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Ein LDL-Cholesterin- (LDL-C-) Spiegel oberhalb einer Konzentration von 70 mg/dl ist mit einem stetig steigenden kardiovaskulären Risiko verbunden. Dies gilt sowohl für Gesunde als auch für Patienten mit angeborenen Cholesterinstoffwechselstörungen und für Dyslipidämien bei Diabetes mellitus Typ 2 und metabolischem Syndrom. Zahlreiche Studien bestätigen die Bedeutung einer LDL-C-Senkung für die Verringerung des kardiovaskulären Risikos. Allerdings werden häufig selbst durch Therapie mit hochpotenten Statinen und Kombinationstherapien die von den Leitlinien geforderten LDL-Zielwerte nicht erreicht. Die Bedeutung des HDL-C zur Einschätzung des kardiovaskulären Risikos ist gut etabliert. Allerdings wurde der protektive Effekt einer pharmakologischen Erhöhung des HDL-Spiegels zur Senkung des kardiovaskulären Risikos bisher nicht nachgewiesen. Neue hochpotente Therapeutika werden derzeit in Phase-III-Studien auf ihre Wirksamkeit und Sicherheit im Rahmen der Therapie von Dyslipoproteinämien untersucht. Sie erreichen eine LDLC-Senkung bzw. HDL-C-Erhöhung und könnten sich bei Patienten mit persistierend hohen LDLC- Werten trotz ausdosierter Statintherapie zur Senkung des kardiovaskulären Risikos bewähren. Der Artikel fasst den aktuellen Kenntnisstand zum LDL- und HDL-Cholesterin inklusive der etablierten und innovativen Therapieansätze zusammen.

The examination of renal function in the daily practice may give important information on the risk status of a given patient. For example, the diagnosis of microalbuminuria carries high predictive value for a future cardiovascular risk of patients with hypertension, diabetes, congestive heart failure, as well as myocardial infarction. The findings of the Hypertension and Diabetes Screening and Awareness Study (HYDRA) indicate that screening for microalbuminuria is performed not often enough in patients with diabetes or hypertension, respectively, and a positive screening finding often does not trigger necessary consequences as for additional diagnosis or therapy.

Almost every second patient seeing a primary care doctor suffers from arterial hypertension and about every fifth has diabetes mellitus. These diseases often occur at the same time. They are associated in more than 80% of the cases with other severe concomitant and subsequent diseases (heart attack, stroke, renal failure, neuropathy etc.). The magnitude especially of subsequent and concomitant diseases, the dimension of the personal suffering and the immense diagnostic and therapeutic challenges for the doctors have been massively underestimated so far. The article informs about the prevalence of the above disease, and structure of the problem. Before the background of an extremely high patient load seen by German General Physicians, the mainstay challenge is highlighted how to achieve further improvements of the quality of care on the basis of scientific guidelines alone, without a concomitant change in the system structure.

Microalbuminuria has been widely appreciated in recent years to be a valuable risk marker for an increased cardiovascular disease morbidity and mortality. Thus guidelines for the treatment of type-2-diabetes in Germany and the US recommend an annual screening as soon as the diagnosis of diabetes is established and a quarterly control when microalbuminuria is present. While nationally representative epidemiologic data from the US have been available, data from Germany, especially from the primary care sector are missing. This is especially important in light of the gatekeeper function of the primary care physician. The "Hypertension and Diabetes Risk Screening Study" (HYDRA) has been identifying 37.8% of patients with hypertension and diabetes to have a positive dipstick test for microalbuminuria on the study day while only 12.5% of these are diagnosed by the doctor as having nephropathy. These patients additionally show a high burden of associated comorbidities and thus call for early detection and intervention especially because effective therapy is available. Although screening for microalbuminuria is recommended in the guidelines the value of a routine screening for microalbuminuria in primary care is under recognized.