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Phlebologie 2001; 30(03): 68-74
DOI: 10.1055/s-0037-1617271
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Schattauer GmbH

Epidemiologie und Prävention der arteriellen Verschlusskrankheit

Epidemiology and prevention of peripheral arterial disease
K.-L. Schulte
1   Gefäßzentrum Berlin/Med. Klinik (Leiter: Prof. Dr. med. K.-L. Schulte), Ev. Krankenhaus Königin Elisabeth, Akad. Lehrkrankenhaus der Charité (Humboldt-Universität Berlin)
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Publication History

Publication Date:
29 December 2017 (online)

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Zusammenfassung

Die Prävalenz der arteriellen Verschlusskrankheit (AVK) und das assoziierte kardiovaskuläre Morbiditäts- und Mortalitätsrisiko werden häufig unterschätzt. Die AVK ist zu 90% durch eine Atherosklerose verursacht, die selten isoliert in den Beinen zu finden ist. Die Prävalenz der symptomatischen Erkrankung liegt unabhängig vom Geschlecht bei 4,5% ab einem Alter von 55 Jahren. Hingegen ist die Prävalenz der asymptomatischen AVK bei über 20% anzusetzen. Die 5-Jahres-Mortalitätsrate von männlichen Patienten mit einer AVK beträgt 5-17%, die Lebenserwartung ist um 10 Jahre verkürzt. Haupttodesursachen sind kardiale sowie zerebrale Erkrankungen. Dies unterstreicht die hohe Koinzidenz von AVK, koronarer Herzkrankheit und zerebralen Gefäßerkrankungen. Die Empfehlungen zur Behandlung der Risikofaktoren für eine AVK weisen auf ihre Bedeutung hin. Neben einer strikten Nikotinkarenz und frühzeitigen Thrombozytenfunktionshemmung sollten nichtpharmakologisch und medikamentös Diabetes mellitus (Nüchternglukose 80-120 mg%; HbA1c <7%), Hyperlipoproteinämie (LDL-Cholesterin <100 mg%) und arterielle Hypertonie (<130/85 mmHg) behandelt werden. Die Bedeutung einer Hyperhomocysteinämie und Hyperfibrinogenämie ist bekannt, der präventive Nutzen ihrer Therapie jedoch nicht bewiesen. Als weitere präventiv wirksame Maßnahmen sind Gewichtsnormalisierung und Ausdauertraining zu nennen.

Summary

The prevalence of peripheral arterial disease (PAD) is underestimated. PAD is a serious risk factor for cardiovascular morbidity and mortality. The disease is seldom localized only in the legs and in 90% of the patients caused by atherosclerosis. The prevalence of symptomatic PAD is both in women and men aged ≥55 years 4.5%. However, the prevalence of asymptomatic PAD is >20%. The 5-year mortality rate in male patients with PAD may be as high as 5-17%. The life expectancy is reduced by 10 years. The main causes of death are coronary and cerebral vascular diseases. These facts demonstrate a high rate of coexistence of PAD, coronary artery disease and cerebral vascular diseases. The guide lines for the treatment of the risk factors for the development of PAD underline their importance. Smoking cessation and antiplatelet therapy already in asymptomatic patients should be accompanied by nonpharmacological as well as pharmacological therapy of diabetes mellitus (fasting blood sugar 80-120 mg%, HbA1c <7%), hyperlipidemia (LDL cholesterol <100 mg%) and arterial hypertension (<130/85 mmHg). Furthermore, the importance of hyperhomocysteinemia and hyperfibrinogenemia are well known. However, the preventive efficacy of specific therapies could not yet be defined. Furthermore, additional therapeutic strategies as exercise and weight reduction in obese patients should be mentioned.

Résumé

La prévalence de la maladie occlusive artérielle (MOA) et les risques cardiovasculaires de morbidité et de mortalité qui y sont associés sont souvent sous-estimés. La MOA est entraînée à 90% par une athérosclérose qui apparaît de façon rarement isolée au niveau des jambes. La prévalence de la pathologie symptomatique, indépendamment du sexe est de 4,5% à partir de 55 ans. En revanche, la prévalence de la MOA asymptomatique est de plus de 20%. Le taux de mortalité sur cinq ans des patients masculins atteints d’une MOA est de 5 à 17% et l’espérance de vie est réduite de 10 ans. Les causes principales sont les pathologies cardiaques et cérébrales. Ces phénomènes soulignent la coïncidence élevée de la MOA, des cardiopathies et des vasculopathies cérébrales. Les recommandations de traitement des facteurs de risque de la MOA sont fonction de son importance. Outre une stricte carence nicotinique et une inhibition précoce des fonctions thrombocytaires, le diabète sucré, (glucose à jeun 80–120 mg% hbAic <7%), l’hyperlipoprotéinémie (cholestérol LDL <100 mg%) et l’hypertension artérielle (<130/85 mmHg) doivent être traités de façon non pharmacologique et médicamenteuse. L’importance d’une hyperhomocystinurie et d’une hyperfibrinogénémie est connue, l’utilité préventive de leur traitement n’est cependant pas attestée. Comme autres mesures efficaces de prévention, on peut citer la normalisation du poids et l’entraînement à l’endurance.

Epidémiologie et prévention de la maladie occlusive artérielle

Schlüsselwörter

Arterielle Verschlusskrankheit - Epidemiologie - Prävention

Keywords

Peripheral arterial disease - epidemiology - prevention

Mots clés

Maladie occlusive artérielle - épidémiologie - prévention
 

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