Health tip from Prof. Dr. Bernd Krüger, Director of the Medical Clinic III – Kidney, Hypertension and Rheumatic Diseases
Cardiovascular diseases, including heart attacks, strokes, peripheral arterial occlusive disease and chronic kidney disease, are still the most common causes of death in Germany. The most important risk factor, in addition to high blood pressure, chronic kidney disease and diabetes mellitus, is hypercholesterolemia, ie there is an increased cholesterol level in the blood. An unhealthy lifestyle, lack of exercise and an unhealthy diet with high salt consumption are also considered risk factors.
However, it is less the total cholesterol that is considered than a specific sub-fraction, LDL cholesterol, which can now be effectively influenced and controlled with medication. Unfortunately, in Germany, more than 80% of cardiovascular risk patients do not reach their LDL cholesterol target values, either due to inadequate therapy or because the risk is not recognized or treated at all.
In recent years, another important risk factor has increasingly come into focus. This risk factor is called lipoprotein (a), is almost exclusively genetically determined and only slightly influenced by environmental factors. Although there are currently no treatment options for reducing lipoprotein (a) for most patients – various innovative therapeutic approaches are currently being investigated in large studies – it is advisable to have this value determined at least once in your life. Patients with elevated LDL cholesterol and lipoprotein (a) values show an increased risk of cardiovascular disease, so if a high lipoprotein (a) value is detected, more intensive primary or secondary prevention can be carried out at an early stage. Examination of family members is also advisable in this case.
What value should the LDL cholesterol reach? If, for example, a heart attack has already occurred, these patients are placed in the “very high risk” category. Here the LDL cholesterol target value is < 55 mg/dl (1.4 mmol/l), and if a second event has occurred within 2 years even < 40 mg/dl (1 mmol/l). All others fall into the area of primary prevention. Here the LDL cholesterol target value is determined based on a risk assessment, i.e. a risk is calculated based on known pre-existing conditions such as high blood pressure or diabetes mellitus. Various studies have shown a significant improvement in survival when cholesterol is lowered, for example after a heart attack. The data available for primary prevention is not as extensive, but it is no less convincing for most groups.
In practice, we have effective and well-tolerated medications available to treat elevated LDL cholesterol levels. Unfortunately, far too many patients still do not reach their target values, either because they are unaware of their own LDL cholesterol level or their own target value. General practitioners and specialists must work with patients to ensure that these are checked regularly and that therapy is adjusted if necessary.
