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Dtsch Med Wochenschr 2015; 140(09): 650-656
DOI: 10.1055/s-0041-101365
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Herz und Diabetes
© Georg Thieme Verlag KG Stuttgart · New York

Besonderheiten der blutzuckersenkenden Therapie bei herzkranken Patienten

Glucose-lowering therapy in patients with cardiac comorbidities
Juris J. Meier
1   Abteilung für Diabetologie, Universitätsklinikum St. Josef-Hospital, Klinikum der Ruhr-Universität Bochum
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Publication Date:
29 April 2015 (online)

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Zusammenfassung

Das Risiko für kardiovaskuläre Ereignisse, ebenso wie für eine Herzinsuffizienz oder Herzrhythmusstörungen, ist bei Patienten mit Diabetes deutlich erhöht. Wenngleich chronisch erhöhte HbA1c-Werte mit einer gesteigerten kardiovaskulären Ereignisrate assoziiert sind, führt eine aggressive blutzuckersenkende Therapie jedoch nicht zwangsläufig zu einer Prognoseverbesserung. So müssen Therapie-bedinge Nebenwirkungen wie Hypoglykämie und Gewichtszunahme sorgfältig gegen den Nutzen der Blutzuckersenkung abgewogen werden. Ferner sollten spezifische Präparate-bezogene Aspekte berücksichtigt werden: So ist Pioglitazon bei Patienten mit Herzinsuffizienz kontraindiziert, und auch für die DPP-4 Hemmer gibt es Hinweise auf eine gesteigerte Herzinsuffizienz-Rate unter Therapie. Bei der Therapie mit GLP-1 Analoga sollte auf einen Anstieg der Herzfrequenz geachtet werden. Hinweise auf eine Reduktion kardiovaskulärer Endpunkte bei Patienten mit Diabetes finden sich nur für Metformin. Für Insulin und Sulphonylharnstoffe haben die vorliegenden kardiovaskulären Endpunktstudien neutrale Ergebnisse erbracht, für GLP-1 Analoga und SGLT-2 Hemmer liegen derartige Endpunktstudien noch nicht vor. Insgesamt sollten die verschiedenartigen spezifischen Effekte im Herz-Kreislaufsystem sowie das Hypoglykämierisiko bei der Auswahl einer blutzuckersenkenden Therapie bei herzkranken Patienten bedacht werden.

Abstract

The risk for cardiovascular events, congestive heart failure and cardiac arrhythmia is significantly increased in patients with diabetes. Although poor glycaemic control has been associated with an increased cardiovascular event rate, aggressive glucose-lowering strategies have failed to improve cardiovascular endpoints or mortality. Therefore, treatment-associated adverse effects, especially hypoglycaemia and weight gain, must be carefully outbalanced against the potential benefits of better glycaemic control. Furthermore, certain drug-specific aspects must be considered: Pioglitazone is contraindicated in patients with heart failure, and DPP-4 inhibitors have recently been associated with an increased heart failure rate. Heart rate may increase during treatment with GLP-1 analogues. Only with metformin a reduction in cardiovascular endpoint has been demonstrated in patients with diabetes. Insulin and sulphonylureas have yielded neutral results in the available endpoint trials. Endpoint studies with GLP-1 analogues or SGLT-2 inhibitors have not yet been completed. These various drug-specific actions in the cardiovascular system need to be born in mind for the choice of the optimal glucose-lowering strategy in patients with cardiac comorbidities.

Schlüsselwörter

Herzinsuffizienz - Diabetestherapie - koronare Herzkrankheit

Key Words

heart failure - diabetes treatment - coronary heart disease
 

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