Periphere arterielle Verschlusskrankheit: Wann ist ein PCSK9-Inhibitor sinnvoll?

Knut Kröger; Christine Espinola-Klein; Ulrich Hoffmann; Christoph Kalka; Holger Lawall; Norbert Weiss

doi:10.1055/a-0774-4494

Gefäßmedizin Scan - Zeitschrift für Angiologie, Gefäßchirurgie, diagnostische und interventionelle Radiologie, Table of Contents

Gefäßmedizin Scan - Zeitschrift für Angiologie, Gefäßchirurgie, diagnostische und interventionelle Radiologie 2018; 05(04): 295-303
DOI: 10.1055/a-0774-4494

CME-Fortbildung

Periphere arterielle Verschlusskrankheit: Wann ist ein PCSK9-Inhibitor sinnvoll?

Knut Kröger

,

Christine Espinola-Klein

,

Ulrich Hoffmann

,

Christoph Kalka

,

Holger Lawall

,

Norbert Weiss

Subject Editor: Wissenschaftlich verantwortlich gemäß Zertifizierungsbestimmungen für diesen Beitrag ist Prof. Dr. med. Knut Kröger, Krefeld.

Abstract

Die PAVK gehört zu der Gruppe von arteriosklerotischen Erkrankungen mit dem höchsten Risiko für kardio- und periphervaskuläre Ereignisse. Ein erhöhter LDL-Cholesterinwert ist ein unabhängiger Risikofaktor dafür und lässt sich effektiv mit PCSK9-Inhibitoren behandeln. Da Angiologen im Beschluss des GBA als Verordner dieser sehr kostenintensiven Therapie genannt sind, werden im vorliegenden Beitrag die Hintergründe erläutert.

Schlüsselwörter

periphere arterielle Verschlusskrankheit - koronare Herzerkrankung - LDL-Cholesterin - PCSK9-Inhibitor

Full Text

References

Literatur
1 Deutsche Gesellschaft für Angiologie – Gesellschaft für Gefäßmedizin, Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF). AWMF-Register Nr.065/003 S3-Leitlinie zur Diagnostik, Therapie und Nachsorge der peripheren arteriellen Verschlusskrankheit. Im Internet: 2015 https://www.awmf.org/uploads/tx_szleitlinien/065-003l_S3_PAVK_periphere_arterielle_Verschlusskrankheitfinal-2016-04.pdf (Stand: 27.10.2018)
2 Duvall WL, Vorchheimer DA. Multi-bed vascular disease and atherothrombosis: scope of the problem. J Thromb Thrombolysis 2004; 17: 51-61
3 Tendera M, Aboyans V. et al. European Stroke Organisation. ESC Guidelines on the diagnosis and treatment of peripheral artery diseases: document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries: the Task Force on the Diagnosis and Treatment of Peripheral Artery Diseases of the European Society of Cardiology (ESC). Eur Heart J 2011; 32: 2851-2906
4 Kownator S, Cambou JP, Cacoub P. et al. Prevalence of unknown peripheral arterial disease in patients with coronary artery disease: data in primary care from the IPSILON study. Arch Cardiovasc Dis 2009; 102: 625-631
5 Cho SW, Kim BG, Kim DH. et al. Prediction of coronary artery disease in patients with lower extremity peripheral artery disease. Int Heart J 2015; 56: 209-212
6 Hirsch AT, Criqui MH, Treat-Jacobson D. et al. Peripheral arterial disease detection, awareness, and treatment in primary care. JAMA 2001; 286: 1317-1324
7 Steg PG, Bhatt DL, Wilson PW. et al. One-year cardiovascular event rates in outpatients with atherothrombosis. JAMA 2007; 297: 1197-1206
8 Pereg D, Neuman EA, Mosseri M. et al. Comparison of mortality in patients with coronary or peripheral artery disease following the first vascular intervention. Coron Artery Dis 2014; 25: 79-82
9 Aboyans V, Ricco JB, Bartelink MEL. et al. ESC Scientific Document Group. 2017 ESC guidelines on the diagnosis and treatment of peripheral arterial diseases, in collaboration with the European Society for Vascular Surgery (ESVS): document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries. Endorsed by: the European Stroke Organization (ESO), The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS). Eur Heart J 2018; 39 (09) 763-816
10 Daskalopoulou SS, Pathmarajah M, Kakkos SK. et al. Association between ankle-brachial index and risk factor profile in patients newly diagnosed with intermittent claudication. Circ J 2008; 72: 441-448
11 Heart Protection Study Collaborative G. Randomized trial of the effects of cholesterol-lowering with simvastatin on peripheral vascular and other major vascular outcomes in 20 536 people with peripheral arterial disease and other high-risk conditions. J Vasc Surg 2007; 45: 645-654
12 Collins R, Armitage J, Parish S. et al. MRC/BHF Heart Protection Study of cholesterol-lowering with simvastatin in 5963 people with diabetes: a randomised placebo-controlled trial. Lancet 2003; 361: 2005-2016
13 Pedersen TR, Kjekshus J, Pyorala K. et al. Effect of simvastatin on ischemic signs and symptoms in the Scandinavian simvastatin survival study (4S). Am J Cardiol 1998; 81: 333-335
14 Aronow WS, Nayak D, Woodworth S. et al. Effect of simvastatin versus placebo on treadmill exercise time until the onset of intermittent claudication in older patients with peripheral arterial disease at six months and at one year after treatment. Am J Cardiol 2003; 92: 711-712
15 Mohler 3rd ER, Hiatt WR, Creager MA. Cholesterol reduction with atorvastatin improves walking distance in patients with peripheral arterial disease. Circulation 2003; 108: 1481-1486
16 Momsen AH, Jensen MB, Norager CB. et al. Drug therapy for improving walking distance in intermittent claudication: a systematic review and meta-analysis of robust randomised controlled studies. Eur J Vasc Endo Surg 2009; 38: 463-474
17 Schanzer A, Hevelone N, Owens CD. et al. Statins are independently associated with reduced mortality in patients undergoing infrainguinal bypass graft surgery for critical limb ischemia. J Vasc Surg 2008; 47: 774-781
18 Stoekenbroek RM, Boekholdt SM, Fayyad R. et al. Incremental Decrease in End Points Through Aggressive Lipid Lowering Study Group. High-dose atorvastatin is superior to moderate-dose simvastatin in preventing peripheral arterial disease. Heart 2015; 101: 356-362
19 Kumbhani DJ, Steg PG, Cannon CP. et al. Statin therapy and long-term adverse limb outcomes in patients with peripheral artery disease: insights from the REACH registry. Eur Heart J 2014; 35: 2864-2872
20 Westin GG, Armstrong EJ, Bang H. et al. Association between statin medications and mortality, major adverse cardiovascular event, and amputation-free survival in patients with critical limb ischemia. J Am Coll Cardiol 2014; 63: 682-690
21 Catapano AL, Graham I, De Backer G. et al. 2016 ESC/EAS guidelines for the management of dyslipidaemias. Eur Heart J 2016; 37: 2999-3058
22 Conroy RM, Pyorala K, Fitzgerald AP. et al. Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. Eur Heart J 2003; 24: 987-1003
23 Aung PP, Maxwell HG, Jepson RG. et al. Lipid-lowering for peripheral arterial disease of the lower limb. Cochrane Database Syst Rev 2007; 4: CD000123
24 Steen DL, Khan I, Becker L. et al. Patterns and predictors of lipid-lowering therapy in patients with atherosclerotic cardiovascular disease and/or diabetes mellitus in 2014: insights from a large US managed-care population. Clin Cardiol 2017; 40: 155-162
25 Jahn R, Diehm C, Lux G. et al. Patient Care Evaluation – Peripheral Arterial Disease (PACE-PAD) Study Investigators. Effect of guideline orientation on the outcomes of peripheral arterial disease in primary care. Curr Med Res Opin 2011; 27: 1183-1190
26 Gunasekaran P, Jeevanantham V, Sharma S. et al. Implications of the 2013 ACC/AHA cholesterol guidelines on contemporary clinical practice for patients with atherosclerotic coronary and peripheral arterial disease. Indian Heart J 2017; 69: 464-468
27 Schwartz GG, Steg PG, Szarek M. et al. ODYSSEY OUTCOMES Committees and Investigators. Alirocumab and Cardiovascular Outcomes after Acute Coronary Syndrome. NEJM 2018; 69
28 Sabatine MS, Giugliano RP, Keech AC. et al. FOURIER Steering Committee and Investigators. Evolocumab and clinical outcomes in patients with cardiovascular disease. N Engl J Med 2017; 376: 1713-1722
29 Bonaca MP, Nault P, Giugliano RP. et al. Low-density lipoprotein cholesterol lowering with evolocumab and outcomes in patients with peripheral artery disease: insights from the FOURIER Trial. Circulation 2018; 137: 338-350
30 Gemeinsamer Bundesausschuss (GBA). Beschluss des Gemeinsamen Bundesausschusses über eine Änderung der Arzneimittel-Richtlinie (AM-RL): Anlage III – Übersicht über Verordnungseinschränkungen und -ausschlüsse: Alirocumab, vom 04.08.2016. Im Internet: https://www.g-ba.de/downloads/39-261-2676/2016-08-04_AM-RL-III_Alirocumab_BAnz.pdf (Stand: 30.10.2018)
31 Landmesser U, Chapman MJ, Farnier M. et al. 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 2017; 38: 2245-2255