Einfluss erhöhter Lipoprotein-konzentrationen auf die Prognose von Patienten mit Diabetes mellitus

ZUSAMMENFASSUNG

In dieser Übersicht wird der gegenwärtige Kenntnisstand zu Erhöhungen der Lipoproteinkonzentrationen bei Menschen mit Diabetes im Hinblick auf die Prognose in 3 Kategorien dargestellt: Entwicklung von kardiovaskulären Ereignissen, akute Pankreatitis, Neuauftreten eines Diabetes. Triglyzeridanstiege sind sehr wahrscheinlich atherogen. Exzessiv erhöhte Triglyzeridspiegel werden im Rahmen eines Chylomikronämie-Syndroms beobachtet, das akute Pankreatitiden induzieren kann. Im Fokus steht bei Diabetespatienten LDL-Cholesterin, das auch bei einer leichten Anhebung das Risiko für Arteriosklerose erhöht, zumal die LDL-Partikel chemisch modifiziert sein können. Hier stehen als Therapieoptionen Statine, aber auch Ezetimib und PCSK9-Inhibitoren und als ultima ratio eine Lipoproteinapherese zur Verfügung. Die jüngsten internationalen Richtlinien der ESC/EAS haben die LDL-Cholesterin-Zielwerte deutlich herabgesetzt. Es wird die Relevanz der Parameter Non-HDL-Cholesterin und Apolipoprotein B diskutiert. Eine zunehmend größere Bedeutung als Risikofaktor hat der Lipoprotein(a)-Spiegel. Triglyzeriderhöhungen sind mit dem Neuauftreten eines Diabetes verknüpft, während dies bei hohen Lipoprotein(a)-Spiegeln eher nicht der Fall ist.

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