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DOI: 10.1055/s-0033-1359905
Medikamentöse Primärprävention kardiovaskulärer und zerebrovaskulärer Erkrankungen
Statins and ASS for primary prevention of cardiovascular and cerebrovascular diseasePublikationsverlauf
05. Juli 2013
17. Oktober 2013
Publikationsdatum:
28. Januar 2014 (online)
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Zusammenfassung
Während Statine und Acetylsalicylsäure (ASS) in der Sekundärprävention nach stattgehabtem schwerem vaskulären Ereignis, wie Herzinfarkt oder ischämischem Schlaganfall atherothrombotischer Genese, als Medikamente der ersten Wahl gelten, besteht eine uneinheitliche Datenlage zum Einsatz dieser Substanzen in der primären Prävention bei Patienten, die ein erhöhtes Herz-Kreislauf Risiko aufweisen, aber bislang kein schweres vaskuläres Ereignis erlitten haben. Einige Meta-Analysen weisen zwar auf eine Reduktion des Risikos für das Auftreten schwerer vaskulärer Ereignisse unter primär präventiver Verabreichung von Statinen und ASS hin, die Auswirkungen auf die Gesamtsterblichkeit waren in diesen Untersuchungen jedoch uneinheitlich. Angesichts dieser unzureichenden Datenlage werden in den aktuellen Leitlinien der Deutschen Gesellschaft für Allgemeinmedizin und Familienmedizin e. V. eine primär präventiv intendierte Verabreichung von Statinen und ASS nur für solche Patienten empfohlen, bei denen ein 10-Jahres-Gesamtrisiko für schwere vaskuläre Ereignisse von über 20 % vorliegt. Hiervon abweichend wird in den aktuellen Leitlinien der European Society of Cardiology die primärpräventive Anwendung von ASS nicht empfohlen. Studien der Versorgungsforschung deuten darauf hin, dass der therapeutische Erfolg der Primärprävention mit Statinen und ASS u. a. von der Medikamentenadhärenz und dem Verschreibungsverhalten der ordinierenden Ärzte abhängt. Diese Übersichtsarbeit fasst die aktuelle Literatur zur Primärprävention schwerer vaskulärer Ereignisse mit Statinen und ASS zusammen.
Abstract
Whereas statins and acetylsalicylic acid (ASA) are considered gold standard for secondary prevention following myocardial infarction or atherotrombotic stroke, there are inconsistent data on the use of these drugs for primary prevention in patients with increased cardiovascular risk. Some meta-analyses indicated that the use of statins and ASA for primary prevention of cardiovascular disease can reduce the risk of cardiovascular events such as ischemic stroke or myocardial infarction. However, the effects of primary prevention with statins and ASA on mortality varied in the data included in these meta-analyses. Therefore the guidelines of the German College of General Practitioners and Family Physicians recommend primary prevention with statins and ASA only in those patients who have a 10-year risk of cardiovascular events which exceeds 20 %. Divergently, primary prevention with ASA is not recommended by the European Society of Cardiology. Observational studies suggested that treatment success of primary prevention with statins and ASA depends on various factors such as adherence to medication and prescription behavior of physicians. This review summarizes the current literature on primary prevention of cardiovascular events with ASA and statins.
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Literatur
- 1 Antithrombotic Trialists Collaboration. . Baigent C, Blackwell L et al. Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. Lancet 2009; 373: 1849-1860
- 2 Bartolucci AA, Tendera M, Howard G. Meta-analysis of multiple primary prevention trials of cardiovascular events using aspirin. Am J Cardiol 2011; 107: 1796-1801
- 3 Bouchard MH, Dragomir A, Blais L et al. Impact of adherence to statins on coronary artery disease in primary prevention. Brit J Clin Pharmacol 2007; 63: 698-708
- 4 Bukkapatnam RN, Gabler NB, Lewis WR. Statins for primary prevention of cardiovascular mortality in women: a systematic review and meta-analysis. Preventive cardiology 2010; 13: 84-90
- 5 Chokshi NP, Messerli FH, Sutin D et al. Appropriateness of statins in patients aged >/=80 years and comparison to other age groups. Am J Cardiol 2012; 110: 1477-1481
- 6 Cholesterol Treatment Trialists. Baigent C, Blackwell L et al. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet 2010; 376: 1670-1681
- 7 Corrao G, Conti V, Merlino L et al. Results of a retrospective database analysis of adherence to statin therapy and risk of nonfatal ischemic heart disease in daily clinical practice in Italy. Clinical therapeutics 2010; 32: 300-310
- 8 De Berardis G, Sacco M, Evangelista V et al. Aspirin and Simvastatin Combination for Cardiovascular Events Prevention Trial in Diabetes (ACCEPT-D): design of a randomized study of the efficacy of low-dose aspirin in the prevention of cardiovascular events in subjects with diabetes mellitus treated with statins. Trials 2007; 8: 21
- 9 de Vries FM, Denig P, Pouwels KB et al. Primary prevention of major cardiovascular and cerebrovascular events with statins in diabetic patients: a meta-analysis. Drugs 2012; 72: 2365-2373
- 10 Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin. Hausärztliche Leitlinie. Kardiovaskuläre Prävention 2011; Version 1.00
- 11 Dragomir A, Cote R, White M et al. Relationship between adherence level to statins, clinical issues and health-care costs in real-life clinical setting. Value health 2010; 13: 87-94
- 12 Erickson KF, Japa S, Owens DK et al. Cost-effectiveness of statins for primary cardiovascular prevention in chronic kidney disease. J Am Coll Cardiol 2013; 61: 1250-1258
- 13 Filippi A, Bianchi C, Parazzini F et al. A national survey on aspirin patterns of use and persistence in community outpatients in Italy. Eur J Cardiovasc Prev Rehabil 2011; 18: 695-703
- 14 Gibson TB, Mark TL, Axelsen K et al. Impact of statin copayments on adherence and medical care utilization and expenditures. Am J Manag Care 2006; 12 Spec no: SP11-19
- 15 Gibson TB, Mark TL, McGuigan KA et al. The effects of prescription drug copayments on statin adherence. Am J Manag Care 2006; 12: 509-517
- 16 Gohlke H. Risikostratifizierung mit unterschiedlichen Score-Systemen. ESC-SCORE, Framingham-Risk-Score, PROCAM und CARRISMA. Clin Res Cardiol Suppl 2006; 1: 139-148
- 17 Greving JP, Buskens E, Koffijberg H et al. Cost-effectiveness of aspirin treatment in the primary prevention of cardiovascular disease events in subgroups based on age, gender, and varying cardiovascular risk. Circulation 2008; 117: 2875-2883
- 18 Grover SA, Ho V, Lavoie F et al. The importance of indirect costs in primary cardiovascular disease prevention: can we save lives and money with statins?. Arch Intern Med 2003; 163: 333-339
- 19 Jackevicius CA, Mamdani M, Tu JV. Adherence with statin therapy in elderly patients with and without acute coronary syndromes. JAMA 2002; 288: 462-467
- 20 Koller H, Neuhaus O, Schroeter M et al. [Myopathies under therapy with lipid-lowering agents]. Nervenarzt 2005; 76: 212-217
- 21 Lamotte M, Annemans L, Evers T et al. A multi-country economic evaluation of low-dose aspirin in the primary prevention of cardiovascular disease. PharmacoEconomics 2006; 24: 155-169
- 22 Lazar LD, Pletcher MJ, Coxson PG et al. Cost-effectiveness of statin therapy for primary prevention in a low-cost statin era. Circulation 2011; 124: 146-153
- 23 Lemstra M, Blackburn D, Crawley A et al. Proportion and risk indicators of nonadherence to statin therapy: a meta-analysis. Can J Cardiol 2012; 28: 574-580
- 24 Nagata-Kobayashi S, Shimbo T, Matsui K et al. Cost-effectiveness of pravastatin for primary prevention of coronary artery disease in Japan. Int J Cardiol 2005; 104: 213-223
- 25 Nemerovski CW, Salinitri FD, Morbitzer KA et al. Aspirin for primary prevention of cardiovascular disease events. Pharmacotherapy 2012; 32: 1020-1035
- 26 Osterberg L, Blaschke T. Adherence to medication. N Engl J Med 2005; 353: 487-497
- 27 Perk J, De Backer G, Gohlke H et al. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). Eur Heart J 2012; 33: 1635-1701
- 28 Pignone M, Earnshaw S, Pletcher MJ et al. Aspirin for the primary prevention of cardiovascular disease in women: a cost-utility analysis. Arch Intern Med 2007; 167: 290-295
- 29 Pletcher MJ, Lazar L, Bibbins-Domingo K et al. Comparing impact and cost-effectiveness of primary prevention strategies for lipid-lowering. Ann Intern Med 2009; 150: 243-254
- 30 Rahilly-Tierney CR, Lawler EV, Scranton RE et al. Cardiovascular benefit of magnitude of low-density lipoprotein cholesterol reduction: a comparison of subgroups by age. Circulation 2009; 120: 1491-1497
- 31 Raju N, Sobieraj-Teague M, Hirsh J et al. Effect of aspirin on mortality in the primary prevention of cardiovascular disease. Am J Med 2011; 124: 621-629
- 32 Ray KK, Seshasai SR, Erqou S et al. Statins and all-cause mortality in high-risk primary prevention: a meta-analysis of 11 randomized controlled trials involving 65,229 participants. Arch Intern Med 2010; 170: 1024-1031
- 33 Seshasai SR, Wijesuriya S, Sivakumaran R et al. Effect of aspirin on vascular and nonvascular outcomes: meta-analysis of randomized controlled trials. Arch Intern Med 2012; 172: 209-216
- 34 Spaans JN, Coyle D, Fodor G et al. Application of the 1998 Canadian cholesterol guidelines to a military population: health benefits and cost effectiveness of improved cholesterol management. Can J Cardiol 2003; 19: 790-796
- 35 Taylor F, Huffman MD, Macedo AF et al. Statins for the primary prevention of cardiovascular disease. Cochrane database of systematic reviews 2013; (01) CD004816
- 36 Tonelli M, Lloyd A, Clement F et al. Efficacy of statins for primary prevention in people at low cardiovascular risk: a meta-analysis. CMAJ 2011; 183: E1189-1202
- 37 Ward S, Lloyd Jones M, Pandor A et al. A systematic review and economic evaluation of statins for the prevention of coronary events. Health technolo assess 2007; 11: 1-160, iii-iv