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Makroangiopathie bei Diabetes mellitus

Risikostratifizierung und (Sekundär-)Prävention

Peripheral arterial disease (PAD) in diabetes Risk stratification and (secondary) prevention

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Clinical Research in Cardiology Supplements Aims and scope

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Zusammenfassung

Diabetiker entwickeln häufiger, früher und zumeist schwerer eine oft generalisierte Atherosklerose/Atherothrombose als Nichtdiabetiker. Die periphere Makroangiopathie (PAVK) bei Diabetes mellitus hat sich dabei als Indikator für ein hohes Risiko für Herz- und Hirninfarkt und somit erhöhte Morbidität und Mortalität erwiesen, das Screening auf PAVK mit dem Knöchel-Arm-Index (ABI) zur Risikostratifizierung bewährt. Patienten mit peripherer Makroangiopathie sollten so umfassend wie KHK- oder Schlaganfallpatienten behandelt werden. Neben der spezifischen Therapie des „metabolisch-vaskulären Syndroms“ gehört zum Risikomanagement immer eine medikamentöse (Sekundär-)Prävention mit Thrombozytenfunktionshemmern (TFH), bei niedrigem Risiko mit ASS. Clopidogrel wird als Dauergabe bei symptomatischer PAVK und bei Patienten mit hohem Risiko für Schlaganfall und gleichzeitiger asymptomatischer PAVK empfohlen sowie in Kombination mit ASS über mindestens (9–)12 Monate nach ACS sowie PCI.

Abstract

Diabetics are more likely to develop earlier and usually heavier, frequently generalized atherosclerosis/atherothrombosis as non-diabetics. The peripheral arterial disease (PAD) in diabetes mellitus has proved to be an indicator of high risk for myocardial infarction, stroke and vascular death and thus increased morbidity and mortality. The screening for PAD with the anklebrachial index (ABI) was shown to be reliable for risk stratification. Thus, patients with peripheral arterial disease should be treated as cardiovascular or stroke patients. In addition to an intensive therapy of metabolic vascular syndrome, risk management should be accompanied by medical (secondary) prevention with thrombocyte inhibitors – at low risk acetylic salicylic acid (ASA) is mainly used. Clopidogrel is indicated in secondary prevention of PAD, of stroke in the presence of PAD, and for the first 9(–12) months after ACS and PCI in combination with ASA.

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  1. Leiter der Abt. Angiologie, Praxisklinik Herz und Gefäße, Akad. Lehrpraxisklinik der TU Dresden, Forststraße 3, 01099, Dresden, Germany

    R. Sternitzky

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Correspondence to R. Sternitzky.

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Sternitzky, R. Makroangiopathie bei Diabetes mellitus. Clin Res Cardiol Suppl 3, 29–34 (2008). https://doi.org/10.1007/s11789-008-0046-8

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  • DOI: https://doi.org/10.1007/s11789-008-0046-8

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