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Empfehlungen der Projektgruppe Prävention der DGK zur risikoadjustierten Prävention von Herz- und Kreislauferkrankungen

Teil 1: Risikostratifikation und Umsetzung der Prävention

Recommendations of the Project Group on Prevention of the German Cardiac Society on risk-adjusted prevention of cardiovascular disease

Part 1: Risk stratification and implementation of prevention

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Der Kardiologe Aims and scope

An Erratum to this article was published on 01 April 2012

Zusammenfassung

Der Primärprävention der koronaren Herzerkrankung (KHK) bekommt wegen der Behandlungskosten der KHK eine zunehmende Bedeutung. Die Bestimmung des Gesamtrisikos steht im Bereich der Patientenversorgung im Vordergrund, um die Sinnhaftigkeit einer medikamentösen Therapie zu beurteilen. Als Risikoscores kommen in Deutschland vorwiegend der PROCAM-Algorithmus und der ESC-SCORE zum Einsatz: Wenn das 10-Jahres-Risiko von 20% für Herzinfarkt bzw. 5% für kardiovaskulären Tod überschritten wird, ist eine medikamentöse Therapie kosteneffektiv und die „number needed to treat“ (NNT), normiert auf 1 Jahr, liegt unter 200. Auch bei einzelnen, stark ausgeprägten Risikofaktoren wird eine NNT von unter 200 erreicht. Im CARRISMA-Algorithmus werden Lebensstilfaktoren zusätzlich zur Risikostratifizierung genutzt, was Ansatzpunkte für die Therapie ergibt. Da sich die mittlere Lebenserwartung in den letzten 2 Jahrzehnten um etwa 6 Jahre erhöht und die Präventionsmöglichkeiten sich verbessert haben, sollte eine Risikostratifikation bis zum 70. Lebensjahr erfolgen. Risikoscores ermöglichen eine evidenzbasierte und kosteneffektive Prävention.

Abstract

Primary prevention of coronary artery disease (CAD) is becoming increasingly important because of the treatment costs of CAD. The assessment of overall cardiovascular risk is of importance to evaluate the effectiveness of medical therapy. Risk stratification in Germany is usually performed using the PROCAM algorithm or the ESC score. If the 10-year risk of myocardial infarction (PROCAM) or cardiovascular death (ESC SCORE) exceeds 20 or 5%, respectively, intensive risk intervention including medical therapy is cost-effective and the number needed to treat (NNT) is usually < 200. An NNT of < 200 can also be achieved by treating a single pronounced risk factor. The CARRISMA system uses lifestyle factors in addition to conventional factors to improve risk stratification and also supports lifestyle modification. During the last two decades average life expectancy has increased by 6 years and possibilities for prevention have improved. Risk stratification for prevention should therefore be offered up to the age of 70. Risk scores support evidence-based and cost-effective prevention.

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Interessenkonflikt

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Authors and Affiliations

  1. -, Neue Kirchstr. 22, 79282, Ballrechten-Dottingen, Deutschland

    H. Gohlke

  2. Herz-Zentrum, Bad Krozingen, Deutschland

    H. Gohlke

  3. Klinik und Poliklinik für Psychosomatik und Psychotherapie, Universitätsklinikum 4 , Köln, Deutschland

    C. Albus

  4. Park-Klinikum, Bad Krozingen, Deutschland

    G. Bönner

  5. Klinik f.Kardiologie, Angiologie u. Intensivmedizin, Vivantes Klinikum Neukölln , Berlin, Deutschland

    H. Darius

  6. Herz- und Diabeteszentrum Nordrhein Westfalen, Bad Oeynhausen, Deutschland

    S. Eckert

  7. Herz-Zentrum, Bad Krozingen, Deutschland

    C. Gohlke-Bärwolf

  8. Kardiologisch-Angiologische Gemeinschaftspraxis, Köln-Poll, Deutschland

    D. Gysan

  9. Klinik Schwabenland, Isny-Neutrauchburg, Deutschland

    H. Hahmann

  10. Präventive und Rehabilitative Sportmedizin, Klinikum rechts der Isar, Technische Universität München, München, Deutschland

    N. Halle

  11. Klinik f. Kardiologie im Klinikum Links der Weser, Bremen, Deutschland

    R, Hambrecht

  12. Kardiologische Abteilung, Rehabilitationszentrum, München, Deutschland

    P. Mathes

  13. Deutsche Sporthochschule, Köln, Deutschland

    H.-G. Predel

  14. -, Miesbach, Deutschland

    G. Sauer

  15. Abteilung Präventive Kardiologie der Ludwig-Maximilians-Universität, München, Deutschland

    C. von Schacky

  16. Klinik für Innere Medizin/Kardiologie, Herzzentrum Leipzig, Leipzig, Deutschland

    G. Schuler

  17. Institut für Medizinsoziologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland

    J. Siegrist

  18. Institut für Laboratoriumsmedizin, Klinische Chemie und Molekulare Diagnostik, Universitätsklinikum Leipzig, Leipzig, Deutschland

    J. Thiery

  19. Herz- und Diabeteszentrum Nordrhein Westfalen, Bad Oeynhausen, Deutschland

    D. Tschöpe

  20. Department für Rehabilitationswissenschaften, Universität Potsdam, Potsdam, Deutschland

    H. Völler

  21. Deutsche Adipositasgesellschaft, Bad Rothenfelde, Deutschland

    A. Wirth

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  1. H. Gohlke
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Correspondence to H. Gohlke.

Additional information

Ein Erratum zu diesem Beitrag ist unter http://dx.doi.org/10.1007/s12181-012-0421-z zu finden.

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Gohlke, H., Albus, C., Bönner, G. et al. Empfehlungen der Projektgruppe Prävention der DGK zur risikoadjustierten Prävention von Herz- und Kreislauferkrankungen. Kardiologe 6, 63–76 (2012). https://doi.org/10.1007/s12181-011-0383-6

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