Summary
Peripheral arterial disease (PAD) is an under-recognized and underestimated complication of diabetes. Prevalence of PAD in diabetic patients is 25–30%. The main reason for underreporting is the largely asymptomatic nature of PAD in diabetes. It is important to diagnose PAD as soon as possible because PAD is an important marker for systemic atherosclerosis. Patients with claudication have approximately a 30% five-year mortality rate. PAD patients die 10 years earlier than patients without this atherothrombotic disease. About 70% of the PAD patients die from coronary heart disease, 5–11% die from stroke. PAD and diabetes are comorbid conditions and are associated with the risk of death from coronary artery bypass graft surgery. The prevalence of diabetes in patients who undergo cardiac surgery is 30% and the prevalence of PAD is 18%. The presence of PAD in diabetic patients had a similar 2-fold increase in the annual incidence of death compared with diabetic patients without PAD. The theory that diabetes and PAD together is associated with small vessel disease may play a role in the cause of the higher long-term mortality seen in at least two studies (Circulation 2004; suppl II: II/41–II/44).
Zusammenfassung
Die periphere arterielle Verschlusskrankheit (PAD) ist eine zu wenig erkannte und unterschätzte Komplikation der Diabetes. Die Prävalenz bei Diabetespatienten beträgt zwischen 25–30%. Hauptursache für das Underreporting ist der überwiegend symptomfreie Charakter der PAD bei Diabetes. Es ist wichtig, PAD so früh wie möglich zu diagnostizieren, denn PAD ist ein wichtiger Marker für systemische Atherosklerose. Patienten mit Klaudikation haben eine ca. 30%ige 5-Jahres-Mortalitätsrate. PAD-Patienten versterben 10 Jahre früher als Patienten ohne diese arterielle Verschlusskrankheit. Etwa 70% der PAD-Patienten sterben an koronarer Herzerkrankung, 5–11% sterben an einem Schlaganfall. PAD und Diabetes sind als komorbide Erkrankung zu sehen und stehen mit dem Sterblichkeitsrisiko bei Koronararterien-Bypasstransplantations-Operationen in Zusammenhang. Die Prävalenz von Diabetes bei Patienten, die sich herzchirurgischen Eingriffen unterziehen, ist 30% und die von PAD 18%. Bei Diabetespatienten bewirkte das Vorhandensein von PAD eine zweifach erhöhte Todesfallzahl gegenüber den Diabetespatienten ohne PAD. Die Theorie, dass Diabetes und PAD gemeinsam mit Mikroangiopathie in Zusammenhang stehen, spielt möglicherweise eine Rolle für die Ursache der höheren langfristigen Mortalität, wie es zumindest in 2 Studien gesehen werden konnte (Circulation 2004).
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Diehm, C., Lawall, H. Diabetes, Herzchirurgie und periphere Gefäße. Clin Res Cardiol 95 (Suppl 1), i63–i69 (2006). https://doi.org/10.1007/s00392-006-1123-y
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DOI: https://doi.org/10.1007/s00392-006-1123-y