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Kardiovaskuläres Risiko und medikamentöse Lipidtherapie

Cardiovascular risk and lipid-lowering drug therapy

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Der Diabetologe Aims and scope

Zusammenfassung

Menschen mit Typ-2- und fortgeschrittenem Typ-1-Diabetes weisen ein enormes Risiko für Herz-Kreislauf-Erkrankungen auf; hierfür ist die Dyslipidämie wesentlich mitverantwortlich. Daher profitieren besonders Patienten mit Diabetes von einer intensiven lipidsenkenden Therapie. Die Behandlung der Dyslipidämie gewährleistet nur dann die optimale Risikoreduktion, wenn die empfohlenen Lipidzielwerte konsequent angestrebt und erreicht werden. Die Senkung des „Low-density-lipoprotein“-Cholesterins (LDL-C) bzw. „Non-high-density-lipoprotein“-Cholesterins (Non-HDL-C) mit Statinen stellt auch beim Patienten mit Diabetes den Grundpfeiler der medikamentösen Lipidtherapie dar. Zur Zielwerterreichung werden oft hochpotente Statine eingesetzt werden. Ezetimib und Gallensäurebinder senken ebenfalls primär erhöhte Cholesterinspiegel und können in Kombination mit Statinen oder bei Statinunverträglichkeit eingesetzt werden. Fibrate senken effektiv erhöhte Triglyzeridkonzentrationen und bringen bei Patienten, die gleichzeitig einen niedrigen HDL-C-Wert aufweisen, klinische Vorteile. Nikotinsäure und hochdosierte langkettige ω3-Fettsäuren reduzieren ebenfalls die Triglyzeridkonzentrationen und können durch HDL-C-Steigerung bzw. antiarrhythmische sowie andere Wirkungen zusätzliche Verbesserungen bringen.

Abstract

Patients with type 2 and advanced type 1 diabetes bear a very high risk for cardiovascular disease, which is substantially driven by the associated dyslipidemia; therefore, patients with diabetes clearly benefit from intensive lipid-lowering therapy. To ensure optimal risk reduction, lipid-lowering therapy must consistently aim at and achieve the recommended target values. Statins reduce low-density lipoproteins (LDL) and non-high-density lipoprotein (HDL) cholesterol and are the mainstay of lipid-lowering therapy also in diabetes patients but highly potent statins are often applied to reach the goals. Ezetimib and bile acid sequestrants also lower cholesterol levels and may be given in combination with statins or to statin-intolerant patients. Fibrates effectively lower serum triglycerides and provide clinical benefits in patients with concurrent low HDL cholesterol levels. Nicotinic acid and long-chain ω3 fatty acids could provide improvements due to HDL cholesterol elevation, anti-arrhythmic and other effects.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: Der Autor erhielt Reiseeinladungen und Honorare für Vorträge und Beratung von Abbott Laboratories, AstraZeneca, Merck Sharp & Dohme.

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  1. Christian Doppler-Labor für Kardio-Metabolische Immuntherapie und Klinische Abteilung für Endokrinologie und Stoffwechsel, Klinik für Innere Medizin III, Medizinische Universität und Allgemeines Krankenhaus Wien, Währinger Gürtel 18–20, 1090, Wien, Österreich

    T. Stulnig

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Correspondence to T. Stulnig.

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Stulnig, T. Kardiovaskuläres Risiko und medikamentöse Lipidtherapie. Diabetologe 8, 568–572 (2012). https://doi.org/10.1007/s11428-012-0891-4

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