Neue Entwicklungen in der Lipidologie

Abstract

Statins are the cornerstone of lipid therapy because they have been proven beneficial in numerous outcome studies. Combinations of statins with omega-3-fatty acids or fibrates have shown no additional risk reduction, although subgroups may benefit from such combinations. Combinations of statins with either ezetimibe or niacin are currently investigated in large outcome trials. New compounds such as mipomersen (apoB antisense oligonucleotide), MTP inhibitors, and PCSK9 antibodies primarily decrease LDL-cholesterol but also reduce lipoprotein(a) to a varying degree. CETP inhibitors and apoA1 directed approaches primarily enhance reverse cholesterol transport but may also affect LDL-cholesterol concentration (CETP inhibitors). Although the lipid effects of these new compounds are promising only clinical studies will show which drugs will ultimately be beneficial to the patients.

Kernaussagen

• Die Indikation für die Therapie mit Lipidsenkern orientiert sich am Lipidwert und dem Gesamtrisiko des Patienten.

• Zur Prävention von Atheroskleroseereignissen kommt primär eine Statintherapie in Betracht. Bei ausreichend hohem Risiko und entsprechend veränderten Lipidwerten sollte eine Kombinationstherapie erwogen werden.

• Die Kombination Statin mit Ezetimibe sollte bei ausgeprägter LDL-Hypercholesterinämie diskutiert werden.

• Die Kombination Statin mit Niacin kommt insbesondere bei gemischten Hyperlipoproteinämien (und Lipoprotein(a)-Erhöhung) in Betracht. Die Kombination Statin mit Fibrat kann ggf. bei zusätzlicher Triglyzeriderhöhung erwogen werden.

• Unter den in Entwicklung befindlichen Substanzen adressieren ApoB-Antisense-Oligonukleotide (Mipomersen), MTP-Inhibitoren (Lomitapide) und PCSK9-Antikörper primär erhöhte LDL-Cholesterinwerte und sind, falls es zur Zulassung kommt, vor allem für Patienten mit schwerer LDL-Hypercholesterinämie zu diskutieren.

• CETP-Inhibitoren erhöhen HDL-Cholesterin und senken LDL-Cholesterin und könnten deshalb bei gemischten Hyperlipoproteinämien zum Einsatz kommen. ApoAI-Ansätze stimulieren den Cholesterinrücktransport und sollen so antiatherosklerotisch wirken.

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