Cholesterinhomöostase und kardiovaskuläres Risiko

 

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Zusammenfassung

Hypercholesterinämie ist ein wesentlicher Risikofaktor für kardiovaskuläre Erkrankungen. Cholesterin wird enteral resorbiert und endogen synthetisiert. Statine hemmen die HMG-CoA-Reduktase, das geschwindigkeits-bestimmende Enzym der endogenen Cholesterinsynthese und senken Serumcholesterinspiegel und kardiovaskuläre Morbidität und Mortalität. Indirekte Evidenz aus kleineren Studien zeigt, dass Patienten mit hoher Baseline-Cholesterinresorption möglicherweise nur gering auf eine Statintherapie ansprechen. Darüber hinaus deuten aktuelle klinische Studien darauf hin, dass eine vermehrte Cholesterinresorption bei verringerter Cholesterinsynthese mit einem erhöhten kardiovaskulären Risiko assoziiert ist. Diese Übersichtsarbeit fasst die aktuelle Literatur zusammen und fordert prospektiv angelegte Studien, um zu klären, ob das Verhältnis von Cholesterin-Synthese zu Resorption zu einer individualisierten Lipidtherapie beitragen kann und ob bei selektionierten Patienten mit hoher Cholesterinresorptionsrate eine Hemmung der enteralen Cholesterinaufnahme kardiovaskuläre Ereignisse weiter vermindern kann.

Abstract

Hypercholesterolemia is a major risk factor for cardiovascular diseases. Serumcholesterol concentrations are regulated by enteral absorption and hepatic synthesis. Statins inhibit the rate-limiting enzyme of endogenous cholesterol synthesis, HMG-CoA-reductase and reduce serum cholesterol concentrations as well as cardiovascular morbidity. Indirect evidence from smaller studies shows, that patients with high baseline cholesterol absorption may show only a small response to statin treatment in terms of cholesterol lowering. Moreover, evidence from recent clinical studies suggests that increased cholesterol absorption and decreased hepatic cholesterol synthesis is associated with an increased cardiovascular risk. This article reviews the current literature on this issue and suggests prospective clinical studies to analyze whether determination of the baseline relation of cholesterol synthesis and absorption may facilitate an individualized lipid lowering therapy to further reduce cardiovascular risk.

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Oliver WeingärtnerM.D. 

Klinik für Innere Medizin III
Kardiologie, Angiologie und Internistische Intensivmedizin
Universitätsklinikum des Saarlandes

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Phone: 06841/1621333

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