Zusammenfassung
Eine erhöhte Plasmakonzentration triglyceridreicher
Lipoproteine ist mit einem erhöhten kardiovaskulären
Risiko und überdies bei vielen Patienten auch mit weiteren
kardiovaskulären Risikofaktoren wie Adipositas, arterieller
Hypertonie und pathologischer Glukosetoleranz vergesellschaftet.
Entscheidend für die Beurteilung des individuellen Risikos
eines Patienten mit erhöhten Triglyceridwerten ist nicht
allein die Höhe der Triglyceride sondern neben LDL- und
HDL-Cholesterin auch das Vorliegen von Begleiterkrankungen, die
Zusammensetzung der triglyceridreichen Lipoproteine und eine positive
Familienanamnese für eine frühzeitige koronare
Herzerkrankung. Vorrangige Therapieziele bei der Behandlung sind
die Reduktion des kardiovaskulären Risikos und die Prävention
Triglycerid-assoziierter Komplikationen wie des Chylomikronämiesyndroms.
Die wesentliche Maßnahme zur Behandlung einer Hypertriglyceridämie
besteht in einer dauerhaften Umstellung des Lebensstils (kalorien-
und fettreduzierte Ernährung, Verzicht auf Alkohol, vermehrte
körperliche Aktivität, Gewichtsreduktion, Rauchverzicht).
Wenn Allgemein- und Lebensstilmaßnahmen keine ausreichende
Triglyceridsenkung bewirken, muss eine medikamentöse Therapie
erwogen werden. Hierfür stehen Nicotinsäure, Fibrate
und Omega-3-Säurenethylester zur Verfügung. Zusätzlich
zur Senkung der Triglyceridwerte ist eine Senkung des Non-HDL-Cholesterins
durch Statine zur Risikoreduktion indiziert.
Abstract
Elevated Triglyceride levels are associated with increased risk
for atherosclerotic disease and additional vascular risk factors
such as obesity, hypertension and impaired glucose tolerance. To
estimate the individual cardiovascular risk of a patient with elevated
triglycerides LDL- and HDL-cholesterol levels, concomitant diseases,
composition of triglyceride rich lipoproteins and a family history
for premature coronary heart disease are important. Primary goals
for the management of hypertriglyceridemia are a reduction of cardiovascular
risk and prevention of triglyceride associated complications such
as the chylomicronemia syndrome. The basis of treatment are lifestyle changes:
dietary intervention, alcohol avoidance, regular physical activity,
weight loss and smoking cessation to modify risk factors. If triglyceride
levels can not be sufficiently reduced by lifestyle intervention
pharmacotherapy (nicotinic acid, fibrates and omega-3-acid ethyl
esters) is indicated. Beyond reduction of triglyceride levels optimization
of non-HDL-cholesterol by statin treatment is warranted to reduce
vascular risk.
Schlüsselwörter
Hypertriglyceridämie - kardiovaskuläres Risiko - Lebensstilmaßnahmen - Pharmakotherapie
Keywords
hypertriglyceridemia - cardiovascular risk - lifestyle intervention - pharmacotherapy
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Dr. Florian Custodis
Klinik für Innere Medizin IIIKardiologie,
Angiologie und internistische IntensivmedizinUniversitätsklinikum
des Saarlandes
66421 Homburg/Saar
Phone: 06841/1623000
Email: florian.custodis@uks.eu
