Download PDF
Diabetologie und Stoffwechsel 2006; 1(3): 181-186
DOI: 10.1055/s-2006-941556
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Lipoproteine und Zielwerte bei Diabetes mellitus

Lipoproteins and Target Values in Diabetes MellitusD. Müller-Wieland1 , J. Kotzka1
  • 1Institut für Klinische Biochemie und Pathobiochemie
Further Information

Publication History

Manuskript eingegangen am 18.3.2006

revidiertes Manuskript angenommen am 24.3.2006

Publication Date:
19 May 2006 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Patienten mit Diabetes mellitus sind in den allermeisten Fällen kardiovaskuläre Hochrisikopatienten. Deswegen sollte ein Zielwert für LDL-Cholesterin im Plasma < 100 mg/dl (2,6 mmol/l) angestrebt bzw. eine mindestens 30 - 40 %-ige Reduktion bei bereits niedrigen Ausgangswerten erreicht werden. Bei Patienten mit Diabetes und kardiovaskulären Komplikationen ist aufgrund der neuen Studienlage die Absenkung des LDL-Cholesterin < 70 mg/dl (1,8 mmol/l) eine gerechtfertigte therapeutische Option. In dieser Übersicht werden zudem Prinzipien der Pathogenese einer diabetischen Dyslipidämie skizziert und das grundsätzliche Vorgehen bei zusätzlich erhöhten Triglyzeriden und niedrigem HDL-Cholesterin vor dem Hintergrund klinischer Endpunktstudien dargestellt.

Abstract

Patients with diabetes mellitus have in most cases a high cardiovascular risk. Therefore a target value for LDL-Cholesterol < 100 mg/dl (2,6 mmol/l) or at least a reduction by 30 - 40 % in case of low basal levels is recommended. In patients with diabetes and cardiovaskular complications recents studies have provided evidence that lowering of LDL-Cholesterol below 70 mg/dl (1,8 mmol/l) is considered as a justified therapeutic option. In addition, this review will outline some principal mechanisms of the pathogenesis of diabetic dyslipidemia and basic aspects how to procede in case triglyceride levels are elevated and HDL-Cholesterol is low.

Literatur

  • 1 The International Task Force for Prevention of Coronary Heart Disease in cooperation with the International Atherosclerosis Society: Coronary Heart Disease: Reducing the Risk. The scientific background for primary and secondary prevention of coronary heart disease. Nutr Metab Cardiovasc Dis 1998 8: 205-271
    Google Scholar
  • 2 Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III). JAMA 2001 285: 2486-2497
    Google Scholar
  • 3 American Diabetes Association: Standards of Medical Care in Diabetes. Diabetes Care 2006 29, Supplement 1: S18-19
    Google Scholar
  • 4 Haffner S M, Lehto S, Ronnemaa T. et al . Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction.  N Engl J Med. 1998;  339 229-243
    CrossrefGoogle Scholar
  • 5 The DECODE study group: Glucose tolerance and mortality: comparison of WHO and American Diabetes Association diagnostic criteria. Lancet 1999 354: 617-621. Comment in Lancet 1999; 354 : 610 - 611
    Google Scholar
  • 6 Qiao Q, Jousilahti P, Eriksson J, Tuomilehto J. Predictive properties of impaired glucose tolerance for cardiovascular risk are not explained by the development of overt diabetes during follow-up.  Diabetes Care. 2003;  26 2910-2914
    Google Scholar
  • 7 Ridker P M, Buring J E, Cook N R, Rifai N. C-reactive protein, the metabolic syndrome, and riks of incident cardiovascular events: an 8-year follow-up of 14.719 initially healthy American women.  Circulation. 2003;  107 391-397
    CrossrefPubMedGoogle Scholar
  • 8 Alexander G M, Landman P B, Teutsch S M, Haffner S M. NCEP-defined metabolic syndrome, diabetes, and prevalence of coronary heart disease among NHANES III participants aged 50 years and older.  Diabetes. 2003;  52 1210
    CrossrefPubMedGoogle Scholar
  • 9 Grundy S M. et al . Definition of metabolic syndrome. Report of the National Heart, Lung, and Blood Institute/American Heart Associaction conference on scientific issues related definition.  Circulation. 2004;  109 433-438
    CrossrefPubMedGoogle Scholar
  • 10 Ninomiya J K, L’Italien G, Criqui M H. et al . Association of the metabolic syndrome with history of myocardial infarction and stroke in the Third National Health and Nutrition Examination Survey.  Circulation. 2004;  209 42-46
    Google Scholar
  • 11 Bartnik M, Ryden L, Ferrari R. et al . Euro Heart Survey Investigators. The prevalence of abnormal glucose regulation in patients with coronary artery disease across Europe. The Euro Heart Survey on diabetes and the heart.  Eur Heart J. 2004;  25 1990-1997
    CrossrefGoogle Scholar
  • 12 Ruotolo G, Howard B V. Lipid and Lipoprotein Metabolism. In: DeFronzo RA, Ferrannini E, Keen H, Zimmet P International Textbook of Diabetes Mellitus, Third Edition. 2004 John Wiley & Sons, Ltd S. 335-348
    Google Scholar
  • 13 Taskinen M R. Hypolipidemic Agents and Their Role in the Therapy of Diabetes Mellitus. In: DeFronzo RA, Ferrannini E, Keen H, Zimmet P International Textbook of Diabetes Mellitus, Third Edition. 2004 John Wiley & Sons, Ltd S. 981-994
    Google Scholar
  • 14 Betteridge D J, Krone W, Müller-Wieland D. Dylipidemia and diabetes. In: Goldstein BJ, Müller-Wieland D Textbook of Type 2 Diabetes. 2003 Martin Dunitz Ltd S. 343-355
    Google Scholar
  • 15 Krauss R M. Lipids and lipoproteins in patients with type 2 diabetes.  Diabetes Care. 2004;  27 1496-1504
    Google Scholar
  • 16 Streicher R, Kotzka J, Muller-Wieland D. et al . SREBP-1 mediates activation of the low density lipoprotein receptor promoter by insulin and insulin-like growth factor-I.  J Biol Chem. 1996;  271 7128-7133
    CrossrefGoogle Scholar
  • 17 Kotzka J, Müller-Wieland D. Sterol regulatory element-binding protein (SREBP)-1: gene regulatory target for insulin resistance?.  Expert Opin Ther Targets. 2004;  8 141-149
    CrossrefGoogle Scholar
  • 18 Sniderman A D, Scantlebury T, Cianflone K. Hypertriglyceridemic hyperapo B: the unappreciated atherogenic dyslipoporteinemia in type 2 diabetes.  Ann Intern Med. 2001;  135 447-459
    Google Scholar
  • 19 van Wijk J PH, Halkes C JM, Erkelens D W, Cabezas M C. Fasting and Daylong Triglycerides in Obesity With and Without Type 2 Diabetes.  Metabolism. 2003;  52 1043-1049
    CrossrefGoogle Scholar
  • 20 Large V, Peroni O, Letexier D, Ray H, Beylot M. Metabolism of lipids in human white adipocyte.  Diabetes Metab. 2004;  30 294-309
    Google Scholar
  • 21 Blackburn P, Lamarche B, Couillard C. et al .Contribution of Visceral Adiposity to the Exaggerated Postprandial Lipemia of Men With Impaired Glucose Intolerance. Diabetes Care 2003: 3303-3309
    Google Scholar
  • 22 Mekki N, Christofilis M A, Charbonnier M, Atlan-Gepner C, Defoort C, Juhel C, Borel P, Portugal H, Pauli A M, Vialettes B, Lairon D. Influence of Obesity and Body Fat Distribution on Postprandial Lipemia and Triglyceride-Rich Lipoproteins in Adult Women.  J Clin Endocrinol Metab. 1999;  84 184-191
    CrossrefGoogle Scholar
  • 23 Ng T WK, Watts G F, Farvid M S. et al . Adipocytokines and VLSL Metabolism. Independent Regulatory Effects of Adiponectin, Insulin Resistance, and Fat Compartments on VLDL Apoliporpotein B-100 Kinetics?.  Diabetes. 2005;  54 795-802
    Google Scholar
  • 24 Schulze M B, Shai I, Rimm E B. et al . Adiponectin and Future Coronary Heart Disease Events Among Men With Type 2 Diabetes.  Diabetes. 2005;  54 534-539
    CrossrefGoogle Scholar
  • 25 Syvanne M, Ahola M, Lahdenera S. HDL subfractions in NIDDM and coronary artery disease. J Lipid Res 1995: 573-582
    Google Scholar
  • 26 Grundy M S, Cleeman J I, Merz C NB. et al . Implication of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines.  Circulation. 2004;  110 227-239
    CrossrefPubMedGoogle Scholar
  • 27 Rubins H B, Robins S J, Collins D. et al . for the Veterans Affairs High-Density Lipoprotein Cholesterol Intervention Trial Study Group. Gemfibrozil for the secondary prevention of coronary heart disease in men with low levels of high-density lipoprotein cholesterol.  N Engl J Med. 1999;  341 410-418
    CrossrefGoogle Scholar
  • 28 Rubins H B, Robins S J, Collins D. et al . Diabetes, plasma insulin, and cardiovascular disease: subgroup analysis from the Department of Veterans Affairs high-density lipoprotein intervention trial (VA-HIT).  Arch Intern Med. 2002;  162 2597-2604
    CrossrefGoogle Scholar
  • 29 The BIP Study Group. Secondary prevention by raising HDL cholesterol and reducing triglycerides in patients with coronary artery disease. The Bezafibrate Infarction Prevention (BIP) Study. Circulation 2000 102: 21-27
    Google Scholar
  • 30 Arcavi L, Behar S, Caspi A. et al . High fasting glucose levels as a predictor of worse clinical outcome in patients with coronary artery disease: results from Bezafibrate Infarction Prevention (BIP) study.  Am Heart J. 2004;  147 239-245
    CrossrefGoogle Scholar
  • 31 Keech A, Simes R J, Barter P. et al . FIELD-Study investigators. Effects of long-term fenofibrate therapy on cardiovascular events in 9795 people with type 2 diabetes mellitus (the FIELD study): randomised controlled trial.  Lancet. 2005;  366 1829-1831
    CrossrefGoogle Scholar
  • 32 Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of Cholesterol-Lowering with Simvastatin in 5963 People with Diabetes: a Randomised Placebo-Controlled Trial. Lancet 2003 361: 2005-2026
    Google Scholar
  • 33 Colhoun H M, Betteridge D J, Durrington P N. et al . on behalf of the CARDS investigators. Primary prevention of cardiovascular disease with atorvastatin in type 2 diabets in the Collaborative Atorvastatin Diabetes Study (CARDS): multicentre randomised placebo-controlled trial.  Lancet. 2004;  364 685-696
    CrossrefPubMedGoogle Scholar
  • 34 Grundy S M. et al . Clinical management of metabolic syndrome. Report of the American Heart Association/National Heart, Lung, and Blood Institute/American Diabetes Association conference on scientific issues related to management.  Circulation. 2004;  109 551-556
    CrossrefGoogle Scholar
  • 35 Toeller M. et al . Evidenz-basierte Ernährungsempfehlungen zur Behandlung und Prävention des Diabetes mellitus.  Diabetes und Stoffwechsel. 2005;  14 75-94
    Google Scholar
  • 36 American Diabetes Association. Management of Dyslipidemia in Adults with Diabetes. Diabetes Care 2003 26 (Suppl. 1): S83-86
    Google Scholar
  • 37 Garcia P J, Spellman C W. Should All Diabetic Patients Receive Statins?.  Current Atherosclerosis Reports. 2006;  8 13-18
    Google Scholar
  • 38 Fischer S, Hanefeld M, Müller-Wieland D. et al .Therapie bei sekundären Formen und bei Sonderindikationen.  In: Praxisleitlinien Fettstoffwechselstörungen. S. 28
    Google Scholar
  • 39 Ginsberg H N. Review: Efficacy and Mechanisms of Action of Statins in the Treatment of Diabetic Dyslipidemia.  J Clin Endocrinol Metab. 2006;  91 383-392
    Google Scholar
  • 40 Grundy S M, Vega G L, McGovern M E. et al . Efficacy, safety, and tolerability of once-daily niacin for the treatment of dyslipidemia associated with type 2 diabetes.  Arch Intern Med. 2002;  162 1568-1576
    CrossrefGoogle Scholar

D. Müller-Wieland

Institut für Klinische Biochemie und Pathobiochemie

Deutsches Diabetes-Zentrum an der Heinrich-Heine-Universität Düsseldorf

Leibniz-Zentrum für Diabetes-Forschung

Auf’m Hennekamp 65

40225 Düsseldorf

Phone: 0211/3382-240

Fax: 0211/3382-430

Email: mueller-wieland@ddz.uni-duesseldorf.de

      >