Skip to main content
SpringerLink
Log in

Akutes Koronarsyndrom

Prävention

Acute coronary syndrome

Prevention

  • Schwerpunkt
  • Published:
Herz Aims and scope Submit manuscript

Zusammenfassung

In der Lebensstilmodifikation haben Primär- und Sekundärprävention des akuten Koronarsyndroms (ACS) weitestgehend Ähnlichkeiten, wenn auch in der postinfarziellen Situation im rehabilitativen Sinne funktionsdiagnostische Programme zu gestalten sind. Alle 3 Lebensstilsäulen (Bewegung, Ernährung und Entspannung) implizieren prognostische Bedeutung, die präventive Effektivität ist sekundär höher als primär. Pharmakotherapeutisch ist die Indikation der Thrombozytenaggregationshemmung an das Vorhandensein von Atherosklerose gebunden, die der Statinmedikation auch bereits an die kardiovaskuläre Risikofaktorenstratifikation, zu der Scores verwendet werden. Je nach postinfarzieller Myokardschädigung nach ACS sind zusätzliche Pharmakotherapien wie die mit ACE(„angiotensin-converting enzyme“)-Hemmern oder Angiotensin-II-Rezeptor-Antagonisten, Betablockern oder auch Mineralokortikoidrezeptorantagonisten evident. Neue präventive Potenziale kommen den neuen oralen Antikoagulanzien (NOAK) im Zusammenhang mit koinzidentem Vorhofflimmern zu.

Abstract

For life style modifications primary and secondary prevention of acute coronary syndrome (ACS) are approximately similar, even though in the postinfarction situation functional diagnostic programs have to be performed in a rehabilitative manner. All three life style pillars of fitness, nutrition and relaxation implicate prognostic significance and the efficacy is higher for secondary prevention than for primary. The pharmacotherapeutic indications for thrombocyte aggregation inhibition are connected to the presence of atherosclerosis and statin medication is already connected to cardiovascular risk factor stratification, for which scores are used. Depending on the postinfarction myocardial destruction after ACS, additional pharmacotherapies, such as angiotensin-converting enzyme (ACE) inhibitors, angiotensin-II receptor antagonists, beta blockers and also mineral corticoid receptor antagonists are evident. New potential for prevention is ascribed to the new oral anticoagulants (NOAC) in the context of coincidental atrial fibrillation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6

Literatur

  1. Nixdorff U (2009) Herz-Kreislauf-Check-Up. In: Nixdorff U (Hrsg) Check-Up-Medizin. Prävention von Krankheiten – Evidenz-basierte Empfehlungen für die Praxis. Thieme, Stuttgart, New York, S 28–48

    Google Scholar 

  2. Piepoli MF, Hoes AW, Agewall S et al (2016) 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts), developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J 37:2315–2381

    Article  Google Scholar 

  3. Horstick G (2014) Prävention nach akutem Koronarsyndrom. Dtsch Med Wochenschr 139:S43–6

    Article  Google Scholar 

  4. Roffi M, Patrano C, Collet JP et al (2016) 2015 ESC Guideline for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J 37:267–315

    Article  CAS  Google Scholar 

  5. Dawber TR, Kannel WB (1958) An epidemiologic study of heart disease: the Framingham study. Nutr Rev 16:1–4

    Article  CAS  Google Scholar 

  6. Yusuf S, Hawken S, Ounpuu S et al (2004) Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet 364:937–952

    Article  Google Scholar 

  7. Naghavi M, Falk E, Hecht HS et al (2006) From vulnerable plaque to vulnerable patient—part III: executive summary of the screening for heart attack prevention and education (SHAPE) task force report. Am J Cardiol 98:2H–15H

    Article  Google Scholar 

  8. Ross R (1999) Atherosclerosis—an inflammatory disease. N Engl J Med 340:115–126

    Article  CAS  Google Scholar 

  9. Ridker PM, MacFadyen J, Libby P, Glynn RJ (2010) Relation of baseline high-sensitivity C‑reactive protein level to cardiovascular outcomes with rosuvastatin in the Justification for Use of statins in Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER). Am J Cardiol 106:204–209

    Article  CAS  Google Scholar 

  10. Ridker PM, Everett BM, Thuren T et al (2017) Antiinflammatory therapy with canakinumab for atherosclerotic disease. N Engl J Med 377:1119–1131

    Article  CAS  Google Scholar 

  11. Erbel R, Budoff M (2012) Improvement of cardiovascular risk prediction using coronary imaging: subclinical atherosclerosis: the memory of lifetime risk factor exposure. Eur Heart J 33:1201–1217

    Article  Google Scholar 

  12. Nixdorff U, Achenbach S, Bengel F et al (2015) Imaging in cardiovascular prevention. The ESC Textbook of Preventive Cardiology. Oxford University Press, Oxford, S 54–76

    Book  Google Scholar 

  13. Huikuri HV, Castellanos A, Myerburg RJ (2001) Sudden death due to cardiac arrhythmias. N Engl J Med 345:1473–1482

    Article  CAS  Google Scholar 

  14. Mureddu GF, Brandimarte F, Faggiano P, Rigo F, Nixdorff U (2013) Between risk charts and imaging: how should we stratify cardiovascular risk in clinical practice? Eur Heart J Cardiovasc Imaging 14:401–416

    Article  Google Scholar 

  15. Greenland P, Alpert JS, Beller GA et al (2010) 2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults. A report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines. Circulation 122:e584–e636

    PubMed  Google Scholar 

  16. Assmann G, Cullen P, Schulte H (2002) Simple scoring scheme for calculating the risk of acute coronary events based on the 10-year follow-up of the Prospective Cardiovascular Munster (PROCAM) study. Circulation 105:310–315

    Article  Google Scholar 

  17. Pencina MJ, D’Agostino RB Sr, D’Agostino RB Jr, Vasan RS (2008) Evaluating the added predictive ability of a new marker: from area under the ROC curve to reclassification and beyond. Stat Med 27:157–172

    Article  Google Scholar 

  18. Perk J, De Backer G, Gohlke H et al (2012) European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts). Eur Heart J 33:1635–1701

    Article  CAS  Google Scholar 

  19. Erbel R, Möhlenkamp S, Lehmann N et al (2008) Kardiovaskuläre Risikofaktoren und Zeichen subklinischer Atherosklerose. Dtsch Ärztebl 105:1–8

    Google Scholar 

  20. Erbel R, Möhlenkamp S, Moebus S et al (2010) Coronary risk stratification, discrimination, and reclassification improvement based on quantification of subclinical coronary atherosclerosis. The Heinz Nixdorf Recall Study. J Am Coll Cardiol 56:1397–1406

    Article  Google Scholar 

  21. Osawa K, Trejo MEP, Nakanishi R (2018) Coronary artery calcium and carotid artery intima-media thickness for the prediction of stroke and benefit from statins. Eur J Prev Cardiol 25:1980–1987

    Article  Google Scholar 

  22. The Lp-PLA2 Studies Collaboration (2010) Lipoprotein-associated phospholipase A2 and risk of coronary disease, stroke, and mortality: collaborative analysis of 32 prospective studies. Lancet 375:1535–1544

    Google Scholar 

  23. Näslund U, Ng N, Lundgren A et al (2018) Visualization of asymptomatic atherosclerotic disease for optimum cardiovascular prevention (VIPVIZA): a pragmatic, open-label, randomised controlled trial. Lancet. https://doi.org/10.1016/S0140-6736(18)32818-6

    Article  PubMed  Google Scholar 

  24. Lechner K, McKenzie AL, von Schacky C et al Paradigm shift in cardiovascular prevention: causal and not symptomatic therapy. A review. JAMA Intern Med. (submitted)

  25. Mozaffarian D, Wilson PW, Kannel WB (2008) Beyond established and novel risk factors: lifestyle risk factors for cardiovascular disease. Circulation 117:3031–3038

    Article  Google Scholar 

  26. Nixdorff U (2009) Clinical management of coronary heart disease risk factors. Modification of lifestyle: stopping smoking. Pocket guide to: prevention of coronary heart disease. Thomson Reuters, Münster, S 49–52 (International Task Force for Prevention of Coronary Heart Disease, International Atherosclerosis Society)

    Google Scholar 

  27. Dehghan M, Mente A, Rangarajan S et al (2018) Association of dairy intake with cardiovascular disease and mortality in 21 countries from five continents (PURE): a prospective cohort study. Lancet 392:2288–2297

    Article  Google Scholar 

  28. Williams B, Mancia G, Spiering E et al (2018) 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J 39:3021–3104

    Article  Google Scholar 

  29. Catapano AL, Graham I, De Backer G et al (2016) 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias. Eur Heart J 37:2999–3058

    Article  Google Scholar 

  30. Rydén L, Grant PJ, Anker SD et al (2013) ESC Guideline on diabetes, pre-diabetes, and cardiovascular disease developed in collaboration with the EASD. Eur Heart J 34:3035–3087

    Article  Google Scholar 

  31. Steering Committee of the Physicians’ Health Study Research Group (1989) Final report on the Aspirin component of the ongoing Physicians’ Health Study. N Engl J Med 321:129–135

    Article  Google Scholar 

  32. McNeil JJ, Woods RL, Nelson MR et al (2018) Effect of Aspirin on disability-free survival in the healthy elderly. N Engl J Med 379:1499–1508

    Article  CAS  Google Scholar 

  33. Gaziano JM, Brotons C, Coppolecchia R et al (2018) Use of aspirin to reduce risk of initial vascular events in patients at moderate risk of cardiovascular disease (ARRIVE): a randomised, double-blind, placebo-controlled trial. Lancet 392:1036–1046

    Article  CAS  Google Scholar 

  34. Leitlinie zur Rehabilitation von Patienten mit Herzkreislauferkrankungen (LL-KardReha) Deutschland – Österreich – Schweiz 2019; in Bearbeitung durch Deutsche Gesellschaft für Prävention und Rehabilitation von Herz-Kreislauferkrankungen (DGPR).

  35. Connolly SJ, Eikelboom JW, Bosch J et al (2018) Rivaroxaban with or without aspirin in patients with stable coronary artery disease: an international, randomised, double-blind, placebo-controlled trial. Lancet 391:205–218

    Article  CAS  Google Scholar 

  36. Opie LH, Commerford PJ, Gersh BJ, Pfeffer MA (2006) Controversies in ventricular remodelling. Lancet 367:356–367

    Article  Google Scholar 

  37. Nixdorff U, Erbel R, Pop T et al (1993) Long-term follow-up of global and regional left ventricular function by two-dimensional echocardiography after thrombolytic therapy in acute myocardial infarction. Int J Cardiol 41:31–47

    Article  CAS  Google Scholar 

  38. Werdan K, Baldus S, Frey N et al (2017) Klug entscheiden – Empfehlungen in der Kardiologie. Internist 58:556–567

    Article  CAS  Google Scholar 

  39. Gibson CM, Mehran R, Bode C et al (2016) Prevention of bleeding in patients with atrial fibrillation undergoing PCI. N Engl J Med 375:2423–2434

    Article  CAS  Google Scholar 

  40. Cannon CP, Bhatt DL, Oldgren J et al (2017) Dual antithrombotic therapy with Dabigatran after PCI in atrial fibrillation. N Engl J Med 377:1513–1524

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. European Prevention Center im Medical Center Düsseldorf (GrandArc), Luise-Rainer-Str. 6–10, 40235, Düsseldorf, Deutschland

    U. Nixdorff

  2. Praxis für Gefäß- und Herzmedizin, Neustadt a. d. Weinstraße, Deutschland

    G. Horstick

  3. Abteilung 1 (Kardiologie, Diabetologie), Paracelsus-Harz-Klinik Bad Suderode, Quedlinburg, Deutschland

    A. Schlitt

Authors
  1. U. Nixdorff
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. G. Horstick
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Schlitt
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to U. Nixdorff.

Ethics declarations

Interessenkonflikt

U. Nixdorff, G. Horstick und A. Schlitt geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nixdorff, U., Horstick, G. & Schlitt, A. Akutes Koronarsyndrom. Herz 44, 45–52 (2019). https://doi.org/10.1007/s00059-019-4782-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00059-019-4782-y

Schlüsselwörter

Keywords

Search

Navigation