Lipidtherapie im Alltag

Zusammenfassung

Patienten mit einem erhöhten kardiovaskulären Risiko sind in der klinischen Praxis häufig. Eine umfassende Behandlung der modifizierbaren Risikofaktoren, insbesondere der Dyslipidämie, ist erforderlich. Zahlreiche Studien in der hausärztlichen Praxis haben die Diskrepanz zwischen den Empfehlungen der einschlägigen Leitlinien und der tatsächlich erreichten Therapieeinstellung herausgearbeitet. Aktuelle Daten zur Behandlungssituation von Patienten mit hohem kardiovaskulären Risiko liefert das prospektive Register LIMA, in das niedergelassene Ärzte in 2387 Praxen in Deutschland insgesamt 13942 Patienten mit koronarer Herzkrankheit (KHK), Diabetes mellitus oder peripherer arterieller Verschlusskrankheit (PAVK) einschlossen. Die Vorbehandlung mit Simvastatin 40 mg/d war ein Einschlusskriterium. Die Ärzte dokumentierten die Arzneimittelanwendung, Laborwerte (Lipide, Blutzucker), Blutdruck und klinische Ereignisse über 1 Jahr, und erhielten nach Dateneingabe Informationen über die Zielwerterreichung ihrer Patienten. Im Mittel waren die Patienten 65,7 Jahre alt, und in 61,6 % Männer. KHK wurde in 70,6 % berichtet, Diabetes mellitus in 58,2 % und PAVK bei 14,9 %. Die meisten Patienten (68 %) erhielten auch nach der Eingangsdokumentation weiterhin Simvastatin als Monotherapie; 20,6 % der Patienten erhielten zusätzlich den Cholesterinabsorptionshemmer Ezetimib in den ersten 6 Monaten, und 23.3 % der Patienten in den zweiten 6 Monaten. Die Patienten erreichten den LDL-Cholesterin-Zielwert in 31,8 % zu Beginn und in 50,0 % nach einem Jahr. Den Blutdruckzielwert < 140 /90 mmHg erreichten 65,8 % nach 1 Jahr. Von den Patienten mit Diabetes mellitus erreichten 40,0 % einen HbA_1c-Wert unter 6,5 %. Klinische Ereignisse (Tod, Krankenhauseinweisung, (kardio-)vaskuläre Ereignisse, Dialyse) traten in 11,7 % der Patienten zwischen Beginn und Monat 6, und in 12,0 % zwischen Monat 7 und 12 auf. In der täglichen Praxis bleibt die umfassende Einstellung der Risikofaktoren von Patienten mit hohem kardiovaskulären Risiko eine Herausforderung. Zur Normalisierung erhöhter LDL- Cholesterinwerte wird Ezetimib zu einer bestehenden Statintherapie hinzugefügt, was die Aussichten der Patienten für die Erreichung der Zielwerte verbessert.

Abstract

Patients with increased cardiovascular risk profile are frequently seen in general practice. Comprehensive management of modifiable risk factors, in particular dyslipidemia, is mandatory. Many studies in clinical practice have shown a gap between the recommendations in clinical guidelines and the actual situation. Current data on the management situation of patients with high cardiovascular risk is provided by the prospective registry LIMA. Primary care physicians in 2,387 offices throughout Germany documented 13,924 patients with coronary artery disease (CAD), diabetes mellitus or peripheral arterial disease (PAD). Treatment with simvastatin 40 mg was an inclusion criterion. Physicians documented drug utilization, laboratory values (lipids, blood glucose), blood pressure and clinical events over one year and received feedback about the target value attainment of their patients after data entry. Mean age of the patients was 65.7 years, and 61.6 % were men. CAD was reported in 70.6 %, diabetes mellitus in 58.2 % and PAD in 14.9 %. Most patients (68 %) received simvastatin as monotherapy also after the inclusion visit; 20.6 % of patients received in addition the cholesterol absorption inhibitor (ezetimibe) in the first 6 months, and 23.3 % in the second 6 months. Patients achieved the LDL-cholesterol target value in 31.8 % at entry and 50.0 % after one year. The blood pressure target < 140 /90 mmHg was reached by 65.8 % after one year. Of patients with diabetes mellitus 40.0 % reached an HbA1_c value below 6.5 %. Clinical events (death, hospitalization, (cardio-) vascular events, and dialysis) were reported by 11.7 % of patients between entry and Month 6, and by 12.0 % between Month 7 and 12. In daily practice comprehensive management of risk factors in patients at high cardiovascular risk remains a challenge. For normalization of increased LDL cholesterol values addition of ezetimibe to existing statin therapy improves the chances of patients for target level attainment.

Schlüsselwörter

Lipidstörungen - klinische Praxis - Beobachtungsstudie - Zielwerterreichung - Cholesterinabsorptionshemmer

Keywords

lipid disorders - clinical practice - observational study - target level attainment - cholesterol absorption inhibitor

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