Der Internist

, Volume 52, Issue 5, pp 505–517

Kardiale Endorganschäden bei Diabetes

Schwerpunkt
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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.

Schlüsselwörter

Koronare Herzkrankheit Arterielle Hypertonie Antihyperglykämische Behandlung Aortokoronare Bypassoperation Perkutane Koronarintervention 

Cardial target-organ damage in diabetes

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.

Keywords

Coronary artery disease Arterial hypertension Antihyperglycemic treatment Coronary artery bypass surgery Percutaneous coronary intervention 

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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  1. 1.Klinik für KardiologieHerz- und Diabeteszentrum Mecklenburg-VorpommernKarlsburgDeutschland
  2. 2.Klinik für Diabetes und StoffwechselerkrankungenHerz- und Diabeteszentrum Mecklenburg-VorpommernKarlsburgDeutschland

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