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Dtsch Med Wochenschr 2015; 140(09): 657-662
DOI: 10.1055/s-0041-101941
Dossier
Herz und Diabetes
© Georg Thieme Verlag KG Stuttgart · New York

Therapie der stabilen Angina pectoris bei Diabetes mellitus Typ 2: Medikamente, Koronarintervention und Bypass

Treatment of stable coronary artery disease in type II diabetes mellitus: drugs, coronary intervention and bypass surgery
Christian A. Schneider
1   PAN-Klinik, Köln
,
Roman Pfister
2   Klinik III für Innere Medizin, Universitätsklinik Köln
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Publication History

Publication Date:
29 April 2015 (online)

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Zusammenfassung

Die Lebenserwartung des Diabetikers wird durch das Auftreten kardiovaskulärer Erkrankungen deutlich verkürzt. Bei Verdacht auf KHK sollte daher aktiv nach dem Vorliegen von Hochrisiko-Faktoren gesucht werden. Die Behandlung der symptomatischen KHK besteht zunächst aus der Umsetzung von Allgemeinmassnahmen und der Therapie der Angina pectoris durch bewährte Antianginosa. Sollten diese nicht ausreichen, ist eine zusätzliche Therapie mit Ranolazin oder Ivabradin zu rechtfertigen. Früh sollte bei solchen Patienten an die Möglichkeit einer Herzkatheter-Untersuchung gedacht werden. Die Blutzucker-senkende Therapie orientiert sich am Gesamtbild des Patienten, das Erreichen sehr niedriger HBA1c Zielwerte ist häufig entbehrlich, eine Hypoglykämie-arme Therapie empfehlenswert. Eine schonende Blutdrucksenkung verbessert die Prognose der Diabetiker. Ein Blutdruck-Zielwert zwischen 130-139 mmHg ist sinnvoll, die primäre Therapie mit einem ACE-Inhibitor oder –bei Unverträglichkeit- eines Angiotensin II-Blocker ist empfehlenswert. Die LDL Cholesterin Senkung zielt auf Werte unter 70 mg / dl, die die Prognose des Diabetikers verbessern. In der Regel werden für die Erreichung dieser Zielwerte starke Statine oder eine Kombinationstherapie notwendig sein. Eine invasive Diagnostik sollte bei Patienten mit Hochrisiko-Faktoren durchgeführt werden. In Abhängigkeit vom Befund wird sich häufig eine interventionelle Therapie mit Stents der 2. Generation oder eine Bypass Operation anschließen.

Abstract

The prognosis of patients with type 2 diabetes is reduced by coronary artery disease. The aim of treatment is therefore not only to treat angina symptoms but also improve the prognosis by medical and interventional treatment. LDL-lowering and coronary revascularisation have the largest beneficial impact on prognosis.

Schlüsselwörter

Diabetes mellitus - kardiovaskuläre Krankheiten - stabile Angina pectoris

Key Words

diabetes mellitus - cardiovascular diseases - stable angina pectoris
 

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