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Diabetische Kardiopathie

Pathomechanismen, Diagnostik und Therapie

  • Schwerpunkt: Endorganschäden
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Zusammenfassung

Der Diabetes mellitus gehört zu den weitverbreitetsten Stoffwechselerkrankungen in den westlichen Industrienationen. Die Prävalenz steigt weiter aufgrund einer stetig älter werdenden Bevölkerungsstruktur, die auch durch eine Zunahme der Adipositasrate und durch einen bewegungsarmen Lebensstil charakterisiert ist. Dabei stellen die kardiovaskulären Erkrankungen die prognostisch wesentlichen Komplikationen des Diabetikers dar. Von kardiologischer Seite kann sich eine diabetische Kardiopathie auf unterschiedlichen funktionellen und strukturellen Ebenen des Herzens manifestieren. Dabei sind Störungen der Mikro- und Makrozirkulation (Angiopathie), der Ventrikelfunktion (Kardiomyopathie) und des intrakardialen Nervensystems (autonome Neuropathie) zu unterscheiden.

In der folgenden Übersichtsarbeit fassen wir vor allem das kardiovaskuläre Risiko mit besonderem Augenmerk auf die Pathogenese, Diagnostik und Therapie der diabetes-mellitus-bedingten koronaren Herzerkrankung und der diabetischen Kardiomyopathie zusammen.

Abstract

Diabetes mellitus is one of the most widespread metabolic diseases in Western industrial countries with increasing prevalence due to a progressively aging population that is also characterized by increasing obesity and a sedentary life style. Cardiovascular conditions are the major prognostic complications of diabetes. Cardiologically, diabetic cardiopathy may become manifest on different structural and functional levels of the heart. Disorders may involve the micro- and macrocirculation (angiopathy), ventricular function (cardiomyopathy) and the intracardial nervous system (autonomous neuropathy).

The following survey summarizes the cardiovascular risk with particular attention to the pathogenesis, diagnostics and therapy of diabetes mellitus related coronary disease and diabetic cardiomyopathy.

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Literatur

  1. Grundy SM, Howard B, Smith S Jr, Eckel R, Redberg R, Bonow RO (2002) Prevention Conference VI: Diabetes and cardiovascular disease: executive summary: conference proceeding for healthcare professionals from a special writing group of the American Heart Association. Circulation 105: 2231–2239

    Google Scholar 

  2. Kannel WB, Hjortland M, Castelli WP (1974) Role of diabetes in congestive heart failure: the Framingham study. Am J Cardiol 34: 29–34

    Google Scholar 

  3. Stamler J, Vaccaro O, Neaton JD, Wentworth D (1993) Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in the Multiple Risk Factor Intervention Trial. Diabetes Care 16: 434–44

    Google Scholar 

  4. Rösen P (2002) Endotheliale Dysfunktion: ein Synonym für funktionelle Atherosklerose. J Kardiol 9: 556–562

    Google Scholar 

  5. Rösen P, Ferber P, Tschöpe D (2001) Macrovascular disease in diabetes: current status. Exp Clin Endocrinol Diabetes 109 (Suppl 2): S474–486

    Google Scholar 

  6. Gohlke H, Kubler W, Mathes P, Meinertz T, Schuler G, Gysan DB, Sauer G (2002) German Society of Cardiology-Heart- and Vascular Research Recommendations for comprehensive risk reduction for patients with coronary heart disease, vascular diseases and diabetes. Distributed by the leadership of the German Society of Cardiology-Heart- and Vascular Research. Produced by request of the Committee of Clinical Cardiology by the Prevention Project Group. Z Kardiol 91 (Suppl 2): 61–62

  7. Fisher M (2003) Prevention of marovascular complications. Eur Heart J 5 (Suppl B): 21–26

  8. UK Prospective Diabetes Study (UKPDS) Group (1998) Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). Lancet 352: 854–865

    Google Scholar 

  9. Diabetes Atherosclerosis Intervention Study Investigators (2001) Effect of fenofibrate on progression of coronary-artery disease in type 2 diabetes: the Diabetes Atherosclerosis Intervention Study, a randomised study. Lancet 357: 905–910

    Google Scholar 

  10. Khaw KT, Wareham N, Luben R, Bingham S, Oakes S, Welch A, Day N (2001) Glycated haemoglobin, diabetes, and mortality in men in Norfolk cohort of European prospective investigation of cancer and nutrition (EPIC-Norfolk). BMJ 322: 15–18

    Google Scholar 

  11. Malmberg K (1997) Prospective randomised study of intensive insulin treatment on long term survival after acute myocardial infarction in patients with diabetes mellitus. DIGAMI (Diabetes Mellitus, Insulin Glucose Infusion in Acute Myocardial Infarction) Study Group. BMJ 314: 1512–1515

    Google Scholar 

  12. Diaz R, Paolasso EA, Piegas LS et al. (1998) Metabolic modulation of acute myocardial infarction. The ECLA (Estudios Cardiologicos Latinoamerica) Collaborative Group. Circulation 98: 2227–2234

    Google Scholar 

  13. Stein B, Weintraub WS, Gebhart SP et al. (1995) Influence of diabetes mellitus on early and late outcome after percutaneous transluminal coronary angioplasty. Circulation 91: 979–989

    Google Scholar 

  14. Van Belle E, Bauters C, Hubert E et al. (1997) Restenosis rates in diabetic patients: a comparison of coronary stenting and balloon angioplasty in native coronary vessels. Circulation 96: 1454–1460

    Google Scholar 

  15. Tschöpe D, Driesch E, Schwippert B, Lampeter EF (1997). Activated platelets in subjects at increased risk of IDDM. DENIS Study Group. Deutsche Nikotinamid Interventionsstudie. Diabetologia 40: 573–577

    Google Scholar 

  16. Meier-Ewert HK, Nesto RW (2002) Targeting the use of glycoprotein IIb/IIIa antagonists—the diabetic patient. Rev Cardiovasc Med 3 (Suppl 1): 20–27

    Google Scholar 

  17. Regar E, Serruys PW, Bode C et al., RAVEL Study Group (2002) Angiographic findings of the multicenter Randomized Study With the Sirolimus-Eluting Bx Velocity Balloon-Expandable Stent (RAVEL): sirolimus-eluting stents inhibit restenosis irrespective of the vessel size. Circulation 106: 1949–1956

    Google Scholar 

  18. Corr LA, Stables R (2003) Managing heart disease. Coronary revascularization: knife or catheter. Eur Heart J 5 (Suppl B): 43–48

  19. Zarich SW, Nesto RW (1989) Diabetic cardiomyopathy. Am Heart J 118: 1000–1012

    Google Scholar 

  20. Grossman E, Messereli FH (1996) Diabetic and hypertensive heart disease. Ann Intern Med 125: 304–310

    Google Scholar 

  21. Ferrara R, Guardigli, Ferrari R (2003) Undestanding patient needs myocardial metabolism: the diabetic heart. Eur Heart J 5 (Suppl B): 15–18

  22. Williamson JR, Chang K, Frangos M et al. (1993) Hyperglycemic pseudohypoxia and diabetic complications. Diabetes 42: 801–813

    Google Scholar 

  23. Watschinger B, Brunner C, Wagner A, Schnack C, Prager R, Weissel M, Burghuber OC (1993) Left ventricular diastolic impairment in type 1 diabetic patients with microalbuminuria. Nephron 63: 145–151

    Google Scholar 

  24. Poirier P, Garneau C, Bogaty P et al. (2000) Impact of left ventricular diastolic dysfunction on maximal treadmill performance in normotensive subjects with well-controlled type 2 diabetes mellitus. Am J Cardiol 85: 473–477

    Google Scholar 

  25. Schannwell CM, Schneppenheim M, Perings S, Plehn G, Strauer BE (2002) Left ventricular diastolic dysfunction as an early manifestation of diabetic cardiomyopathy. Cardiology 98: 33–39

    Google Scholar 

  26. Fischer M, Baessler A, Hense HW et al. (2003) Prevalence of left ventricular diastolic dysfunction in the community. Results from a Doppler echocardiographic-based survey of a population sample. Eur Heart J 24: 320–328

    Google Scholar 

  27. Romanens M, Fankhauser S, Saner B, Michaud L, Saner H (1999) No evidence for systolic or diastolic left ventricular dysfunction at rest in selected patients with long-term type I diabetes mellitus. Eur J Heart Fail 1: 169–175

    Google Scholar 

  28. Airaksinen KE, Koistinen MJ, Ikaheimo MJ et al. (1989) Augmentation of atrial contribution to left ventricular filling in IDDM subjects as assessed by Doppler echocardiography. Diabetes Care 12: 159–161

    Google Scholar 

  29. Paillole C, Dahan M, Paycha F, Solal AC, Passa P, Gourgon R (1989) Prevalence and significance of left ventricular filling abnormalities determined by Doppler echocardiography in young type I (insulin-dependent) diabetic patients. Am J Cardiol 64: 1010–1016

    Google Scholar 

  30. Zile MR, Brutsert DL (2002) New concepts in diastolic dysfunction and diastolic heart failure: Part I: diagnosis, prognosis, and measurements of diastolic function. Circulation 19: 1387–1393

    Google Scholar 

  31. Zile MR, Brutsaert DL (2002). New concepts in diastolic dysfunction and diastolic heart failure: Part II: causal mechanisms and treatment. Circulation 105: 1503–1508

    Google Scholar 

  32. Paulus WJ (2000) Beneficial effects of nitric oxide on cardiac diastolic function: "the flip side of the coin". Heart Fail Rev 5: 337–344

    Google Scholar 

  33. Abe T, Ohga Y, Tabayashi N et al. (2002) Left ventricular diastolic dysfunction in type 2 diabetes mellitus model rats. Am J Physiol Heart 282: H138–148

    Google Scholar 

  34. Willenheimer RB, Erhardt LR, Nilsson H, Lilja B, Juul-Moller S, Sundkvist G (1998) Parasympathetic neuropathy associated with left ventricular diastolic dysfunction in patients with insulin-dependent diabetes mellitus. Scand Cardiovasc J 32: 17–22

    Google Scholar 

  35. Mizushige K, Yao L, Noma T et al. (2000) Alteration in left ventricular diastolic filling and accumulation of myocardial collagen at insulin-resistant prediabetic stage of a type II diabetic rat model. Circulation 29: 899–907

    Google Scholar 

  36. Brilla CG, Rupp H, Funck R, Maisch B (1995) The renin-angiotensin-aldosterone system and myocardial collagen matrix remodelling in congestive heart failure. Eur Heart J 16 (Suppl O): 107–109

  37. Tschöpe C, Schultheiss HP (2002) Diastolische Dysfunktion. Was diagnostisch nötig und therapeutisch möglich ist. Cardiovasc 2: 35–39

    Google Scholar 

  38. Krum H, Gilbert R (2001) Management of the heart failure patient with diabetes. Medicographio 32: 129–134

    Google Scholar 

  39. Heart Outcomes Prevention Evaluation Study Investigators (2000) Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE substudy. Lancet 355: 253–259

    Google Scholar 

  40. Packer M, Poole-Wilson PA et al. (1999) Comparative effects of low and high doses of the angiotensin-converting enzyme inhibitor, lisinopril, on morbidity and mortality in chronic heart failure. ATLAS Study Group. Circulation 100: 212–238

    Google Scholar 

  41. Mogensen CE, Neldam S, Tikkanen I, Oren S, Viskoper R, Watts RW, Cooper ME (2000) Randomised controlled trial of dual blockade of renin-angiotensin system in patients with hypertension, microalbuminuria, and non-insulin dependent diabetes: the candesartan and lisinopril microalbuminuria (CALM) study. BMJ 321: 1440–1444

    Google Scholar 

  42. Pitt B, Zannad F, Remme WJ et al. (1999) The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators. N Engl J Med 34: 709–717

    Google Scholar 

  43. Cosin J, Diez J (2002) Torasemide in chronic heart failure: results of the TORIC study. Eur J Heart Fail 4: 507–513

    Google Scholar 

  44. The Digitalis Investigation Group (1997) The effect of digoxin on mortality and morbidity in patients with heart failure. N Engl J Med. 336: 525–533

    Google Scholar 

  45. Rathore SS, Wang Y, Krumholz HM (2002) Sex-based differences in the effect of digoxin for the treatment of heart failure. N Engl J Med 347: 1403–1411

    Google Scholar 

  46. UK Prospective Diabetes Study (UKPDS) Group (1998) Intensive blood-glucose control with sulphonylurease or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 352: 837–853

    Google Scholar 

  47. Gilbert RE, Cooper ME, Krum H (1998) Drug administration in patients with diabetes mellitus. Safety considerations. Drug Saf 18: 441–455

    Google Scholar 

  48. He Z, Rask-Madsenn C, King GL (2003) Managing heart disease. Mechansims of cardiovascular complications in diabetes and potential new pharmacological therapies. Eur Heart J 5 (Suppl B): 51–57

  49. Lonn E, Yusuf S, Hoogwerf B et al. (2002) Effects of vitamin E on cardiovascular and microvascular outcomes in high-risk patients with diabetes: results of the HOPE study and MICRO-HOPE substudy. Diabetes Care 25: 1919–1927

    Google Scholar 

  50. Tsuji T, Mizushige K, Noma T, Murakami K, Ohmori K, Miyatake A, Kohno M (2001) Pioglitazone improves left ventricular diastolic function and decreases collagen accumulation in prediabetic stage of a type II diabetic rat. J Cardiovasc Pharmacol 38: 868–874

    Google Scholar 

  51. Stitt A, Gardiner TA, Alderson NL et al. (2002) The AGE inhibitor pyridoxamine inhibits development of retinopathy in experimental diabetes. Diabetes 51: 2826–2832

    Google Scholar 

  52. Doggrell SA (2001) ALT-711 decreases cardiovascular stiffness and has potential in diabetes, hypertension and heart failure. Exp Opin Invest Drugs 10: 981–983

    Google Scholar 

  53. Kuwahara F, Kai H, Tokuda K, Kai M, Takeshita A, Egashira K, Imaizumi T (2002) Transforming growth factor-beta function blocking prevents myocardial fibrosis and diastolic dysfunction in pressure-overloaded rats. Circulation 106: 130–135

    Google Scholar 

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Authors and Affiliations

  1. Abteilung für Kardiologie und Pulmologie, Medizinische Klinik II, Universitätsklinikum Benjamin Franklin, Freie Universität Berlin

    C. Tschöpe & H. P. Schultheiss

  2. Abteilung für Kardiologie und Pulmologie, Medizinische Klinik II, Universitätsklinikum Benjamin Franklin Freie Universität, Berlin, Hindenburgdamm 30, 12200, Berlin

    C. Tschöpe

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  2. H. P. Schultheiss
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Correspondence to C. Tschöpe.

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Tschöpe, C., Schultheiss, H.P. Diabetische Kardiopathie. Internist 44, 806–818 (2003). https://doi.org/10.1007/s00108-003-0947-z

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