Medikamentöse Senkung des LDL-Cholesterins
Abstract
Zusammenfassung. Hypercholesterinämie ist einer der am umfassendsten dokumentierten modifizierbaren kardiovaskulären Risikofaktoren. Wir diskutieren die Grundpfeiler der medikamentösen Therapie bei Hypercholesterinämie in der Primär- und Sekundärprävention. Dabei stehen Indikation, klinisches Outcome und Verträglichkeit etablierter Therapien mit Statinen, Ezetimib und Fibraten sowie innovative Ansätze wie die Hemmung der PCSK9 im Fokus. Unser Übersichtsartikel befasst sich auch mit spezifischen Indikationen wie familiärer Hypercholesterinämie und Sekundärprävention bei Patienten mit kardiovaskulären Ereignissen sowie mit Therapieoptionen bei Patienten mit Statinintoleranz.
Abstract. Hypercholesterolemia is one of the best documented modifiable cardiovascular risk factors. We discuss the basics of drug therapy for hypercholesterolemia in primary and secondary prevention. The focus is on the indication, clinical outcome and tolerability of established therapies, such as statins, ezetimibe, and fibrates, as well as innovative approaches, such as PCSK9 inhibitors. The article aims to provide an overview of the available data with special attention to the treatment of familial hypercholesterolemia, the role of LDL reduction in secondary prevention and therapy options for patients with statin intolerance.
Résumé. L’hypercholestérolémie représente l’un des facteurs de risque cardiovasculaire modifiable les mieux documentés. Seront discutées ici les bases du traitement médicamenteux dans la prévention primaire et secondaire. L’attention sera portée sur l’indication, le devenir clinique et la tolérance de traitements bien établis, à savoir les statines, l’ézétimibe et les fibrates, de même que l’approche innovante constituée par les inhibiteurs de la PCSK9. Cet article a pour but de revoir les données disponibles, avec une attention particulière portant sur l’hypercholestérolémie familiale, le rôle de la diminution des taux de LDL-cholestérol dans la prévention secondaire et les options thérapeutiques pour les malades intolérants aux statines.
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