Diabetes mellitus und kardiovaskuläre Prävention

Menschen mit Diabetes leiden überproportional häufig an Herz-Kreislauf-Erkrankungen. Nicht zuletzt deshalb liegt ein mindestens 2-fach erhöhtes Risiko für einen frühzeitigen Tod im Vergleich zu Menschen ohne Diabetes vor, und die Lebenserwartung ist im Durchschnitt um etwa 5–6 Jahre kürzer. Zur Prognoseverbesserung von Menschen mit Diabetes ist deswegen eine Reduzierung der kardiovaskulären Risikofaktoren unabdingbar.

Abstract

Diabetes mellitus is the most common metabolic disease with >500 million people affected worldwide and currently 8,7 million in Germany. About 90% of diabetes cases are due to type 2 diabetes mellitus (T2D). This form of diabetes is characterized by an increased release of proinflammatory adipokines, endothelial dysfunction and hyperglycemia, among others. Hypertension and dyslipidemia are also very commonly present. The prevalence of cardiovascular disease is about 2–3 times higher in T2D than in age-matched individuals without a diagnosis of diabetes. Cardiovascular mortality is also about twice as high in people with diabetes compared to a non-diabetic population. People with diabetes are therefore generally considered a high-risk cardiovascular group and require special attention in the diagnosis and treatment of cardiovascular disease. Contributing factors to reduce high cardiovascular risk include a healthy lifestyle, normalization of blood pressure, optimization of blood lipid levels, and specific diabetes therapy tailored to cardiovascular risk. This review addresses the specific treatment options for reducing cardiovascular risk in patients with diabetes mellitus.

Schlüsselwörter

Diabetes mellitus - kardiovaskuläres Risiko - kardiovaskuläre Prävention

Keywords

diabetes mellitus - cardiovascular risk - cardiovascular prevention

Publication History

Article published online:
09 October 2024

• Literatur

• 1 Schmidt C, Reitzle L, Paprott R. et al. Diabetes mellitus und Begleiterkrankungen – Querschnittstudie mit Kontrollgruppe anhand vertragsärztlicher Abrechnungsdaten. J Health Monitor 2021; 6: 20-36
• 2 Pearson-Stuttard J, Bennett J, Cheng YJ. et al. Trends in predominant causes of death in individuals with and without diabetes in England from 2001 to 2018: an epidemiological analysis of linked primary care records. Lancet Diabetes Endocrinol 2021; 9: 165-173
• 3 Emerging Risk Factors Collaboration. Life expectancy associated with different ages at diagnosis of type 2 diabetes in high-income countries: 23 million person-years of observation. Lancet Diabetes Endocrinol 2023; 11: 731-742
• 4 Marx N, Federici M, Schütt K. et al. 2023 ESC Guidelines for the management of cardiovascular disease in patients with diabetes. Eur Heart J 2023; 44: 4043-4140
• 5 ESC (European Society of Cardiology) CVD Risk Calculation App. Accessed April 16, 2024 at: www.escardio.org/Education/ESC-Prevention-of-CVD-Programme/Risk-assessment/esc-cvd-risk-calculation-app
• 6 Wing RR, Bahnson JL, Bray GA. et al. Long-term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes mellitus: Four-year results of the look AHEAD trial. Arch Intern Med 2010; 170: 1566-1575
• 7 Lean ME, Leslie WS, Barnes AC. et al. Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, clusterrandomised trial. Lancet 2018; 391: 541-551
• 8 Look Ahead Research Group. Association of the magnitude of weight loss and changes in physical fitness with long-term cardiovascular disease outcomes in overweight or obese people with type 2 diabetes: a post-hoc analysis of the Look AHEAD randomised clinical trial. Lancet Diabetes Endocrinol 2016; 4: 913-921
• 9 Estruch R, Ros E, Salas-Salvadó J. et al. Primary Prevention of Cardiovascular Disease with a Mediterranean Diet Supplemented with Extra-Virgin Olive Oil or Nuts. N Engl J Med 2018; 378: e34
• 10 Polsky S, Akturk HK. Alcohol Consumption, Diabetes Risk, and Cardiovascular Disease Within Diabetes. Curr Diab Rep 2017; 17: 136
• 11 Wood AM, Kaptoge S, Butterworth AS. et al. Risk thresholds for alcohol consumption: combined analysis of individual-participant data for 599912 current drinkers in 83 prospective studies. Lancet 2018; 391: 1513-1523
• 12 Critchley JA, Capewell S. Mortality risk reduction associated with smoking cessation in patients with coronary heart disease: a systematic review. JAMA 2003; 290: 86-97
• 13 Wahid A, Manek N, Nichols M. et al. Quantifying the association between physical activity and cardiovascular disease and diabetes: a systematic review and meta-analysis. J Am Heart Assoc 2016; 5: e002495
• 14 Emdin CA, Rahimi K, Neal B. et al. Blood Pressure Lowering in Type 2 DiabetesA Systematic Review and Meta-analysis. JAMA 2015; 313: 603-615
• 15 ElSayed N, Aleppo G, Aroda VR. et al. Cardiovascular disease and risk management: Standards of care in Diabetes – 2023. Diabetes Care 2023; 46 (Suppl. 01) S158-S190
• 16 Parhofer KG, Birkenfeld AL, Krone W. et al. Lipidtherapie bei Patienten mit diabetes mellitus. Diabetologie 2023; 18 (Suppl. 02) S330-S336
• 17 Nissen SE, Lincoff AM, Brennan D. et al. Bempedoic Acid and Cardiovascular Outcomes in Statin-Intolerant Patients. N Engl J Med 2023; 388: 1353-1364
• 18 The ASCEND Study Collaborative Group. Effects of Aspirin for Primary Prevention in Persons with Diabetes Mellitus. N Engl J Med 2018; 379: 1529-1539
• 19 Balletshofer B, Böckler D, Diener H. et al. Positionspapier zur Diagnostik und Therapie der peripheren arteriellen Verschlusskrankheit (pAVK) bei Menschen mit Diabetes mellitus. Diabetologie 2022; 17 (Suppl. 02) S354-S364
• 20 Visseren FLJ, Mach F, Smulders YM. et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J 2021; 42: 3227-3337
• 21 ElSayed N, Aleppo G, Aroda VR. et al. Glycemic Targets: Standards of Care in Diabetes – 2023. Diabetes Care 2023; 46 (Suppl. 01) S97-S110
• 22 Nationale VersorgungsLeitlinie Typ-2-Diabetes (2021). Accessed April 16, 2024 at: www.leitlinien.de/themen/diabetes/pdf/diabetes-2aufl-vers1.pdf
• 23 UK Prospective Diabetes Study (UKPDS) Group. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). Lancet 1998; 352: 854-865
• 24 Frias JP. An update on tirzepatide for the management of type 2 diabetes: a focus on the phase 3 clinical development program. Expert Rev Endocrinol Metab 2023; 18: 111-130
• 25 KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease. Kidney International 2022; 102 (Suppl. 05) S1-S127
• 26 ElSayed N, Aleppo G, Aroda VR. et al. Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes – 2023. Diabetes Care 2023; 46 (Suppl. 01) S191-S202
• 27 Davies MJ, Aroda VR, Collins BS. et al. Management of hyperglycaemia in type 2 diabetes, 2022. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia 2022; 65: 1925-1966