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ESC/EASD-Leitlinien zu Diabetes und kardiovaskulären Erkrankungen

ESC/EASD Joint Guidelines on Diabetes and Cardiovascular Diseases

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Zusammenfassung

Die Leitlinien der European Society of Cardiology/European Association for the Study of Diabetes (ESC/EASD) zu Diabetes und kardiovaskulären Erkrankungen haben im europäischen Rahmen erstmalig der pathophysiologischen Entität von Diabetes mellitus und kardiovaskulären Erkrankungen Rechnung getragen. Diabetes ist nach diesen Leitlinien von Anfang an eine Herz- und Gefäßerkrankung, deren vital bedrohliche Komplikationen Herzinfarkt und Schlaganfall nur durch eine fachübergreifende konzertierte Aktion vermieden werden können. Als wichtigste Information für die interdisziplinäre Zusammenarbeit von Hausärzten, Diabetologen und Kardiologen finden sich in diesen Leitlinien die beiden Postulate, dass Patienten mit der Hauptdiagnose Diabetes mellitus mit oder ohne bekannte koronare Herzkrankheit (KHK) in regelmäßigen Intervallen einem Kardiologen und Patienten mit der Hauptdiagnose KHK mit oder ohne bekannten Diabetes mellitus in regelmäßigen Abständen einem Diabetologen vorgestellt werden sollen. Von fundamentaler Bedeutung ist die Prävention von Diabetes mellitus und KHK durch eine umfassende Lebensstilmodifikation mit Nikotinkarenz, regelmäßiger körperlicher Aktivität und Gewichtsreduktion, die von einer evidenzbasierten medikamentösen Therapie flankiert werden sollte. Im Rahmen eines multimodalen Risikomanagements haben eine optimale medikamentöse Einstellung einer begleitenden arteriellen Hypertonie, eine Statintherapie bei erhöhtem LDL-Cholesterin oder unabhängig vom Ausgangs-LDL-Cholesterin bei gesicherter KHK, eine ACE-Hemmer-, Angiotensin-II-Hemmer- oder β-Blocker-Therapie bei begleitender Herzinsuffizienz und eine Antikoagulation zur Schlaganfallprophylaxe bei chronischem Vorhofflimmern jeweils Klasse-I-Empfehlungen. Hinsichtlich der bevorzugten koronaren Revaskularisation kann man heute bei Diabetikern generell keine starre Therapieempfehlung für oder gegen eine chirurgische Revaskularisation bzw. für oder gegen eine perkutane Koronarintervention geben. Die Entscheidung für ein bestimmtes Revaskularisationsverfahren muss in jedem einzelnen Fall nach einer eingehenden Analyse des individuellen Koronarbefunds getroffen werden.

Abstract

The ESC/EASD (European Society of Cardiology/European Association for the Study of Diabetes) joint Guidelines on diabetes, pre-diabetes, and cardiovascular diseases have, for the first time, addressed diabetes mellitus and cardiovascular diseases (CVD) as a pathophysiological entity in Europe. Based on these guidelines, diabetes mellitus is regarded from the outset to be a cardiovascular disease, whose life-threatening complications myocardial infarction and stroke can only be avoided by an interdisciplinary concerted action. The most important information of these guidelines for the interdisciplinary cooperation of primary-care physicians, diabetologists and cardiologists are the postulations that patients with the main diagnosis diabetes mellitus with or without known CVD should, at regular intervals, be referred to a cardiologist, and patients with the main diagnosis CVD with or without diabetes mellitus should, at regular intervals, be referred to a diabetologist. Of fundamental importance is the prevention of diabetes and CVD by a comprehensive lifestyle modification including smoking cessation, regular physical activity and weight control, flanked by an evidence-based drug therapy. Within the framework of a multimodal risk management, an optimal antihypertensive therapy of a concomitant elevated blood pressure; a statin therapy in case of elevated LDL cholesterol or regardless of an elevated LDL in proven CVD; ACE inhibitors, angiotensin II receptor blockers, or β-blockers in case of heart failure; and an anticoagulant therapy for the prevention of cardioembolic stroke in patients with atrial fibrillation all have class I recommendations. Concerning the preferred coronary revascularization procedure in diabetics, today no rigid general recommendation can be given in favor of or against coronary bypass surgery, or in favor of or against percutaneous coronary intervention. The decision for a specific revascularization procedure should, in any case, be based on a detailed analysis of the individual coronary anatomy.

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Authors and Affiliations

  1. Klinikum Karlsburg der Klinikgruppe Dr. Guth GmbH & Co KG, Karlsburg, Germany

    Wolfgang Motz

  2. Praxisklinik Herz und Gefäße, Kardiologie · Angiologie · Radiologie · Nuklearmedizin, Akademische Lehrpraxisklinik der TU Dresden, Dresden, Germany

    Rolf Dörr

  3. Ärztlicher Direktor, Klinikum Karlsburg der Klinikgruppe Dr. Guth GmbH & Co KG, Greifswalder Straße 11, 17495, Karlsburg, Germany

    Wolfgang Motz

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Correspondence to Wolfgang Motz.

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Motz, W., Dörr, R. ESC/EASD-Leitlinien zu Diabetes und kardiovaskulären Erkrankungen. Herz 34, 21–29 (2009). https://doi.org/10.1007/s00059-009-3203-z

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