Skip to main content
SpringerLink
Log in

Kardiale Endorganschäden bei Diabetes

Cardial target-organ damage in diabetes

  • Schwerpunkt
  • Published:
Der Internist Aims and scope Submit manuscript

Zusammenfassung

Koronare Herzkrankheit und Typ-2-Diabetes mellitus stellen quasi eine Syntropie dar. Entsprechend sind Kardiologen und Diabetologen gefordert, herzkranke Diabetiker interdisziplinär zu betreuen. Die häufig zusätzlich bestehende Hypertonie hat beim Diabetiker eine besonders hohe Morbiditäts- und Mortalitätsrate in Folge der Beteiligung der koronaren Mikrozirkulation. Die koronare Herzkrankheit ist charakterisiert durch eine rasche Progression und diffuse Ausbreitung bis in die Peripherie. Entsprechend sollte bei einer schweren diabetischen koronaren Herzkrankheit eher ein koronarchirurgisches Vorgehen angestrebt werden als eine interventionelle Stenttherapie, die eher für weniger schwere Fälle in Frage kommt. Bei der antihyperglykämischen Behandlung ist bisher nur eine Reduktion kardiovaskulärer Endpunkte unter Metformin weitgehend gesichert. Die Therapie mit Glitazonen ist wegen einer Zunahme der koronaren Morbidität und Mortalität unter Rosiglitazon wieder verlassen worden. Inwieweit Glukagon-like-Peptid-I-Analoga und Dipeptidylpeptidase-4-Inhibitoren kardiovaskuläre Endpunkte reduzieren, muss abgewartet werden. Deswegen beschränkt sich eine endpunktorientierte antiglykämische Behandlung weiter auf Insulin, Metformin und Sulfonylharnstoffe.

Abstract

Coronary heart disease and type 2 diabetes mellitus can be considered as a syntropy. Accordingly, cardiologists and diabetologists should organize an interdisciplinary car of the patient with both cardiac disease and diabetes mellitus. Arterial hypertension is frequently present in the diabetic condition and increases further morbidity and mortality rates due to the involvement of the coronary microcirculation. Coronary artery disease is characterized by a rapid progression and a diffuse distribution particularly in the periphery. Consequently in severe diabetic coronary artery disease coronary bypass surgery should be preferred rather than percutaneous coronary stenting, which should be favored in less severe cases. In the antihyperglycemic treatment a reduction in cardiovascular endpoints has only be documented after metformin. Therapy with thiazolidinediones has been terminated due to an increase in coronary morbidity and mortality under rosiglitazone. In as much glukagon-like peptid-I analogues und dipeptidylpeptidase 4 inhibitors will reduce cardiovascular endpoints has to be waited for. Thus an endpoint orientated antihyperglycemic treatment is limited to insulin, metformin and sulfonylureas.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3

Literatur

  1. (n a) (1995) U.K. prospective diabetes study 16. Overview of 6 years‘ therapy of type II diabetes: a progressive disease. U.K. Prospective Diabetes Study Group. Diabetes 44:1249–1258

  2. (n a) (1998) Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). UK Prospective Diabetes Study (UKPDS) Group. Lancet 352:854–865

  3. (n a) (1998) Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet 352:837–853

  4. Action to Control Cardiovascular Risk in Diabetes Study Group, Gerstein HC, Miller ME et al (2008) Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med 358:2545–2559

    Article  Google Scholar 

  5. Andersson C, Olesen JB, Hansen PR et al (2010) Metformin treatment is associated with a low risk of mortality in diabetic patients with heart failure: a retrospective nationwide cohort study. Diabetologia 53:2546–2553

    Article  PubMed  CAS  Google Scholar 

  6. Asghar O, AL-Sunni A, Khavandi K et al (2009) Diabetic cardiomyopathy. Clin Sci (Lond) 116:741–760

    Google Scholar 

  7. Banning AP, Westaby S, Morice MC et al (2010) Diabetic and nondiabetic patients with left main and/or 3-vessel coronary artery disease: comparison of outcomes with cardiac surgery and paclitaxel-eluting stents. J Am Coll Cardiol 55:1067–1075

    Article  PubMed  CAS  Google Scholar 

  8. BARI 2D Study Group, Frye RL, August P, Brooks MM et al (2009) A randomized trial of therapies for type 2 diabetes and coronary artery disease. N Engl J Med 360:2503–2515

    Article  Google Scholar 

  9. Baumgart D, Klauss V, Baer F et al (2007) One-year results of the SCORPIUS study: a German multicenter investigation on the effectiveness of sirolimus-eluting stents in diabetic patients. J Am Coll Cardiol 50:1627–1634

    Article  PubMed  Google Scholar 

  10. Camm AJ, Kirchhof P, Lip GY et al (2010) Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J 31:2369–2429

    Article  PubMed  Google Scholar 

  11. Cholesterol Treatment Trialists Collaborators, Kearney PM, Blackwell L et al (2008) Efficacy of cholesterol-lowering therapy in 18,686 people with diabetes in 14 randomised trials of statins: a meta-analysis. Lancet 371:117–125

    Article  Google Scholar 

  12. Control Group, Turnbull FM, Abraira C, Anderson RJ et al (2009) Intensive glucose control and macrovascular outcomes in type 2 diabetes. Diabetologia 52:2288–2298

    Article  Google Scholar 

  13. DeFronzo RA, Stonehouse AH, Han J et al (2010) Relationship of baseline HbA1c and efficacy of current glucose-lowering therapies: a meta-analysis of randomized clinical trials. Diabet Med 27:309–317

    Article  PubMed  CAS  Google Scholar 

  14. Deutsche Hochdruckliga (2009) Leitlinien zur Behandlung der arteriellen Hypertonie. Nieren Hochdruckkrankh 38:137–138

    Google Scholar 

  15. Dormandy JA, Charbonnel B, Eckland DJ et al (2005) Secondary prevention of macrovascular events in patients with type 2 diabetes in the PROactive Study (PROspective pioglitAzone Clinical Trial In macroVascular Events): a randomised controlled trial. Lancet 366:1279–1289

    Article  PubMed  CAS  Google Scholar 

  16. Duckworth W, Abraira C, Moritz T et al (2009) Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med 360:129–139

    Article  PubMed  CAS  Google Scholar 

  17. Eurich DT, McAlister FA, Blackburn DF et al (2007) Benefits and harms of antidiabetic agents in patients with diabetes and heart failure: systematic review. BMJ 335:497

    Article  PubMed  CAS  Google Scholar 

  18. Evans JM, Doney AS, Al Zadjali MA et al (2010) Effect of Metformin on mortality in patients with heart failure and type 2 diabetes mellitus. Am J Cardiol 106:1006–1010

    Article  PubMed  CAS  Google Scholar 

  19. Grossman E, Shemesh J, Shamiss A et al (1992) Left ventricular mass in diabetes-hypertension. Arch Intern Med 152:1001–1004

    Article  PubMed  CAS  Google Scholar 

  20. Group AC, Patel A, MacMahon S et al (2008) Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med 358:2560–2572

    Article  Google Scholar 

  21. Haffner SM, Lehto S, Ronnemaa T et al (1998) Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med 339:229–234

    Article  PubMed  CAS  Google Scholar 

  22. Hennersdorf MG, Kelm M, Schannwell CM et al (2000) Cardiac complications in diabetes mellitus. Med Klin (Munich) 95:487–495

    Google Scholar 

  23. Holman RR, Paul SK, Bethel MA et al (2008) 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med 359:1577–1589

    Article  PubMed  CAS  Google Scholar 

  24. Home PD, Pocock SJ, Beck-Nielsen H et al; RECORD Study Team (2009) Rosiglitazone evaluated for cardiovascular outcomes in oral agent combination therapy for type 2 diabetes (RECORD): a multicentre, randomised, open-label trial. Lancet 373:2125–2135

    Article  PubMed  CAS  Google Scholar 

  25. Jouven X, Lemaitre RN, Rea TD et al (2005) Diabetes, glucose level, and risk of sudden cardiac death. Eur Heart J 26:2142–2147

    Article  PubMed  Google Scholar 

  26. Kaiser C, Galatius S, Erne P et al (2010) Drug-eluting versus bare-metal stents in large coronary arteries. N Engl J Med 363:2310–2319

    Article  PubMed  CAS  Google Scholar 

  27. Kannel WB, Hjortland M, Castelli WP (1974) Role of diabetes in congestive heart failure: the Framingham study. Am J Cardiol 34:29–34

    Article  PubMed  CAS  Google Scholar 

  28. Kapur A, Hall RJ, Malik IS et al (2010) Randomized comparison of percutaneous coronary intervention with coronary artery bypass grafting in diabetic patients. 1-year results of the CARDia (Coronary Artery Revascularization in Diabetes) trial. J Am Coll Cardiol 55:432–440

    Article  PubMed  Google Scholar 

  29. Kooy A, Jager J de, Lehert P et al (2009) Long-term effects of metformin on metabolism and microvascular and macrovascular disease in patients with type 2 diabetes mellitus. Arch Intern Med 169:616–625

    Article  PubMed  CAS  Google Scholar 

  30. Lamanna C, Monami M, Marchionni N, Mannucci E (2011) Effect of metformin on cardiovascular events and mortality: a meta-analysis of randomised clinical trials. Diabetes Obes Metab 13:221–228

    Article  PubMed  CAS  Google Scholar 

  31. Law MR, Morris JK, Wald NJ (2009) Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies. BMJ 338:b1665

    Article  PubMed  CAS  Google Scholar 

  32. Mancia G, De Backer G, Dominiczak A et al (2007) 2007 ESH-ESC Practice Guidelines for the management of arterial hypertension: ESH-ESC Task Force on the Management of Arterial Hypertension. J Hypertens 25:1751–1762

    Article  PubMed  CAS  Google Scholar 

  33. Montalescot G, Wiviott SD, Braunwald E et al (2009) Prasugrel compared with clopidogrel in patients undergoing percutaneous coronary intervention for ST-elevation myocardial infarction (TRITON-TIMI 38): double-blind, randomised controlled trial. Lancet 373:723–731

    Article  PubMed  CAS  Google Scholar 

  34. Nissen SE (2010) The rise and fall of rosiglitazone. Eur Heart J 31:773–776

    Article  PubMed  CAS  Google Scholar 

  35. Nissen SE, Wolski K (2007) Effect of rosiglitazone on the risk of myocardial infarction and death from cardiovascular causes. N Engl J Med 356:2457–2471

    Article  PubMed  CAS  Google Scholar 

  36. Norhammar A, Tenerz A, Nilsson G et al (2002) Glucose metabolism in patients with acute myocardial infarction and no previous diagnosis of diabetes mellitus: a prospective study. Lancet 359:2140–2144

    Article  PubMed  CAS  Google Scholar 

  37. Phung OJ, Scholle JM, Talwar M et al (2010) Effect of noninsulin antidiabetic drugs added to metformin therapy on glycemic control, weight gain, and hypoglycemia in type 2 diabetes. JAMA 303:1410–1418

    Article  PubMed  CAS  Google Scholar 

  38. Rao AD, Kuhadiya N, Reynolds K et al (2008) Is the combination of sulfonylureas and metformin associated with an increased risk of cardiovascular disease or all-cause mortality?: a meta-analysis of observational studies. Diabetes Care 31:1672–1678

    Article  PubMed  Google Scholar 

  39. Rustenbeck I, Baltrusch S, Tiedge M (2010) Do insulinotropic glucose-lowering drugs do more harm than good? The hypersecretion hypothesis revisited. Diabetologia 53:2105–2111

    Article  PubMed  CAS  Google Scholar 

  40. Ryden L, Standl E, Bartnik M et al (2007) Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: executive summary. The Task Force on Diabetes and Cardiovascular Diseases of the European Society of Cardiology (ESC) and of the European Association for the Study of Diabetes (EASD). Eur Heart J 28:88–136

    Article  PubMed  CAS  Google Scholar 

  41. Schwabe U, Pfaffrath D (2009) Arzneiverordnungs-Report 2009. Springer, Berlin Heidelberg New York

  42. Serruys PW, Morice MC, Kappetein AP et al (2009) Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N Engl J Med 360:961–972

    Article  PubMed  CAS  Google Scholar 

  43. Sherifali D, Nerenberg K, Pullenayegum E et al (2010) The effect of oral antidiabetic agents on A1C levels: a systematic review and meta-analysis. Diabetes Care 33:1859–1864

    Article  PubMed  CAS  Google Scholar 

  44. Silber S, Borggrefe M, Bohm M et al (2008) Drug-eluting coronary stents and drug eluting balloon catheters: summary of the position papers of the DGK. Clin Res Cardiol 97:548–563

    Article  PubMed  Google Scholar 

  45. Stamler J, Vaccaro O, Neaton JD et al (1993) Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in the Multiple Risk Factor Intervention Trial. Diabetes Care 16:434–444

    Article  PubMed  CAS  Google Scholar 

  46. Stettler C, Allemann S, Wandel S et al (2008) Drug eluting and bare metal stents in people with and without diabetes: collaborative network meta-analysis. BMJ 337:a1331

    Article  PubMed  Google Scholar 

  47. Stirban AO, Tschoepe D (2008) Cardiovascular complications in diabetes: targets and interventions. Diabetes Care (Suppl 31)2:S215–S221

    Google Scholar 

  48. Stratmann B, Tschoepe D (2005) Pathobiology and cell interactions of platelets in diabetes. Diab Vasc Dis Res 2:16–23

    Article  PubMed  Google Scholar 

  49. Strauer BE, Motz W, Vogt M et al (1997) Evidence for reduced coronary flow reserve in patients with insulin-dependent diabetes. A possible cause for diabetic heart disease in man. Exp Clin Endocrinol Diabetes 105:15–20

    Article  PubMed  CAS  Google Scholar 

  50. Teuscher A, Egger M, Herman JB (1989) Diabetes and hypertension. Blood pressure in clinical diabetic patients and a control population. Arch Intern Med 149:1942–1945

    Article  PubMed  CAS  Google Scholar 

  51. Wallentin L, Becker RC, Budaj A et al (2009) Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med 361:1045–1057

    Article  PubMed  CAS  Google Scholar 

  52. Wiviott SD, Braunwald E, McCabe CH et al (2007) Prasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med 357:2001–2015

    Article  PubMed  CAS  Google Scholar 

  53. Yudkin JS, Richter B, Gale EA (2010) Intensified glucose lowering in type 2 diabetes: time for a reappraisal. Diabetologia 53:2079–2085

    Article  PubMed  CAS  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Klinik für Kardiologie, Herz- und Diabeteszentrum Mecklenburg-Vorpommern, Greifswalder Straße 11, 17495, Karlsburg, Deutschland

    W. Motz

  2. Klinik für Diabetes und Stoffwechselerkrankungen, Herz- und Diabeteszentrum Mecklenburg-Vorpommern, Karlsburg, Deutschland

    W. Kerner

Authors
  1. W. Motz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. W. Kerner
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to W. Motz.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Motz, W., Kerner, W. Kardiale Endorganschäden bei Diabetes. Internist 52, 505–517 (2011). https://doi.org/10.1007/s00108-010-2732-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00108-010-2732-0

Schlüsselwörter

Keywords

Search

Navigation