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Labordiagnostik in der präventiven Kardiologie

Laboratory procedures in preventive cardiology

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Zusammenfassung

In den letzten Jahren wurden zahlreiche kardiovaskuläre Risikofaktoren identifiziert. Ihre Bestimmung optimiert die Risikoabschätzung, die jedoch nach wie vor eine „Schätzung” bleibt. Die sichere Vorhersage eines drohenden kardiovaskulären Ereignisses ist derzeit noch immer nicht möglich. Entsprechend sorgfältig muß der Einsatz einer aufwendigen Labordiagnostik geplant und auf den Einzelfall bezogen eingesetzt werden.

Häufig reicht es für die notwendigen therapeutischen Entscheidungen aus, das Gesamtcholesterin, die Triglyzeride, das HDL-sowie LDL-Cholesterin und das Lp(a) zu bestimmen. Eine weiterführende Diagnostik sollte bei schwereren Dyslipidämien, familiär gehäuft auftretender koronarer Herzkrankheit und bei Patienten mit einer koronaren Herzkrankheit ohne offenkundige Stoffwechselstörungen durchgeführt werden. Neben den Laborparametern sind Faktoren wie die genetische Belastung und Familienanamnese sowie die klinischen Daten (vorbekannte koronare Herzkrankheit oder arterielle Verschlußkrankheit, arterielle Hypertonie, Diabetes mellitus, Raucher) für eine Risikostratefizierung von großer Bedeutung.

Die alleinige Betrachtung der Laborparameter wird in der Regel keine suffiziente Beratung und Therapie der Betroffenen ermöglichen. Mittlerweile stehen „Expertensysteme” bereit, die eine Risikoabschätzung unter Eingabe der Laborparameter (LDL-Cholesterin, HDL-Cholesterin, Triglyzeride) sowie relevanter klinischer Angaben (Blutdruck, familiäre Belastung, Anamnese etc.) erlauben. Der Zugriff zu diesem System ist unter der Adresse „http://www.chd-taskforce.com” im Internet möglich.

Abstract

In recent years a large number of coronary artery disease risk factors were discovered. The knowledge of these factors improves the estimate of the coronary artery disease (CAD) risk — however it still remains to be only an “estimate”. A perfect prediction of an upcoming CAD event is not possible, despite all high score laboratory technology. Therefore the use of specialized laboratory procedures should be applied carefully.

Knowing the blood levels of cholesterol, triglycerides, HDL-and LDL-cholesterol and Lp(a) can be sufficient for many therapeutical decisions. Severe dyslipidemia, familial CAD and CAD without any obvious reasons demand a more specialized work-up, however, risk stratification factors such as family history, clinical history (CAD, hypertension, diabetes mellitus, smoker) and genetics are crucial, apart from the above mentioned laboratory values.

Purely on the basis of the lipidologic baseline concentrations we can’t give well based recommendations for the treatment of individual patients. Currently there are expert systems available which allow a risk estimate once important laboratory values (LDL cholesterol, HDL cholesterol, Triglycerides) as well as clinical data (blood pressure, family history, clinical history) are available. This system can be accessed by internet under „http://www.chd-taskforce.com”.

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Authors and Affiliations

  1. Zentrum für Innere Medizin, Klinik für Innere Medizin und Kardiologie, Philipps-Universität Marburg, Baldingerstraße, D-35033, Marburg

    Muhidien Soufi, Bernd Noll, Matthias Herzum, Bernd Simon, Bernhard Maisch & Jürgen R. Schaefer

  2. Abteilung für Innere Medizin, St. Nikolaus-Stiftshospital GmbH, Andernach

    Armin Steinmetz

Authors
  1. Muhidien Soufi
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  2. Bernd Noll
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  3. Matthias Herzum
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  4. Bernd Simon
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  5. Armin Steinmetz
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  7. Jürgen R. Schaefer
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Correspondence to Jürgen R. Schaefer.

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Soufi, M., Noll, B., Herzum, M. et al. Labordiagnostik in der präventiven Kardiologie. Herz 24, 13–25 (1999). https://doi.org/10.1007/BF03043814

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