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<p>Cardiovascular diseases are still the leading cause of death in Germany, despite a&#xa0;strong downward trend. Statins can reduce the rate of heart attacks. However, there is disagreement between the specialist societies as to the dose at which statins should be used—and whether a&#xa0;specific low-density lipoprotein (LDL) target should be aimed for. This article presents systematic evidence research on which the lipid guidelines of the AKdÄ (<i>Arzneimittelkommission der deutschen Ärzteschaft</i>) are based. The result is that there is no evidence of benefit for either high-dose statins or LDL dose titration in primary prevention of cardiovascular disease. The evidence for certain LDL targets after myocardial infarction is inconsistent. Statins in high compared to moderate doses do not reduce mortality in secondary prevention, reduce the risk of a&#xa0;new heart attack only slightly and have adverse effects of a&#xa0;comparable magnitude. Ezetimibe, PCSK‑9 antibodies, and bempedoic acid also do not reduce mortality and only slightly reduce the rate of re-infarction.</p>

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LDL-Cholesterin: Wie weit sollen wir es denn senken?

  • 期刊论文

  • 发表日期：

    2025年9月29日

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  • Günther Egidi

摘要

Cardiovascular diseases are still the leading cause of death in Germany, despite a strong downward trend. Statins can reduce the rate of heart attacks. However, there is disagreement between the specialist societies as to the dose at which statins should be used—and whether a specific low-density lipoprotein (LDL) target should be aimed for. This article presents systematic evidence research on which the lipid guidelines of the AKdÄ (Arzneimittelkommission der deutschen Ärzteschaft) are based. The result is that there is no evidence of benefit for either high-dose statins or LDL dose titration in primary prevention of cardiovascular disease. The evidence for certain LDL targets after myocardial infarction is inconsistent. Statins in high compared to moderate doses do not reduce mortality in secondary prevention, reduce the risk of a new heart attack only slightly and have adverse effects of a comparable magnitude. Ezetimibe, PCSK‑9 antibodies, and bempedoic acid also do not reduce mortality and only slightly reduce the rate of re-infarction.