Wirkungsverstärkung und Wirkungsergänzung - Aktueller Stand der lipidsenkenden Kombinationstherapie

Die Möglichkeit der Prävention von Gefäßerkrankungen mit Statinen gilt als einer der großen klinischen Fortschritte der jüngeren Zeit. Kontrovers wird allerdings bewertet, wie groß der Nutzen einer Behandlung für den Patienten ist. Während bei einem niedrigen absoluten Risiko die relative Risikosenkung von 20-30 % gesundheitsökonomisch hinterfragbar sein kann, wäre ein gleiches Ausmaß der Risikoreduktion unter einer Statinmonotherapie bei Hochrisikopatienten zu wenig. Sowohl im Sinne einer stärkeren Reduktion des LDL-Cholesterins wie auch im Sinne einer Erweiterung der Dyslipidämie durch die Anhebung der HDL-Cholesterinspiegel ist die Kombination eines Statins zum Beispiel mit Nikotinsäure oder Cholesterinresorptionshemmern eine viel versprechende Perspektive. Doch welche Kombination führt zum Erfolg? Für die Aufnahme der neuen Kombinationen in evidenzbasierte Therapieleitlinien werden die Ergebnisse klinischer Endpunktstudien entscheidend sein.

The possibility of preventing vascular diseases through the use of statins ranks among the major clinical advances of recent times. When it comes to assessing the size of the benefit to the patients, however, opinion is controversial. When in the presence of a low absolute risk, a relative lowering of the risk by 20-30 % may questionably represent a health economics benefit, a reduction of the same magnitude under statin therapy in high-risk patients is too small. Both in the sense of a greater lowering of the LDL cholesterol and in the sense of modifying the dyslipidaemia by elevating the HDL cholesterol level, the combination of a statin, for example with nicotinic acid or cholesterol absorption inhibitors, is a highly promising prospect. But what constitutes the most effective combination? For the incorporation of new combinations in evidence-based guidelines, the results of appropriate clinical studies will be decisive.

Key Words

atherosclerosis prevention - lipid-lowering therapy - monotherapy - combination therapy

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1 Cholesterol Lowering Atherosclerosis Study

2 Familial Atherosclerosis Treatment Study

3 HDL-Atherosclerosis Treatment Study

4 ARterial Biology for the Investigation of the Treatment Effects of Reducing cholesterol

5 Armed Forces REGression Study

6 Ezetimibe and simvastatiN in hypercholesterolemia enHANces atherosClerosis regression

7 Simvastatin and Ezetimibe in Aortic Stenosis

8 Study of Heart And Renal Protection

9 IMProved Reduction of Outcomes: Vyotrin Efficacy International Trial

10 VYtorin Versus Atorvastatin

11 ADvicor Versus Other Cholesterol-modulated Agents Trial Evaluation

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