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Möglichkeiten und Grenzen der modernen Lipidtherapie

Optimal lipid treatment: possibilities and current limitations

  • Arzneimitteltherapie
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Zusammenfassung

Präventive Maßnahmen haben einen relevanten Anteil am beobachteten Rückgang kardiovaskulärer Morbidität und Mortalität. Unveränderter Handlungsbedarf auch in der Prävention ergibt sich aus der Tatsache, dass Herz-Kreislauf-Erkrankungen in Deutschland weiter die häufigste Todesursache (42%) geblieben sind. Der gesunde Lebensstil, unverändert Basis aller Empfehlungen, hat seine Grenze in oft unzureichender Compliance oder im individuellen Fall nicht ausreichender Wirksamkeit. Nach der neuen Metaanalyse der Cholesterol Treatment Trialists lässt sich pro 1 mmol (39 mg/dl) LDL-Cholesterinsenkung mit Statinen eine Reduktion vaskulärer Ereignisse um 21% erreichen. Ob unsere Versorgung mit Lipidsenkern ausreichend ist oder Defizite im Erreichungsgrad der LDL-Cholesterin-Zielwerte Konsequenzen in der Therapieumsetzung haben sollten, wird diskutiert. Als weitere Grenze der modernen Lipidtherapie wird auf das trotz Statintherapie verbleibende kardiovaskuläre Risko hingewiesen. Mögliche Einflussnahmen sind stärkere oder über LDL-Cholesterin hinausgehende Lipoproteinwirkungen. Entsprechend werden indikationsrelevante Charakteristika zur Verfügung stehender lipidwirksamer Maßnahmen abgehandelt und auf zukünftige Entwicklungen hingewiesen.

Abstract

Prevention is a major contributor to the decline in cardiovascular morbidity and mortality. Cardiovascular diseases still are the leading cause of death (42%) in Germany and indicate unmet preventive needs. Limitations of healthy lifestyle, the basis of many recommendations, include insufficient compliance and efficacy in individual cases. In their latest metaanalysis the Cholesterol Treatment Trialists’ Collaborators showed updated estimates of treatment effects of statins including more or less intensive regimens.The average reduction in major vascular events was 21% per 1.0 mmol/l reduction in LDL cholesterol. Appropriateness of receiving lipid modulating treatment in the population will be discussed in the light of controversial recommendations in treatment strategies. Residual risk in statin treated patients may be ameliorated by options beyond LDL-lowering. Suggestions for clinical practice are provided on the background of clinical relevant characteristics of current lipid lowering drugs and future developments are outlined.

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Interessenkonflikt

Der Autor weist auf folgende Beziehungen hin:

Vortragshonorare, Symposiumsunterstützung oder Advisory Board Tätigkeit bei AstraZeneca, BMS, Genzyme, MSD, Pfizer, Roche.

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  1. Internistische Praxisgemeinschaft Dres. T. Beckenbauer, S. Maierhof, Hans-Thoma-Straße 31, 28209, Bremen, Deutschland

    G. Klose

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Klose, G. Möglichkeiten und Grenzen der modernen Lipidtherapie. Internist 52, 328–335 (2011). https://doi.org/10.1007/s00108-010-2799-7

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