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KHK-Sekundärprävention

Gibt es eine „untere Grenze“ beim LDL-C?

  • Fortbildung_Lipidologie
  • Published:
CardioVasc Aims and scope

Eine therapeutische Beeinflussung des Lipidstoffwechsels durch nicht medikamentöse und medikamentöse Maßnahmen ist wesentlicher Bestandteil in der Primär- und insbesondere Sekundärprävention kardiovaskulärer Hochrisikopatienten. Die Absenkung der LDL-Cholesterinkonzentration nimmt dabei eine zentrale Rolle ein. Neben der fest etablierten Therapie mit Statinen sind mit der intestinalen Cholesterinresorptions-Hemmung und der PCSK9-Hemmung weitere Therapieformen verfügbar geworden, die eine zusätzliche erhebliche Absenkung der LDL-Cholesterinkonzentration ermöglichen. Somit stellt sich die Frage nach einer möglichen „unteren Grenze“ für die therapeutische Senkung der LDL-Cholesterinkonzentration.

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Literatur

  1. Naghavi M, Wang H, Lozano R et al. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;385:117–71

    Article  Google Scholar 

  2. Townsend N, Wilson L, Bhatnagar P et al. Cardiovascular disease in Europe: epidemiological update 2016. Eur Heart J. 2016 Aug 14. DOI: 10.1093/eurheartj/ehw334

  3. Yusuf S, Hawken S, Ounpuu S et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364(9438):937–52

    Article  PubMed  Google Scholar 

  4. Ference BA, Yoo W, Alesh I et al. Effect of long-term exposure to lower low-density lipoprotein cholesterol beginning early in life on the risk of coronary heart disease: a Mendelian randomization analysis. J Am Coll Cardiol. 2012;60:2631–9

    Article  CAS  PubMed  Google Scholar 

  5. Ference BA, Majeed F, Penumetcha R et al. Effect of naturally random allocation to lower low-density lipoprotein cholesterol on the risk of coronary heart disease mediated by polymorphisms in NPC1L1, HMGCR, or both: a 2x2 factorial Mendelian randomization study. J Am Coll Cardiol. 2015;65:1552–61

    Article  CAS  PubMed  Google Scholar 

  6. Nordestgaard BG, Chapman MJ, Humphries SE et al. Familial hypercholesterolaemia is underdiagnosed and undertreated in the general population: guidance for clinicians to prevent coronary heart disease: consensus statement of the European Atherosclerosis Society. Eur Heart J. 2013;34:3478–90

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Wald DS, Bestwick JP, Morris JK et al. Child-parent familial hypercholesterolemia screening in primary care. N Engl J Med. 2016;375:1628–37

    Article  CAS  PubMed  Google Scholar 

  8. Fulcher J, O’Connell R, Voysey M et al. Efficacy and safety of LDL-lowering therapy among men and women: meta-analysis of individual data from 174,000 participants in 27 randomised trials. Lancet. 2015;385:1397–405

    Article  PubMed  Google Scholar 

  9. Cannon CP, Blazing MA, Giugliano RP et al. Ezetimibe added to statin therapy after acute coronary syndromes. N Engl J Med. 2015;372:2387–97

    Article  CAS  PubMed  Google Scholar 

  10. Packard CJ, Fjord I. Long-term follow-up of lipid-lowering trials. Curr Opin Lipidol. 2015;26:572–9

    Article  CAS  PubMed  Google Scholar 

  11. Gaede P, Oellgard J, Carstensen B et al. Years of life gained by multifactorial intervention in patients with type 2 diabetes mellitus and microalbuminuria: 21 years follow-up on the Steno-2 randomised trial. Diabetologia. 2016;59:2298–2307

    Article  CAS  PubMed  Google Scholar 

  12. Piepoli MF, Hoes AW, Agewall S et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2016;37(29):2315–81

    Article  PubMed  Google Scholar 

  13. Catapano AL, Graham I, De Backer G et al. 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias Eur Heart J. 2016;37:2999–3058

    PubMed  Google Scholar 

  14. LaRosa JC, Pedersen TR, Somaratne R, Wasserman SM. Safety and effect of very low levels of low-density lipoprotein cholesterol on cardiovascular events. Am J Cardiol. 2013;111:1212–29

    Article  Google Scholar 

  15. O'Keefe LH, Cordain L, Harris WH et al. Optimal low-density lipoprotein is 50 to 70 mg/dl - Lower ist better and physiologically normal. J Am Coll Cardiol. 2004;43:2142–6

    Article  PubMed  Google Scholar 

  16. Schonfeld G, Lin X, Yue P. Familial hypolipoproteinemia: genetics and metabolism. Cell Mol Life Sci. 2005;62:1372–8

    Article  CAS  PubMed  Google Scholar 

  17. Poirier S, Mayer G. The biology of PCSK9 from the endoplasmic reticulum to lysosomes: new and emerging therapeutics to control low-density lipoprotein cholesterol. Drug Des Devel Ther. 2013;7:1135–48

    PubMed  PubMed Central  Google Scholar 

  18. Cohen JC, Boerwinkle E, Mosley TH, Hobbs HH. Sequence variations in PSCK9, low LDL, and protection against coronary heart disease. N Engl J Med. 2006;354:1264–72

    Article  CAS  PubMed  Google Scholar 

  19. Zhao Z, Tuakli-Wosornu Y, Lagace TA et al. Molecular characterization of loss-of-function mutations in PSCK9 and identification of a compound heterozygote. Am J Hum Genet. 2006;79:514–23

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Collins R, Reith C, Emberson J et al. Interpretation of the evidence for the efficacy and safety of statin therapy Lancet. 2016 Sep 8. doi: 10.1016/S0140-6736(16)31357-5

  21. Preiss D, Seshasai SR, Welsh P et al. Risk of incident diabetes with intensive-dose compared with moderate-dose statin therapy: a meta-analysis. JAMA. 2011;305(24):2556–64

  22. Cholesterol Treatment Trialists (CTT) Collaboration. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170 000 participants in 26 randomized trials. Lancet. 2010;376:1670-81

  23. American Diabetes Association. 8. Cardiovascular Disease and Risk Management. Diabetes Care. 2016; 39 Suppl. 1:S60-S71

  24. Roffi M, Patrono C, Collet JP et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2016;37(3):267–315

    Article  PubMed  Google Scholar 

  25. Giugliano RP, Wiviott SD, Blazing MA et al. Safety and efficacy of long-term very low achieved LDL-C in the IMPROVE IT trial. Eur Heart J. 2015;36(Suppl 1):2

    Google Scholar 

  26. Sabatine MS, Giugliano RP, Wiviott SD et al. Efficacy and safety of evolocumab in reducing lipids and cardiovascular events. N Engl J Med. 2015;372(16):1500–9

    Article  CAS  PubMed  Google Scholar 

  27. Robinson JG, Farnier M, Krempf M et al. Efficacy and safety of alirocumab in reducing lipids and cardiovascular events. N Engl J Med. 2015;372(16):1489–99

    Article  CAS  PubMed  Google Scholar 

  28. Lipinski MJ, Benedetto U, Escarcega RO et al. The impact of proprotein convertase subtilisin-kexin type 9 serine protease inhibitors on lipid levels and outcomes in patients with primary hypercholesterolaemia: a network meta-analysis. Eur Heart J. 2016;37:536–45

    Article  PubMed  Google Scholar 

  29. Colhoun HM, Ginsberg HN, Robinson JG et al. No effect of PCSK9 inhibitor alirocumab on the incidence of diabetes in a pooled analysis from 10 ODYSSEY Phase 3 studies. Eur Heart J. 2016 Jul 26. DOI: 10.1093/eurheartj/ehw292

  30. Landmesser U, John Chapman M, Farnier M et al. European Society of Cardiology/European Atherosclerosis Society Task Force consensus statement on proprotein convertase subtilisin/kexin type 9 inhibitors: practical guidance for use in patients at very high cardiovascular risk. Eur Heart J. 2016 Oct 27. DOI: 10.1093/eurheartj/ehw480

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Authors and Affiliations

  1. Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover (MHH), Carl-Neuberg-Strasse 1, 30625, Hannover, Deutschland

    Holger Leitolf

  2. Dres. med. T. Beckenbauer und S. Maierhof, Am Markt 11, 28195, Bremen, Deutschland

    Gerald Klose (Gemeinschaftspraxis)

Authors
  1. Holger Leitolf
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  2. Gerald Klose
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Correspondence to Holger Leitolf.

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Leitolf, H., Klose, G. Gibt es eine „untere Grenze“ beim LDL-C?. CV 16, 43–47 (2016). https://doi.org/10.1007/s15027-016-1031-7

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  • DOI: https://doi.org/10.1007/s15027-016-1031-7

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