Dtsch Med Wochenschr 2019; 144(05): 322-328
DOI: 10.1055/a-0657-1668
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© Georg Thieme Verlag KG Stuttgart · New York

Therapie der Hypercholesterinämie in der Primärprävention

Therapy of Hypercholesterolemia in Primary Prevention
Veronika Sanin
,
Wolfgang Koenig
Further Information

Publication History

Publication Date:
05 March 2019 (online)

Abstract

Atherosclerotic cardiovascular disease is the leading cause of premature mortality and morbidity worldwide. Dyslipidemia is a commonly encountered clinical condition and is an important determinant of cardiovascular disease. The causality of plasma low-density lipoprotein-cholesterol (LDL-C) in the pathophysiology of cardiovascular disease has been established beyond any reasonable doubt. In this context, individual risk estimation, the determination of target values and lipid-lowering strategies represent an essential part and a challenge in the daily clinical practice to prevent cardiovascular events. Statins are recommended as first-line therapy for patients with hypercholesterolemia in secondary prevention. Controversies remain in the context of primary prevention, however, as to which kind of subjects to treat, the magnitude of the benefit, and potential harm. This article gives a brief overview of the current evidence, guideline recommendations and strategies for lowering of LDL-C in the primary prevention of cardiovascular disease.

Atherosklerotische Herz-Kreislauf-Erkrankungen (HKE) stellen weltweit die führende Ursache für frühzeitige Mortalität und Morbidität dar. Pathophysiologisch nimmt die Hyperlipidämie – insbesondere das erhöhte LDL-Cholesterin – eine zentrale und kausale Schlüsselrolle ein [1]. Dieser Beitrag gibt einen Überblick über aktuelle Studiendaten, Leitlinienempfehlungen und Strategien zur primärpräventiven Senkung eines erhöhten LDL-Cholesterins.

 
  • Literatur

  • 1 Jansen H, Samani NJ, Schunkert H. Mendelian randomization studies in coronary artery disease. Eur Heart J 2014; 35: 1917-1924
  • 2 Lewington S, Whitlock G, Clarke R. et al. Blood cholesterol and vascular mortality by age, sex, and blood pressure: a meta-analysis of individual data from 61 prospective studies with 55000 vascular deaths. Lancet 2007; 370: 1829-1839
  • 3 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
  • 4 Baigent C, Keech A, Kearney PM. et al. Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins. Lancet 2005; 366: 1267-1278
  • 5 Catapano AL, Graham I, De Backer G. et al. 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias. Rev Esp Cardiol 2017; 70: 115
  • 6 Catapano AL, Graham I, De Backer G. et al. 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias. Kardiol Pol 2016; 74: 1234-1318
  • 7 Grundy SM, Stone NJ, Bailey AL. et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2018 Nov 3. pii: S0735-1097(18)39033-8 [Epub ahead of print]
  • 8 Shepherd J, Cobbe SM, Ford I. et al. Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. West of Scotland Coronary Prevention Study Group. N Engl J Med 1995; 333: 1301-1307
  • 9 Ford I, Murray H, McCowan C. et al. Long-term safety and efficacy of lowering low-density lipoprotein cholesterol with statin therapy: 20-year follow-up of West of Scotland Coronary Prevention Study. Circulation 2016; 133: 1073-1080
  • 10 Ridker PM, Danielson E, Fonseca FA. et al. Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. N Engl J Med 2008; 359: 2195-2207
  • 11 Yusuf S, Bosch J, Dagenais G. et al. Cholesterol lowering in intermediate-risk persons without cardiovascular disease. N Engl J Med 2016; 374: 2021-2031
  • 12 Taylor F, Huffman MD, Macedo AF. et al. Statins for the primary prevention of cardiovascular disease. Cochrane Database Syst Rev 2013; 1: CD004816
  • 13 Mihaylova B, Emberson J, Blackwell L. et al. The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: meta-analysis of individual data from 27 randomised trials. Lancet 2012; 380: 581-590
  • 14 Weng TC, Yang YH, Lin SJ. et al. A systematic review and meta-analysis on the therapeutic equivalence of statins. J Clin Pharm Ther 2010; 35: 139-151
  • 15 Sattar N, Preiss D, Murray HM. et al. Statins and risk of incident diabetes: a collaborative meta-analysis of randomised statin trials. Lancet 2010; 375: 735-742
  • 16 Ridker PM, Pradhan A, MacFadyen JG. et al. Cardiovascular benefits and diabetes risks of statin therapy in primary prevention: an analysis from the JUPITER trial. Lancet 2012; 380: 565-571
  • 17 Cannon CP, Blazing MA, Giugliano RP. et al. Ezetimibe added to statin therapy after acute coronary syndromes. N Engl J Med 2015; 372: 2387-2397
  • 18 Heller DJ, Coxson PG, Penko J. et al. Evaluating the impact and cost-effectiveness of statin use guidelines for primary prevention of coronary heart disease and stroke. Circulation 2017; 136: 1087-1098
  • 19 Mortensen MB, Falk E. Primary prevention with statins in the elderly. J Am Coll Cardiol 2018; 71: 85-94
  • 20 Ridker PM, Lonn E, Paynter NP. et al. Primary prevention with statin therapy in the elderly: new meta-analyses from the contemporary JUPITER and HOPE-3 randomized trials. Circulation 2017; 135: 1979-1981
  • 21 Collins R, Reith C, Emberson J. et al. Interpretation of the evidence for the efficacy and safety of statin therapy. Lancet 2016; 388: 2532-2561