Hypercholesterinämie – Wen, wann, wie behandeln?

Was ist neu?

LDL-Cholesterin und Arteriosklerose In den letzten Jahren haben klinisch wissenschaftliche Daten zu LDL-Cholesterin und Arteriosklerose zu immer niedrigeren LDL-Cholesterin-Zielwerten und zur Ausweitung der Indikation für eine medikamentöse Lipidtherapie auf immer größere Bevölkerungs- bzw. Patientengruppen geführt.

Kardiovaskuläres Risiko und Therapieziele Bei der Einschätzung des kardiovaskulären Risikos von Patienten werden neben z.B. vorbestehender kardiovaskulärer Erkrankung, familiärer Hypercholesterinämie und Typ-II-Diabetes auch Typ-I-Diabetes, diabetische Folgeerkrankungen, Niereninsuffizienz und subklinische Arteriosklerose berücksichtigt.

Lipidologische Therapie zur kardiovaskulären Risikoreduktion Zur Berechnung des kardiovaskulären Risikos in der Primärprävention wurden die Kalkulatoren SCORE2 und SCORE-OP neu entwickelt. Eine diätetische Intervention gehört an den Anfang jeder lipidsenkenden Therapie. Bempedoinsäure und Inclisiran stellen neue medikamentöse Therapieoptionen dar.

Therapeutisches Vorgehen Nach der Anamnese erfolgt die Zielwertsetzung und die stufenweise Aufdosierung eines Statins. Nach 6–12 Wochen wird diese Therapie ggf. mit einem ACL-Inhibitor kombiniert, um die Wirkung zu verstärken.

Abstract

In recent years, clinical scientific data on LDL cholesterol and atherosclerosis has led to lowering of LDL-C targets and the expansion of the indication for lipid drug therapy to larger populations or patients. The calculators SCORE2 and SCORE-OP were newly developed to calculate the cardiovascular risk in primary prevention. When assessing the cardiovascular risk of patients, in addition to e.g., pre-existing cardiovascular disease, familial hypercholesterolaemia and type II diabetes, type I diabetes, diabetic complications, renal insufficiency and subclinical arteriosclerosis are also considered. Statins are the basic therapy for hypercholesterolemia. Alternative medication are ACL inhibitors e.g., Bempedoic acid and Inclisiran which represent new drug therapy options for statin intolerance. Nevertheless, a dietary intervention belongs at the beginning of every lipid-lowering therapy.

Schlüsselwörter

Hypercholesterinämie - LDL-Cholesterin - kardiovaskuläres Risiko - SCORE2 - Ernährung

Keywords

hypercholesterolaemia - LDL cholesterol - cardiovascular risk - SCORE2 - nutrition

Publikationsverlauf

Artikel online veröffentlicht:
23. August 2023

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