Nicht pharmakologische Sekundärprävention und Rehabilitation: aktuelle Evidenz

Zusammenfassung

Die Sekundärprävention der koronaren Herzkrankheit umfasst einerseits eine pharmakologische, andererseits eine lebensstilbasierte Säule, die idealerweise interagieren und sich potenzieren. Neben der medikamentösen Blutdruck- und Lipideinstellung auf leitlinienorientierte Zielwerte ermöglichen moderne Antidiabetika eine Optimierung des glukometabolischen Kontinuums und eine Prognosebesserung. Die Lebensstiloptimierung setzt sich aus koronarprotektiver Ernährung, einer individualisierten Trainingstherapie, einer konsequenten Nikotinkarenz und stressreduzierenden Maßnahmen zusammen. Die kardiologische Rehabilitation (Phase II) schließt sich idealerweise unmittelbar einem stationären Aufenthalt wegen eines akuten Koronarereignisses an, kann aber auch im Rahmen einer stabilen Koronarsituation im Rahmen eines allgemeinen Antragsverfahrens durchgeführt werden. Randomisierte und prospektiv angelegte Interventionsstudien belegen die prognostische Wertigkeit der kardiologischen Rehabilitation auch im Zeitalter akuter Revaskularisationstherapie mit 24-h-PCI und moderner Pharmakotherapie.

Abstract

Secondary prevention of coronary artery disease includes pharmacological and lifestyle-based therapy that ideally interact and potentiate. In addition to blood pressure and lipid adjustment to guideline-oriented target values, modern antidiabetic agents enable an optimization of the glucometabolic continuum and improve prognosis. Lifestyle optimization consists of coronary protective nutrition, individualized training therapy, consistent nicotine withdrawal and stress-reducing measures. Cardiological rehabilitation (phase II) ideally immediately follows an inpatient stay due to an acute coronary event, but can also be carried out in the context of a stable coronary situation. Randomized and prospective intervention studies prove the prognostic value of cardiological rehabilitation even in the age of acute revascularization therapy with 24-hour PCI and modern pharmacotherapy.

Schlüsselwörter

Sekundärprävention - kardiologische Rehabilitation - Trainingstherapie - Ernährung - berufliche Wiedereingliederung

Key words

cardiac rehabilitation - physical activity - nutrition - professional reintegration - secondary prevention

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