Hämostasefaktoren und koronare Herzkrankheit

Zusammenfassung

Die Erkenntnis, daß die Atherothrombose einen zentralen Pathomechanismus in der Genese instabiler Koronarsyndrome darstellt, hat nicht nur neue Wege in der Akuttherapie und Sekundärprävention eröffnet, sondern zugleich auch die Frage nach der pathophysiologischen Bedeutung von Hämostaseund Fibrinolysefaktoren für die koronare Atheround Thrombogenese erneut aufgeworfen. Aus klinischer Sicht geht es vorrangig um die prädiktive Wertigkeit von Konzentrationsoder Aktivitätsänderungen dieser Parameter im Hinblick auf die kardiovaskuläre Krankheitsinzidenz, d. h. um die Identifizierung zusätzlicher kardiovaskulärer Risikoindikatoren bzw. Risikofaktoren. Langfristiges Ziel ist eine Verbesserung der Primärprävention bei entsprechenden Hochrisikogruppen.

Die vorliegende Übersicht faßt die Ergebnisse kontrollierter Querschnittstudien und prospektiver Untersuchungen zur Assoziation von Fibrinogen, Faktor VII und Plasminogenaktivator-Inhibitor mit Prävalenz bzw. Inzidenz der koronaren Herzkrankheit in ihren unterschiedlichen Manifestationsformen zusammen. Alle drei Parameter korrelieren in unterschiedlichem Ausmaß mit »etablierten« Risikofaktoren und anderen kardiovaskulären Einflußgrößen. Insbesondere die Fibrinogenkonzentration im Plasma erweist sich darüber hinaus als ein unabhängiger Risikoindikator. Mögliche pathophysiologische Zusammenhänge, die den Terminus »Risikofaktor« rechtfertigen würden, werden diskutiert.

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