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CC BY-NC-ND 4.0 · Dtsch Med Wochenschr 2023; 148(19): e101-e110
DOI: 10.1055/a-2117-6504
Originalarbeit

Primär- und Sekundärprävention bei Hypercholesterinämie – versorgungsrelevante Unterschiede in der PROCYON-Studie

Primary and secondary prevention in hypercholesterolemia: differences relevant to patient care in the PROCYON trial
Umidakhon Makhmudova
1   Universitätsklinikum Jena, Klinik für Innere Medizin I,
,
Michaela Wolf
2   Cholesterin & Co e. V.: Patientenorganisation für Patienten mit Familiärer Hypercholesterinämie oder anderen schweren genetischen Fettstoffwechselstörungen (CholCo e. V.), Frankfurt/M.,
,
Kathy Willfeld
3   Novartis Pharma GmbH, Nürnberg,
,
Lea Beier
4   Novartis Pharma GmbH, Nürnberg.,
,
Oliver Weingärtner
5   Klinik für Innere Medizin I, Universitatsklinikum Jena, Jena, GERMANY (Ringgold ID: RIN39065)
› Author AffiliationsSupported by: Novartis Pharma
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Zusammenfassung

Hintergrund Herz-Kreislauf-Erkrankungen sind für ein Drittel der Todesfälle in Deutschland verantwortlich. Erhöhte Spiegel des Low-Density-Lipoprotein-Cholesterols (LDL-C) gelten als ein wesentlicher Risikofaktor. Die Senkung des LDL-C-Spiegels ist daher integraler Bestandteil der Prävention kardiovaskulärer Ereignisse.

Methoden Ziel dieser Arbeit ist es, in einer post-hoc ausgeführten Gegenüberstellung von Querschnittsdaten aus der Umfrage PROCYON potenzielle Unterschiede zwischen der Primärprävention (PP) und der Sekundärprävention (SP) zu identifizieren. Es wurden Anamnese, Begleiterkrankungen, Adhärenz und Krankheitsbewusstsein in Bezug auf die Hypercholesterinämie abgefragt.

Ergebnisse An der Befragung nahmen 5494 Patient*innen teil (PP: 3798; SP 1696). Der Vergleich der Ergebnisse zeigte einen numerisch höheren Anteil von Frauen (PP 70,7% vs. SP 42,5%) sowie häufigere Komorbiditäten wie Bluthochdruck (PP 45,6% vs. SP 61,0%), Adipositas (PP 20,9% vs. SP 27,4%) und Diabetes mellitus Typ 2 (PP 14,1% vs. SP 23,8%). In der Primärprävention wurde die Hypercholesterinämie-Diagnose zumeist in der Vorsorgeuntersuchung gestellt (PP 74,6%), in der Sekundärprävention geschah dies am häufigsten im Laufe eines kardiovaskulär bedingten Krankenhausaufenthalts (SP 58,0%). Ein/e Kardiolog*in wurde von 16,3% (PP) bzw. 54,0% (SP) konsultiert. Mindestens halbjährliche LDL-C-Kontrollen (PP 46,8% vs. SP 77,9%) sowie eine medikamentöse Intervention (PP 43,0% vs. SP 87,0%) waren in der Sekundärpräventionsgruppe häufiger. Außerdem zeigten sich Unterschiede in der Umsetzung von Veränderungen im Lebensstil, der Verbesserung der LDL-C-Werte, der Anpassung der Therapie sowie der Adhärenz, Therapiezufriedenheit und Informiertheit der Patient*innen.

Schlussfolgerung Der Vergleich der Primär- und Sekundärprävention aus der Umfrage PROCYON zeigt insgesamt eine bessere Ausschöpfung der Therapieoptionen und eine höhere Versorgungsintensität in der Gruppe der Sekundärprävention. In beiden Gruppen besteht jedoch noch großes Verbesserungspotenzial, um eine effiziente Prävention kardiovaskulärer Ereignisse sicherzustellen.

Graphical Abstract

Abstract

Background Cardiovascular disease accounts for one third of deaths in Germany. Elevated levels of low-density lipoprotein cholesterol (LDL-C) are considered a major risk factor. Lowering LDL-C levels is therefore an integral part of the prevention of cardiovascular events.

Methods The aim of this work is to identify potential differences between primary prevention (PP) and secondary prevention (SP) by means of a post-hoc comparison of cross-sectional data from the PROCYON survey. Medical history, concomitant diseases, adherence, and disease awareness in relation to hypercholesterolemia were queried.

Results 5,494 patients had participated in the survey (PP: 3,798; SP: 1,696). Comparison of the results showed a numerically higher proportion of women (PP 70.7% vs. SP 42.5%) as well as more frequent comorbidities such as hypertension (PP 45.6% vs. SP 61.0%), obesity (PP 20.9% vs. SP 27.4%), and type 2 diabetes mellitus (PP 14.1% vs. SP 23.8%). In primary prevention, hypercholesterolemia was most often diagnosed during screening (PP 74.6%), and in secondary prevention, the diagnosis was most often made during cardiovascular-related hospitalization (SP 58.0%). A cardiologist was consulted by 16.3% (PP) and 54.0% (SP) of patients, respectively. At least semiannual LDL-C checks (PP 46.8% vs. SP 77.9%) and drug intervention (PP 43.0% vs. SP 87.0%) were more frequent in the secondary prevention group. In addition, differences in the implementation of lifestyle changes, improvement of LDL-C levels, adjustment of therapy as well as adherence, treatment satisfaction and patient knowledge were observed.

Conclusion The comparison of primary and secondary prevention from the PROCYON survey shows overall better utilization of treatment options and higher intensity of care in the secondary prevention group. However, there is still great potential for improvement in both groups to ensure efficient prevention of cardiovascular events.

Schlüsselwörter

Primärprävention - Sekundärprävention - Hyperlipoproteinämie - LDL-Cholestein

Zusatzmaterial



Publication History

Article published online:
21 August 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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