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Lebensstilintervention in der Primärprävention von kardiovaskulären Erkrankungen

Lifestyle intervention in the primary prevention of cardiovascular diseases

Zusammenfassung

Kardiovaskuläre Erkrankungen sind die führende Todesursache weltweit. In der Primärprävention haben Lebensstilfaktoren einen hohen Stellenwert und können das Risiko für kardiale Erkrankungen um bis zu 70 % reduzieren. Zu diesem Lebensstil gehören sowohl nach europäischen als auch nach amerikanischen Leitlinien das lebenslange Nichtrauchen, eine kardioprotektive Ernährung (niedriger Anteil gesättigter Fettsäuren, hoher Anteil an ungesättigten Fettsäuren, salzarm), möglichst tägliche körperliche Aktivität von mindestens 150 min/Woche bei moderater oder 75 min/Woche bei höher intensiver körperlicher Aktivität, ein Körpergewicht mit einem Body-Mass-Index zwischen 20 und 25 kg/m2, arterielle Blutdruckwerte unter 140/90 mm Hg (optimal: <130/80 mm Hg) sowie LDL(„low-density lipoprotein“)-Cholesterin-Zielwerte in Abhängigkeit vom kardiovaskulären Risiko und ein normaler Glukosestoffwechsel bei Diabetes mellitus Typ 2 mit einer Einstellung des HbA1c unter 7 %. Lebensstilmaßnahmen mit Gewichtsreduktion und Intensivierung der körperlichen Aktivität können kardiometabolische Risikofaktoren verbessern. So sind Senkungen des systolischen und diastolischen Blutdrucks von etwa 10–15 mm Hg, HbA1c-Senkungen von etwa 1 % und Triglyzeridsenkungen von zirka 30–40 % möglich. LDL-Cholesterin und Lipoprotein(a) können kaum beeinflusst werden. Jenseits der Empfehlungen zum kardioprotektiven Lebensstil ist ggf. in Abhängigkeit vom kardiovaskulären Risikoprofil zusätzlich eine medikamentöse Therapie indiziert.

Abstract

Cardiovascular diseases are the leading cause of death worldwide. Adherence to a healthy lifestyle lifelong is capable of significantly reducing the cardiovascular risk by up to 70% and is therefore a key component in primary prevention of cardiovascular disease. According to the European and American guidelines lifestyle interventions include not smoking, daily physical activity of ≥150 min/week at moderate intensity or 75 min/week for higher intensity physical activity, a cardioprotective nutrition (high proportion of unsaturated fatty acids, low amounts of saturated fatty acids and low salt intake), normal body weight (body mass index 20–25 kg/m2), arterial blood pressure <140/90 mm Hg (optimum <130/80 mm Hg), low-density lipoprotein (LDL)-cholesterol target values depending on the cardiovascular risk and a normal glucose metabolism in type 2 diabetes mellitus with adjustment of a HbA1c to <7%. Lifestyle measures with weight reduction and intensification of physical activity can improve the cardiometabolic risk factors. In this way reduction of the systolic and diastolic blood pressures by approximately 10–15 mm Hg, reduction of HbA1c by approximately 1 % and reduction of triglycerides by ca. 30–40 % are possible. The LDL-cholesterol and lipoprotein(a) levels cannot be easily influenced. Beyond the recommendations for a cardioprotective lifestyle, additional pharmacological therapy may have to be added depending on the cardiovascular risk profile.

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Correspondence to Univ.-Prof. Dr. med. Martin Halle.

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V. Heinicke und M. Halle geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Heinicke, V., Halle, M. Lebensstilintervention in der Primärprävention von kardiovaskulären Erkrankungen. Herz 45, 30–38 (2020). https://doi.org/10.1007/s00059-019-04886-y

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Schlüsselwörter

  • Kardiovaskuläres Risiko
  • Herzerkrankungen
  • Rauchen
  • Gesunde Ernährung
  • Körperliche Aktivität

Keywords

  • Cardiovascular risk
  • Heart disease
  • Smoking
  • Healthy diet
  • Exercise