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Herz

, Volume 43, Issue 3, pp 230–237 | Cite as

Lipidsenkende Therapie im Alter

Wer profitiert von welchem Zielwert?
  • E. Windler
  • F.-U. Beil
  • G. Klose
  • J. Thiery
Schwerpunkt
  • 524 Downloads

Zusammenfassung

Die Senkung des LDL(„low-density lipoprotein“)-Cholesterins (LDL-C) reduziert erwiesenermaßen die Inzidenz kardio- und zerebrovaskulärer Ereignisse und senkt die Mortalität. Bisherige Zielwertempfehlungen machten keine Angaben zur Dauer einer Cholesterinsenkung und orientierten sich bisher stark an ökonomischen Beschränkungen und derzeit verfügbaren Pharmaka. Vor dem Hintergrund des Preisverfalls für Statine als wesentlichem Therapeutikum und der erhöhten Effektivität therapeutischer Möglichkeiten kann sich heute die Behandlung an Zielwerten orientieren, die einen optimalen Effekt bis ins hohe Alter erwarten lassen. Der günstigste Spiegel des LDL-C für die Primärprävention liegt um und unter 100 mg/dl, allerdings bei Einhalten dieses niedrigen Spiegels durchgängig von Jugend an. Bei jeder später einsetzenden Cholesterinsenkung muss mit bereits ersten atheromatösen Ablagerungen gerechnet werden. Daher gleicht sich das Behandlungsoptimum mit Alter und weiteren Risikofaktoren zunehmend den Erfahrungswerten aus der Sekundärprävention an. Sowohl Messungen des Effekts einer Cholesterinsenkung auf das Volumen atheromatöser Plaques als auch auf die Inzidenz vaskulärer Ereignisse deuten auf einen Zielwert für das LDL-C deutlich unter 70 mg/dl im Bereich von 50–60 mg/dl hin. Bei Beginn der Cholesterinsenkung im höheren Alter ist mit einem geringeren Effekt zu rechnen, aber aufgrund der zunehmenden Inzidenzrate mit einer höheren Anzahl vermeidbarer Ereignisse, sodass die Effizienz nicht notwendigerweise abnimmt. Langzeituntersuchungen weisen allerdings darauf hin, dass frühere Cholesterinsenkung auch noch nach mehr als einem Jahrzehnt einen Vorteil bietet, der eher noch zunimmt. Daher ist für eine optimale kardiovaskuläre Prävention der frühe Beginn moderater Maßnahmen zum lebenslangen Erhalt eines LDL-C unter 100 mg/dl empfehlenswert.

Schlüsselwörter

Cholesterin Statine Zielwert Kardiovaskuläre Prävention Senioren 

Lipid-lowering therapy in the elderly

Who profits from which target values?

Abstract

Lowering low-density lipoprotein (LDL) cholesterol levels has been proven to reduce the incidence of cardiovascular and cerebrovascular events and mortality. So far recommendations have not provided information as to a meaningful duration of cholesterol-lowering therapy and were largely guided by economic constraints and limited therapeutic options. In light of the decline in the price of statins, the essential therapeutic agent and the increased efficacy of therapeutic options, treatment can nowadays be geared to target values that can be expected to have an optimal effect even in old age. The most favorable level of LDL-cholesterol for primary prevention is around and below 100 mg/dl, provided continuous adherence to these low levels from adolescence onwards. With later onset of cholesterol reduction the existence of initial atheromatous deposits must be expected. Therefore, with age and the manifestation of other risk factors the optimal treatment targets increasingly converge to those for which experience has been gained from secondary prevention. Both measurements of the effect of cholesterol lowering on the volume of atheromatous plaques and of the incidence of vascular events indicate a target for LDL-cholesterol well below 70 mg/dl and in the range 50–60 mg/dl. At the onset of cholesterol lowering in advanced age, a smaller effect has to be expected but due to the increasing incidence rate of vascular events a higher number of events may be avoided; thus, the efficiency does not necessarily decrease; however, long-term studies indicate that earlier cholesterol lowering provides an advantage for more than a decade, in terms of preventing vascular disease, which tends to increase. Therefore, optimal cardiovascular prevention involves moderate measures to maintain the LDL-cholesterol below 100 mg/dl lifelong from childhood on.

Keywords

Cholesterol Statins Target value Cardiovascular prevention Aged 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

E. Windler, F.-U. Beil, G. Klose und J. Thiery geben an, dass kein Interessenkonflikt besteht.

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

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.Präventive Medizin, Universitäres Herzzentrum HamburgUniversitätsklinikum Hamburg-EppendorfHamburgDeutschland
  2. 2.AmbulanzzentrumUniversitätsklinikum Hamburg-EppendorfHamburgDeutschland
  3. 3.Praxis Dres. T. Beckenbauer & S. MaierhofBremenDeutschland
  4. 4.Praxis Dres. I. van de Loo & K. SpiekerBremenDeutschland
  5. 5.Department für Diagnostik, Institut für Laboratoriumsmedizin, Klinische Chemie und Molekulare DiagnostikUniversitätsklinikum LeipzigLeipzigDeutschland

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