Abstract
Zusammenfassung. Menschen mit Diabetes haben ein erhöhtes kardiovaskuläres Risiko. Neben der Optimierung der Glykämie steht die Diagnose und Kontrolle kardiovaskulärer Risikofaktoren im Vordergrund. Die Therapiemöglichkeiten umfassen die Anpassung des Lebensstils, die individualisierte medikamentöse Therapie sowie die leitliniengerechte Behandlung kardiovaskulärer Begleit- oder Folgeerkrankungen, die häufiger bei Menschen mit Diabetes auftreten. Sie umfassen Herzinsuffizienz und Vorhofflimmern genauso wie die koronare Herzkrankheit und den plötzlichen Herztod. Durch die korrekte Wahl antidiabetischer Medikamente und gerätetechnischer Interventionen können kardiovaskuläre Risikofaktoren kontrolliert, das kardiovaskuläre Risiko gesenkt und Begleit- bzw. Folgeerkrankungen zielgerichtet behandelt werden. Der vorliegende Review soll als Orientierung zur Diagnose, Behandlung und Wahl der Therapie bei Menschen mit Diabetes Typ 2 ohne und mit kardiovaskulären Begleit- oder Folgeerkrankungen dienen.
Abstract. Diabetes is associated with an increased cardiovascular risk. In addition to optimizing glycemia, timely diagnosis and stringent control of cardiovascular risk factors is essential for individuals with diabetes. Therapeutic options include lifestyle-optimization, individualized drug therapy and targeted treatment of concomitant or secondary cardiovascular disease. Cardiovascular disease occurs more often in individuals with diabetes and includes heart failure, atrial fibrillation, coronary heart disease and sudden cardiac death. The correct choice of antidiabetic drugs and interventions can control cardiovascular risk factors, reduce cardiovascular risk and treat concomitant or secondary diseases in a targeted manner. This review is intended to provide guidance on diagnosis, treatment and choice of therapy for individuals with type 2 diabetes without and with concomitant or secondary cardiovascular disease.
Résumé. Le diabète augmente le risque cardiovasculaire. Le contrôle de la glycémie est aussi important que le diagnostic et le contrôle des autres facteurs de risque cardiovasculaire. La thérapie comprend l’adaptation du mode de vie, l’administration individuelle de médicaments et le traitement des maladies cardiovasculaires concomitantes ou secondaires. Il s’agit notamment de l’insuffisance cardiaque, de la fibrillation auriculaire, des maladies coronariennes et de la mort cardiaque subite. Le bon choix des médicaments et des interventions antidiabétiques permet de traiter les facteurs de risque cardiovasculaire, de réduire le risque cardiovasculaire et de traiter les maladies secondaires. Cette revue résume le diagnostic, le traitement et la thérapie des personnes atteintes de diabète de type 2 avec et sans maladie cardiovasculaire concomitante.
Bibliografie
American Diabetes Association . 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes – 2020. Diabetes Care. 2020;43:S14–S31.American Diabetes Association . Disclosures: Standards of Medical Care in Diabetes – 2020. Diabetes Care. 2020;43:S205–S206.. Glycated hemoglobin A(1c) as screening for diabetes mellitus in HIV-infected individuals. AIDS patient care STDS. 2012;26:197–201.
. Association between iron deficiency and A1C Levels among adults without diabetes in the National Health and Nutrition Examination Survey, 1999–2006. Diabetes Care. 2010;33:780–785.
, Prevalence of diabetes and high risk for diabetes using A1C criteria in the U.S. population in 1988–2006. Diabetes Care. 2010;33:562–568.
, A large proportion of prediabetes and diabetes goes undiagnosed when only fasting plasma glucose and/or HbA1c are measured in overweight or obese patients. Diabetes Metab. 2010;36:312–328.
, Not performing an OGTT results in significant underdiagnosis of (pre)diabetes in a high risk adult Caucasian population. Int J Obes (Lond). 2017;41: 1615–1620.
. Impaired glucose tolerance, but not impaired fasting glucose, is associated with increased levels of coronary heart disease risk factors: results from the Baltimore Longitudinal Study on Aging. Diabetes. 2004;53:2095–2100.
,, Mortality and cardiovascular disease in type 1 and type 2 diabetes. N Engl J Med. 2017;376:1407–1418.
, Sex differences in diabetes and risk of incident coronary artery disease in healthy young and middle-aged adults. Diabetes Care. 2014;37(3):830–838.
. Gender differences in coronary heart disease. Neth Heart J. 2010;18(12): 598–602.
. Gender bias in the clinical management of women with angina: another look at the Yentl syndrome. J Womens Health (Larchmt). 2008;17(3):331–342.
, Screening for dysglycaemia in patients with coronary artery disease as reflected by fasting glucose, oral glucose tolerance test, and HbA1c: a report from EUROASPIRE IV – a survey from the European Society of Cardiology. Eur Heart J. 2015;36(19):1171–1177.
American Diabetes Association . 4. Comprehensive medical evaluation and assessment of comorbidities: standards of medical care in diabetes – 2020. Diabetes Care. 2020;43:S37–S47.Diabetes Canada Clinical Practice Guidelines Expert Committee , , Screening for the presence of cardiovascular disease. Can J Diabetes. 2018;42 Suppl 1:S170–S177.. Silent myocardial ischemia. Circulation. 203;108:1263–1277.
. Screening for coronary artery disease in patients with diabetes. Diabetes Care. 2007;30(10):2729–2736.
, Risk factors, mortality, and cardiovascular outcomes in patients with type 2 diabetes. N Engl J Med. 2018;379:633–644.
, 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J. 2020;41(2): 255–323.
. Effect of intensive versus standard blood glucose control in patients with type 2 diabetes mellitus in different regions of the world: systematic review and meta-analysis of randomized controlled trials. J Am Heart Assoc. 2015;4(5):e001577.
American Diabetes Association . 6. Glycemic targets: standards of medical care in diabetes – 2020. Diabetes Care. 2020;43:S66–S76.Schweizerische Gesellschaft für Endokrinologie und Diabetologie (SGED/SSED) . Empfehlungen der Schweizerischen Gesellschaft für Endokrinologie und Diabetologie (SGED/SSED) für die Behandlung von Diabetes mellitus Typ 2. 2020. https://www.sgedssed.ch/fileadmin/user_upload/6_Diabetologie/61_Empfehlungen_Facharzt/2020_Swiss_Recomm_Medis_DE_def.pdf; letzter Zugriff: 24.08.2020.. Comparison of the Atkins, Ornish, Weight Watchers, and Zone diets for weight loss and heart disease risk reduction: a randomized trial. JAMA. 2005;293:43–53.
, Association of the magnitude of weight loss and changes in physical fitness with long-term cardiovascular disease outcomes in overweight or obese people with type 2 diabetes: a post-hoc analysis of the Look AHEAD randomised clinical trial. Lancet Diabetes Endocrino. 2016;4(11):913–921.
, Effect of lifestyle intervention in patients with type 2 diabetes: a meta-analysis. Metabolism. 2015;64(2):338–347.
, Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;352:837–853.
. Impact of metformin on cardiovascular disease: a meta-analysis of randomised trials among people with type 2 diabetes. Diabetologia. 2017;60:1620–1629.
, Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med. 2015;373(22):2117–2128.
, Canagliflozin and cardiovascular and renal events in type 2 diabetes. N Engl J Med. 2017;377:644–657.
, Dapagliflozin and cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2019; 380(4):347–357.
, Liraglutide and cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2016;375(4):311–322.
, Semaglutide and cardiovascular outcomes in patients with type 2 diabetes. N Engl J Med. 2016;375:1834–1844.
, Dulaglutide and cardiovascular outcomes in type 2 diabetes (REWIND): a double-blind, randomised placebo-controlled trial. Lancet. 2019;394(10193):121–130.
, Effect of linagliptin vs glimepiride on major adverse cardiovascular outcomes in patients with type 2 diabetes: The CAROLINA Randomized Clinical Trial. JAMA. 2019;322(12):1155–1166.
. Cardiovascular safety of sulfonylureas: a meta-analysis of randomized clinical trials.Diabetes Obes Metab. 2013;15(10):938–953.
. Risk of major cardiovascular events, severe hypoglycaemia, and all-cause mortality for users of insulin degludec versus insulin glargine U100-A Danish cohort study. Diabetes Metab Res Rev. 2020;36(1): e3225.
. Empagliflozin and progression of kidney disease in type 2 diabetes. N Engl J Med. 2016; 375(18):1801–1802.
, Canagliflozin and renal outcomes in type 2 diabetes and nephropathy. N Engl J Med. 2019;380(24):2295–2306.
, Liraglutide and renal outcomes in type 2 diabetes. N Engl J Med. 2017;377(9): 839–848.
, Dapagliflozin in patients with heart failure and reduced ejection fraction. N Engl J Med. 2019;381:1995–2008.
. Sulfonylurea use and incident cardiovascular disease among patients with type 2 diabetes: prospective cohort study among women. Diabetes Care. 2014;37:3106–3113.
. Insulin-treated diabetes is associated with a marked increase in mortality in patients with advanced heart failure. Am Heart J. 2005;149(1):168–174.
, Efficacy and Safety of Degludec versus Glargine in Type 2 Diabetes. N Engl J Med. 2017;377(8):723–732.
, More similarities than differences testing insulin glargine 300 units/mL versus insulin degludec 100 units/mL in insulin-naive type 2 diabetes: The Randomized Head-to-Head BRIGHT Trial. Diabetes Care. 2018;41(10):2147–2154.
, Effect of insulin glargine up-titration vs insulin degludec/liraglutide on glycated hemoglobin levels in patients with uncontrolled type 2 diabetes: the DUAL V Randomized Clinical Trial. JAMA. 2016;315(9):898–907.
, Association of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes (UKPDS 36): prospective observational study. BMJ. 2000;321:412–419.
, (2016) 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 37: 2129–2200.
. Risk factors for heart failure in the elderly: a prospective community-based study. Am J Med. 1999;106(6): 605–612.
. Congestive heart failure in type 2 diabetes: prevalence, incidence, and risk factors. Diabetes Care. 2001;24(9):1614–1619.
, Alogliptin after acute coronary syndrome in patients with type 2 diabetes. N Engl J Med. 2013;369:1327–1335.
, High prevalence of previously unknown heart failure and left ventricular dysfunction in patients with type 2 diabetes. Diabetologia. 2012;55(8):2154–2162.
, The association of hemoglobin a1c with incident heart failure among people without diabetes: the atherosclerosis risk in communities study. Diabetes. 2010;59(8):2020–2026.
, Angiotensin-neprilysin inhibition versus enalapril in heart failure. N Engl J Med. 2014; 371(11):993–1004.
, Impact of diabetes on outcomes in patients with low and preserved ejection fraction heart failure: an analysis of the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) programme. Eur Heart J. 2008;29(11):1377–1385.
, In-hospital and 1-year mortality associated with diabetes in patients with acute heart failure: results from the ESC-HFA Heart Failure Long-Term Registry. Eur J Heart Fail. 2017;19(1):54–65.
. Clinical diabetic cardiomyopathy: a two-faced disease with restrictive and dilated phenotypes. Eur Heart J. 2015;36:1718–1727c.
, Heart failure and diabetes: metabolic alterations and therapeutic interventions: a state-of-the-art review from the Translational Research Committee of the Heart Failure Association-European Society of Cardiology. Eur Heart J. 2018;39:4243–4254.
. Renin inhibition in heart failure and diabetes: the real story. Eur J Heart Fail. 2018;20:149–151.
, 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur J Cardiothorac Surg. 2016;50(5):e1–e88.
, Risks of cardiovascular events and effects of routine blood pressure lowering among patients with type 2 diabetes and atrial fibrillation: results of the ADVANCE study. Eur Heart J. 2009;30:1128–1135.
, 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: The Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC). Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC). Eur Heart J. 2015;36:2793–2867.
. Diabetes, glucose level, and risk of sudden cardiac death. Eur Heart J. 2005;26:2142–2147.
. Sudden coronary death in women. Am Heart J. 1998;136:205–212.
, Sudden cardiac death after myocardial infarction in patients with type 2 diabetes. Heart Rhythm. 2010;7:1396–1403.
, Euro Heart Survey Investigators. Glucose lowering treatment in patients with coronary artery disease is prognostically important not only in established but also in newly detected diabetes mellitus: a report from the Euro Heart Survey on Diabetes and the Heart. Eur Heart J. 2008;29(2):177–184.
, Patients with coronary artery disease and diabetes need improved management: a report from the EUROASPIRE IV survey: a registry from the EuroObservational Research Programme of the European Society of Cardiology. Cardiovasc Diabetol. 2015;14:133.
, Saraste A, 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J. 2020;41(3):407–477.
, 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J. 2019;40(2):87–165.
, Drug-eluting stents vs. coronary-artery bypass grafting in multivessel coronary disease. N Engl J Med. 2008;358(4):331–341.
, Strategies for multivessel revascularization in patients with diabetes. N Engl J Med. 2012;367:2375–2384.
American Diabetes Association . 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Medical Care in Diabetes – 2020. Diabetes Care. 2020;43:S98–S110.
