Download PDF
Diabetes aktuell 2016; 14(07): 335-339
DOI: 10.1055/s-0042-119469
Schwerpunkt
© Georg Thieme Verlag Stuttgart · New York

Herzinsuffizienz und blutzuckersenkende Medikamente

Aktuelle Studienlage und Empfehlungen für die PraxisHeart failure and antihypertensives - Evidence from clinical studies and practical recommendations
Christian A Schneider
1   Kardiologie / Innere Medizin, PAN Klinik, Köln
,
Roman Pfister
2   Klinik für Kardiologie, Angiologie, Pneumologie und internistische Intensivmedizin, Herzzentrum, Universitätsklinik Köln
› Author Affiliations
Further Information

Publication History

Publication Date:
25 November 2016 (online)

Also available at
    Permissions and Reprints

Allein schon aufgrund der diabetischen Kardiomyopathie oder bestehenden klassischen Risikofaktoren wie Bluthochdruck bzw. Hypercholesterinämie haben Patienten mit Diabetes mellitus ein erheblich erhöhtes Risiko, im Laufe ihrer Diabeteserkrankung eine Herzinsuffizienz zu entwickeln. Dazu kommt ihre im Vergleich zu Stoffwechselgesunden deutlich schlechtere Prognose. Dementsprechend darf der notwendige Einsatz blutzuckersenkender Medikamente das Risiko dieser Patientengruppe nicht noch weiter erhöhen. Generell sollten daher Substanzen bevorzugt werden, für die zumindest kein schädlicher Effekt bezüglich der verschiedenen Herzinsuffizienzendpunkte dokumentiert wurde. Bei Patienten mit Diabetes und Herzinsuffizienz empfehlen die aktuellen ESC-Leitlinien derzeit den Einsatz von Metformin als Standardtherapie. Darüber hinaus sind Empagliflozin und Liraglutid interessante Therapieoptionen für Risikopatienten: Beide Wirkstoffe sind nicht nur sicher, sondern reduzieren auch die Gesamtsterblichkeit signifikant.

Patients with diabetes mellitus are at increased risk of developing heart failure in the course of their disease. This is associated with diabetic cardiomyopathy, as well as classical risk factors, such as hypertension or hypercholesterolaemia. Moreover, their prognosis is clearly worse than for patients with normal metabolism. These patients must be given antiglycaemic drugs, but these should not increase the risk to which they are exposed. In general, substances should be selected that - at the very least - have no unfavourable effect on the different endpoints for heart failure. Current ESC guidelines recommend metformin for patients with diabetes and heart failure. Empagliflozin and liraglutide are also interesting options for patients at risk; they are not only safe, but significantly reduce overall mortality.

Key words

heart failure - diabetic cardiomyopathy - patients at risk - ESC guidelines - metformin - empagliflozin - liraglutide
 

  • Literatur

  • 1 Cavender MA, Steg PG, Smith Jr SC et al Impact of diabetes mellitus on hospitalization for heart failure, cardiovascular events and death. Circulation 2015; 132: 923-931
    CrossrefGoogle Scholar
  • 2 Johansson I, Dahlström U, Edner M et al Risk factor, treatment and prognosis in men and women with heart failure with and without diabetes. Heart 2015; 101: 1139-1148
    CrossrefGoogle Scholar
  • 3 Fritz TPA, Warmbier S, Pfister R et al Prognostische Bedeutung von Diabetes mellitus für Patienten mit symptomatischer Herzinsuffizienz im Rahmen eines kommunalen Versorgungsprojektes. Jahrestagung der Deutschen Gesellschaft für Innere Medizin, Wiesbaden 28.04.2014; P 2132
    Google Scholar
  • 4 Hippisley-Cox J, Coupland C. Diabetes treatment and risk of heart failure, cardiovascular disease and all cause mortality: cohort study in primary care. BMJ 2016; 354: i3477
    Google Scholar
  • 5 [No authors listed] Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). UK Prospective Diabetes Study (UKPDS) Group. Lancet 1998; 352: 854-865
    CrossrefGoogle Scholar
  • 6 Eurich DT, Majumdar SR, McAlister FA et al Improved clinical outcomes associated with metformin in patients with diabetes and heart failure. Diabetes Care 2005; 28: 2345-2351
    CrossrefPubMedGoogle Scholar
  • 7 Masoudi FA, Inzucchi SE, Wang Y et al Thiazolidinediones, metformin, and outcomes in older patients with diabetes and heart failure: an observational study. Circulation 2005; 111: 583-590
    CrossrefGoogle Scholar
  • 8 Eurich DT, Weir DL, Majumdar SR et al Comparative safety and effectiveness of metformin in patients with diabetes mellitus and heart failure: systematic review of observational studies involving 34,000 patients. Circ Heart Fail 2013; 6: 395-402
    CrossrefGoogle Scholar
  • 9 Ponikowski Pl, Voors AA, Anker SD et al 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 2016; 18: 891-916
    Google Scholar
  • 10 [No authors listed], Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet 1998; 352: 837-853
    CrossrefGoogle Scholar
  • 11 McAlister FA, Eurich DT, Majumdar SR, Johnson JA. The risk of heart failure in patients with type 2 diabetes treated with oral agent monotherapy. Eur J Heart Fail 2008; 10: 703-708
    CrossrefGoogle Scholar
  • 12 Pantalone KM, Katalan MW, Yu C et al The risk of developing coronary artery disease or congestive heart failure, and overall mortality in type 2 diabetic patients receiving rosiglitazone, pioglitazone, metformin, or sulfonylureas: a retrospective analysis. Acta Diabetol 2009; 46: 145-154
    CrossrefGoogle Scholar
  • 13 Tzoulaki I, Molokhia M, Curcin V et al Risk of cardiovascular disease and all cause mortality among patients with type 2 diabetes prescribed oral antidiabetes drugs: retrospective cohort study using UK general practice research database. BMJ 2009; 339: b4731
    CrossrefPubMedGoogle Scholar
  • 14 Hanefeld M, Cagatay M, Petrowitsch T et al Acarbose reduces the risk for myocardial infarction in type 2 diabetes patients: meta-analysis of seven long-term studies. Eur Heart J 2004; 25: 10-16
    CrossrefPubMedGoogle Scholar
  • 15 Scirica BM, Bhatt DL, Braunwald E et al Saxagliptin and cardiovascular outcomes in patients with type 2 diabetes mellitus. N Engl J Med 2013; 369: 1317-1326
    CrossrefGoogle Scholar
  • 16 White WB, Cannon CP, Heller SR et al Alogliptin after acute coronary syndrome in patients with type 2 diabetes. N Engl J Med 2013; 369: 1327-1335
    CrossrefGoogle Scholar
  • 17 Green JB, Bethel MA, Armstrong PW et al Effect of sitagliptin on cardiovascular outcomes in type 2 diabetes. N Engl J Med 2015; 373: 232-242
    CrossrefGoogle Scholar
  • 18 Scirica BM, Braunwald W, Raz I et al Heart failure, saxagliptin, and diabetes mellitus: observations from the SAVOR-TIMI 53 randomized trial. Circulation 2014; 130: 1579-1588
    CrossrefGoogle Scholar
  • 19 Zannad F, Canon CP, Cushman WC et al Heart failure and mortality outcomes in patients with type 2 diabetes taking alogliptin versus placebo in EXAMINE: a multicentre, randomised, double-blind trial. Lancet 2015; 385: 2067-2076
    CrossrefGoogle Scholar
  • 20 MacMurray J. The Vildagliptin in Ventricular Dysfunction Diabetes trial (VIVIDD). Präsentiert auf dem Heart Failure Congress. 2013 Abstract 99
    Google Scholar
  • 21 Li L, Li S, Denkg K et al Dipeptidyl peptidase-4 inhibitors and risk of heart failure in type 2 diabetes: systematic review and meta-analysis of randomized and observational studies. BMJ 2016; 17 352: i610
    Google Scholar
  • 22 Filion KB, Azoulay L, Platt RW et al A multicenter observational study of incretin-based drugs and heart failure. N Engl J Med 2016; 374: 1145-1154
    CrossrefGoogle Scholar
  • 23 McGuire DK, Van de Werf F, Armstrong PW et al Association between sitagliptin use and heart failure hospitalization and related outcomes in type 2 diabetes mellitus: secondary analysis of a randomized clinical trial. JAMA Cardiol 2016; 1: 126-135
    CrossrefGoogle Scholar
  • 24 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
    CrossrefGoogle Scholar
  • 25 Fitchett D, Zinman B, Wanner C et al EMPA-REG OUTCOME trial investigators. Heart failure outcomes with empagliflozin in patients with type 2 diabetes at high cardiovascular risk: results of the EMPA-REG OUTCOME® trial. Eur Heart J 2016; 37: 1526-1534
    CrossrefGoogle Scholar
  • 26 Rocchini AP, Katch V, Kveselis D et al Insulin and renal sodium retention in obese adolescents. Hypertension 1989; 14: 367-374
    CrossrefGoogle Scholar
  • 27 BARI 2D Study Group. Frye RL, August P, Brooks MM et al A randomized trial of therapies for type 2 diabetes and coronary artery disease. N Engl J Med 2009; 360: 2503-2515
    CrossrefGoogle Scholar
  • 28 ORIGIN Trial Investigators. Gerstein HC, Bosch J, Dagenais GR et al Basal insulin and cardiovascular and other outcomes in dysglycemia. N Engl J Med 2012; 367: 319-328
    CrossrefGoogle Scholar
  • 29 Smooke S, Horwich TB, Fonarow GC. Insulin-treated diabetes is associated with a marked increase in mortality in patients with advanced heart failure. Am Heart J 2005; 149: 168-174
    CrossrefGoogle Scholar
  • 30 Nikolaidis LA, Elahi D, Hentosz T et al Recombinant glucagon-like peptide-1 increases myocardial glucose uptake and improves left ventricular performance in conscious dogs with pacing-induced dilated cardiomyopathy. Circulation 2004; 110: 955-961
    CrossrefGoogle Scholar
  • 31 Margulies KB, Hernandez AF, Redfield MM et al Effects of liraglutide on clinical stability among patients with advanced heart failure and reduced ejection fraction. A randomized trial. J Am Coll Cardiol 2016; 316: 500-508
    Google Scholar
  • 32 Marso SP, Daniels GH, Brown-Frandsen K et al Liraglutide and cardiovascular outcomes in type 2 diabetes. N Engl Med 2016; 375: 311-322
    CrossrefGoogle Scholar
  • 33 Pfeffer MA, Claggett B, Diaz R et al Lixisenatide in patients with type 2 diabetes and acute coronary syndrome. N Engl J Med 2015; 373: 2247-2257
    CrossrefGoogle Scholar
  • 34 Marso SP, Bain SC, Consoli A et al Semaglutide and cardiovascular outcomes in patients with type 2 diabetes. N Engl J Med. 15.09.2016 [Epub ahead of print]
    Google Scholar
  • 35 Pfister R, Calms R, Erdmann E, Schneider CA. A clinical risk score for heart failure in patients with type 2 diabetes and macrovascular disease: an analysis of the PROactive study. Int J Cardiol 2013; 162: 112-116
    CrossrefGoogle Scholar
  • 36 Wang Y, Negishi T, Negishi K, Marwick TH. Prediction of heart failure in patients with type 2 diabetes mellitus ̶ a systematic review and meta-analysis. Diabetes Res Clin Pract 2015; 108: 55-66
    CrossrefGoogle Scholar