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Altersabhängige Veränderungen des hämostaseologischen Risikoprofils aus kardiologischer Sicht

Cardiological aspects of age-dependent changes in the hemostatic risk profile

  • Klinische Pharmakologie
  • Published:
Der Kardiologe Aims and scope

Zusammenfassung

Neben den klassischen kardiovaskulären Risikofaktoren werden prothrombogene Veränderungen des Gerinnungssystems als wichtige Marker für ein erhöhtes Atheroskleroserisiko angesehen. Erworbene Störungen der Hämostase sind häufig bei älteren Patienten anzutreffen und stehen im Zusammenhang mit der erhöhten Prävalenz chronischer Erkrankungen in diesem Kollektiv. Pathophysiologisch ist eine Verknüpfung von Krankheiten, die mit einer Hyperinsulinämie einhergehen, wie dem Diabetes mellitus, dem metabolischen Syndrom und der arteriellen Hypertonie, und einem veränderten Gleichgewicht der hämostaseologischen Faktoren gut belegt. Die Hyperinsulinämie ist als Indikator peripherer Insulinresistenz ein unabhängiger Risikofaktor der koronaren Herzkrankheit. Plasminogenaktivatorinhibitor wird als pathophysiologisches Bindeglied dieser Assoziation betrachtet. Chronische Entzündungsprozesse, die im Alter häufig sind, können über eine Hyperfibrinogenämie weiter zur Störung des hämostaseologischen Gleichgewichts beitragen. Schließlich ist denkbar, dass diese prothrombogenen Veränderungen die Progression der Atherosklerose im Alter beschleunigen und das Auftreten akuter Koronarsyndrome begünstigen. Diese Zusammenhänge unterstreichen, dass die optimierte Behandlung von chronischen Begleiterkrankungen ein wichtiger Aspekt der Primär- und Sekundärprävention atherosklerotischer Manifestationen im Alter ist. Darüber hinaus bietet die prothrombogene Aktivierung des Gerinnungssystems einen vielversprechenden Ansatzpunkt für spezifische Therapienkonzepte.

Abstract

In addition to traditional cardiovascular risk factors, prothrombotic alterations of the hemostatic system are assumed to play a major role in the pathogenesis of atherosclerosis. Prothrombotic conditions are common in the elderly and were found to be associated with a high prevalence of chronic illness in these patients. The important link between hyperinsulinemia, a pathophysiological feature of several chronic diseases such as diabetes, metabolic syndrome and essential hypertension, and a hemostatic dysbalance is well documented. Insulin resistance and associated hyperinsulinemia are an independent risk factor for ischemic heart disease. Plasminogen activator inhibitor is considered to be the pathophysiologic link between the two conditions. Chronic inflammatory disease, which is common among elderly patients, may cause high fibrinogen levels, which may further contribute to hypercoagulability. It is thus conceivable that prothrombotic mechanisms may lead to an increase in the progression of atherosclerosis and in the incidence of coronary events in the elderly. These links underline the importance of adequate treatment of chronic concomitant disease to improve primary and secondary prevention of cardiovascular disease in the elderly. Moreover, prothrombotic alterations of the hemostatic system are a promising target for future treatment strategies.

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Authors and Affiliations

  1. Medizinische Klinik II (Schwerpunkte Kardiologie und Angiologie), Ruhr-Universität Bochum, Hölkeskampring 40, 44625, Herne, Deutschland

    G. Plehn, A. Meissner & H.-J. Trappe

  2. Profil Institut für Stoffwechselforschung GmbH, Neuss, Deutschland

    T.W. Jax

  3. Klinik für Kardiologie, Pneumologie und Angiologie, Klinikum Esslingen a. N., Esslingen, Deutschland

    M. Leschke

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  1. G. Plehn
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Correspondence to G. Plehn.

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Plehn, G., Jax, T., Leschke, M. et al. Altersabhängige Veränderungen des hämostaseologischen Risikoprofils aus kardiologischer Sicht. Kardiologe 3, 480–488 (2009). https://doi.org/10.1007/s12181-009-0204-3

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