ESC-Leitlinie zur Prävention kardiovaskulärer Erkrankungen – Was hat sich geändert ?

Weltweit werden kardiovaskuläre Erkrankungen auch auf absehbare Zeit häufigste Todesursachen bleiben. In Europa und Nordamerika hat indes in den letzten Jahren die kardiovaskuläre Sterblichkeit deutlich abgenommen. Diese Entwicklung ist sowohl auf Erfolge in der Krankheitsprävention als auch auf Verbesserungen in der Akutbehandlung von Herz-Kreislauf-Erkrankungen zurückzuführen. Die Europäische Gesellschaft für Kardiologie hat im Jahr 2012 eine aktualisierte Version ihrer Leitlinie zu Prävention von Herz-Kreislauf-Erkrankungen vorgestellt. Für die Bewertung des kardiovaskulären Risikos wird ein neues Verfahren mit 4 Risikokategorien (niedrig, moderat, hoch, sehr hoch) vorgeschlagen. Neben den Ergebnissen eines multivariaten Prognosemodells (Systematic Coronary Risk Evaluation, SCORE) gehen vorbestehende kardiovaskuläre Erkrankungen und vermehrt auch einzelne, schwerwiegende Risikofaktoren ein. Weitere neue Aspekte der Leitlinie sind die Einführung des Konzepts des biologischen Alters als Instrument für die Kommunikation von Risiken, die Betonung psychosozialer Faktoren, Empfehlungen für die Anwendung „neuer“ biochemischer Marker (C-reaktives Protein, Fibrinogen, Homozystein oder lipoproteinassoziierte Phospholipase A2) oder bildgebender Verfahren zur Verfeinerung der Risikoabschätzung und Hinweise für einen „gesunden“ Lebensstil (Vermeidung des Passivrauchens, Ernährung). Diese Arbeit fasst die wesentlichen Elemente der neuen Leitlinie zusammen.

In the foreseeable future cardiovascular diseases will remain the most frequent causes of death worldwide. In the past years in Europe and North America cardiovascular mortality has declined markedly. This development is attributable not only to success in disease prevention but also to improvements in the acute treatment for diseases of the heart and circulation. In 2012 the European Society for Cardiology presented an updated version of their guidelines for the prevention of heart and circulation diseases. A new procedure with four risk categories (low, moderate, high, very high) for the assessment of cardiovascular risks has been suggested. Besides the results of a multivariate prognosis model (systematic coronary risk evaluation, SCORE), this includes pre-existing cardiovascular diseases and to a greater extent also individual severe risk factors. Further new aspects of the guidelines are the introduction of the concept of biological age as an instrument for the communication of risks, an emphasis on psycho-social factors, recommendations for the use of „new” biochemical markers (C-reactive protein, fibrinogen, homocysteine or lipoprotein-associated phospholipase A2), as well as imaging procedures to refine risk assessment and tips for a healthy life-style (avoidance of passive smoking, nutrition). This article summarizes the more important elements of the new guidelines.

Key words

Cardiovascular diseases - prevention - risk stratification - hypertension - hyperlipidemia - diabetes mellitus

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