Lipidsenkende Therapie in Europa und den USA

Zusammenfassung

Die 2013 von der American Heart Association (AHA) und dem American College of Cardiology (ACC) vorgelegte neue Leitlinie zur Evaluation des kardiovaskulären Risikos empfiehlt eine Lipidsenkende Therapie mittels hochdosierter Statintherapie mit dem Ziel einer 30-50%-igen LDL-C-Reduktion [1]. Die Berücksichtigung eines LDL-Cholesterin (LDL-C)-Zielwertes wie sie in den europäischen Leitlinien enthalten ist, tritt in den Hintergrund. Begründet wird die Änderung der amerikanischen Leitlinien dadurch, dass für die bisher empfohlenen LDL-C-Zielwerte keine Evidenz in Form randomisierter Studien vorliege. Dieser Paradigmenwechsel führte bei den Fachgesellschaften zu kontroversen Diskussionen. Kritiker bemängeln die fehlende Möglichkeit einer Therapieevaluation oder Berücksichtigung zusätzlicher lipidmodifizierender Therapieoptionen. Die amerikanische Präventionsstrategie eines „Fire and Forget“ steht einem individualisierten, patientenorientierten europäischen Behandlungskonzept (Treat to target) gegenüber.

Abstract

The 2013 AHA/ ACC guidelines on the assessment of cardiovascular risk recommend high-dose statin treatment to reduce LDL-cholesterol (LDL-C) by at least 30-50% without suggesting a specific target value [1]. Favoring a strict Evidence Based Medicine approach the authors focus on randomized clinical trials only and neglect a target value since none of the randomized trials has titrated statin therapy to a specific LDL-C concentration. This is in contrast to current European guidelines. This paradigm shift has created a lot of controversy and confusion due to the lacking opportunity to assess medication adherence and the addition of further lipid lowering therapy. Moreover, these new guidelines might discourage clinicians to individualize patient care.

Schlüsselwörter

Hypercholesterinämie - LDL-Cholesterin - Statintherapie - fire and forget - treat to target

Keywords

LDL-Cholesterol - statin therapy - hypercholesterolemia - fire and forget - treat to target

^* Veronika Sanin und Vanessa Pfetsch teilen sich die Erstautorenschaft.

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