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Kommentar zu den neuen Leitlinien (2012) der Europäischen Gesellschaft für Kardiologie zur kardiovaskulären Prävention

Comments on the new guidelines (2012) of the European Society of Cardiology on cardiovascular disease prevention

  • Leitlinien
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Der Kardiologe Aims and scope

Zusammenfassung

Die neuen europäischen Leitlinien für die Prävention kardiovaskulärer (CV) Erkrankungen werden von 9 medizinischen Fachgesellschaften getragen. Sie sind neu strukturiert, kürzer gefasst und besser lesbar: Kernaussagen werden jedem Unterkapitel vorangestellt, Empfehlungen werden mit ihrem Evidenzgrad aufgeführt. Am Ende eines jeden Unterkapitels werden die neuesten Informationen benannt und ebenfalls Bereiche mit unzureichender Studienlage für weiteren Forschungsbedarf aufgeführt. Eine der wichtigsten Neuerungen ist sicherlich die Unterteilung des 10-jährigen Risikos für kardiovaskulären Tod in 4 Risikogruppen: geringes (<1%), mittleres (1% bis <5%), hohes (5% bis <10%) und sehr hohes Risiko (10% und mehr). Alle Patienten mit CV-Erkrankung werden der höchsten Risikogruppe zugeordnet mit entsprechenden Konsequenzen z. B. für den Lipidzielwert: LDL-Cholesterin von <70 mg/dl (1,8 mmol/l). Eine Therapieadhärenz und Verhaltensänderung können am ehesten mit motivierenden Gesprächen erreicht werden, die Zeit beanspruchen; auf die ärztliche Verantwortung, klare Empfehlungen im Entlassungsbrief nach Krankenhausaufenthalt zu formulieren und Hilfen bei der Umsetzung anzubieten, wird besonders eingegangen.

Abstract

The new European guidelines on cardiovascular disease (CV) prevention are supported by nine medical societies. They have been restructured, are shorter and more readable. Each subchapter starts with key messages and recommendations are labelled with an evidence level. The subchapter ends with the most important newest information and persisting gaps of evidence for further research. The most important change is the categorization of cardiovascular risk in four levels: low (<1%), medium (1%-<5%), high (5%-<10%) and very high risk (>10%). All patients with CV disease are in the very high risk group with, e.g. a low-density lipoprotein (LDL) cholesterol goal of <70 mg/dl (<1.8 mmol/l). Treatment adherence and behavioral changes can best be achieved by motivational interviews which require some time. The physician has the responsibility for clear recommendations in the discharge summary after hospitalization and for offering help and feedback in the implementation phase of behavioral change.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. G. Schuler, W. Koenig, V. Adams und H. Gohlke geben an, dass kein Interessenkonflikt besteht. Alle im vorliegenden Manuskript beschriebenen Untersuchungen am Menschen wurden mit Zustimmung der zuständigen Ethik-Kommission, im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt. Von allen beteiligten Patienten liegt eine Einverständniserklärung vor. Alle Patienten, die über Bildmaterial oder anderweitige Angaben innerhalb des Manuskripts zu identifizieren sind, haben hierzu ihre schriftliche Einwilligung gegeben. Im Falle von nicht mündigen Patienten liegt die Einwilligung eines Erziehungsberechtigen oder des gesetzlich bestellten Betreuers vor. Alle nationalen Richtlinien zur Haltung und zum Umgang mit Labortieren wurden eingehalten und die notwendigen Zustimmungen der zuständigen Behörden liegen vor.

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Authors and Affiliations

  1. Klinik für Innere Medizin/Kardiologie, Universität Leipzig - Herzzentrum GmbH, Strümpellstr. 39, 04289, Leipzig, Deutschland

    G.C. Schuler & V. Adams

  2. Zentrum für Innere Medizin, Klinik für Innere Medizin II, Universitätsklinikum Ulm, Ulm, Deutschland

    W. Koenig

  3. Projektgruppe Prävention der Deutschen Gesellschaft für Kardiologie, -, Deutschland

    H. Gohlke

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  1. G.C. Schuler
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  2. W. Koenig
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  3. V. Adams
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  4. H. Gohlke
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Correspondence to G.C. Schuler.

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Schuler, G., Koenig, W., Adams, V. et al. Kommentar zu den neuen Leitlinien (2012) der Europäischen Gesellschaft für Kardiologie zur kardiovaskulären Prävention. Kardiologe 7, 251–260 (2013). https://doi.org/10.1007/s12181-013-0507-2

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