Diabetes und Herzinsuffizienz

Der Diabetes mellitus ist eine wichtige Komorbidität bei Patienten mit Herzinsuffizienz. Liegen beide Erkrankungen gemeinsam vor, verschlechtert dies die Prognose der Patienten nachhaltig. Um das Outcome zu verbessern, sind eine suffiziente Diagnostik und eine differenzierte medikamentöse Therapie von entscheidender Bedeutung. Dieser Beitrag gibt einen Überblick über die Epidemiologie, Pathogenese, Diagnostik und therapeutischen Optionen.

Abstract

Diabetes is a very important comorbidity in patients with heart failure. When both diseases are present, mortality is greatly increased. Therefore, it is important to sufficiently diagnose and treat patients with diabetes and heart failure to improve outcome. This article provides an overview on epidemiology, pathogeneses, diagnostic and therapeutic options.

Schlüsselwörter

Diabetes - Herzinsuffizienz - Pathophysiologie - Diagnose - Therapie

Key words

diabetes - heart failure - pathophysiology - diagnosis - therapy

Publication History

Article published online:
24 August 2020

• Literatur

• 1 Ponikowski P, Voors AA, Anker SD. et al 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016; 37: 2129-2200 . doi:10.1093/eurheartj/ehw128
• 2 Nichols GA, Gullion CM, Koro CE. et al The incidence of congestive heart failure in type 2 diabetes: an update. Diabetes Care 2004; 27: 1879-1884 . doi:10.2337/diacare.27.8.1879
• 3 Bahrami H, Bluemke DA, Kronmal R. et al Novel Metabolic Risk Factors for Incident Heart Failure and Their Relationship With Obesity. The MESA (Multi-Ethnic Study of Atherosclerosis) Study. J Am Coll Cardiol 2008; 51: 1775-1783 . doi:10.1016/j.jacc.2007.12.048
• 4 Nichols GA, Koro CE, Gullion CM. et al The incidence of congestive heart failure associated with antidiabetic therapies. Diabetes Metab Res Rev 2005; 21: 51-57 . doi:10.1002/dmrr.480
• 5 Van Melle JP, Bot M, De Jonge P. et al Diabetes, glycemic control, and new-onset heart failure in patients with stable coronary artery disease: Data from the heart and soul study. Diabetes Care 2010; 33: 2084-2089 . doi: 10.2337/dc10-0286
• 6 Cavender MA, Steg PG, Smith SC. et al Impact of Diabetes Mellitus on Hospitalization for Heart Failure, Cardiovascular Events, and Death: Outcomes at 4 Years from the Reduction of Atherothrombosis for Continued Health (REACH) Registry. Circulation 2015; 132: 923-931 . doi:10.1161/CIRCULATIONAHA.114.014796
• 7 Matsue Y, Suzuki M, Nakamura R. et al Prevalence and Prognostic Implications of Pre-Diabetic State in Patients With Heart Failure. Circ J 2011; 75: 2833-2839 . doi:10.1253/circj.CJ-11-0754
• 8 Lehrke M, Marx N. Diabetes Mellitus and Heart Failure. Am J Cardiol 2017; 120: S37-S47 . doi:10.1016/j.amjcard.2017.05.014
• 9 Kristensen SL, Preiss D, Jhund PS. et al Risk Related to Pre-Diabetes Mellitus and Diabetes Mellitus in Heart Failure with Reduced Ejection Fraction: Insights from Prospective Comparison of ARNI with ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure Trial. Circ Hear Fail 2016; 9: 1-12 . doi:10.1016/j.amjcard.2017.05.014
• 10 Gustafsson I, Brendorp B, Seibaek M. et al Danish Investigatord of A, Mortality on Dofetilde Study G. Influence of diabetes and diabetes-gender interaction on the risk of death in patients hospitalized with congestive heart failure. J Am Coll Cardiol 2004; 43: 771-777 . doi:10.1016/j.jacc.2003.11.024
• 11 Solomon SD, McMurray JJV, Anand IS. et al Angiotensin–Neprilysin Inhibition in Heart Failure with Preserved Ejection Fraction. N Engl J Med 2019; 381: 1609-1620 . doi:10.1056/NEJMoa1908655
• 12 Buse JB, Wexler DJ, Tsapas A. et al 2019 Update to: Management of Hyperglycemia in Type 2 Diabetes, 2018. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 2020; 43: 487-493 . doi:10.2337/dci19-0066
• 13 Cosentino F, Grant PJ, Aboyans V. et al 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD: The Task Force for diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and the European Association for the Study of Diabetes (EASD). Eur Heart J 2019; 41: 255-323 . doi:10.1093/eurheartj/ehz486
• 14 Thomas MC, Cherney DZI. The actions of SGLT2 inhibitors on metabolism, renal function and blood pressure. Diabetologia 2018; 61: 2098-2107 . doi:10.1007/s00125-018-4669-0
• 15 Zinman B, Wanner C, Lachin JM. et al Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes. N Engl J Med 2015; 373: 2117-2128 . doi:10.1056/NEJMoa1504720
• 16 Neal B, Perkovic V, Mahaffey KW. et al Canagliflozin and Cardiovascular and Renal Events in Type 2 Diabetes. N Engl J Med 2017; 377: 644-657 . doi:10.1056/NEJMoa1611925
• 17 Wiviott SD, Raz I, Bonaca MP. et al Dapagliflozin and Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med 2019; 380: 347-357 . doi:10.1056/NEJMoa1812389
• 18 McMurray JJV, Solomon SD, Inzucchi SE. et al Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction. N Engl J Med 2019; 381: 1995-2008 . doi:10.1056/NEJMoa1911303
• 19 Marso SP, Daniels GH, Brown-Frandsen K. et al Liraglutide and Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med 2016; 375: 311-322 . doi:10.1056/NEJMoa1603827
• 20 Marso SP, Bain SC, Consoli A. et al Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes. N Engl J Med 2016; 375: 1834-1844 . doi:10.1056/NEJMoa1607141
• 21 Hernandez AF, Green JB, Janmohamed S. et al Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial. Lancet 2018; 392: 1519-1529 . doi:10.1016/s0140-6736(18)32261-x
• 22 Gerstein HC, Colhoun HM, Dagenais GR. et al Dulaglutide and cardiovascular outcomes in type 2 diabetes (REWIND): a double-blind, randomised placebo-controlled trial. Lancet 2019; 394: 121-130 . doi:10.1016/s0140-6736(19)31149-3
• 23 Aguilar D, Chan W, Bozkurt B. et al Metformin use and mortality in ambulatory patients with diabetes and heart failure. Circ Heart Fail 2011; 4: 53-58 . doi:10.1161/circheartfailure.110.952556
• 24 Ou SM, Shih CJ, Chao PW. et al Effects on Clinical Outcomes of Adding Dipeptidyl Peptidase-4 Inhibitors Versus Sulfonylureas to Metformin Therapy in Patients With Type 2 Diabetes Mellitus. Ann Intern Med 2015; 163: 663-672 . doi:10.7326/m15-0308