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ESC-Leitlinien 2016 – Dyslipidämien

ECS guidelines 2016 – dyslipidaemias

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Zusammenfassung

Von der European Society of Cardiology (ESC) und der European Atherosclerosis Society (EAS) wurden im August 2016 gemeinsame neue Leitlinien zur Behandlung der Dyslipidämien vorgestellt und veröffentlicht. Die europäischen Leitlinien empfehlen, bei der Behandlung der Dyslipidämien risikoadaptierte LDL („low-density-lipoprotein“)-Cholesterin-Zielwerte anzustreben. Das LDL-Cholesterin wird als primäres Behandlungsziel hervorgehoben (was u. a. auch auf die fehlende Wirksamkeit HDL [„high-density lipoprotein“]-Cholesterin-anhebender Therapieansätze zurückzuführen ist). Für Patienten mit einem sehr hohen Risiko für kardiovaskuläre Ereignisse besteht ein LDL-Cholesterin-Zielwert von unter 70 mg/dl. Zusätzlich wird nun bei Patienten mit LDL-Cholesterin-Ausgangswert zwischen 70 und 135 mg/dl bei sehr hohem kardiovaskulären Risiko bzw. zwischen 100 und 200 mg/dl bei hohem kardiovaskulären Risiko eine Reduktion des LDL-Cholesterins um mehr als 50 % empfohlen. Bei der medikamentösen Therapie sind Statine das Mittel der ersten Wahl. Weiterhin wurde der Empfehlungsgrad für die zusätzliche Therapie mit Ezetimib bei Patienten, welche trotz maximal tolerierter Statintherapie weiterhin deutlich erhöhte LDL-Cholesterin-Werte haben, angehoben (aktuell IIa-Empfehlung). Neu wird die PCSK9 (Proproteinkonvertase Subtilisin/Kexin Typ 9)-Hemmer-Therapie erwähnt. Ein weiteres gerade veröffentlichtes ESC/EAS-Konsensusdokument gibt genauere Informationen darüber, bei welchen Patienten heute eine solche Therapie erwogen werden kann. Insbesondere sind dies Patienten mit familiärer Hypercholesterinämie oder Patienten mit sehr hohem kardiovaskulären Risiko, welche trotz maximal tolerierter Statin- und Ezetimibtherapie anhaltend deutlich erhöhte LDL-Cholesterin-Werte aufweisen.

Abstract

Dyslipidaemia is a major cause of atherosclerotic cardiovascular disease and its progression towards clinical complications, such as acute coronary syndromes and stroke. In August 2016 the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS) issued new joint guidelines for the management of dyslipidaemias. In these new guidelines, the concept of treating patients to a risk-based low-density lipoprotein (LDL) cholesterol target is reinforced. The task force considers LDL cholesterol as the primary target for dyslipidaemia treatment, whereas high-density lipoprotein (HDL) cholesterol is not recommended as a treatment target (based on the failure of HDL cholesterol elevation treatment strategies to reduce cardiovascular risk in recent studies). In patients with a very high risk for cardiovascular events it is recommended to treat to an LDL cholesterol target of less than 70 mg/dl. Moreover, the new guidelines now additionally recommend a > 50% reduction of LDL cholesterol in patients with very high cardiovascular risk patients and baseline levels between 70 and 135 mg/dl as well as in patients with high cardiovascular risk and baseline LDL cholesterol levels between 100 and 200 mg/dl. Statins are recommended as first-line medicinal treatment and the LDL cholesterol goals given imply the more frequent use of maximum tolerated statin therapy, in particular for patients with very high cardiovascular risk. Treatment with ezetimibe in patients with substantially elevated LDL cholesterol levels despite maximum tolerated statin therapy has now received a stronger recommendation (currently IIa recommendation). The guidelines also now include the potential use of the novel proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors and a recent ESC/EAS consensus document provides more detailed information on which patients can be considered for treatment with PCSK9 inhibitors, i. e. in particular patients with familial hypercholesterolemia and patients at very high cardiovascular risk who have markedly elevated LDL cholesterol levels despite maximum tolerated statin and ezetimibe therapy.

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Authors and Affiliations

  1. Klinik für Kardiologie, Charité – Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Deutschland

    D. Sinning &  U. Landmesser

  2. Berlin Institute of Health (BIH), Berlin, Deutschland

    U. Landmesser

  3. Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Berlin, Deutschland

    U. Landmesser

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D. Sinning hat Advisory-Honorare von Amgen erhalten. U. Landmesser hat Vortrags- bzw. Advisory-Honorare von MSD, Amgen, Sanofi, Pfizer und Berlin-Chemie erhalten.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Sinning, D., Landmesser, U. ESC-Leitlinien 2016 – Dyslipidämien. Herz 41, 671–676 (2016). https://doi.org/10.1007/s00059-016-4505-6

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