Dialyse aktuell 2020; 24(09): 345-348
DOI: 10.1055/a-1190-8023
Expertentipp

Von der Diät bis zu Lipoproteinapherese

Leitliniengerechtes Vorgehen in der Behandlung einer Hypercholesterinämie
Volker J.J. Schettler

Es ist unstrittig, dass eine erhöhte LDL-C-Konzentration (LDL-C: Low-Density-Lipoprotein-Cholesterin) ein kausaler Risikofaktor für kardiovaskuläre Ereignisse ist [1]. Es ist daher nachvollziehbar, wenn mit einer therapeutischen LDL-C-Absenkung auch parallel weitere kardiovaskuläre Ereignisse vermindert werden [2]. Interessant ist dabei, dass offensichtlich weniger der therapeutische Weg der LDL-C-Absenkung, sondern primär die so erreichte LDL-C-Konzentration, der LDL-C-Zielwert, zu einer Reduktion von kardiovaskulären Ereignissen führt [3].



Publication History

Article published online:
12 November 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • Literatur

  • 1 Ference BA, Ginsberg HN, Graham I. et al Low-density lipoproteins cause atherosclerotic cardiovascular disease. 1. Evidence from genetic, epidemiologic, and clinical studies. A consensus statement from the European Atherosclerosis Society Consensus Panel. Eur Heart J 2017; 38: 2459-2472 doi:10.1093/eurheartj/ehx144
  • 2 Preiss D, Tobert JA, Hovingh GK, Reith C. Lipid-Modifying Agents, From Statins to PCSK9 Inhibitors: JACC Focus Seminar. J Am Coll Cardiol 2020; 75: 1945-1955 doi:10.1016/j.jacc.2019.11.072
  • 3 Viljoen A, Wierzbicki AS. Enhanced LDL-C reduction: lower is better. Does it matter how?. Int J Clin Pract 2008; 62: 518-520 doi:10.1111/j.1742-1241.2008.01721.x
  • 4 Hooper AJ, Burnett JR. Recent developments in the genetics of LDL deficiency. Curr Opin Lipidol 2013; 24: 111-115 doi:10.1097/MOL.0b013e32835ca0d9
  • 5 Julius U, Kuss S, Tselmin S. et al Why Some Patients Undergoing Lipoprotein Apheresis Therapy Develop New Cardiovascular Events?. J Cardiovasc Dev Dis 2020; 7: E25 doi:10.3390/jcdd7030025
  • 6 Carmena R, Ascaso JF, Redon J. Chronic kidney disease as a cardiovascular risk factor. J Hypertens 2020 Jul 6. doi:10.1097/HJH.0000000000002506. Online ahead of print.
  • 7 Mach F, Baigent C, Catapano AL. et al 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J 2020; 41: 111-188 doi:10.1093/eurheartj/ehz455
  • 8 Nakajima K, Tanaka A. Atherogenic postprandial remnant lipoproteins; VLDL remnants as a causal factor in atherosclerosis. Clin Chim Acta 2018; 478: 200-215 doi:10.1016/j.cca.2017.12.039
  • 9 Fonseca L, Paredes S, Ramos H. et al Apolipoprotein B and non-high-density lipoprotein cholesterol reveal a high atherogenicity in individuals with type 2 diabetes and controlled low-density lipoprotein-cholesterol. Lipids Health Dis 2020; 19: 127 doi:10.1186/s12944-020-01292-w
  • 10 Carr SS, Hooper AJ, Sullivan DR, Burnett JR. Non-HDL-cholesterol and apolipoprotein B compared with LDL-cholesterol in atherosclerotic cardiovascular disease risk assessment. Pathology 2019; 51: 148-154 doi:10.1016/j.pathol.2018.11.006
  • 11 Pfetsch V, Sanin V, Koenig W. [Lipid-lowering therapy in Europe and the United States – treat to target or fire and forget?]. Dtsch Med Wochenschr 2016; 141: 857-862 doi:10.1055/s-0042-106626
  • 12 Wiegman A, Gidding SS, Watts GF. et al Familial hypercholesterolaemia in children and adolescents: gaining decades of life by optimizing detection and treatment. Eur Heart J 2015; 36: 2425-2437 doi:10.1093/eurheartj/ehv157
  • 13 Balder JW, Rimbert A, Zhang X. et al Genetics, Lifestyle, and Low-Density Lipoprotein Cholesterol in Young and Apparently Healthy Women. Circulation 2018; 137: 820-831 doi:10.1161/CIRCULATIONAHA.117.032479
  • 14 Banach M, Duell PB, Gotto Jr AM. et al Association of Bempedoic Acid Administration With Atherogenic Lipid Levels in Phase 3 Randomized Clinical Trials of Patients With Hypercholesterolemia. JAMA Cardiol 2020 Jul 1 e202314. DOI: doi:10.1001/jamacardio.2020.2314. Online ahead of print.
  • 15 Elamin AFM, Grafton-Clarke C, Wen Chen K. et al Potential use of PCSK9 inhibitors as a secondary preventative measure for cardiovascular disease following acute coronary syndrome: a UK real-world study. Postgrad Med J 2019; 95: 61-66 doi:10.1136/postgradmedj-2018-136171
  • 16 Catapano AL, Pirillo A, Norata GD. New Pharmacological Approaches to Target PCSK9. Curr Atheroscler Rep 2020; 22: 24 doi:10.1007/s11883-020-00847-7
  • 17 Zenti MG, Stefanutti C, Sanga V. et al Evolocumab and lipoprotein apheresis combination therapy may have synergic effects to reduce low-density lipoprotein cholesterol levels in heterozygous familial hypercholesterolemia: A case report. J Clin Apher 2018; 33: 546-550 doi:10.1002/jca.21632
  • 18 Gencer B, Mach F. Lipid management in ACS: Should we go lower faster?. Atherosclerosis 2018; 275: 368-375 doi:10.1016/j.atherosclerosis.2018.06.871
  • 19 Rosenblit PD. Lowering Targeted Atherogenic Lipoprotein Cholesterol Goals for Patients at “Extreme” ASCVD Risk. Curr Diab Rep 2019; 19: 146 doi:10.1007/s11892-019-1246-y
  • 20 Yeang C, Witztum JL, Tsimikas S. ‘LDL-C’ = LDL-C + Lp(a)-C: implications of achieved ultra-low LDL-C levels in the proprotein convertase subtilisin/kexin type 9 era of potent LDL-C lowering. Curr Opin Lipidol 2015; 26: 169-178 doi:10.1097/MOL.0000000000000171
  • 21 Boffa MB, Koschinsky ML. Oxidized phospholipids as a unifying theory for lipoprotein(a) and cardiovascular disease. Nat Rev Cardiol 2019; 16: 305-318 doi:10.1038/s41569-018-0153-2
  • 22 Mallya UG, Boklage SH, Koren A. et al Budget Impact Analysis of PCSK9 Inhibitors for the Management of Adult Patients with Heterozygous Familial Hypercholesterolemia or Clinical Atherosclerotic Cardiovascular Disease. Pharmacoeconomics 2018; 36: 115-126 doi:10.1007/s40273-017-0590-5
  • 23 Heigl F, Hettich R, Lotz N. et al Clinical benefit of long-term lipoprotein apheresis in patients with severe hypercholesterolemia or Lp(a)-hyperlipoproteinemia with progressive cardiovascular disease. Clin Res Cardiol Suppl 2015; 10: 8-13 doi:10.1007/s11789-015-0071-3