Aktuelle Neurologie 2002; 29(5): 254-261
DOI: 10.1055/s-2002-32033
Arzneimitteltherapie
© Georg Thieme Verlag Stuttgart · New York

Einsatz der Statine in der Neurologie

The Use of Statins in Clinical NeurologyJ.  Bösel1 , M.  Endres1
  • 1Klinik und Poliklinik für Neurologie, Charité, Humboldt-Universität zu Berlin
Further Information

Publication History

Publication Date:
05 June 2002 (online)

Zusammenfassung

HMG-CoA-Reduktase-Hemmer (Statine) sind potente Cholesterinsenker und werden seit vielen Jahren zur medikamentösen Behandlung der Hypercholesterinämie eingesetzt. Darüber hinaus sind die Statine zur Sekundärprophylaxe der koronaren Herzkrankheit (KHK) selbst bei durchschnittlichen Cholesterinspiegeln indiziert, wie in großen klinischen Studien (4S, CARE, LIPID, u. a.) nachgewiesen wurde. Obwohl Hypercholesterinämie kein eindeutiger Risikofaktor für den ischämischen Schlaganfall ist, zeigte sich in diesen Studien auch eine signifikante Reduktion der Schlaganfallinzidenz bei Patienten mit einer manifesten KHK. Ob Statine auch generell zur Sekundärprophylaxe des Schlaganfalls indiziert sind, ist jedoch noch unklar und wird in laufenden Studien (PROSPER, SPARCL) untersucht. Sowohl klinische als auch experimentelle Daten sprechen für cholesterinunabhängige, protektive Wirkungen der Statine auf vaskulärer, thrombozytärer, inflammatorischer und möglicherweise auch neuronaler Ebene (sog. pleiotrope Effekte). Weiterhin gibt es erste klinische Hinweise sowie viel versprechende experimentelle Daten für eine mögliche Wirksamkeit von Statinen bei Demenzen. Bezüglich einer möglichen Wirksamkeit von Statinen bei weiteren neurologischen Erkrankungen, wie z. B. Hirntumoren oder neuroimmunologischen Erkrankungen, liegen momentan lediglich erste experimentelle Befunde vor. Eine evidenzbasierte Indikation für Statine in der Neurologie ergibt sich derzeit lediglich zur Schlaganfallprophylaxe bei Patienten mit manifester KHK.

Abstract

HMG-CoA reductase inhibitors (statins) are potent cholesterol-lowering drugs and are established for the treatment of hypercholesterolemia. Furthermore, large clinical trials (4S, CARE, LIPID) demonstrated that statins are indicated for secondary prophylaxis of coronary heart disease (CHD) even in patients with average cholesterol levels. Although hypercholesterolemia is not an established risk factor for ischemic stroke, these studies demonstrated that statins also reduce stroke incidence in patients with CHD. The question whether or not statins are generally indicated for secondary prevention of stroke is subject of two ongoing trials (i.e. PROSPER, SPARCL). Clinical as well as experimental evidence supports the notion that statins exert cholesterol-independent (so-called „pleiotropic”) protective effects. These include anti-inflammatory and anti-thrombotic effects, improvement of endothelial function and even direct neuroprotective effects. Furthermore, experimental and preliminary clinical studies suggest a potential role of statins for the treatment of dementia. Regarding the use of statins in clinical neurology, current evidence only supports the use for stroke prophylaxis in patients with a history of CHD.

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PD Dr. Matthias Endres

Klinik und Poliklinik für Neurologie · Charité · Humboldt-Universität zu Berlin

Schumannstraße 20/21

10098 Berlin

Email: matthias.endres@charite.de

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