Skip to main content
SpringerLink
Log in

Diabetes, Prädiabetes und kardiovaskuläres Risiko

Diabetes, prediabetes and cardiovascular risk

  • CME Zertifizierte Fortbildung
  • Published:
Der Internist Aims and scope Submit manuscript

Zusammenfassung

Herz-Kreislauf-Erkrankungen erhöhen die Morbidität und Mortalität in der Gesellschaft. Diabetes mellitus gilt als Risikofaktor für eine koronare Herzkrankheit (KHK), Herzinsuffizienz und für vaskuläre Ereignisse. Die Mehrzahl der Patienten weist eine Risikokonstellation aus Hypertonie, Dyslipoproteinämie und (prä-)diabetischer Stoffwechsellage auf, die eine exponentielle Risikoerhöhung bedingt. Aus der Perspektive der Organerkrankung zeigen zwei Drittel der Patienten mit symptomatischer KHK Glukosestoffwechselstörungen. Umgekehrt haben bei Manifestation eines Myokardinfarkts 25–28 % der Patienten keine Glukosestoffwechselstörung. Frauen sind häufiger betroffen und weisen eine schlechtere Prognose auf, wenn die Diabetesdiagnose und ein Gefäßereignis zusammenfallen. Diabetes mellitus ist signifikant häufiger mit Vorhofflimmern und dem Risiko einer Herzinsuffizienz assoziiert. Mit der unzureichenden Blutzuckereinstellung steigt das Risiko für vaskuläre Ereignisse überproportional an.

Abstract

Cardiovascular diseases continue to be the mainstay in morbidity and mortality in modern society with diabetes mellitus being a known risk factor for coronary artery disease, heart failure and vascular events. Most patients present with a combination of hypertension, dyslipoproteinaemia and (pre)diabetic metabolism potentiating the risk. From the perspective of organ damage two of three patients with coronary artery disease present with impaired glucose metabolism. In case of myocardial infarction 25–28 % of patients do not present with impaired glucose metabolism. Women are more often affected than men and exhibit a more severe outcome, if diagnoses of vascular events and diabetes occur in parallel. Atrial fibrillation and heart failure are significantly associated with diabetes and significantly confer to the overall prognosis. Epidemiologically, the risk for vascular events is closely associated with the glucose burden of the affected patient.

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

Literatur

  1. Ryden L, Grant PJ, Anker SD et al (2013) ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD: the Task Force on diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and developed in collaboration with the European Association for the Study of Diabetes (EASD). Eur Heart J 34:3035–3087

    Google Scholar 

  2. Taubert G, Winkelmann BR, Schleiffer T et al (2003) Prevalence, predictors, and consequences of unrecognized diabetes mellitus in 3266 patients scheduled for coronary angiography. Am Heart J 145:285–291

    Article  Google Scholar 

  3. Doerr R, Hoffmann U, Otter W et al (2011) Oral glucose tolerance test and HbA(1)c for diagnosis of diabetes in patients undergoing coronary angiography: [corrected] the Silent Diabetes Study. Diabetologia 54:2923–2930

    Article  CAS  PubMed  Google Scholar 

  4. Gitt A (2010) Hohe Prävalenz des unbekannten Diabetes bei Patienten mit akutem Myokardinfarkt in Deutschland – Ergebnisse des SWEETHEART-Registers. Diab Stoffw Herz 19:383

    Google Scholar 

  5. Tschoepe D, Towae F, Papp A et al (2012) High 3-year-mortality rates in females with newly diagnosed diabetes after acute STEMI and NSTEMI: results of the SWEETHEART registry. Diabetologia 55

  6. 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

  7. Behrens M, Doerr R, Eckert S et al (2014) Diabetes mellitus und Herz. Diabetol Stoffw 9:S120–S124

    Google Scholar 

  8. Genders TS, Steyerberg EW, Alkadhi H et al (2011) A clinical prediction rule for the diagnosis of coronary artery disease: validation, updating, and extension. Eur Heart J 32:1316–1330

    Article  Google Scholar 

  9. (o A) (2014) Nationale VersorgungsLeitlinie KHK. http://www.leitlinien.de/nvl

  10. Pryor DB, Bruce RA, Chaitman BR et al (1989) Task force I: determination of prognosis in patients with ischemic heart disease. J Am Coll Cardiol 14:1016–1025

  11. Young LH, Wackers FJ, Chyun DA et al (2009) Cardiac outcomes after screening for asymptomatic coronary artery disease in patients with type 2 diabetes: the DIAD study: a randomized controlled trial. JAMA 301:1547–1555

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  12. Wackers FJ, Young LH (2009) Lessons learned from the detection of ischemia in asymptomatic diabetics (DIAD) study. J Nucl Cardiol 16:855–859

  13. Muhlestein JB, Lappe DL, Lima JA et al (2014) Effect of screening for coronary artery disease using CT angiography on mortality and cardiac events in high-risk patients with diabetes: the FACTOR-64 randomized clinical trial. JAMA 312:2234–2243

    Article  CAS  PubMed  Google Scholar 

  14. Ryden L, Standl E, Bartnik M et al (2007) Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death – executive summary. Rev Port Cardiol 26:1213–1274

    PubMed  Google Scholar 

  15. Poulsen MK, Henriksen JE, Dahl J et al (2010) Left ventricular diastolic function in type 2 diabetes mellitus: prevalence and association with myocardial and vascular disease. Circ Cardiovasc Imaging 3:24–31

    Article  PubMed  Google Scholar 

  16. Reaven PD, Moritz TE, Schwenke DC et al (2009) Intensive glucose-lowering therapy reduces cardiovascular disease events in veterans affairs diabetes trial participants with lower calcified coronary atherosclerosis. Diabetes 58:2642–2648

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  17. Farkouh ME, Domanski M, Sleeper LA et al (2012) Strategies for multivessel revascularization in patients with diabetes. N Engl J Med 367:2375–2384

  18. Kappetein AP, Head SJ, Morice MC et al (2013) Treatment of complex coronary artery disease in patients with diabetes: 5-year results comparing outcomes of bypass surgery and percutaneous coronary intervention in the SYNTAX trial. Eur J Cardiothorac Surg 43:1006–1013

    Article  PubMed  Google Scholar 

  19. Mohr FW, Morice MC, Kappetein AP et al (2013) Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomised, clinical SYNTAX trial. Lancet 381:629–638

    Article  PubMed  Google Scholar 

  20. Halle M, Gitt AK, Hanefeld M et al (2012) Diabetes and heart failure: a practically oriented critical appraisal. Dtsch Med Wochenschr 137:437–441

    Article  CAS  PubMed  Google Scholar 

  21. Stratmann B, Tschoepe D (2011) Heart in diabetes: not only a macrovascular disease. Diabetes Care 34(Suppl 2):S138–S144

    Article  PubMed Central  PubMed  Google Scholar 

  22. Iribarren C, Karter AJ, Go AS et al (2001) Glycemic control and heart failure among adult patients with diabetes. Circulation 103:2668–2673

    Article  CAS  PubMed  Google Scholar 

  23. Stratton IM, Adler AI, Neil HA et al (2000) Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ 321:405–412

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  24. Gustafsson I, Brendorp B, Seibaek M et al (2004) Influence of diabetes and diabetes-gender interaction on the risk of death in patients hospitalized with congestive heart failure. J Am Coll Cardiol 43:771–777

  25. Widya RL, Meer RW van der, Smit JW et al (2013) Right ventricular involvement in diabetic cardiomyopathy. Diabetes Care 36:457–462

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  26. Huxley RR, Filion KB, Konety S, Alonso A (2011) Meta-analysis of cohort and case-control studies of type 2 diabetes mellitus and risk of atrial fibrillation. Am J Cardiol 108:56–62

    Article  PubMed Central  PubMed  Google Scholar 

  27. Du X, Ninomiya T, Galan B de et al (2009) Risks of cardiovascular events and effects of routine blood pressure lowering among patients with type 2 diabetes and atrial fibrillation: results of the ADVANCE study. Eur Heart J 30:1128–1135

    Article  Google Scholar 

  28. Huxley RR, Alonso A, Lopez FL et al (2012) Type 2 diabetes, glucose homeostasis and incident atrial fibrillation: the Atherosclerosis Risk in Communities study. Heart 98:133–138

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  29. 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). Europace 12:1360–1420

    Article  PubMed  Google Scholar 

  30. Hanefeld M, Bramlage P (2013) Insulin use early in the course of type 2 diabetes mellitus: the ORIGIN trial. Curr Diab Rep 13:342–349

    Article  CAS  PubMed Central  PubMed  Google Scholar 

Download references

Einhaltung ethischer Richtlinien

Interessenkonflikt. B. Stratmann und D. Tschoepe geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

Author information

Authors and Affiliations

  1. Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Deutschland

    B. Stratmann &  D. Tschoepe

Authors
  1. B. Stratmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. D. Tschoepe
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to D. Tschoepe.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Stratmann, B., Tschoepe, D. Diabetes, Prädiabetes und kardiovaskuläres Risiko. Internist 56, 653–663 (2015). https://doi.org/10.1007/s00108-015-3681-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00108-015-3681-4

Schlüsselwörter

Keywords

Search

Navigation