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Stratifizierung des kardiovaskulären Risikos bei Patienten mit Typ-2-Diabetes

Cardiovascular risk stratification in patients with type 2 diabetes

  • Leitthema
  • Published:
Der Diabetologe Aims and scope

Zusammenfassung

Hintergrund

In den letzten Jahren wurden zahlreiche Prognosemodelle zur Bewertung des kardiovaskulären Risikos bei Patienten mit Typ-2-Diabetes entwickelt. Dabei besteht ein hoher Bedarf für die Etablierung zuverlässiger Risiko-Scores.

Material und Methode

Der vorliegende Übersichtsbeitrag fasst die wichtigsten publizierten Studien zur Stratifizierung des kardiovaskulären Risikos bei Patienten mit Typ-2-Diabetes zusammen. Es werden populationsbasierte und spezifische Prognosemodelle für den Typ-2-Diabetes beschrieben und deren prädiktive Güte anhand von Diskriminierungs- und Kalibrierungswerten miteinander verglichen.

Ergebnisse

Die vorgestellten diabetesspezifischen Prognosemodelle weisen insgesamt eine etwas höhere prognostische Güte als die populationsbasierten Modelle auf und erscheinen daher für die klinische Praxis besser geeignet. Bisher wurden nur die Modelle UKPDS, DCS und ADVANCE in externen Studienkohorten validiert, wobei die prognostische Güte für diese 3 Risiko-Scores in den externen Kohorten als moderat zu bezeichnen ist. Zu berücksichtigen ist dabei, dass Diskriminierungsfähigkeit und Kalibrierung in den externen Kohorten von den untersuchten Populationen und ethnischen Gruppen abhängen.

Abstract

Background

In recent years, many forecast models for the assessment of cardiovascular risk in patients with type 2 diabetes have been developed. Thus, there is great need for the establishment of reliable risk scores.

Materials and methods

This review summarizes the most important studies published on cardiovascular risk stratification in patients with type 2 diabetes. General, population-based, and diabetes-specific risk scores for type 2 diabetes are described and their predictive validity compared using discrimination and calibration values.

Results

The diabetes-specific risk stratification models presented have an overall slightly higher prognostic accuracy than population-based models and therefore appear more suitable for clinical practice. So far only the models UKPDS, DCS, and ADVANCE have been validated in external study cohorts, whereby the prognostic accuracy for these three risk scores in the external cohorts must be described as moderate. However, it must be taken into account that the discrimination and calibration in external cohorts is dependent on the populations and ethnic groups investigated.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. V. H. Schmitt, C. Jünger und T. Münzel geben an, dass kein Interessenkonflikt besteht. V. Grossmann und P. S. Wild werden vom Bundesministerium für Bildung und Forschung finanziert (BMBF 01EO1003). P.S. Wild erhielt Forschungsförderung von Boehringer Ingelheim, PHILIPS Medical Systems, Sanofi-Aventis, Bayer Vital, Daiichi Sankyo Europa, IMO Institut, Portavita B. V., der Bundesanstalt für Arbeitsschutz und Arbeitsmedizin (BAuA), der Initiative Gesundheitswirtschaft und Demografie Rheinland-Pfalz (MSAGD) sowie der Stiftung Mainzer Herz. P. S. Wild erhielt außerdem Honorare für Vorträge bei Beratungstätigkeiten für Boehringer Ingelheim sowie dem Masterstudiengang Public Health der Heinrich-Heine-Universität Düsseldorf. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Centrum für Thrombose und Hämostase, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Deutschland

    V. Grossmann, T. Münzel &  P.S. Wild M.Sc.

  2. 2. Medizinische Klinik, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Deutschland

    V.H. Schmitt & T. Münzel

  3. Präventive Kardiologie und Präventive Medizin, 2. Medizinische Klinik, Klinische Epidemiologie, Centrum für Thrombose und Hämostase, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland

    V.H. Schmitt, C. Jünger &  P.S. Wild M.Sc.

  4. Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Standort Rhein-Main, Mainz, Deutschland

    T. Münzel &  P.S. Wild M.Sc.

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  1. V. Grossmann
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Correspondence to P.S. Wild M.Sc..

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V. Grossmann und V. H. Schmitt waren gleichermaßen an der Erstellung dieses Beitrags beteiligt.

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Grossmann, V., Schmitt, V., Jünger, C. et al. Stratifizierung des kardiovaskulären Risikos bei Patienten mit Typ-2-Diabetes. Diabetologe 10, 572–580 (2014). https://doi.org/10.1007/s11428-014-1213-9

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  • DOI: https://doi.org/10.1007/s11428-014-1213-9

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