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Dtsch Med Wochenschr 2018; 143(19): 1391-1396
DOI: 10.1055/a-0639-8325
Review
© Georg Thieme Verlag KG Stuttgart · New York

Periphere arterielle Verschlusskrankheit: Wann ist ein PCSK9-Inhibitor sinnvoll?

Peripheral Arterial Disease: When is a PCSK9 Inhibitor Useful?
Knut Kröger
1   Klinik für Gefäßmedizin, HELIOS Klinik Krefeld
,
Christine Espinola-Klein
2   Abteilung für Angiologie, Zentrum für Kardiologie/Kardiologie I, Universitätsmedizin der Johannes-Gutenberg-Universität, Mainz
,
Ulrich Hoffmann
3   Sektion Angiologie, München Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität München
,
Christoph Kalka
4   Klinik für Angiologie und Kardiologie, Marienhospital Brühl
,
Holger Lawall
5   Praxis für Herzkreislauferkrankungen und Akademie für Gefäßkrankheiten, Ettlingen
,
Norbert Weiss
6   Universitäts GefäßCentrum & Medizinische Klinik III – Bereich Angiologie, Universitätsklinikum Carl Gustav Carus Dresden an der Technischen Universität Dresden
› Author Affiliations
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Publication History

Publication Date:
04 July 2018 (online)

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Zusammenfassung

Die Leitlinie der Europäischen Gesellschaft für Kardiologie empfiehlt bei Patienten mit manifester peripherer arterieller Verschlusskrankheit (PAVK) ebenso wie bei KHK oder zerebrovaskulärer Erkrankung einen LDL-C-Zielwert < 70 mg/dL oder eine Reduktion um 50 %, wenn der Ausgangswert zwischen 70 und 135 mg/dL liegt. Die Applikation eines PCSK9-Inhibitors ermöglicht die Zielwerterreichung für viele Patienten, die dies unter einer maximalen Statintherapie in Kombination mit Ezetemib nicht erreichen. In der Fourier-Studie konnte für Patienten mit PAVK, die bei Studieneinschluss weder einen Myokardinfarkt noch einen Apoplex erlitten hatten, eine deutliche Risikoreduktion (RR) sowohl der kardiovaskulären (RR = 0,67; 0,47 – 0,96; p = 0,0283) als auch der die Extremität betreffenden Endpunkte (RR = 0,43; 0,19 – 0,99; p = 0,042) erreicht werden. Diese Patienten werden insbesondere bei Fachärzten für Angiologie erkannt und diese Facharztgruppe ist im GBA-Beschluss als Verordner speziell genannt.

Abstract

The guideline of the European Society of Cardiology recommends an LDL-C target < 70 mg/dL or a 50 % reduction in patients with manifest peripheral arterial disease (PAD) as well as in CHD or cerebrovascular disease when the baseline LDL-C is between 70 and 135 mg/dL. Application of a PCSK9 inhibitor allows target attainment for those patients who do not achieve this under maximal conventional therapy with a statin in combination with ezetemib. In the Fourier study, patients with PAOD who had neither a myocardial infarction nor a stroke at admission of the study had a significant risk reduction (RR) of both cardiovascular (RR = 0.67, 0.47 – 0.96, p = 0.0283) as well as extremity endpoints (RR = 0.43 (0.19 – 0.99; p = 0.042). In Germany these patients are primarily seen by angiologists. This group of vascular specialists is specifically mentioned in the decision of the Federal Joint Committee as one of those who may indicate treatment with PCSK9 inhibitors.

Schlüsselwörter

periphere arterielle Verschlusskrankheit - koronare Herzerkrankung - LDL-Cholesterin - PCSK9-Inhibitor

Key words

peripheral arterial disease - coronary heart disease - LDL cholesterol - PCSK9 inhibitors
 

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