Download PDF
ZFA (Stuttgart) 2004; 80(2): 71-76
DOI: 10.1055/s-2004-816221
Fortbildung

© Georg Thieme Verlag Stuttgart · New York

Risikofaktoren und Risikoindikatoren für kardiovaskuläre Erkrankungen: Prognoseverbesserung als Maßstab

Risk Factors and Risk Indicators for Cardio-Vascular Diseases: Improvement in Prognosis as Evaluation FactorE. Baum1 , S. Hensler1 , U. Popert1
  • 1Abteilung Allgemeinmedizin, Universität Marburg, Marburg
Further Information

Publication History

Publication Date:
10 March 2004 (online)

    Permissions and Reprints

Zusammenfassung

Eine Reihe von Risikofakoren für kardiovaskuläre Erkrankungen sind etabliert: Alter, Geschlecht, Familienanamnese, Hypertonie, Diabetes, Lipidwerte und Rauchen. Bei typischer Anamnese müssen auch frühere kardiovaskuläre Ereignisse und linksventrikuläre Hypertrophie in Betracht gezogen werden. Weitere neue Parameter werden kritisch betrachtet: Homocystein, CRP, psychische Belastung, körperliche Fitness, Intima-media-Dicke der Karotis, retinale Gefäßveränderungen, Koronarkalk und andere. Ihr Einsatz kann derzeit nicht als Routine empfohlen werden, da eine allgemeine Beratung zu gesunder Lebensweise ohnehin bei allen Bevölkerungsgruppen sinnvoll ist und eine Prognoseverbesserung durch Einbeziehung der neuen Parameter bisher nicht nachgewiesen wurde.

Abstract

In CVD prevention, a number of risk factors are well established: age, sex, family history, hypertension, diabetes, blood lipids and smoking. In patients with a typical history, additional risks like previous cardiovascular events or left ventricular hypertrophy are to be considered. Further new parameters are under scrutiny: homocysteine, C-reactive protein, psychological factors, physical fitness, carotid-intima-media-thickness, status of retinal vessels, coronary artery calcification, and others. As these additional risk factors at present offer no improvement in prognosis and healthy lifestyle is to be generally recommended anyway, routine use of these tests is not recommended.

Schlüsselwörter

Kardiovaskuläre Erkrankungen - Risikofaktoren - Prognose - Intervention - Risikoreduktion

Key words

Cardiovascular diseases - risk-factors - prognosis - intervention - risk-reduction

Literatur

  • 1 Albert M, Danielson E, Rifai N. et al for the PRINCE Investigators . Effect of statin therapy on C-reactive protein levels.  JAMA. 2001;  286 64-70
    CrossrefPubMedGoogle Scholar
  • 2 Anderson K M, Wilson P WF, Odell P M, Kannel W B. An updated coronary risk factor profile: a statement for health professionals.  Circulation. 1991;  83 356-362
    CrossrefPubMedGoogle Scholar
  • 3 Assmann G, Cullen P, Schulte H. Simple scoring scheme for calculating the risk of acute coronary events based on the 10-year follow-up of the prospective cardiovascular Munster (PROCAM) study.  Circulation. 2002;  105 900
    PubMedGoogle Scholar
  • 4 Blair S N, Kampert J B, Kohl H W. et al . Influences of cardiorespiratory fitness and other precursers on cardiovascular disease and all-cause mortality.  JAMA. 1996;  276 205-210
    CrossrefPubMedGoogle Scholar
  • 5 Blair S N, Kohl H W, Pfaffenbarger R S. et al . Physical fitness and all-cause mortality.  JAMA. 1989;  262 2395-2341
    CrossrefPubMedGoogle Scholar
  • 6 Blake G J, Ridker P M. Novel clinical markers of vascular wall inflammation.  Circ Res. 2001;  89 763-771
    PubMedGoogle Scholar
  • 7 Blake G J, Rifai N, Buring J E, Ridker P M. Blood pressure, C-Reactive Protein and Risk of future Cardiovascular events.  Circulation. 2003;  108 994-1000
    PubMedGoogle Scholar
  • 8 Blumenthal J A, Lett H S, Babyak M A. et al . Depression as a risk factor for mortality after coronary bypass surgery.  Lancet. 2003;  362 604-609
    CrossrefPubMedGoogle Scholar
  • 9 Booth G L, Wang E E. Preventive health care, 2 000 update: screening and management of hyperhomocysteinemia for the prevention of coronary artery disease events. The Canadian Task Force on Preventive Health Care.  CMAJ. 2000;  163 21-29
    PubMedGoogle Scholar
  • 10 Bots M L, Hoes A W, Koudstaal P J, Hofman A, Grobbee D E. Common carotid intima-media thickness and risk of stroke and myocardial infarction: the Rotterdam Study.  Circulation.. 1997;  96 1432-1437
    CrossrefPubMedGoogle Scholar
  • 11 Broedl U C, Geiss H C, Parhofer K G. Comparison of current guidelines for primary prevention of coronary heart disease: risk assessment and lipid-lowering therapy.  J Gen Intern Med. 2003;  18 190-195
    CrossrefPubMedGoogle Scholar
  • 12 Chambless L E, Folsom A R, Clegg L X, Sharrett A R, Shahar E, Nieto F J, Rosamond W D, Evans G. Carotid wall thickness is predictive of incident clinical stroke: the Atherosclerosis Risk in Communities (ARIC) study.  Am J Epidemiol. 2000;  151 478-487
    CrossrefPubMedGoogle Scholar
  • 13 Chambless L E, Heiss G, Folsom A R, Rosamond W, Szklo M, Sharrett A R, Clegg L X. Association of coronary heart disease incidence with carotid arterial wall thickness and major risk factors: the Atherosclerosis Risk in Communities (ARIC) Study, 1987-1993.  Am J Epidemiol. 1997;  146 483-494
    PubMedGoogle Scholar
  • 14 Conroy R M, Pyorala K, Fitzgerald A P, Sans S, Menotti A, De Backer G, De Bacquer D, Ducimetiere P, Jousilahti P, Keil U, Njolstad I, Oganov R G, Thomsen T, Tunstall-Pedoe H, Tverdal A, Wedel J, Whincup P, Wilhelmsen L, Graham I M.. SCORE project group . Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project.  Eur Heart J. 2003;  24 987-1003
    CrossrefPubMedGoogle Scholar
  • 15 Coppola W G, Whincup P H, Papacosta O, Walker M, Ebrahim S. Scoring system to identify men at high risk of stroke: a strategy for general practice.  Br J Gen Pract. 1995;  45 185-189
    PubMedGoogle Scholar
  • 16 D'Agostino R B, Russell M W, Huse D M, Ellison C, Silbershatz H, Wilson P W. et al . Primary and subsequent coronary risk appraisal: new results from the Framingham study.  Am Heart J. 2000;  139 272-281
    PubMedGoogle Scholar
  • 17 Danesh J, Whincup P, Walker M. et al . Low grade inflammation and coronary heart disease: prospective study and updated meta-analyses.  BMJ. 2000;  321 199-204
    CrossrefPubMedGoogle Scholar
  • 18 del Sol A I, Moons K G, Hollander M, Hofman A, Koudstaal P J, Grobbee D E, Breteler M M, Witteman J C, Bots M L. Is carotid intima-media thickness useful in cardiovascular disease risk assessment? The Rotterdam Study.  Stroke. 2001;  32 1532-1538
    PubMedGoogle Scholar
  • 19 Frasure-Smith N, Lesperance F, Talajic M. Depression following myocardial infarction. Impact on 6-month survival.  JAMA. 1993;  270 1819-1825
    CrossrefPubMedGoogle Scholar
  • 20 Fröhlich M, Imhof A, Berg G. et al . Association between C-reactive protein and features of the metabolic syndrome.  Diabetes Care. 2000;  23 1835-1839
    PubMedGoogle Scholar
  • 21 Heinz A, Hermann D, Smolka M N, Rieks M, Gräf K J, Pöhlau D, Kuhn W, Bauer M. Effects of acute psychological stress on adhesion molecules, interleukins and sex hormones: implications for coronary heart disease.  Psychopharmacology. 2003;  165 111-117
    PubMedGoogle Scholar
  • 22 Hense H W, Schulte H, Lowel H, Assmann G, Keil U. Framingham risk function overestimates risk of coronary heart disease in men and women from Germany - results from the MONICA Augsburg and the PROCAM cohorts.  Eur Heart J. 2003;  24 937-945
    CrossrefPubMedGoogle Scholar
  • 23 Herzog C. Multidetector-Row Cardiac CT. Diagnostic value of calcium scoring and CT-Coronary Angiography in patients with symptomatic but atypical chest pain.  Eur Radiol. 2003;  (in press)
    PubMedGoogle Scholar
  • 24 Hoogeveen E K, Kostense P J, Jakobs C. et al . Hyperhomocysteinemia increases risk of death, especially in type 2 diabetes.  Circulation. 2000;  101 1506-1511
    PubMedGoogle Scholar
  • 25 http://www.e-eyecare.de/200/2020.php. 
    Google Scholar
  • 26 Hutchinson A, McIntosh A, Peters J, O'Keeffe C, Khunti K, Baker R, Booth A. Effectiveness of screening and monitoring tests for diabetic retinopathy - a systematic review.  Diabet Med. 2000;  17 495-506
    CrossrefPubMedGoogle Scholar
  • 27 Jadhav U M, Kadam N N. Carotid intima-media thickness as an independent predictor of coronary artery disease.  Indian Heart J. 2001;  53 458-462
    PubMedGoogle Scholar
  • 28 Klerk M, Verhoef P, Clarke R. et al . MTHFR 677C-T polymorphism and risk of coronary heart disease - a meta-analysis.  JAMA. 2002;  288 2023-2031
    CrossrefPubMedGoogle Scholar
  • 29 Koenig W, Sund M, Fröhlich M. et al . C-reactive protein, a sensitive marker of inflammation, predicts future risk of coronary heart disease in initially healthy middle-aged men - Results from the MONICA Augsburg cohort study, 1984 to 1992.  Circulation. 1999;  99 237-242
    CrossrefPubMedGoogle Scholar
  • 30 Kop W J. Chronic and acute psychological risk factors for clinical manifestations of coronary artery disease.  Psychosom Med. 1999;  61 476-487
    PubMedGoogle Scholar
  • 31 Kurl S, Laukkanen J A, Rauramaa R. et al . Cardiorespiratory fitness and the risk for stroke in men.  Arch Intern Med. 2003;  163 1682-1688
    CrossrefPubMedGoogle Scholar
  • 32 Lange T. et al .Vortrag beim amerikanischen Kardiologenkongress ACC 2003. 
    Google Scholar
  • 33 Lawlor D A, Ebrahim S, Smith G D. Role of endogenous oestrogen in aetiology of coronary heart disease: analysis of age related trends in coronary heart disease and breast cancer in England and Wales and Japan.  BMJ. 2002;  325 311-312
    CrossrefPubMedGoogle Scholar
  • 34 Leung H, Wang J J, Rochtchina E, Tan A G, Wong T Y, Klein R, Hubbard L D, Mitchell P. Relationships between age, blood pressure, and retinal vessel diameters in an older population.  Invest Ophthalmol Vis Sci. 2003;  44 2900-2904
    CrossrefPubMedGoogle Scholar
  • 35 Lin D Y, Blumenkranz M S, Brothers R J, Grosvenor D M. The sensitivity and specificity of single-field nonmydriatic monochromatic digital fundus photography with remote image interpretation for diabetic retinopathy screening: a comparison with ophthalmoscopy and standardized mydriatic color photography.  Am J Ophthalmol. 2002;  134 204-213
    CrossrefPubMedGoogle Scholar
  • 36 Looker H C, Fagot-Campagna A, Gunter E W. et al . Homocysteine as a risk factor for nephropathy and retinopathy in type 2 diabetes.  Diabetologia. 2003;  46 766-772
    CrossrefPubMedGoogle Scholar
  • 37 Malhotra A, White D P. Obstructive sleep apnoea.  The Lancet. 2002;  360 237-245
    CrossrefPubMedGoogle Scholar
  • 38 Nelson J C, Kennedy J S, Pollock B G. et al . Treatment of major depression with nortryptiline and paroxetine in patients with ischemic heart disease.  Am J Psychiatry. 1999;  156 1024-1028
    PubMedGoogle Scholar
  • 39 O'Leary D H, Polak J F, Kronmal R A, Manolio T A, Burke G L, Wolfson S K. Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. Cardiovascular Health Study Collaborative Research Group.  N Engl J Med. 1999;  340 14-22
    CrossrefPubMedGoogle Scholar
  • 40 O'Leary D, Polak J F, Kronmal R A, Savage P J, Borhani N O, Kittner S J, Tracy R, Gardin J M, Price T R, Furberg C D. for the Cardiovascular Health Study Collaborative Research Group . Thickening of the carotid wall: a marker for atherosclerosis in the elderly?.  Stroke.. 1996;  27 224-231
    CrossrefPubMedGoogle Scholar
  • 41 Pocock S J, McCormack V, Gueyffier F, Boutitie F, Fagard R H, Boissel J P. A score for predicting risk of death from cardiovascular disease in adults with raised blood pressure, based on individual patient data from randomised controlled trials.  BMJ. 2001;  323 75-81
    CrossrefPubMedGoogle Scholar
  • 42 Redberg M S, Cui Y, Whiteman M K. et al . Ability of exercise testing to predict cardiovascular an all-cause death in asymptomatic women: a 20-year follow-up of the lipid research clinic prevalence study.  JAMA. 2003;  290 1600-1607
    CrossrefPubMedGoogle Scholar
  • 43 Ridker P, Glynn R J, Hennekens C H. C-reactive protein adds to the predictive value of total and HDL cholesterol in determining risk of first myocardial infarction.  Circulation. 1998;  97 2007-2011
    CrossrefPubMedGoogle Scholar
  • 44 Ridker P, Rifai N, Rose L. et al . Comparison of C-reactive protein and low-density lipoprotein cholesterol levels in the protection of first cardiovascular events.  N Engl J Med. 2002;  347 1557-1565
    CrossrefPubMedGoogle Scholar
  • 45 Roose S P, Glassman A H, Aflia E, Woodring S, Giardina G, Bigger J T. Cardiovascular effects of fluoxetine in depressed patients with heart disease.  Am J Psychiatry. 1998;  155 660-665
    PubMedGoogle Scholar
  • 46 Rozanski A, Blumenthal J A, Kaplan J. Impact of psychological factors on the pathogenesis of cardiovascular disease and implications for therapy.  Circulation. 1999;  99 2192-2197
    CrossrefPubMedGoogle Scholar
  • 47 Sandvik L, Erikssen L, Thaulow E. et al . Physical fitness as a predictor of mortality among healthy, middle aged Norwegian men.  N Engl J Med. 1993;  328 553-557
    CrossrefPubMedGoogle Scholar
  • 48 Scanlon P H, Malhotra R, Thomas G, Foy C, Kirkpatrick J N, Lewis-Barned N, Harney B, Aldington S J. The effectiveness of screening for diabetic retinopathy by digital imaging photography and technician ophthalmoscopy.  Diabet Med. 2003;  20 467-474
    CrossrefPubMedGoogle Scholar
  • 49 Schnyder G, Roffi M, Flammer Y. et al . Effect of homocysteine-lowering therapy with folic acid, vitamin B12, and Vitamin B6 on clinical outcome after percutaneous coronary intervention: the Swiss Heart study: a randomized controlled trial.  JAMA. 2002;  288 973-979
    CrossrefPubMedGoogle Scholar
  • 50 Shaw C, Abrams K, Marteau T M. Psychological impact of predicting individuals' risks of illness - a systematic review.  Soc Sci Med. 1999;  49 1571-1598
    CrossrefPubMedGoogle Scholar
  • 51 Shishehbor M, Aviles R J, Brennan M L. et al . Association of nitrotyrosine levels with cardiovascular disease and modulation by statin therapy.  JAMA. 2003;  289 1675-1680
    CrossrefPubMedGoogle Scholar
  • 52 Siegrist J. Psychosoziale Einflüsse auf Entstehung und Verlauf der koronaren Herzerkrankung.  Herz. 2001;  26 316-325
    CrossrefPubMedGoogle Scholar
  • 53 Siu S C, Ko T C, Wong K W, Chan W N. Effectiveness of non-mydriatic retinal photography and direct ophthalmoscopy in detecting diabetic retinopathy.  Hong Kong Med J. 1998;  4 367-370
    PubMedGoogle Scholar
  • 54 Smith T W, Ruiz J M. Psychosocial influences on the development and course of coronary heart disease: current status and implications for research and practice.  J Consult Clin Psychol. 2002;  70 548-568
    CrossrefPubMedGoogle Scholar
  • 55 Sniderman A D, Furbertg C D, Keeck A. et al . Apolipoproteins versus lipids as indices of coronary risk and as targets for statin treatment.  Lancet. 2003;  361 777-780
    CrossrefPubMedGoogle Scholar
  • 56 Strik J J, Honig A, Lousberg R. et al . Efficacy and safety of fluoxetine in the treatment of patients with major depression after first myocardial infarction: findings from a double-blind, placebo-controlled trial.  Psychosom Med. 2000;  62 783-789
    PubMedGoogle Scholar
  • 57 Tehernof A, Nolan A, Sites C T. et al . Weight loss reduces C-reactive protein levels in obese postmenopausal women.  Circulation. 2002;  105 564-569
    CrossrefPubMedGoogle Scholar
  • 58 The Homocysteine Studies Collaboration . Homocysteine and risk of ischemic heart disease and stroke - a meta analysis.  JAMA. 2002;  288 2015-2022
    CrossrefPubMedGoogle Scholar
  • 59 van de Meer I, de Maat M PM, Kiliaan A J. et al . The value of C-reactive protein in cardiovascular risk prediction.  Arch Intern Med. 2003;  163 1323-1328
    CrossrefPubMedGoogle Scholar
  • 60 Vivekananthan D P, Penn M S, Sapp S K. et al . Use of anitioxidant vitamins for the prevention of cardiovascular disease: a meta-analysis of randomised trials.  Lancet. 2003;  361 2017-2023
    CrossrefPubMedGoogle Scholar
  • 61 Voss R, Cullen P, Schulte H, Assmann G. Prediction of risk of coronary events in middle-aged men in the Prospective Cardiovascular Munster Study (PROCAM) using neural networks.  Int J Epidemiol.. 2002;  31 1253-1262
    PubMedGoogle Scholar
  • 62 Voutilainen S, Lakka T A, Hämelahti P. et al . Plasma total homocysteine concentration and the risk of acute coronary events: the Kuopio ischaemic heart disease risk factor study.  J Intern Med. 2000;  248 217-222
    CrossrefPubMedGoogle Scholar
  • 63 Wald D S, Law M, Morris J K. Homocysteine and cardiovascular disease: evidence on causality from a meta-analysis.  BMJ. 2002;  325 1202-1206
    CrossrefPubMedGoogle Scholar
  • 64 Wexler L, Brundage B, Crause J. et al . Coronary artery calcification: pathophysiology, epidemiology, imaging methods, and clinical implications. A statement for health professionals from the American Heart Association Writing Group.  Circulation. 1996;  94 1175-1192
    PubMedGoogle Scholar
  • 65 Williams R R, Hunt S C, Heiss G, Province M A, Bensen J T, Higgins M, Chamberlain R M, Ware J, Hopkins P N. Usefulness of cardiovascular family history data for population-based preventive medicine and medical research (the Health Family Tree Study and the NHLBI Family Heart Study).  Am J Cardiol. 2001;  87 129-135
    CrossrefPubMedGoogle Scholar
  • 66 Wilson P FW. Homocysteine and coronary heart disease - how great is the hazard.  JAMA. 2002;  288 2042-2043
    CrossrefPubMedGoogle Scholar
  • 67 Wong T Y, Klein R, Couper D J, Cooper L S, Shahar E, Hubbard L D, Wofford M R, Sharrett A R. Retinal microvascular abnormalities and incident stroke: the Atherosclerosis Risk in Communities Study.  Lancet. 2001;  358 1134-1140
    CrossrefPubMedGoogle Scholar
  • 68 Wong T Y, Klein R, Sharrett A R, Duncan B B, Couper D J, Tielsch J M, Klein B E, Hubbard L D. Retinal arteriolar narrowing and risk of coronary heart disease in men and women. The Atherosclerosis Risk in Communities Study.  JAMA. 2002;  287 1153-1159
    CrossrefPubMedGoogle Scholar
  • 69 Wong T Y, Klein R, Sharrett A R, Manolio T A, Hubbard L D, Marino E K, Kuller L, Burke G, Tracy R P, Polak J F, Gottdiener J S, Siscovick D S. The prevalence and risk factors of retinal microvascular abnormalities in older persons: The Cardiovascular Health Study.  Ophthalmology. 2003;  110 658-666
    CrossrefPubMedGoogle Scholar
  • 70 Writing Group fort he Women's Health Initiative Investigators . Risks and benefits of estrogen plus progestin in healthy postmenopausal women.  JAMA. 2002;  288 321-333
    CrossrefPubMedGoogle Scholar

Prof. Dr. med. Erika Baum

Dresdener Str. 34

35444 Biebertal

Phone: 0 64 09-70 76 (20 07)

Fax: -28 78

Email: Baum064092007@t-online.de