 34 Alkhalil M. Effects of intensive lipid-lowering therapy on mortality after coronary bypass surgery: A meta-analysis of 7 randomised trials. Atherosclerosis 2020; 293: 75-78 DOI: 10.1016/j.atherosclerosis.2019.12.006. (PMID: 31865057)
• 35 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 DOI: 10.1056/NEJMoa1615664. (PMID: 28304224)
• 36 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 DOI: 10.1056/NEJMoa1410489. (PMID: 26039521)
• 37 Navarese EP, Robinson JG, Kowalewski M. et al. Association Between Baseline LDL-C Level and Total and Cardiovascular Mortality After LDL-C Lowering: A Systematic Review and Meta-analysis. JAMA 2018; 319: 1566-1579 DOI: 10.1001/jama.2018.2525. (PMID: 29677301)
• 38 Cosentino F, Grant PJ, Aboyans V. et al. 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J 2020; 41: 255-323 DOI: 10.1093/eurheartj/ehz486. (PMID: 31497854)
• 39 Zinman B, Wanner C, Lachin JM. et al. Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes. N Engl J Med 2015; 373: 2117-2128 DOI: 10.1056/NEJMoa1504720. (PMID: 26378978)
• 40 Marso SP, Daniels GH, Brown-Frandsen K. et al. Liraglutide and Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med 2016; 375: 311-322 DOI: 10.1056/NEJMoa1603827. (PMID: 27295427)
• 41 Marso SP, Bain SC, Consoli A. et al. Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes. N Engl J Med 2016; 375: 1834-1844 DOI: 10.1056/NEJMoa1607141. (PMID: 27633186)
• 42 Gerstein HC, Colhoun HM, Dagenais GR. et al. Dulaglutide and cardiovascular outcomes in type 2 diabetes (REWIND): a double-blind, randomised placebo-controlled trial. Lancet 2019; 394: 121-130 DOI: 10.1016/S0140-6736(19)31149-3. (PMID: 31189511)
• 43 Dencker D, Pedersen F, Engstrøm T. et al. Major femoral vascular access complications after coronary diagnostic and interventional procedures: A Danish register study. Int J Cardiol 2016; 202: 604-608 DOI: 10.1016/j.ijcard.2015.09.018. (PMID: 26447671)
• 44 Conte MS, Bradbury AW, Kolh P. et al. Global Vascular Guidelines on the Management of Chronic Limb-Threatening Ischemia. Eur J Vasc Endovasc Surg 2019; 58: S1-S109.e33 DOI: 10.1016/j.ejvs.2019.05.006. (PMID: 31182334)
• 45 Eckstein HH, Kühnl A, Berkefeld J. et al. S3-Leitlinie „Diagnostik, Therapie und Nachsorge der extrakraniellen Karotisstenose“. 2020 Accessed February 02, 2022 at: https://www.awmf.org/uploads/tx_szleitlinien/004-028l_extracranielle-Carotisstenose-Diagnostik-Therapie-Nachsorge_2020-02_03.pdf