In Germany, it is rarely possible to sufficiently lower the LDL cholesterol of high-risk patients in accordance with the guidelines. This significantly increases the risk of heart attack, stroke and heart failure. Women and older people are particularly affected by gaps in care.

This is shown by the “LipidSnapshot” research project of the German Society of Cardiology (DGK), the Federal Association of Registered Cardiologists (BNK) and the German Society of Lipidology (DGFL). In primary care, only twelve percent of patients reach the recommended target value of less than 55 mg/dl. In cardiology practices, the figure is 27 percent. One in four heart patients in general practice does not receive any lipid-lowering therapy at all. In patients under 50 years of age, the undersupply is even greater.

The European Society of Cardiology (ESC/EAS) recommends lowering LDL cholesterol to below 55 mg/dl and at least 50 percent from baseline if there is a high risk. However, many family doctors are guided by the national care guideline (NVL), which provides for less strict target values. In addition, there are bureaucratic hurdles in the prescription of modern lipid-lowering drugs such as PCSK9 inhibitors.

The German Heart Foundation warns that many patients underestimate the risks of high blood lipid levels and take prescribed medication irregularly. Prof. Dr. Heribert Schunkert, Deputy Chairman of the Board of the Heart Foundation, emphasizes: A consistent LDL reduction is crucial to protect the heart and brain from infarctions.

The Heart Foundation dedicates the current issue of the journal “HERZ heute” to the topic and calls for uniform therapy goals, better involvement of family doctors and easier access to modern medicines. The issue can be ordered free of charge.

Good to know:

In particular, high levels of LDL (LDL = Low Density Lipoprotein) cholesterol increase the risk to the heart and blood vessels. This is because excess LDL-C in the blood is stored in the upper layers of the vessel wall. As a “silent vascular killer”, high LDL-C – together with other risk factors such as high blood pressure, diabetes mellitus or smoking – damages the vessels over time without noticeable discomfort for those affected, until heart attack, stroke, PAD or even death occurs in the course of vascular calcification (arteriosclerosis).

Blood lipids
Lipids have many vital tasks in the body. Among other things, they serve as energy stores, are building blocks of cell walls and basic substances for hormones. The most important lipids in the blood include:
– LDL cholesterol (the so-called bad cholesterol),
– HDL cholesterol,
– Triglycerides (neutral fats, these are mainly absorbed through food and can be easily influenced by a change in diet with alcohol reduction) and
– Lipoprotein(a), abbreviated Lp(a), a hereditary risk factor

What LDL-C target value should be aimed for?
For treatment of high LDL-C levels, the individual person, including their overall risk of cardiovascular disease, must always be considered. For example, is only LDL-C slightly elevated or are there additional cardiovascular risk factors and/or concomitant diseases (smoking, lack of exercise, diabetes mellitus, high blood pressure) as well as extreme risks such as pronounced arteriosclerosis? Current therapy recommendations of the medical societies agree that the following LDL values should be strived for:

– For healthy people with low risk, without risk factors, an LDL cholesterol level below 116 mg/dl (<3.0 mmol/l) is considered the target value.
– In the case of medium risk, an LDL cholesterol target value below 100 mg/dl (below 2.6 mmol/l) should be aimed for.

In addition, relative reduction of at least 50 percent compared to baseline:
– In the case of a high overall cardiovascular risk (e.g. smoking, severe high blood pressure, genetically high cholesterol levels), a target LDL cholesterol value below 70 mg/dl (below 1.8 mmol/l) should be sought.
– In the case of a very high overall cardiovascular risk (e.g. diabetes or pre-existing cardiovascular disease), an LDL target value below 55 mg/dl (below 1.4 mmol/l) should be sought.
– In the case of extremely high overall cardiovascular risk (e.g. in the case of cardiac events despite statin therapy, in the case of multi-vessel diseases or pronounced arteriosclerosis in imaging), an LDL target value below 40 mg/dl (below 1.0 mmol/l) should be sought.

Further information:

Cholesterol – an overview | Heart Foundation

Read Also:

Healthy diet lowers cholesterol only to a limited extent – medication is often indispensable – MedLabPortal

Editor: X-Press Journalistenbüro GbR

Gender Notice. The personal designations used in this text always refer equally to female, male and diverse persons. Double/triple naming and gendered designations are used for better readability. ected.