Medikamentöse Primärprävention kardiovaskulärer und zerebrovaskulärer Erkrankungen

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.

Schlüsselwörter

Acetylsalicylsäure - Statine - Primärprävention - schweres vaskuläres Ereignis - Medikamentenadhärenz

Keywords

acetylsalicylic acid - statins - primary prevention - cardiovascular event - adherence

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