Sinn oder Unsinn? Vitamine und Supplemente in der Kardiologie

Zusammenfassung

„Eine ausgewogene Ernährung reicht“ – da weder definiert ist, was eine ausgewogene Ernährung ist, noch wozu sie reicht, ist diese vielfach akzeptierte Feststellung nur ein unbelegtes und unbelegbares Dogma. Veränderungen in unserem Lebensstil und in unserer Ernährung haben dazu geführt, dass weite Teile der Bevölkerung niedrige Spiegel von Vitamin D und/oder marinen Omega-3-Fettsäuren aufweisen. Statintherapie senkt die Spiegel von Coenzym Q10, was für muskuläre Beschwerden unter Statintherapie verantwortlich gemacht wird. Ein Anheben niedriger Spiegel von Vitamin D bessert Knochenstruktur, Muskelkraft und mindert Stürze; Interventionsstudien zu weiteren Endpunkten laufen. Das Anheben niedriger Spiegel mariner Omega-3-Fettsäuren bessert komplexe kognitive Leistungen, Interventionsstudien zu kardiovaskulären Endpunkten hatten wohl aus methodischen Gründen neutrale Ergebnisse, wobei allerdings bei Herzinsuffizienz Mortalität und Krankenhauswiederaufnahmen gesenkt wurden. Treten unter Statintherapie muskuläre Beschwerden auf und sind die Spiegel niedrig, so lohnt sich der Versuch mit Coenzym Q10. Bei Herzinsuffizienz kann Coenzym Q10 jetzt schon empfohlen werden. Die europäische „Food Safety Authority“ hält die Gabe von Vitamin D bis 100 IE/d, von marinen Omega-3-Fettsäuren bis 5 g/d und von Coenzym Q10 bis 200 mg/d für sicher, was eine therapeutische Entscheidung erleichtert. Wegen Problemen der Bioverfügbarkeit sollten bei den 3 genannten Substanzen ca. 3 Monate nach Therapiebeginn die jeweiligen Spiegel kontrolliert werden. Die Datenlage für andere Substanzen ist weniger klar. Das Dogma, dass eine „ausgewogene Ernährung reicht“, wird abnehmend haltbar.

Abstract

While it has not been defined what a balanced diet is nor what it provides, there is a dogma that a balanced diet provides everything we need. Due to changes in our lifestyle and diet, substantial proportions of the population have low levels of vitamin D and/or marine omega-3 fatty acids. Statin therapy lowers levels of coenzyme Q10, thought to be responsible for muscle issues during statin therapy. Increasing low levels of vitamin D improves bone structure, muscle strength and reduces falls; intervention studies with other endpoints are currently ongoing. Increasing low levels of marine omega-3 fatty acids improved complex brain activities, intervention studies with cardiovascular endpoints had neutral results, probably due to methodological issues, while mortality and rehospitalizations were reduced in patients with congestive heart failure. In case of muscular problems during statin therapy combined with low levels of coenzyme Q10, a trial of coenzyme Q10 appears worthwhile. In congestive heart failure, Conzyme Q10 can be recommended already now. The European Food Safety Authority considers a daily uptake of up to 100 IU Vitamin D, 5 g/d marine omega-3 fatty acids, and 200 mg coenzyme Q10 as safe, facilitating therapeutic decisions. Problems of bioavailability of all three substances mentioned suggest controlling levels after approximately three months of increased intake. Current data for other nutrients are less clear. The dogma that a balanced diet provides everything we need becomes difficult to maintain.

Schlüsselwörter

Vitamine - Fettsäuren - kardiovaskuläre Erkrankungen

Key words

vitamins - fatty acids - cardiovascular diseases

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