Hypercholesterinämie – wann und wie behandeln?

Zusammenfassung

Durch die Therapie der Hypercholesterinämie können kardiovaskuläre Ereignisse in der Sekundärprävention und Primärprävention reduziert werden. Bei der Familiären Hypercholesterinämie als Hochrisikokonstellation soll LDL-Cholesterin frühzeitig und signifikant gesenkt werden. Aktuell erweitert sich das Spektrum der Therapie-Möglichkeiten um vielversprechende neue Substanzen. Für die homozygote Familiäre Hypercholesterinämie wurde der MTP-Inhibitor Lomitapide, der LDL-Cholesterin unabhängig vom LDL-Rezeptor senkt, zugelassen. Auch der erste der PCSK9-Inhibitoren, die den Abbau der LDL-Rezeptoren reduzieren und den LDL-Spiegel Rezeptor abhängig senken, wurde gerade zugelassen. Beide Ansätze sind vielversprechend; weitere Studien müssen die Langzeit-Sicherheit und die – in ersten PCSK9-Daten erkennbare –Reduktion kardiovaskulärer Ereignisse zeigen. Es ist zu erwarten, dass diese Substanzen in Kombination mit den etablierten Therapien oder als Monotherapie bei Unverträglichkeiten die risikoadaptierte Therapie verbessern werden.

Abstract

Treating hypercholesterolemia reduces cardiovascular events in secondary and primary prevention. Familial hypercholesterolemia is a high risk constellation per se and LDL-cholesterol should be lowered early in life and significantly. Some novel agents will broaden our therapeutic options. The MTP-inhibitor Lomitapide, that reduces LDL-cholesterol independently of the LDL-receptor, and PCSK9-inhibitors, that reduce LDL-cholesterol by blocking the degradation of the LDL-receptor, were approved recently. Both novel therapeutic principles are promising. Further trials have to address long term safety and – as first data suggest in case of PCSK9-inhibitors – the reduction of cardiovascular events. One can expect that these novel agents will improve the risk adapted therapy – in combination with well-established therapies or in case of intolerances as mono-therapy.

Schlüsselwörter

Hypercholesterinämie - familiäre Hypercholesterinämie - Prävention - kardiovaskuläre Krankheiten

Keywords

hypercholesterolaemia - familiar hypercholesterolaemia - prevention - cardiovascular diseases

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