Patient Education
Selected topics to help you better understand common cardiac conditions. For individual questions or other concerns, a consultation can be requested.
Atrial Fibrillation (AF)
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Short Overview
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Atrial fibrillation is an irregular and often rapid heart rhythm. It may feel like palpitations, a racing heart, or sometimes only mild chest discomfort.
Depending on individual risk factors, atrial fibrillation can increase the risk of stroke, which is why some patients require blood-thinning medication.
Treatment depends on symptoms and overall condition. Options include medication, electrical cardioversion, or catheter ablation to restore and maintain a normal heart rhythm.
Detailed Explanation
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What is atrial fibrillation?
Atrial fibrillation is an irregular heart rhythm in which the atria (upper chambers of the heart) are activated very rapidly and chaotically. As a result, the heartbeat becomes irregular and may be fast or sometimes normal in rate.
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Causes and risk factors
​The exact mechanism is not fully understood. However, several risk factors are known, including hypertension, obesity, diabetes, alcohol use, smoking, sleep apnea, genetic predisposition, and increasing age. In many cases, atrial fibrillation is triggered by electrical activity originating from the pulmonary veins.
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Why it matters
​Because the atria no longer contract effectively, blood flow can become slower, especially in the left atrial appendage. This increases the risk of blood clot formation, which may lead to stroke. In addition, a persistently fast and irregular heart rate can weaken the heart over time.
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Stroke risk and blood thinners
Not all patients with atrial fibrillation have the same risk of stroke. Risk is assessed using established scoring systems such as the CHAâ‚‚DSâ‚‚-VASc score, which includes factors like age, hypertension, heart disease, and prior stroke.
Patients with higher risk benefit from anticoagulation (blood-thinning therapy), which significantly reduces the likelihood of stroke. These medications include vitamin K antagonists and modern oral anticoagulants. Aspirin is not effective for stroke prevention in atrial fibrillation.
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Types of atrial fibrillation
Atrial fibrillation can occur in different forms:
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newly diagnosed
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paroxysmal (intermittent)
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persistent
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permanent
The type of atrial fibrillation helps guide treatment decisions.
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When treatment is needed
​Treatment depends on symptoms, age, overall condition, and the presence of heart disease. Some patients, especially older individuals with minimal symptoms, may be managed conservatively, while others benefit from active rhythm control.
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Treatment options
Treatment may include:
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medications to control heart rate or rhythm
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electrical cardioversion to restore normal rhythm
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catheter ablation, which targets the sources of abnormal electrical activity
The choice of treatment is individualized and based on symptoms, risks, and expected benefits.
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Blood Pressure
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Short Overview
High blood pressure (hypertension) is defined in Europe as values of 140/90 mmHg or higher. Values between 130–139/85–89 mmHg are considered a borderline range.
Untreated hypertension increases the risk of heart attack, stroke, and other organ damage. Early detection and treatment are therefore essential.
Initial management includes lifestyle changes such as weight control, physical activity, and diet. If needed, medication is added to achieve stable blood pressure control.
Detailed Explanation
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What is blood pressure?
Blood pressure is the force of blood pushing against the walls of the arteries. If this pressure is too high over time, it can damage blood vessels and organs.
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Systolic and diastolic values
Blood pressure is given as two numbers:
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Systolic (upper value): pressure when the heart contracts
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Diastolic (lower value): pressure when the heart relaxes
A normal value is around 120/80 mmHg. Lower values such as 110/70 mmHg are generally considered optimal.
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When is it considered hypertension?
In Europe, hypertension is defined as blood pressure of 140/90 mmHg or higher.
In some countries, lower thresholds are used.
Very high values (e.g. above 200 mmHg systolic) represent a hypertensive emergency and require immediate medical attention.
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Why it matters
Persistently high blood pressure can damage blood vessels and organs over time. It is a major risk factor for:
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heart attack and coronary artery disease
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stroke
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kidney disease
Because of this, early diagnosis and effective treatment are essential.
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Causes and risk factors
In most cases, no single cause can be identified (so-called essential hypertension).
However, several factors contribute to elevated blood pressure, including:
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genetic predisposition
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overweight
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lack of physical activity
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smoking and alcohol
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diabetes
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sleep apnea
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Treatment
Treatment usually starts with lifestyle modification:
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weight reduction
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regular physical activity
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healthy diet
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reducing alcohol and nicotine
If blood pressure remains elevated, medication is introduced. Today, treatment often begins with a combination of medications to achieve effective control.
Regular monitoring is important, often including long-term blood pressure measurements. Therapy is then adjusted individually.
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Goal of treatment
The aim is stable and long-term blood pressure control, as this significantly reduces the risk of cardiovascular complications and improves life expectancy.
Heart Failure
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Short overview
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Heart failure means that the heart is no longer able to pump blood effectively enough to meet the body’s needs.
Typical symptoms include shortness of breath, reduced physical capacity, fatigue, and often swelling of the legs due to fluid retention.
Diagnosis is usually based on echocardiography (heart ultrasound), supported by blood tests and, if needed, further examinations. Treatment depends on the underlying cause and may include medication, interventional procedures, or device therapy.
Detailed Explanation
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What is heart failure?
Heart failure describes a condition in which the heart is unable to pump blood efficiently. This can be due to reduced pumping function or despite a normal pumping function when the heart becomes stiff and cannot fill properly.
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Causes
Heart failure can have many causes, including:
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coronary artery disease or previous heart attack
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heart valve disease
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cardiac arrhythmias
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long-standing high blood pressure
The exact cause determines the treatment strategy.
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Symptoms
Common symptoms include:
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shortness of breath, especially on exertion
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reduced physical capacity and fatigue
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swelling of the legs (edema)
Fluid retention occurs because the heart cannot circulate blood effectively, leading to accumulation of fluid in tissues and sometimes in the lungs.
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Diagnosis
The most important examination is echocardiography, which evaluates heart function and structure.
Depending on findings, additional tests may include:
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blood tests
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cardiac catheterization
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imaging studies
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Treatment of the underlying cause
Treatment focuses first on identifying and addressing the cause:
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coronary artery disease → possible stenting
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valve disease → repair or replacement (surgical or catheter-based)
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arrhythmias → rhythm treatment or ablation
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Medication
Medication is a central part of treatment. Several drug groups are used, often in combination, to:
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improve symptoms
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reduce fluid retention
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support heart function
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improve long-term prognosis
Consistent and long-term use is essential.
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Device therapy
In selected patients, device therapy may be indicated:
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special pacemakers to improve heart coordination
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defibrillators to protect against life-threatening arrhythmias
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Advanced stages
In some cases, heart failure may progress despite optimal treatment. In these situations, careful reassessment and, when necessary, discussion of long-term management and realistic treatment goals are important.
Coronary Artery Disease (CAD) / Heart Attack
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Shor Overview
Coronary artery disease (CAD) occurs when the blood vessels supplying the heart muscle become narrowed or blocked. This reduces oxygen supply to the heart.
Typical symptoms include chest pain or discomfort (angina), often during physical exertion. In severe cases, a complete blockage of a vessel can lead to a heart attack.
Early diagnosis and treatment are essential to restore blood flow and prevent permanent damage to the heart muscle.
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Detailed Explanation
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What is coronary artery disease?
The heart muscle requires a constant supply of oxygen and nutrients through the coronary arteries. When these vessels become narrowed or blocked, the blood supply to the heart is reduced.
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Causes and risk factors
The most common cause is atherosclerosis, where deposits (plaques) build up in the vessel walls.
Important risk factors include:
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smoking
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high cholesterol
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high blood pressure
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diabetes
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genetic predisposition
Symptoms
Reduced blood flow can cause chest discomfort (angina pectoris), often described as pressure or burning behind the breastbone. Symptoms typically occur during exertion and improve with rest.
In some cases, symptoms may be atypical, such as shortness of breath or discomfort in the neck or arms.
Heart attack
If a coronary artery becomes completely blocked, a heart attack occurs. Symptoms are usually more severe and may persist at rest.
Without rapid treatment, part of the heart muscle can be permanently damaged.
Treatment
The main goal is to restore and maintain blood flow to the heart.
In acute cases, the blocked vessel is reopened using cardiac catheterization and stent implantation.
In addition, long-term treatment includes medication such as:
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blood thinners
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cholesterol-lowering drugs
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blood pressure and heart rate control
Long-term management
After diagnosis, long-term outcomes depend not only on treatment but also on lifestyle.
Important measures include:
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regular physical activity
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healthy diet
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smoking cessation
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consistent medication use
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regular medical follow-up
These measures significantly improve prognosis and reduce the risk of future events.
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Short Overview
Syncope is a temporary loss of consciousness caused by a short reduction in blood flow to the brain. It usually lasts only a few seconds, followed by a quick and complete recovery.
In many cases, the cause is harmless, but syncope can also be related to a cardiac rhythm disorder. For this reason, recurrent or unexplained fainting should be evaluated carefully.
Detailed Explanation,
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What is syncope?
Syncope is a temporary loss of consciousness caused by a brief reduction in blood flow to the brain. Patients usually recover quickly and completely within seconds.
Syncope and presyncope
Sometimes the reduction in blood flow is not enough to cause full loss of consciousness. In that case, patients may describe “almost fainting,” blackening of vision, or sudden weakness. This is called presyncope and may have the same medical significance as syncope.
Possible causes
In younger individuals, fainting is often harmless and may occur in certain situations, such as fear, pain, emotional stress, or blood sampling.
However, syncope can also be caused by heart disease, especially cardiac arrhythmias. One important cause is a very slow heart rate or a pause in the heartbeat, which reduces oxygen supply to the brain.
Why evaluation is important
Although not every fainting episode is dangerous, every unexplained syncope should be assessed carefully. In some cases, serious rhythm disturbances or other cardiac conditions may be responsible.
The urgency and setting of the evaluation depend on the individual situation. Some patients can be assessed as outpatients, while others require hospital-based investigation.
Diagnosis
The diagnostic work-up depends on the suspected cause. In some patients, long-term rhythm monitoring is particularly important.
One useful method is an implantable loop recorder, a small device placed under the skin that continuously records the ECG over a long period. If another episode occurs, the heart rhythm at that moment can be reviewed, which may help identify whether a pacemaker or other treatment is needed.
Sudden Tachycardias / Arrhythmias
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Short Overview
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Many patients experience sudden episodes of rapid or irregular heartbeat, known as cardiac arrhythmias.
These can be regular or irregular, short-lasting or persistent. In younger individuals, many of these rhythm disturbances are harmless but may be uncomfortable. In older patients, atrial fibrillation is the most common type.
Depending on symptoms and findings, treatment may range from reassurance to medication or, in selected cases, catheter ablation.
Detailed Explanation
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What are cardiac arrhythmias?
Cardiac arrhythmias are disturbances of the heart’s electrical system, leading to irregular, too fast, or occasionally too slow heart rhythms. They can occur even in otherwise healthy individuals.
Sudden rapid heart rhythms (tachycardias)
In younger patients, sudden episodes of very fast and regular heartbeat are often caused by so-called re-entrant tachycardias. These are electrical circuits within the heart that can suddenly start and stop (“on-off phenomenon”), sometimes reaching heart rates of up to 200 beats per minute.
Although usually not dangerous, these episodes can be very uncomfortable. If symptoms are frequent or severe, catheter ablation can provide a definitive treatment.
Extrasystoles (premature beats)
Many patients notice occasional “skipped beats” or brief palpitations. These are usually caused by premature beats (extrasystoles), which can originate from the atria or the ventricles.
Extrasystoles are very common and, in most cases, harmless. However, in some patients they can be frequent or bothersome and may require further evaluation or, in selected cases, treatment.
Other arrhythmias
There are also more complex and potentially serious rhythm disorders, especially in patients with underlying heart disease. These require careful evaluation and, if necessary, specific treatment.
When evaluation is needed
Any recurrent or unexplained arrhythmia should be assessed. The type of investigation depends on the symptoms and may include ECG, long-term monitoring (Holter ECG), or event recorders.
The decision whether and how to treat a rhythm disorder is always individualized, based on symptoms, underlying conditions, and overall risk.
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Heart Valve Disease
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Short Overview
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Heart valve disease occurs when one or more of the heart valves do not function properly. This can involve either narrowing (stenosis) or leakage (regurgitation).
Mild valve abnormalities are common and often harmless. More severe forms can lead to symptoms such as shortness of breath and, over time, heart failure.
Treatment depends on the severity and type of valve disease and may include monitoring, medication, or valve repair or replacement.
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Detailed Explanation
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What is heart valve disease?
The heart has four valves that regulate blood flow through the heart. When a valve becomes narrowed or does not close properly, blood flow is impaired.
The two most common problems are valve leakage (regurgitation) and valve narrowing (stenosis).
Mitral valve regurgitation
The mitral valve lies between the left atrium and the left ventricle. If it does not close properly, blood flows back into the atrium during each heartbeat.
Over time, this can lead to enlargement of the atrium, increased pressure in the lungs, and symptoms such as shortness of breath. If untreated, it may result in heart failure.
Diagnosis typically includes echocardiography, often supplemented by transesophageal echocardiography, and in some cases cardiac catheterization or MRI.
Treatment depends on the severity and underlying cause. Options include surgical repair or replacement, as well as catheter-based procedures in selected patients.
Aortic valve stenosis
Aortic valve stenosis is a narrowing of the valve between the left ventricle and the aorta. It is most commonly caused by age-related calcification.
As the valve narrows, the heart must work harder to pump blood, which can eventually lead to symptoms such as shortness of breath, chest pain, or reduced physical capacity.
There is no medication that can reverse valve calcification. In symptomatic or severe cases, treatment is required.
Treatment options
Treatment may include:
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surgical valve repair or replacement
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minimally invasive catheter-based procedures
One important catheter-based method is transcatheter aortic valve implantation (TAVI), in which a new valve is inserted via the groin artery.
The choice of treatment depends on the patient’s condition, valve anatomy, and overall risk.
Individual decision-making
Not all patients are suitable for every treatment option. Careful evaluation and imaging are essential to determine the best approach. The goal is to improve symptoms, preserve heart function, and enhance long-term outcomes.
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Cholesterol
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Short Overview
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There is hardly a topic in medicine that has been as well studied as the relationship between cholesterol and cardiovascular disease. Especially in patients with myocardial infarction or coronary artery disease, it has been clearly demonstrated that the level of cholesterol in the blood is directly associated with mortality. In these patients, it is worthwhile to reduce cholesterol levels to the minimum - with lifestyle, diet, nicotine abstinence, exercise and medication. Important: cholesterol can be elevated even in slim and otherwise healthy people, it is not always the expression of unhealthy diet, it can also be genetically elevated.
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Detailed Explanation
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What is cholesterol?
Cholesterol is a fatty substance in the blood that is essential for many bodily functions. It is transported through the bloodstream by different types of lipoproteins.
“Good” and “bad” cholesterol
In clinical practice, cholesterol is often simplified into:
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HDL (high-density lipoprotein) – often called “good” cholesterol, as it helps transport cholesterol back to the liver for elimination
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LDL (low-density lipoprotein) – often called “bad” cholesterol, as it transports cholesterol to tissues and can contribute to plaque formation in blood vessels
Why LDL matters
Elevated LDL cholesterol plays a central role in the development of atherosclerosis. Over time, cholesterol deposits can build up in the vessel walls, leading to narrowing of the arteries.
In the coronary arteries, this process can result in coronary artery disease and increase the risk of heart attack.
Cholesterol and cardiovascular risk
In patients with known cardiovascular disease, lowering LDL cholesterol is one of the most effective ways to reduce mortality and prevent further events.
The general principle is: the higher the risk, the lower the target LDL level.
Treatment
Treatment begins with lifestyle measures:
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healthy diet
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regular physical activity
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smoking cessation
If these are not sufficient, medication is introduced. The first-line treatment usually includes statins, which lower LDL cholesterol and stabilize existing plaques.
If target levels are not reached, additional medications may be added, including injectable therapies in selected cases.
Individual approach
In patients without known heart disease, the decision to treat elevated cholesterol depends on overall cardiovascular risk, including age, risk factors, and individual assessment.
Even in healthy individuals, long-term cholesterol control plays an important role in preventing cardiovascular disease.
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