Auf die besondere Stoffwechselsituation einstellen - Welche Medikamente für den koronarkranken Diabetiker?

Zusammenfassung

Diabetiker müssen mit den gleichen Präventionsmaßnahmen für Herz und Kreislauf behandelt werden wie Nichtdiabetiker, die bereits einen Herzinfarkt erlebt und überlebt haben - dies machen aktuelle Studiendaten deutlich. Bei einer Koronarintervention sollten alle Diabetiker einen Drug-eluting-Stent erhalten und im Rahmen der Intervention mit einem Glykoprotein-IIb/IIIa-Rezeptorenblocker behandelt werden. Doch nicht nur bei der interventionellen koronaren Therapie muss man sich auf die besondere Stoffwechselsituation beim Diabetiker einstellen. So müssen beim Diabetiker bereits leicht erhöhte Blutdruckwerte konsequent behandelt werden. Essenziell ist dabei vor allem die AT₁-Rezeptorblockade, weil diese die diabetische Stoffwechselsituation besonders günstig beeinflussen kann. Aber auch die Therapie mit einem CSE-Hemmer ist bei Diabetikern indiziert - sowohl in der Primär- als auch in der Sekundärtherapie und insbesondere nach einer Koronarintervention.

Data from recent studies show that in diabetics the same measures for the prevention of cardiovascular disease apply as in non-diabetics who have already suffered and survived a myocardial infarction. All diabetics needing a coronary intervention should receive a drug-eluting stent, as well as medication with a glycoprotein IIb/IIIa receptor blocker. However, the need to take account of the particular metabolic situation presenting in diabetics is not confined to treatment with a coronary intervention. For example, diabetics with even mildly elevated blood pressure values need meticulous management. An essential aspect of such therapy is AT₁ receptor blockade, since this can have a particularly favourable impact on the metabolic state in diabetics. But treatment with a CSE inhibitor is also indicated, both in the primary and secondary treatment of diabetics, and in particular following a coronary intervention.

Key Words

coronary intervention - PTCA - bypass - stents - platelet inhibitor - statins - AT₁ receptor blockade

Literatur

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1 National Hispanic/Latino Diabetes

2 Bypass Angioplasty Revascularization Investigation

3 Arterial Revasularisation Therapy Study

4 Sirolimus-eluting Stent

5 Evaluation of Platelet IIb/IIIa Inhibition in Stenting Trial

6 Scandinavian Simvastatin Survival Study

7 Collaborative Atorvastatin Diabetes Study

8 UK Prospective Diabetes Study

9 CAPtopril Prevention Project

10 Losartan Intervention For Endpoint reduction in hypertension

11 Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity

12 Valsartan Antihypertensive Long-term Use Evaluation

13 Antihypertensive and Lipid-Lowering treatment do prevent Heart-Attack-Trial

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