Der Internist

, Volume 49, Issue 2, pp 154–161

Prävention der koronaren Herzerkrankung

Schwerpunkt: Prävention in der Inneren Medizin
  • 204 Downloads

Zusammenfassung

Atherosklerotische Gefäßerkrankungen im Allgemeinen und die koronare Herzerkrankung im Besonderen sind in westlichen Industrienationen die häufigsten Ursachen für den Verlust der Leistungsfähigkeit, die Verminderung der Lebensqualität und vorzeitigen Tod. Obwohl es sich in den meisten Fällen um vermeidbare Erkrankungen handelt, ist ihre Häufigkeit in den westlich industrialisierten Ländern immer noch inakzeptabel. Bei konsequenter Umsetzung der Empfehlungen zur Prävention zu den Lebensstilaspekten Rauchen, Ernährung, Gewicht und körperliche Aktivität könnten bereits mehr als die Hälfte der atherosklerotischen Erkrankungen in der Bundesrepublik vermieden werden. Diese Übersichtsarbeit zur Prävention der koronaren Herzerkrankungen soll deshalb die wichtigsten Risikofaktoren für diese Erkrankungen in der Allgemeinbevölkerung benennen, ihre Pathophysiologie beleuchten und Wege zu deren Reduktion aufzeigen.

Schlüsselwörter

Prävention Koronare Herzerkrankung Lebensstil Körperliche Aktivität 

Prevention of coronary artery disease

Abstract

Coronary artery disease is still the leading cause of premature death, reduction in physical work capacity and diminished quality of life in western civilizations. Given the fact that coronary artery disease is a preventable disease in most of the cases, its prevalence remains unacceptably high. Consequent application of preventive recommendations with regards to life-style aspects like tobacco use, nutrition, overweight and physical activity could help to reduce the prevalence of atherosclerotic diseases by half. Aim of this review is to focus the reader’s attention to the most important risk factors, their influence on progression of atherosclerotic lesions and ways to reduce risk factor burden.

Keywords

Prevention Coronary artery disease Life-style Physical activity 

Literatur

  1. 1.
    Adams V, Linke A, Kränkel N et al.(2005). Impact of regular physical activity on the NAD(P)H oxidase and angiotensin receptor system in patients with coronary artery disease. Circulation 111: 555–562PubMedCrossRefGoogle Scholar
  2. 2.
    Ambrose JA, Barua RS (2004) The pathophysiology of cigarette smoking and cardiovascular disease: an update. J Am Coll Cardiol 43: 1731–1737PubMedCrossRefGoogle Scholar
  3. 3.
    Arzneimittelkommission der deutschen Ärzteschaft (2003) Deutschland ist Europameister – sowohl bei der Häufigkeit als auch in der mangelhaften Kontrolle des Bluthochdrucks. AkdÄ Newsletter 040/03Google Scholar
  4. 4.
    Assmann G, Cullen P, Schulte H (2002) Simple scoring scheme for calculating the risk of acute coronary events based on the 10-year follow-up of the prospective cardiovascular Münster (PROCAM) study. Circulation 105: 310–315PubMedCrossRefGoogle Scholar
  5. 5.
    Barua RS, Ambrose JA, Saha DC et al. (2002) Smoking is associated with altered endothelialderived fibrinolytic and antithrombotic factors: an in vitro demonstration. Circulation 106: 905–908PubMedCrossRefGoogle Scholar
  6. 6.
    Berenson GS, Srinivasan SR, Bao W et al. (1998) Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. The Bogalusa Heart Study. N Engl J Med 338: 1650–1566PubMedCrossRefGoogle Scholar
  7. 7.
    Bergmann KE, Mensink GBM (1999) Körpermaße und Übergewicht. Gesundheitswesen 61: S115–S120PubMedGoogle Scholar
  8. 8.
    Booth FW, Gordon SE, Carlson CJ et al. (2000) Waging war on modern chronic diseases: primary prevention through exercise biology. J Appl Physiol 88: 774–787PubMedGoogle Scholar
  9. 9.
    Chapman MJ, Assmann G, Fruchart JC et al. European Consensus Panel on HDL-C (2004) Raising high-density lipoprotein cholesterol with reduction of cardiovascular risk: the role of nicotinic acid – a position paper developed by the European consensus panel on HDL-C. Curr Med Res Opin 20: 1253–1268PubMedCrossRefGoogle Scholar
  10. 10.
    Choi D, Kim SK, Choi SH et al. (2004) Preventive effects of rosiglitazone on restenosis after coronary stent implantation in patients with type 2 diabetes. Diabetes Care 27: 2654–2660PubMedCrossRefGoogle Scholar
  11. 11.
    Conroy RM, Pyörälä K, Fitzgerald AP et al. (2003) Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. Eur Heart J 24: 987–1003PubMedCrossRefGoogle Scholar
  12. 12.
    DeFronzo RA, Ferrannini E (1991) Insulin resistance. A multifaceted syndrome responsible for NIDDM, obesity, hypertension, dyslipidemia and atherosclerotic cardiovascular disease. Diabetes Care 14: 173–194PubMedCrossRefGoogle Scholar
  13. 13.
    Deutsche Gesellschaft für Prävention und Rehabilitation Herz-Kreislauferkrankungen e.V., Deutsche Gesellschaft für Rehabilitationswissenschaften e.V., Deutsche Gesellschaft für Sportmedizin und Prävention e.V. (2007) Deutsche Leitlinie zur Rehabilitation von Patienten mit Herz-Kreislauferkrankungen (DLL-KardReha). Clin Res Cardiol (Suppl 2): III/1–III/54Google Scholar
  14. 14.
    EUROASPIRE I and II Group: European Action on Secondary Prevention by Intervention to Reduce Events (2001) Clinical reality of coronary prevention guidelines: a comparison of EUROASPIRE I and II in nine countries. Lancet 357: 995–1001CrossRefGoogle Scholar
  15. 15.
    EUROASPIRE II Study Group (2001) Lifestyle and risk factor management and use of drug therapies in coronary patients from 15 countries, principal results from EUROASPIRE II Euro Heart Survey Programme. Eur Heart J 22: 554–572CrossRefGoogle Scholar
  16. 16.
    Gohlke H, Schuler G (2003) Empfehlungen zur Prävention und evidenzbasierte Medizin. Z Kardiol 92: 522–524PubMedGoogle Scholar
  17. 17.
    Grundy SM, Hansen B, Smith SC et al.(2004) Clinical management of metabolic syndrome. Circulation 109: 551–556PubMedCrossRefGoogle Scholar
  18. 18.
    Hambrecht R, Adams V, Erbs S et al. (2003). Regular physical activity improves endothelial function in patients with coronary artery disease by increasing phosphorylation of endothelial nitric oxide synthase. Circulation 107: 3152–3158PubMedCrossRefGoogle Scholar
  19. 19.
    Hambrecht R, Wolff A, Gielen S et al. (2000) Effect of exercise on coronary endothelial function in patients with coronary artery disease. N Engl J Med 342: 454–460PubMedCrossRefGoogle Scholar
  20. 20.
    Haskell WL, Lee IM, Pate RR et al. American College of Sports Medicine; American Heart Association (2007) Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Circulation 116: 1081–1093PubMedCrossRefGoogle Scholar
  21. 21.
    Heart Protection Study Collaborative Group (2002) MRC/BHF Heart protection study of cholesterol lowering with simvastatin in 20,535 high-risk individuals: a randomised placebo-controlled trial. Lancet 360: 7–22CrossRefGoogle Scholar
  22. 22.
    Heidrich J, Liese AD, Kalic M et al. (2002) Sekundärprävention der koronaren Herzkrankheit – Ergebnisse der Euroaspire I- und II-Studien in der Region Münster, Germany. Dtsch Med Wochenschr 127: 667–672PubMedCrossRefGoogle Scholar
  23. 23.
    Kavey RE, Daniels SR, Lauer RM et al. American Heart Association (2003) American Heart Association guidelines for primary prevention of atherosclerotic cardiovascular disease beginning in childhood. Circulation 107: 1562–1566PubMedCrossRefGoogle Scholar
  24. 24.
    Kopelman PG (2000) Physiopathology of prolactin secretion in obesity. Int J Obes Relat Metab Disord 24 (Suppl 2): S104–108PubMedGoogle Scholar
  25. 25.
    Kuhlmann E (2003) Gender Mainstreaming in den Disease Management Programmen – Das Beispiel Koronare Herzerkrankung. http://www.zes.uni-bremen.de/~kuhlmann/expertise.pdfGoogle Scholar
  26. 26.
    Laufs U, Werner N, Link A et al. (2004) Physical training increases endothelial progenitor cells, inhibits neointima formation, and enhances angiogenesis. Circulation 109: 220–226PubMedCrossRefGoogle Scholar
  27. 27.
    Lavie CJ, Milani RV (1997) Effects of cardiac rehabilitation, exercise training, and weight reduction on exercise capacity, coronary risk factors, behavioral characteristics, and quality of life in obese coronary patients. Am J Cardiol 79: 397–401PubMedCrossRefGoogle Scholar
  28. 28.
    Löwel H, Stieber J, Koenig W et al. (1999) Das Diabetes-bedingte Herzinfarktrisiko in einer süddeutschen Bevölkerung: Ergebnisse der MONICA-Augsburg-Studien 1985–1994. Diabetes Stoffw 8: 11–21Google Scholar
  29. 29.
    Moschandreas J, Kafatos A, Aravanis C et al. (2005) Long-term predictors of survival for the Seven Countries Study cohort from Crete: from 1960 to 2000. Int J Cardiol 100: 85–91PubMedCrossRefGoogle Scholar
  30. 30.
    Paffenbarger RS, Hyde RT, Wing AL et al. (1986) Physical activity, all cause mortality, and longevity of college alumni. N Engl J Med 314: 605–613PubMedCrossRefGoogle Scholar
  31. 31.
    Pearson TA, Blair SN, Daniels SR et al. (2002) AHA guidelines for primary prevention of cardiovascular disease and stroke: 2002 update: consensus panel guide to comprehensive risk reduction for adult patients without coronary or other atherosclerotic vascular diseases. American Heart Association Science Advisory and Coordinating Committee. Circulation 106: 388–391PubMedCrossRefGoogle Scholar
  32. 32.
    Perticone F, Ceravolo R, Pujia A (2001)Prognostic significance of endothelial dysfunction in hypertensive patients. Circulation 104: 191–196PubMedGoogle Scholar
  33. 33.
    Pietinen P, Vartiainen E, Korhonen HJ et al. (1989) Nutrition as a component in community control of cardiovascular disease (the North Karelia Project). Am J Clin Nutr 49 (Suppl): 1017–1024PubMedGoogle Scholar
  34. 34.
    Rosengreen A, Hawken S, Ounpuu S et al. (2004)Association of psychosocial risk factors with risk of acute myocardial infarction in 11,119 cases and 13,648 controls from 52 countries (the INTERHEART study): case control study. Lancet 364: 953–962CrossRefGoogle Scholar
  35. 35.
    Ross R (1993) The pathogenesis of atherosclerosis: a perspective for the 1990s. Nature 362: 801–809PubMedCrossRefGoogle Scholar
  36. 36.
    Sandri M, Adams V, Gielen S et al. (2005) Effects of exercise and ischemia on mobilization and functional activation of blood-derived progenitor cells in patients with ischemic syndromes: results of 3 randomized studies. Circulation 111: 3391–3339PubMedCrossRefGoogle Scholar
  37. 37.
    Schächinger V, Britten MB, Zeiher AM (2000) Prognostic impact of coronary vasodilator dysfunction on adverse long-term outcome of coronary heart disease. Circulation 101: 1899–1906PubMedGoogle Scholar
  38. 38.
    Siegrist J (2006) Was trägt die Stressforschung zur Erklärung des sozialen Gradienten koronarer Herzkrankheit bei? Dtsch Med Wochenschr 131: 762–766PubMedCrossRefGoogle Scholar
  39. 39.
    Statistisches Bundesamt Deutschland (2004) Pressemitteilung vom 24.09.2004. http://www.destatis.de/presse/deutsch/pm2004/p4060092.htmGoogle Scholar
  40. 40.
    Statistisches Bundesamt Deutschland (2006) Gesundheitswesen. http://www.destatis.de/basi/d/gesu/gesutab19.phpGoogle Scholar
  41. 41.
    Strauer BE (1992)The concept of coronary flow reserve. J Cardiovasc Pharmacol 19 (Suppl 5): 67–80CrossRefGoogle Scholar
  42. 42.
    UK Prospective Diabetes Study (UKPDS) Group (1998) Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 352: 837–853CrossRefGoogle Scholar
  43. 43.
    Virtanen KA, Hällsten K, Parkkola R et al. (2003) Differential effects of rosiglitazone and metformin on adipose tissue distribution and glucose uptake in type 2 diabetes subjects. Diabetes 52: 283–290PubMedCrossRefGoogle Scholar
  44. 44.
    World Health Organization (1999) Obesity. Preventing and managing the global epidemic. WHO, Geneva, p 276Google Scholar

Copyright information

© Springer Medizin Verlag 2008

Authors and Affiliations

  1. 1.Klinik für Innere Medizin/ KardiologieUniversität Leipzig – HerzzentrumLeipzigDeutschland

Personalised recommendations