Dtsch Med Wochenschr 2015; 140(17): 1314-1315
DOI: 10.1055/s-0041-103886
Fachwissen
Standpunkt
© Georg Thieme Verlag KG Stuttgart · New York

Was bringt die stärkere Senkung des LDL-Cholesterins durch eine Kombinationstherapie?

What is the use of even lower LDL cholesterol by combination therapy? A critical viewpoint
Erland Erdmann
1   Em. Direktor der Klinik III für Innere Medizin, Herzzentrum der Universität zu Köln
› Author Affiliations
Further Information

Publication History

Publication Date:
25 August 2015 (online)

Zusammenfassung

In der IMPROVE-IT Studie wurde nachgewiesen, dass die Gabe von Ezetimib zusätzlich zu Statinen das LDL-Cholesterin deutlich senkte. Die Zahl der Herzinfarkte und Schlaganfälle wurde ebenfalls reduziert, nicht aber die viel wichtigere Mortalität. Eine prophylaktische kardiovaskuläre Therapie sollte das Leben verlängern oder wenigstens verbessen, andernfalls kann sie nicht empfohlen werden.

Abstract

The IMPROVE-IT study has demonstrated a significant reduction of LDL-C when ezetimibe was given in addition to statins. Although the number of strokes and MI was reduced after 7 to 10 years of this treatment, mortality was unaffected, however. Additive ezetimibe treatment can be recommended only, if a better or longer life has been proved – which is not the case.

 
  • Literatur

  • 1 Taylor F, Huffman MD, Macedo AF et al. Statins for the primary prevention of cardiovascular disease. Cochrane Database Syst Rev 2013; CD004816
  • 2 Abramson JD, Rosenberg HG, Jewell N, Wright JM. Should people at low risk of cardiovascular disease take a statin?. BMJ 2013; 347: f6123
  • 3 Stone N, Robinson J, Lichtenstein A et al. 2013 ACC / AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults. Circulation 2014; 129 (Suppl. 02) S1-S45
  • 4 The AIM-HIGH Investigators. Niacin in patients with low HDL cholesterol levels receiving intensive statin therapy. N Engl J Med 2011; 365: 2255-2267
  • 5 The HPS2-THRIVE Collaborative Group. Effects of extended-release niacin with laropiprant in high-risk patients. N Engl J Med 2014; 371: 203-212
  • 6 The ACCORD Study Group. Effects of combination lipid therapy in type 2 diabetes mellitus. N Engl J Med 2010; 362: 1563-1574
  • 7 Erdmann E, Califf R, Gerstein H et al. Effects of the dual peroxisome proliferator–activated receptor activator aleglitazar in patients with Type 2 Diabetes mellitus or prediabetes. Am Heart J 2015; 170: 117-122
  • 8 The Risk and Prevention Study Collaborative Group. n–3 Fatty acids in patients with multiple cardiovascular risk factors. N Engl J Med 2013; 368: 1800-1808
  • 9 Cannon CH, Blazing M, Giugliano R et al. Ezetimibe added to statin therapy after acute coronary syndromes. N Engl J Med 2015; 372: 2387-2397
  • 10 Custodis F, Laufs U. LDL-Cholesterin: Von der Hypothese zur Kausalität. Dtsch Med Wochenschr 2015; 140: 761-764
  • 11 Antithrombotic Trialists Collaboration. Aspirin in the primary and secondary prevention of vascular disease. Lancet 2009; 373: 1849-1860
  • 12 Ikeda Y, Shimada K, Teramoto T et al. Low-dose aspirin for primary prevention of cardiovascular events in Japanese patients 60 years or older with atherosclerotic risk factors. JAMA 2014; 312: 2510-2520
  • 13 Cannon CH, Braunwald E, McCabe C et al. Intensive versus moderate lipid lowering with statins after acute coronary syndromes. N Engl J Med 2004; 350: 1495-1504
  • 14 Pedersen T, Faergeman O Kastelein et al. High-dose atorvastatin vs usual-dose simvastatin for secondary prevention after myocardial infarction. JAMA 2005; 294: 2437-2445
  • 15 SEARCH Collaborative Group. Intensive lowering of LDL cholesterol with 80 mg versus 20 mg simvastatin daily in 12 064 survivors of myocardial infarction: a double-blind randomised trial. Lancet  2010; 376: 1658-1669
  • 16 LaRosa J, Grundy S, Waters D et al. Intensive lipid lowering with atorvastatin in patients with stable coronary disease. N Engl J Med 2005; 352: 1425-1435