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Aktuelle Kardiologie 2012; 1(1): 60-65
DOI: 10.1055/s-0031-1298297
Übersichtsarbeit
Georg Thieme Verlag KG Stuttgart · New York

Hyperlipoproteinämie – wie behandeln?

Treatment of Hyperlipidemia
C. Werner
1   Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar
,
U. Laufs
1   Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar
› Author Affiliations
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Publication History

Publication Date:
30 March 2012 (online)

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Zusammenfassung

Epidemiologische Studien zeigen eine log-lineare Korrelation der LDL-Cholesterin-Konzentration (LDL-C) mit dem Herzinfarktrisiko. LDL-C ist kausal an der Atherogenese beteiligt, und seine Senkung durch Statine verhindert Myokardinfarkte. Dabei ist die absolute Risikoreduktion abhängig von der Höhe des Ausgangs-Cholesterins, dem Ausmaß der Cholesterinsenkung und dem globalen vaskulären Risiko. Die Basismaßnahmen einer lipidsenkenden Therapie sind Rauch-Stopp und körperliche Aktivität. Alkoholkarenz ist hilfreich bei erhöhten Triglyceriden. Die Empfehlung einer Gewichtsabnahme hat im Alltag nur einen geringen Effekt auf das LDL-C. Die medikamentöse Therapie der ersten Wahl sind die Statine. Die Unterstützung der Einnahmetreue stellt eine zentrale Aufgabe im Rahmen einer Lipidtherapie dar. Folgende Zielwerte werden vorgeschlagen:

a) Für Patienten ohne zusätzliche Risikofaktoren (10-Jahres Herzinfarktrisiko < 10 %): Behandlung (Lebensstilmodifikation, dann ggf. Statin) ab LDL 190 mg/dl mit LDL-Ziel < 160 mg/dl (4,1 mmol/l).

b) Für Patienten mit weiteren Risikofaktoren (10-Jahres-Herzinfarktrisiko 10–20 %): Behandlung (Lebensstilmodifikation, dann ggf. Statin) ab LDL 160 mg/dl mit LDL-Ziel < 130 mg/dl (3,4 mmol/l).

c) Für Patienten mit koronarer Herzerkrankung oder äquivalentem Risiko (Diabetes mellitus, ischämischer Schlaganfall, chronische Niereninsuffizienz, pAVK, Bauchaortenaneurysma): Statin für alle mit LDL-Ziel < 100 mg/dl (2,6 mmol/l).

d) Für Patienten mit koronarer Herzerkrankung und besonderes hohem Risiko kann eine weitere LDL-C Senkung < 70 mg/dl als individuelles Therapieziel erwogen werden.

Abstract

Epidemiologic studies show a log-linear correlation between low-density lipoprotein cholesterin and risk for heart attack. LDL-C ist causally involved in atherogenesis and its reduction prevents myocardial infarctions. The absolute risk reduction depends on the cholesterin level before therapy, the degree of its reduction and the global vascular risk. Basic measurements for lipid reducing therapy are smoking cessation and physical activity. Alcohol abstinence is useful in patient with high triglycerides. Weight loss has only a minor effect on LDL-C. First line pharmacological therapy are statins. Securing patients compliance is one of the most important challenges in lipid lowering therapy. Targets for lipid levels are:

a) For patients with additional risk factors (10 years risk of myocardial infarction < 10 %): therapy (basic measurements, if necessary statins) when LDL > 190 mg/dl; target: LDL < 160 mg/dl (4,1 mmol/l).

b) For patients with additional risk factors (10 years risk of myocardial infarction = 10–20 %): therapy (basic measurements, if necessary statins) when LDL > 160 mg/dl; target: LDL < 130 mg/dl (3,4 mmol/l).

c) For patients with coronary heart disease or equivalent risk factors (diabetes mellitus, ischaemic cerebral infarction, chronic renal insufficiency, peripheral arterial disease, abdominal aortic aneurysm): statins for all patients; target: LDL <100 mg/dl (2,6 mmol/l)

d) For patients with coronary heart disease and exceptionally high risk a further reduction of LDL-C (< 70 mg/dl) can be discussed.

Schlüsselwörter

Lipide - Behandlung - Cholesterin - LDL

Key words

lipids - treatment - cholesterol - LDL
 

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