Zusammenfassung
Bei Patienten mit einem Diabetes mellitus Typ 2 bestimmen kardiovaskuläre Komplikationen maßgeblich die Morbidität und Mortalität. In der Vergangenheit haben große klinische Studien zum Einfluss einer blutzuckersenkenden Therapie auf kardiovaskuläre Erkrankungen ein widersprüchliches Bild ergeben. Im Jahr 2008 haben die Zulassungsbehörden die Vorgaben für den Beleg der kardiovaskulären Sicherheit neuer antidiabetischer Substanzen geändert. Seitdem wurden zahlreiche kardiovaskuläre Endpunktstudien zum Beleg der Sicherheit neuer Substanzen initiiert. Erste Daten aus diesen Sicherheitsstudien liegen jetzt vor; die Ergebnisse sind vielversprechend. Während für die Behandlung mit Dipeptidylpeptidase-4(DPP-4)-Hemmern und dem kurz wirksamen Glucagon-like-peptide-1(GLP-1)-Rezeptor-Agonisten Lixisenatid die kardiovaskuläre Sicherheit belegt werden konnte, wurden für den Sodium-glucose-transporter-2(SGLT-2)-Hemmer Empagliflozin und den lang wirksamen GLP-1-Rezeptor-Agonisten Liraglutid sogar signifikante kardiovaskuläre Vorteile gezeigt. Die kardiovaskulären Vorteile dieser Substanzen werden neue Therapiestrategien zur Behandlung des Diabetes mellitus Typ 2 nach sich ziehen.
Abstract
Cardiovascular disease significantly determines morbidity and mortality in patients with diabetes mellitus type 2. Large clinical trials in the past left controversial evidence about the effect of blood glucose-lowering treatments on cardiovascular outcomes. In 2008, the regulatory authorities defined new requirements on cardiovascular safety data for the approval of new drugs for the treatment of type 2 diabetes mellitus. Since then, numerous large safety studies have been initiated to prove cardiovascular noninferiority of new antidiabetic drugs. Preliminary data from these safety studies have become available and provided promising results. While treatment with DPP-4 inhibitors and the short acting GLP-1 receptor agonist lixisenatide were shown to be safe, treatment with the SGLT-2 inhibitor empagliflozin and the long-acting GLP-1 receptor agonist liraglutide even significantly improved cardiovascular outcomes in patients with type 2 diabetes mellitus. With the evidence of cardiovascular benefits of the new drugs, new treatment strategies for patients with diabetes mellitus type 2 are expected.
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T. Forst ist als Berater für AstraZeneca, Ely Lilly, BMS, Sanofi und Boehringer Ingelheim tätig. Er hat Vortragshonorare von AstraZeneca, Eli Lilly, Novo Nordisk, Sanofi, BMS, Berlin Chemie, Novartis und Boehringer Ingelheim erhalten. M.M. Weber ist als Berater für Novo Nordisk, Eli Lilly und Boehringer Ingelheim tätig und hat Vortragshonorare von Boehringer Ingelheim und MSD Sharp & Dohme GmbH erhalten. L. Plum-Mörschel gibt an, dass kein Interessenkonflikt besteht.
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Forst, T., Plum-Mörschel, L. & Weber, M.M. Kardiovaskuläre Aspekte der Diabetestherapie. Internist 58, 293–302 (2017). https://doi.org/10.1007/s00108-017-0189-0
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DOI: https://doi.org/10.1007/s00108-017-0189-0