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Kardiologie up2date 2013; 09(04): 323-335
DOI: 10.1055/s-0033-1359022
Koronare Herzerkrankung und Atherosklerose
© Georg Thieme Verlag KG Stuttgart · New York

Diabetes und kardiovaskuläre Erkrankungen, Zusammenfassung der ESC-Leitlinien 2013

Corinna Lebherz
,
Michael Lehrke
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Publikationsdatum:
14. Januar 2014 (online)

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Abstract

Patients with Diabetes mellitus have an increased risk for micro- and macrovascular complications. Diabetes therapy should therefore aim for the prevention of cardiovascular disease. This can be reached by a combination of life style modification in addition to optimal medical therapy of blood pressure, -lipids and blood glucose. The therapeutic approach to coronary artery disease, heart failure or arrhythmias does not differ in patients with diabetes from the general population. Yet, if a coronary revascularization therapy is needed, patients with diabetes and complex multi-vessel disease do benefit from aortocoronary bypass operation rather than an interventional approach. Percutaneous coronary intervention in diabetic patients should be performed primarily with drug-eluting stents rather than bare metal stents. Screening for microangiopathic complications including retinopathy, nephropathy or neuropathy is advised on a regular basis.

Kernaussagen

  • Diabetes mellitus ist eine chronische Erkrankung, die mit einem erhöhten Risiko mikro- und makrovaskulärer Erkrankungen einhergeht.

  • Um diesem erhöhen Risiko Rechnung zu tragen, sollte schon in der Primärprävention auf eine optimale Therapie aller Risikofaktoren geachtet werden.

  • Zur optimalen Therapie gehören die Anpassung des Lebensstils und eine optimale Blutzucker-, Blutdruck- und Lipidtherapie.

  • Die medikamentöse Therapie der KHK, Herzinsuffizienz und von Arrhythmien ist bei Patienten mit Diabetes entsprechend den allgemeingültigen Leitlinien anzuwenden.

  • Bezüglich der Revaskularisierungstherapie profitieren Patienten mit Diabetes und komplexem Koronarbefund von einer aortokoronaren Bypass-Operation. Sollte eine perkutane Intervention indiziert sein, wird bei Patienten mit Diabetes ein medikamentenbeschichteter Stent empfohlen.

  • Weil Diabetiker zudem häufig eine pAVK sowie mikroangiopathische Veränderungen wie Retinopathie, Nephropathie oder Neuropathie entwickeln, sollten diesbezüglich regelmäßige Screening-Untersuchungen stattfinden und ggf. eine entsprechende Therapie eingeleitet werden.

 

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