Akutes Koronarsyndrom

Prävention

Acute coronary syndrome

Prevention

Zusammenfassung

In der Lebensstilmodifikation haben Primär- und Sekundärprävention des akuten Koronarsyndroms (ACS) weitestgehend Ähnlichkeiten, wenn auch in der postinfarziellen Situation im rehabilitativen Sinne funktionsdiagnostische Programme zu gestalten sind. Alle 3 Lebensstilsäulen (Bewegung, Ernährung und Entspannung) implizieren prognostische Bedeutung, die präventive Effektivität ist sekundär höher als primär. Pharmakotherapeutisch ist die Indikation der Thrombozytenaggregationshemmung an das Vorhandensein von Atherosklerose gebunden, die der Statinmedikation auch bereits an die kardiovaskuläre Risikofaktorenstratifikation, zu der Scores verwendet werden. Je nach postinfarzieller Myokardschädigung nach ACS sind zusätzliche Pharmakotherapien wie die mit ACE(„angiotensin-converting enzyme“)-Hemmern oder Angiotensin-II-Rezeptor-Antagonisten, Betablockern oder auch Mineralokortikoidrezeptorantagonisten evident. Neue präventive Potenziale kommen den neuen oralen Antikoagulanzien (NOAK) im Zusammenhang mit koinzidentem Vorhofflimmern zu.

Abstract

For life style modifications primary and secondary prevention of acute coronary syndrome (ACS) are approximately similar, even though in the postinfarction situation functional diagnostic programs have to be performed in a rehabilitative manner. All three life style pillars of fitness, nutrition and relaxation implicate prognostic significance and the efficacy is higher for secondary prevention than for primary. The pharmacotherapeutic indications for thrombocyte aggregation inhibition are connected to the presence of atherosclerosis and statin medication is already connected to cardiovascular risk factor stratification, for which scores are used. Depending on the postinfarction myocardial destruction after ACS, additional pharmacotherapies, such as angiotensin-converting enzyme (ACE) inhibitors, angiotensin-II receptor antagonists, beta blockers and also mineral corticoid receptor antagonists are evident. New potential for prevention is ascribed to the new oral anticoagulants (NOAC) in the context of coincidental atrial fibrillation.

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Correspondence to Prof. Dr. med. U. Nixdorff.

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Interessenkonflikt

U. Nixdorff, G. Horstick und A. Schlitt geben an, dass kein Interessenkonflikt besteht.

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

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Nixdorff, U., Horstick, G. & Schlitt, A. Akutes Koronarsyndrom. Herz 44, 45–52 (2019). https://doi.org/10.1007/s00059-019-4782-y

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Schlüsselwörter

  • Myokardinfarkt
  • Lebensstil
  • Risikofaktoren
  • Atherosklerose
  • Thrombozytenaggregation

Keywords

  • Myocardial infarction
  • Life style
  • Risk factors
  • Atherosclerosis
  • Platelet aggregation