Skip to main content
Erschienen in: Herz 6/2017

08.08.2017 | Hypercholesterinämie | CME

Fettstoffwechselstörungen

Diagnostik und Therapie

verfasst von: D. Sinning, Prof. Dr. med. U. Landmesser

Erschienen in: Herz | Ausgabe 6/2017

Einloggen, um Zugang zu erhalten

Zusammenfassung

Bei Fettstoffwechselstörungen ist die risikoadaptierte Einstellung des LDL(„low-density lipoprotein“)-Cholesterins (LDL-C) das primäre therapeutische Ziel, da hier ein kausaler Zusammenhang mit der Verminderung der Progression der atherosklerotischen Gefäßerkrankung nachgewiesen ist. Statine bilden weiterhin die Grundlage der medikamentösen Therapie, und mit Ezetimib und der PCSK9(Proproteinkonvertase Subtilisin/Kexin Typ 9)-Hemmung stehen mittlerweile weitere Optionen mit positiven Endpunktstudien zur Verfügung. Lebensstilmodifizierende Maßnahmen sind eine wichtige Grundlage zur Risikoreduktion und können insbesondere zur Absenkung erhöhter Triglyzeridwerte führen. Bestimmungen von HDL(„high-density lipoprotein“)-C und Lipoprotein(a) (Lp[a]) liefern weitere Informationen bei der Risikostratifizierung, prognoseverbessernde Effekte durch eine medikamentöse Therapie einer HDL-Erhöhung bzw. Lp(a)-Senkung wurden jedoch bisher nicht nachgewiesen.
Literatur
4.
Zurück zum Zitat Scheidt-Nave C, Du Y, Knopf H et al (2013) Prevalence of dyslipidemia among adults in Germany: results of the German Health Interview and Examination Survey for Adults (DEGS 1). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 56(5):661–667. doi:10.1007/s00103-013-1670-0 CrossRefPubMed Scheidt-Nave C, Du Y, Knopf H et al (2013) Prevalence of dyslipidemia among adults in Germany: results of the German Health Interview and Examination Survey for Adults (DEGS 1). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 56(5):661–667. doi:10.​1007/​s00103-013-1670-0 CrossRefPubMed
6.
Zurück zum Zitat Stamler J, Wentworth D, Neaton JD (1986) Is relationship between serum cholesterol and risk of premature death from coronary heart disease continuous and graded? Findings in 356,222 primary screenees of the Multiple Risk Factor Intervention Trial (MRFIT). JAMA 256(20):2823–2828CrossRefPubMed Stamler J, Wentworth D, Neaton JD (1986) Is relationship between serum cholesterol and risk of premature death from coronary heart disease continuous and graded? Findings in 356,222 primary screenees of the Multiple Risk Factor Intervention Trial (MRFIT). JAMA 256(20):2823–2828CrossRefPubMed
7.
Zurück zum Zitat Cholesterol Treatment Trialists Collaboration, Mihaylova B, Emberson J et al (2012) The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: meta-analysis of individual data from 27 randomised trials. Lancet 380(9841):581–590. doi:10.1016/s0140-6736(12)60367-5 CrossRef Cholesterol Treatment Trialists Collaboration, Mihaylova B, Emberson J et al (2012) The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: meta-analysis of individual data from 27 randomised trials. Lancet 380(9841):581–590. doi:10.​1016/​s0140-6736(12)60367-5 CrossRef
8.
Zurück zum Zitat Ference BA, Ginsberg HN, Graham I et al (2017) Low-density lipoproteins cause atherosclerotic cardiovascular disease. 1. Evidence from genetic, epidemiologic, and clinical studies. A consensus statement from the European Atherosclerosis Society Consensus Panel. Eur Heart J. doi:10.1093/eurheartj/ehx144 Ference BA, Ginsberg HN, Graham I et al (2017) Low-density lipoproteins cause atherosclerotic cardiovascular disease. 1. Evidence from genetic, epidemiologic, and clinical studies. A consensus statement from the European Atherosclerosis Society Consensus Panel. Eur Heart J. doi:10.​1093/​eurheartj/​ehx144
10.
Zurück zum Zitat Jorgensen AB, Frikke-Schmidt R, West AS et al (2013) Genetically elevated non-fasting triglycerides and calculated remnant cholesterol as causal risk factors for myocardial infarction. Eur Heart J 34(24):1826–1833. doi:10.1093/eurheartj/ehs431 CrossRefPubMed Jorgensen AB, Frikke-Schmidt R, West AS et al (2013) Genetically elevated non-fasting triglycerides and calculated remnant cholesterol as causal risk factors for myocardial infarction. Eur Heart J 34(24):1826–1833. doi:10.​1093/​eurheartj/​ehs431 CrossRefPubMed
11.
Zurück zum Zitat Kolovou GD, Mikhailidis DP, Kovar J et al (2011) Assessment and clinical relevance of non-fasting and postprandial triglycerides: an expert panel statement. Curr Vasc Pharmacol 9(3):258–270CrossRefPubMed Kolovou GD, Mikhailidis DP, Kovar J et al (2011) Assessment and clinical relevance of non-fasting and postprandial triglycerides: an expert panel statement. Curr Vasc Pharmacol 9(3):258–270CrossRefPubMed
12.
Zurück zum Zitat Mihas C, Kolovou GD, Mikhailidis DP et al (2011) Diagnostic value of postprandial triglyceride testing in healthy subjects: a meta-analysis. Curr Vasc Pharmacol 9(3):271–280CrossRefPubMed Mihas C, Kolovou GD, Mikhailidis DP et al (2011) Diagnostic value of postprandial triglyceride testing in healthy subjects: a meta-analysis. Curr Vasc Pharmacol 9(3):271–280CrossRefPubMed
13.
Zurück zum Zitat National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (2002) Third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 106(25):3143–3421 National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (2002) Third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 106(25):3143–3421
17.
Zurück zum Zitat Cholesterol Treatment Trialists Collaboration, Fulcher J, O’Connell R et al (2015) Efficacy and safety of LDL-lowering therapy among men and women: meta-analysis of individual data from 174,000 participants in 27 randomised trials. Lancet 385(9976):1397–1405. doi:10.1016/s0140-6736(14)61368-4 CrossRef Cholesterol Treatment Trialists Collaboration, Fulcher J, O’Connell R et al (2015) Efficacy and safety of LDL-lowering therapy among men and women: meta-analysis of individual data from 174,000 participants in 27 randomised trials. Lancet 385(9976):1397–1405. doi:10.​1016/​s0140-6736(14)61368-4 CrossRef
21.
Zurück zum Zitat Cholesterol Treatment Trialists Collaboration, Baigent C, Blackwell L et al (2010) Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet 376(9753):1670–1681. doi:10.1016/s0140-6736(10)61350-5 CrossRef Cholesterol Treatment Trialists Collaboration, Baigent C, Blackwell L et al (2010) Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet 376(9753):1670–1681. doi:10.​1016/​s0140-6736(10)61350-5 CrossRef
27.
Zurück zum Zitat Sudhop T, Lutjohann D, Kodal A et al (2002) Inhibition of intestinal cholesterol absorption by ezetimibe in humans. Circulation 106(15):1943–1948CrossRefPubMed Sudhop T, Lutjohann D, Kodal A et al (2002) Inhibition of intestinal cholesterol absorption by ezetimibe in humans. Circulation 106(15):1943–1948CrossRefPubMed
29.
Zurück zum Zitat McKenney JM, Koren MJ, Kereiakes DJ et al (2012) Safety and efficacy of a monoclonal antibody to proprotein convertase subtilisin/kexin type 9 serine protease, SAR236553/REGN727, in patients with primary hypercholesterolemia receiving ongoing stable atorvastatin therapy. J Am Coll Cardiol 59(25):2344–2353. doi:10.1016/j.jacc.2012.03.007 CrossRefPubMed McKenney JM, Koren MJ, Kereiakes DJ et al (2012) Safety and efficacy of a monoclonal antibody to proprotein convertase subtilisin/kexin type 9 serine protease, SAR236553/REGN727, in patients with primary hypercholesterolemia receiving ongoing stable atorvastatin therapy. J Am Coll Cardiol 59(25):2344–2353. doi:10.​1016/​j.​jacc.​2012.​03.​007 CrossRefPubMed
30.
Zurück zum Zitat Landmesser U, Chapman MJ, Farnier M et al (2016) European Society of Cardiology/European Atherosclerosis Society Task Force consensus statement on proprotein convertase subtilisin/kexin type 9 inhibitors: practical guidance for use in patients at very high cardiovascular risk. Eur Heart J. doi:10.1093/eurheartj/ehw480 PubMedCentral Landmesser U, Chapman MJ, Farnier M et al (2016) European Society of Cardiology/European Atherosclerosis Society Task Force consensus statement on proprotein convertase subtilisin/kexin type 9 inhibitors: practical guidance for use in patients at very high cardiovascular risk. Eur Heart J. doi:10.​1093/​eurheartj/​ehw480 PubMedCentral
32.
Zurück zum Zitat Triglyceride Coronary Disease Genetics Consortium, Emerging Risk Factors Collaboration, Sarwar N et al (2010) Triglyceride-mediated pathways and coronary disease: collaborative analysis of 101 studies. Lancet 375(9726):1634–1639. doi:10.1016/s0140-6736(10)60545-4 CrossRef Triglyceride Coronary Disease Genetics Consortium, Emerging Risk Factors Collaboration, Sarwar N et al (2010) Triglyceride-mediated pathways and coronary disease: collaborative analysis of 101 studies. Lancet 375(9726):1634–1639. doi:10.​1016/​s0140-6736(10)60545-4 CrossRef
35.
36.
Zurück zum Zitat Kotseva K, Wood D, De Backer G et al (2009) EUROASPIRE III: a survey on the lifestyle, risk factors and use of cardioprotective drug therapies in coronary patients from 22 European countries. Eur J Cardiovasc Prev Rehabil 16(2):121–137. doi:10.1097/hjr.0b013e3283294b1d CrossRefPubMed Kotseva K, Wood D, De Backer G et al (2009) EUROASPIRE III: a survey on the lifestyle, risk factors and use of cardioprotective drug therapies in coronary patients from 22 European countries. Eur J Cardiovasc Prev Rehabil 16(2):121–137. doi:10.​1097/​hjr.​0b013e3283294b1d​ CrossRefPubMed
38.
Zurück zum Zitat Emerging Risk Factors C, Di Angelantonio E, Gao P et al (2012) Lipid-related markers and cardiovascular disease prediction. JAMA 307(23):2499–2506. doi:10.1001/jama.2012.6571 Emerging Risk Factors C, Di Angelantonio E, Gao P et al (2012) Lipid-related markers and cardiovascular disease prediction. JAMA 307(23):2499–2506. doi:10.​1001/​jama.​2012.​6571
41.
Zurück zum Zitat Nicholls SJ, Lincoff AM, Barter PJ et al (2015) Assessment of the clinical effects of cholesteryl ester transfer protein inhibition with evacetrapib in patients at high-risk for vascular outcomes: rationale and design of the ACCELERATE trial. Am Heart J 170(6):1061–1069. doi:10.1016/j.ahj.2015.09.007 CrossRefPubMed Nicholls SJ, Lincoff AM, Barter PJ et al (2015) Assessment of the clinical effects of cholesteryl ester transfer protein inhibition with evacetrapib in patients at high-risk for vascular outcomes: rationale and design of the ACCELERATE trial. Am Heart J 170(6):1061–1069. doi:10.​1016/​j.​ahj.​2015.​09.​007 CrossRefPubMed
42.
43.
Zurück zum Zitat Investigators A‑H, Boden WE, Probstfield JL et al (2011) Niacin in patients with low HDL cholesterol levels receiving intensive statin therapy. N Engl J Med 365(24):2255–2267. doi:10.1056/nejmoa1107579 CrossRef Investigators A‑H, Boden WE, Probstfield JL et al (2011) Niacin in patients with low HDL cholesterol levels receiving intensive statin therapy. N Engl J Med 365(24):2255–2267. doi:10.​1056/​nejmoa1107579 CrossRef
46.
Zurück zum Zitat Seed M, O’Connor B, Perombelon N et al (1993) The effect of nicotinic acid and acipimox on lipoprotein(a) concentration and turnover. Atherosclerosis 101(1):61–68CrossRefPubMed Seed M, O’Connor B, Perombelon N et al (1993) The effect of nicotinic acid and acipimox on lipoprotein(a) concentration and turnover. Atherosclerosis 101(1):61–68CrossRefPubMed
Metadaten
Titel
Fettstoffwechselstörungen
Diagnostik und Therapie
verfasst von
D. Sinning
Prof. Dr. med. U. Landmesser
Publikationsdatum
08.08.2017
Verlag
Springer Medizin
Erschienen in
Herz / Ausgabe 6/2017
Print ISSN: 0340-9937
Elektronische ISSN: 1615-6692
DOI
https://doi.org/10.1007/s00059-017-4601-2

Weitere Artikel der Ausgabe 6/2017

Herz 6/2017 Zur Ausgabe

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.