Empfehlungen der Projektgruppe Prävention der DGK zur risikoadjustierten Prävention von Herz- und Kreislauferkrankungen: Teil 3: Fettstoffwechselstörungen, arterielle Hypertonie und Glukosestoffwechsel

Dyslipidemia: There is a strong correlation between low-density lipoproteins (LDL) cholesterol level and cardiovascular risk. Risk adjusted treatment, predominantly with statins, improves prognosis (Class I recommendation, evidence level A). The LDL targets depend on the individual risk. For HDL und triglycerides no target levels but only levels below (for HDL-C) or above which an increased cardiovascular risk is documented are defined. The guideline conforming LDL lowering with the defined LDL target levels requires the availability of highly effective statins for all patients. Arterial hypertension: Arterial hypertension is one of the major cardiovascular risk factors leading to myocardial infarction, stroke or dementia. Repeated blood pressure readings of 140/90 mmHg or more confirm the diagnosis hypertension and should lead to further investigations to exclude secondary forms of hypertension or already established end organ damage. Antihypertensive drugs are prescribed according to the individual cardiovascular risk and additional diseases. Life style modifications markedly reduce blood pressure even in patients receiving blood pressure lowering drugs. A combination of drugs is needed in most cases and fixed combinations are recommended. Follow-up has to be performed regularly to control blood pressure response, possible side effects and patient adherence to therapy. Glucosemetabolism and diabetes: The stages in the manifestation of type 2 diabetes mellitus develop over several years ranging from impaired fasting glucose to impaired glucose metabolism and manifest diabetes mellitus. Cardiovascular complications can occur early and the earlier the diagnosis is confirmed with subsequent near normal blood glucose adjustment, the more favorable the prognosis. The glycated hemoglobin (HbA1c) target for patients with established type 2 diabetes is less than 7% (53 mmol/mol). In individual cases particularly with new onset diabetes lower values can be attempted. Particular care should be taken to avoid hypoglycemic episodes because of the high associated risk. Statins should be prescribed to reach the LDL-C target of <70 mg/dl (1.8 mmol/l). Additional cardiovascular risk factors increase cardiovascular risk and are to be treated according to the evidence-based therapy recommendations.