Hypertriglyzeridämie

Zusammenfassung

Eine Erhöhung der Triglyzeride ist ein häufiger Befund. Die klinische Bedeutung einer leichten bzw. moderaten Hypertriglyzeridämie besteht in einer Erhöhung des kardiovaskulären Risikos. Neben Diät, Lebensstilmaßnahmen und der Behandlung ursächlicher Krankheiten wie Diabetes mellitus oder Hypothyreose ist die wichtigste therapeutische Maßnahme eine kardiovaskuläre Risikoreduktion. Dies erfolgt durch zielwertgerechte Senkung des LDL-Cholesterins bzw. des Non-HDL-Cholesterins unter Einsatz von Statinen, Ezetimib und gegebenenfalls PCSK9-Senkern. Fibrate und Omega-3-Fettsäuren spielen keine signifikante Rolle. Das klinische Risiko einer schweren Hypertriglyzeridämie über 880 mg/dl bzw. 10 mmol/l und des familiären Chylomikronämiesyndroms besteht wiederum in einer akuten Pankreatitis. Zusätzlich zu Diät und Lebensstilmaßnahmen kommen insbesondere beim familiären Chylomikronämiesyndrom der Fettersatz durch MCT-Fette und ggf. eine Medikation mit dem Antisense-Oligonukleotid Volanesorsen zur Anwendung.

Abstract

Hypertriglyceridemia is a common finding in patients. The clinical importance of mild or moderate hypertriglyceridemia is an increased risk of cardiovascular disease. In addition to diet, lifestyle and the treatment of causal diseases such as diabetes mellitus or hypothyroidism, the therapeutic goal is to reduce the cardiovascular risk. This is achieved by lowering the LDL cholesterol or non-HDL cholesterol to target value using statins, ezetimibe and, if necessary, PCSK9 inhibitors. Fibrates and omega-3 fatty acids do not play a significant role. On the other hand, severe hypertriglyceridaemia > 880 mg/dl or 10 mmol/l and familial chylomicronemia syndrome result in a high risk of acute pancreatitis. Particularly in the familial chylomicronemia syndrome, besides diet and lifestyle measures, MCT fats and, in rare cases, medication with the antisense oligonucleotide Volanesorsen are used.

Schlüsselwörter

Triglyzeride - kardiovaskuläres Risiko - Chylomikronämie - akute Pankreatitis

Key words

triglycerides - cardiovascular risk - chylomicronemia - acute pancreatitis

• Literatur

• 1 Merkel M, Müller-Wieland D. Lipid profiles from hospitalized patients. unpublished data 2016.
• 2 Nordestgaard BG. Triglyceride-Rich Lipoproteins and Atherosclerotic Cardiovascular Disease: New Insights From Epidemiology, Genetics, and Biology. Circ Res 2016; 118: 547-563
• 3 Hokanson JE, Austin MA. Plasma triglyceride level is a risk factor for cardiovascular disease independent of high-density lipoprotein cholesterol level: a meta-analysis of population-based prospective studies. J Cardiovasc Risk 1996; 3: 213-219
• 4 Nordestgaard BG, Tybjaerg-Hansen A. Genetic determinants of LDL, lipoprotein(a), triglyceride-rich lipoproteins and HDL: concordance and discordance with cardiovascular disease risk. Curr Opin Lipidol 2011; 22: 113-122
• 5 Moulin P, Dufour R, Averna M. et al. Identification and diagnosis of patients with familial chylomicronaemia syndrome (FCS): Expert panel recommendations and proposal of an “FCS score”. Atherosclerosis 2018; 275: 265-272
• 6 Johansen CT, Kathiresan S, Hegele RA. Genetic determinants of plasma triglycerides. J Lipid Res 2011; 52: 189-206
• 7 Austin MA, King MC, Vranizan KM. et al. Atherogenic lipoprotein phenotype. A proposed genetic marker for coronary heart disease risk. Circulation 1990; 82: 495-506
• 8 Boekholdt SM, Arsenault BJ, Mora S. et al. Association of LDL cholesterol, non-HDL cholesterol, and apolipoprotein B levels with risk of cardiovascular events among patients treated with statins: a meta-analysis. JAMA 2012; 307: 1302-1309
• 9 Langlois MR, Chapman MJ, Cobbaert C. et al. Quantifying Atherogenic Lipoproteins: Current and Future Challenges in the Era of Personalized Medicine and Very Low Concentrations of LDL Cholesterol. A Consensus Statement from EAS and EFLM. Clin Chem 2018; 64: 1006-1033
• 10 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 2019; 41: 111-188
• 11 Kearney PM, Blackwell L, Collins R. et al. Efficacy of cholesterol-lowering therapy in 18,686 people with diabetes in 14 randomised trials of statins: a meta-analysis. Lancet 2008; 371: 117-125
• 12 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
• 13 Sabatine MS, Leiter LA, Wiviott SD. et al. Cardiovascular safety and efficacy of the PCSK9 inhibitor evolocumab in patients with and without diabetes and the effect of evolocumab on glycaemia and risk of new-onset diabetes: a prespecified analysis of the FOURIER randomised controlled trial. Lancet Diabetes Endocrinol 2017; 5: 941-950
• 14 Estruch R, Ros E, Salas-Salvado J. et al. Primary Prevention of Cardiovascular Disease with a Mediterranean Diet Supplemented with Extra-Virgin Olive Oil or Nuts. N Engl J Med 2018; 378: e34
• 15 Bruckert E, Labreuche J, Deplanque D. et al. Fibrates effect on cardiovascular risk is greater in patients with high triglyceride levels or atherogenic dyslipidemia profile: a systematic review and meta-analysis. J Cardiovasc Pharmacol 2011; 57: 267-272
• 16 Aung T, Halsey J, Kromhout D. et al. Associations of Omega-3 Fatty Acid Supplement Use With Cardiovascular Disease Risks: Meta-analysis of 10 Trials Involving 77917 Individuals. JAMA Cardiol 2018; 3: 225-234
• 17 Bhatt DL, Steg PG, Miller M. et al. Cardiovascular Risk Reduction with Icosapent Ethyl for Hypertriglyceridemia. N Engl J Med 2019; 380: 11-22
• 18 Witztum JL, Gaudet D, Freedman SD. et al. Volanesorsen and Triglyceride Levels in Familial Chylomicronemia Syndrome. N Engl J Med 2019; 381: 531-542
• 19 Otto S, Schulze PC, Weingärtner O. Begründung für die neuen LDL-Cholesterin-Zielwerte. Aktuel Kardiol 2020;