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Therapie der Dyslipidämie bei entzündlich-rheumatischen Erkrankungen

Therapy of dyslipidemia in rheumatic diseases

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Zusammenfassung

Kardiovaskuläre Erkrankungen stellen weltweit die häufigste Todesursache dar, und Dyslipidämien sind ein wesentlicher, zu ihrer Entwicklung führender Risikofaktor. Patienten mit rheumatischen Erkrankungen, insbesondere aktiver rheumatoider Arthritis und systemischem Lupus erythematodes weisen ungünstige Lipidprofile auf, welche allerdings die erhöhte kardiovaskuläre Mortalität nicht vollständig erklären. Durch eine effektive Krankheitskontrolle, „Life-Style-Änderungen“ und medikamentöse Cholesterinsenkung können ein ungünstiges Lipidprofil und das Mortalitätsrisiko gesenkt werden. Mittel der Wahl bei der medikamentösen Therapie sind Statine, denen auch eine antientzündliche Wirkkomponente zugeschrieben wird. National und international liegen bezüglich der Risikoabschätzung und relevanter Zielwerte variierende Leitlinien zur Primär- und Sekundärprävention von kardiovaskulären Erkrankungen sowie eine Empfehlung der EULAR zu deren Einsatz bei Patienten mit entzündlichen Arthritiden vor.

Abstract

Cardiovascular diseases are the main cause of death worldwide and dyslipidemia constitutes a substantial risk factor. Patients with rheumatic diseases, especially active inflammatory arthritis and systemic lupus erythematosus, show unfavorable lipid profiles, which, however, do not account for the total excess cardiovascular morbidity. Effective disease management, life-style changes and cholesterol-lowering agents can ameliorate the lipid profile and lower cardiovascular mortality. Due to their anti-inflammatory and potent cholesterol-lowering properties, statins are the pharmacological agents of first choice. National and international guidelines on cardiovascular risk prevention differ concerning appraisal of the individual risk and lipid targets. The EULAR recently released recommendations for cardiovascular risk management in patients with inflammatory arthritis.

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Literatur

  1. Deutsche Gesellschaft zur Bekämpfung von Fettstoffwechselstörungen und ihren Folgeerkrankungen DGFF (Lipidliga) (2009) Empfehlungen zur Diagnostik und Therapie von Fettstoffwechselstörungen in der Ärztlichen Praxis, Stand Mai 2009. Internet Zugriff vom 16.5.2010. http://www.lipid-liga.de

  2. Abud-Mendoza C, Fuente H de la, Cuevas-Orta E et al (2003) Therapy with statins in patients with refractory rheumatic diseases: a preliminary study. Lupus 12:607–611

    Article  CAS  PubMed  Google Scholar 

  3. Antonini-Canterin F, Leiballi E, Enache R et al (2009) Hydroxymethylglutaryl coenzyme-A reductase inhibitors delay the progression of rheumatic aortic valve stenosis. J Am Coll Cardiol 53:1874–1879

    Article  CAS  PubMed  Google Scholar 

  4. Antons KA, Williams CD, Baker SK et al (2006) Clinical perspectives of statin-induced rhabdomyolysis. Am J Med 119:400–409

    Article  CAS  PubMed  Google Scholar 

  5. Bansback N, Ara R, Ward S et al (2009) Statin therapy in rheumatoid arthritis: a cost-effectiveness and value-of-information analysis. Pharmacoeconomics 27:25–37

    Article  PubMed  Google Scholar 

  6. Boers M, Nurmohamed MT, Doelman CJA et al (2003) Influence of glucocorticoids and disease activity on total and high density lipoprotein cholesterol in patients with rheumatoid arthritis. Ann Rheum Dis 62:842–845

    Article  CAS  PubMed  Google Scholar 

  7. Böhm M, Laufs U, Hamm C et al (2007) Positionspapier zur Statintherapie. Clin Res Cardiol 2:8–15

    Article  Google Scholar 

  8. Bruce IN (2005) Atherogenesis and autoimmune disease: the model of lupus. Lupus 14:687–690

    Article  CAS  PubMed  Google Scholar 

  9. Choi HK, Hernán MA, Seeger JD et al (2002) Methotrexate and mortality in patients with rheumatoid arthritis: a prospective study. Lancet 359:1173–1177

    Article  CAS  PubMed  Google Scholar 

  10. Colvine K, Kerr AJ, McLachlan A et al (2008) Cardiovascular disease risk factor assessment and management in gout: an analysis using guideline-based electronic clinical decision support. N Z Med J 121:73–81

    PubMed  Google Scholar 

  11. Dandona P, Aljada A, Bandyopadhyay A (2004) Inflammation: the link between insulin resistance, obesity and diabetes. Trends Immunol 25:4–7

    Article  CAS  PubMed  Google Scholar 

  12. Dixon WG, Watson KD, Lunt M et al (2007) Reduction in the incidence of myocardial infarction in patients with rheumatoid arthritis who respond to anti-tumor necrosis factor alpha therapy. Arthritis Rheum 56:2905–2912

    Article  CAS  PubMed  Google Scholar 

  13. Downs JR, Clearfield M, Weis S et al (1998) Primary prevention of acute coronary events with lovastatin in men and women with average cholesterol levels: results of AFCAPS/TexCAPS. JAMA 279:1615–1622

    Article  CAS  PubMed  Google Scholar 

  14. Fischer LM, Schlienger RG, Matter C et al (2004) Effect of rheumatoid arthritis or systemic lupus erythematosus on the risk of first-time acute myocardial infarction. Am J Cardiol 93:198–200

    Article  PubMed  Google Scholar 

  15. Flockhart DA (2007) Cytochrome P450 drug interaction table. Indiana University School of Medicine. http//www.medicine.iupui.edu/clinpharm/ddis/table.asp

  16. García-Gómez C, Nolla JM, Valverde J et al (2009) Conventional lipid profile and lipoprotein(a) concentrations in treated patients with rheumatoid arthritis. J Rheumatol 36:1365–1370

    Article  PubMed  Google Scholar 

  17. García-Gómez C, Nolla JM, Valverde J et al (2008) High HDL-cholesterol in women with rheumatoid arthritis on low-dose glucocorticoid therapy. Eur J Clin Invest 38:686–692

    Article  PubMed  Google Scholar 

  18. Georgiadis AN, Papavasiliou EC, Lourida ES et al (2006) Atherogenic lipid profiles is a feature characteristic of patients with early rheumatoid arthritis: effect of early treatment – a prospective, controlled study. Arthritis Res Ther 8:R82

    Article  PubMed  Google Scholar 

  19. Gerli R, Bocci EB, Vaudo G et al (2006) Traditional cardiovascular risk factors in primary Sjögren’s syndrome – role of dylipidemia. Rheumatology 45:1581–1582

    Article  Google Scholar 

  20. Gerli R, Goodson NJ (2005) Cardiovascular involvement in rheumatoid arthritis. Lupus 14:679–682

    Article  CAS  PubMed  Google Scholar 

  21. Glueck CJ, Rawal B, Khan NA et al (2009) Should high creatine kinase discourage the initiation or continuance of statins for the treatment of hypercholesterolemia? Metabolism 58:233–238

    Article  CAS  PubMed  Google Scholar 

  22. Goldberg RB (2009) Cytokine and cytokine-like inflammation markers, endothelial dysfunction, and imbalanced coagulation in development of diabetes and its complications. J Clin Endocrinol Metab 94:3171–3182

    Article  CAS  PubMed  Google Scholar 

  23. Goodson N (2002) Coronary artery disease and rheumatoid arthritis. Curr Opin Rheumatol 14:115–120

    Article  PubMed  Google Scholar 

  24. Gordon M-M, Thomson EA, Madhok R et al (2002) Can intervention modify adverse lifestyle variables in a rheumatoid population? Results of a pilot study. Ann Rheum Dis 61:66–69

    Article  PubMed  Google Scholar 

  25. Graham DJ, Staffa JA, Shatin D et al (2004) Incidence of hospitalized rhabdomyolysis in patients treated with lipid-lowering drugs. JAMA 292:2585–2590

    Article  CAS  PubMed  Google Scholar 

  26. Graham I, Atar D, Borch-Johnsen K et al (2007) European guidelines on cardiovascular disease prevention in clinical practice. Eur J Cardiovasc Prev Rehabil 14 (Supp):S1–S113

    Article  PubMed  Google Scholar 

  27. Grundy SM (2002) Can statins cause chronic low-grade myopathy? Ann Int Med 137:617–618

    PubMed  Google Scholar 

  28. Grundy SM, Becker D, Clark LT et al (2002) Third report of the national cholesterol education program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III) final report. Circulation 106:3143

    Article  Google Scholar 

  29. Hage FG, Szalai AJ (2007) C-reactive proteine gene polymorphism, c-reactive protein blood levels, and cardiovascular disease risk. J Am Coll Cardiol 50:1115–1122

    Article  CAS  PubMed  Google Scholar 

  30. Hahn BH, Grossman J, Chen W et al (2007) The pathogenesis of atherosclerosis in autoimmune rheumatic dseases: roles of inflammation and dyslipidemia. J Autoimmun 28:69–75

    Article  CAS  PubMed  Google Scholar 

  31. Hahn BH, Grossman J, Kalunian K (2002) Improving joint disease in patients with rheumatoid arthritis: is this enough to treat the accompanying dyslipidemias? Am J Med 113:247–248

    Article  PubMed  Google Scholar 

  32. Jick SS, Choi H, Li L et al (2009) Hyperlipidemia, statin use and the risk of developing rheumatoid arthritis. Ann Rheum Dis 68:546–551

    Article  CAS  PubMed  Google Scholar 

  33. Joy TR, Hegele RA (2009) Narrative review: statin-related myopathy. Ann Int Med 150:858–868

    PubMed  Google Scholar 

  34. Kannel WB, McGee DL (1979) Diabetes and cardiovascular disease. The Framingham study. JAMA 241:2035–2038

    Article  CAS  PubMed  Google Scholar 

  35. Kashani A, Phillips CO, Foody JM et al (2006) Risk associated with statin therapy: a systematic overview of randomized clinical trials. Circulation 114:2788–2797

    Article  CAS  PubMed  Google Scholar 

  36. Lichtenstein AH, Appel LJ, Brands M et al (2006) Diet and lifestyle recommendations revision 2006: a scientific statment from the American Heart Association Nutrition Committee. Circulation 114:82–96

    Article  PubMed  Google Scholar 

  37. Luo G, Cunningham M, Kim T et al (2002) CYP3A4 induction by drugs: correlation between a pregnane X receptor reporter gene assay and CYP3A4 expression in human hepatocytes. Drug Metab Dispos 30:795–804

    Article  CAS  PubMed  Google Scholar 

  38. McCarey D, McInnes IB, Madhok R et al (2004) Trial of atorvastatin in rheumatoid arthritis (TARA): double-blind, randomised placebo-controlled trial. Lancet 363:2015–2021

    Article  CAS  PubMed  Google Scholar 

  39. McMahon M, Brahn E (2008) Inflammatory lipids as a target fot therapy in the rheumatic diseases. Expert Opin Investig Drugs 17:1213–1224

    Article  CAS  PubMed  Google Scholar 

  40. Nurmohamed MT (2007) Atherogenic lipid profiles and its management in patients with rheumatoid arthritis. Vasc Health Risk Management 3:845–852

    CAS  Google Scholar 

  41. Nurmohamed MT, Dijkmans BAC (2009) Dyslipidemia, statins and rheumatoid arthritis. Ann Rheum Dis 68:453–455

    Article  CAS  PubMed  Google Scholar 

  42. Pereira RM, Carvalho JF de, Bonfá E (2009) Metabolic syndrome in rheumatological diseases. Autoimmun Rev 8:415–419

    Article  CAS  PubMed  Google Scholar 

  43. Peters MJL, Symmons DPM, McCarey D et al (2010) EULAR evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis and other forms of inflammatory arthritis. Ann Rheum Dis 69:325–331

    Article  CAS  PubMed  Google Scholar 

  44. Pfeffer MA, Keech A, Sacks FM et al (2002) Safety and tolerability of pravastatin in long-term clinical trials: prospective pravastatin pooling (PPP) project. Circulation 21:2341–2346

    Article  Google Scholar 

  45. Ridker PM, Danielson E, Fonseca FAH et al (2008) Rosuvastatin to prevent vascular events in men and women with elevated c-reactive protein. N Engl J Med 359:2195–2207

    Article  CAS  PubMed  Google Scholar 

  46. Ridker PM, Solomon DH (2009) Should patients with rheumatoid arthritis receive statin therapy? Arthritis Rheum 60:1205–1209

    Article  PubMed  Google Scholar 

  47. Rosenson RS (2004) Current overview of statin-induced myopathy. Am J Med 116:408–416

    Article  CAS  PubMed  Google Scholar 

  48. Soubrier M, Zerkak D, Dougados M (2006) Indications for lowering LDL cholesterol in rheumatoid arthritis: an unrecognized problem. J Rheumatol 33:1766–1769

    CAS  PubMed  Google Scholar 

  49. Tam LS, Gladmann DD, Hallett DC et al (2000) Effect of antimalarial agents on the fasting lipid profile in systemic lupus erythematosus. J Rheumatol 27:2142–2145

    CAS  PubMed  Google Scholar 

  50. Taylor AJ, Villines TC, Stanek EJ et al (2009) Extended-release niacin or ezetimibe and carotid intima-media thickness. N Engl J Med 361:2113–2122

    Article  CAS  PubMed  Google Scholar 

  51. Halm VP van, Nurmohamed MT, Twisk JWR et al (2006) Disease-modifying antirheumatic drugs are associated with a reduced risk fpr cardiovascular disease in patients with rheumatoid arthritis: a case control study. Arthritis Res Ther 8:R151

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Klinik für Endokrinologie, Diabetologie und Rheumatologie, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland

    S. Vordenbäumen, S. Schinner, R. Fischer-Betz & M. Schneider

  2. Zentrum für Prävention und Sportmedizin, Technische Universität München, München, Deutschland

    M. Halle

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  1. S. Vordenbäumen
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  2. S. Schinner
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  4. R. Fischer-Betz
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Correspondence to S. Vordenbäumen.

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Vordenbäumen, S., Schinner, S., Halle, M. et al. Therapie der Dyslipidämie bei entzündlich-rheumatischen Erkrankungen. Z. Rheumatol. 69, 689–695 (2010). https://doi.org/10.1007/s00393-009-0586-4

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