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Aktuelle Kardiologie 2016; 5(05): 333-338
DOI: 10.1055/s-0042-114033
Übersichtsarbeit
Georg Thieme Verlag KG Stuttgart · New York

Primär- und Sekundärprävention der KHK – bekannte und neue Aspekte

Primary and Secondary Prevention of CAD – Common and New Aspects
M. R. Schroeter
Herzzentrum Göttingen, Klinik für Kardiologie und Pneumologie, Universitätsmedizin Göttingen, Georg-August-Universität
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Publication History

Publication Date:
18 October 2016 (online)

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Zusammenfassung

Aufgrund der hohen Relevanz der atherosklerotisch bedingten koronaren Herzerkrankung (KHK) ist eine effektive Präventionstherapie wichtig. Hierbei steht neben einer nicht medikamentösen Therapie die medikamentöse Einstellung der kardiovaskulären Risikofaktoren im Vordergrund. Einen besonderen Risikofaktor stellt der Diabetes mellitus dar. Bei Diabetikern sollten die Blutzuckerwerte individualisiert gut eingestellt und eine mögliche KHK frühzeitig diagnostiziert werden. Einen Eckpfeiler der KHK-Therapie stellt die Plättchenhemmung dar. Schwerpunktmäßig in der Sekundärprophylaxe ist ASS weiterhin der Standard. Die duale plättchenhemmende Therapie ist temporär und bei bestimmten Hochrisikopatienten auch dauerhaft unter Abwägung der Blutungskomplikationen sinnvoll. Ein arterieller Hypertonus sollte sowohl in der Primär- als auch in der Sekundärprävention der KHK behandelt werden, wobei bei letzterer auch eine strengere Einstellung indiziert sein kann. Eine LDL-Cholesterin-senkende Therapie mit Statinen kann in der Primärprävention frühzeitig erwogen werden, in der Sekundärprävention gehört sie zur Standardtherapie. Die zusätzliche Gabe von Ezitimib kann hier unterstützen und die PCSK9-Inhibitoren scheinen bei bestimmten Patienten zukünftig eine wichtige Rolle zu spielen. Spezifische Medikamente zur HDL-Cholesterin-Erhöhung sind bisher nicht sinnvoll. Eine Bestimmung des zusätzlichen Risikofaktors Lipoprotein(a) kann indiziert sein und weitere Therapiemaßnahmen erforderlich machen.

Abstract

Due to the high relevance of atherosclerotic coronary artery disease (CAD), its prevention therapy is an important issue. Beside the non-medicinal therapy, the medical treatment of cardiovascular risk factors is prominent. Diabetes mellitus represents a special cardiovascular risk factor. In diabetics, values of blood glucose should be individually well adjusted and a CAD should be diagnosed as early as possible. Antiplatelet treatment exhibits a cornerstone of the CAD therapy and aspirin is still representing the common agent in secondary prevention. The dual antiplatelet therapy could be temporarily or in special high-risk cases continuously admitted, weighting to the respective bleeding complications. Hypertension should be treated in regard to primary as well as secondary prevention of CAD, in which the latter could also require a strict blood pressure adjustment. The lowering of LDL cholesterol with statin therapy should be precociously considered in the primary prevention and statins are standard therapeutic agents in the secondary prevention of CAD. In this case, the additional use of ezitimib could be supporting and PCSK9 inhibitors seem to play an important role in the future in a special subset of patients, whereas a specific medication to increase the HDL cholesterol is not expedient to date. Measurements of the additional risk factor lipoprotein(a) could be indicated and subsequent therapeutic procedures could be necessary.

Schlüsselwörter

Primärprävention - Sekundärprävention - koronare Herzerkrankung - medikamentöse Therapie - kardiovaskuläre Risikofaktoren

Key words

primary prevention - secondary prevention - coronary artery disease - medicinal therapy - cardiovascular risk factors
 

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