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Aktuelle Kardiologie 2024; 13(04): 289-295
DOI: 10.1055/a-2318-3573
Kurzübersicht

Herzinsuffizienz bei Patienten mit Diabetes mellitus

Heart Failure and Diabetes
Katharina Schütt
1   Klinik für Kardiologie, Angiologie und Internistische Intensivmedizin (Medizinische Klinik I), Uniklinik RWTH Aachen, Aachen, Deutschland
,
Amin Polzin
2   University Hospital Düsseldorf, Medical Faculty of the Heinrich Heine University, Department of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Deutschland
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Zusammenfassung

Patienten mit Diabetes haben ein erhöhtes Risiko, eine Herzinsuffizienz zu entwickeln, und das Vorliegen beider Komorbiditäten geht mit einer schlechteren Prognose einher. Daher ist es von größter Bedeutung, eine Herzinsuffizienz bei Patienten mit Diabetes frühzeitig zu erkennen und umgekehrt alle Patienten mit Herzinsuffizienz auf das Vorhandensein eines Diabetes mellitus zu screenen. Dies ist besonders wichtig, da das Vorliegen einer Herzinsuffizienz bei Patienten mit Diabetes häufig eine Anpassung der antidiabetischen Therapie notwendig macht. Insgesamt ist die Umsetzung der leitliniengerechten Therapien zur Reduzierung des kardiovaskulären Risikos in dieser Hochrisikopopulation von entscheidender Bedeutung. Der vorliegende Artikel legt die Besonderheiten bei der Therapie von Patienten mit Herzinsuffizienz und begleitendem Diabetes mellitus dar.

Abstract

Patients with diabetes are at increased risk of developing heart failure, and the presence of both comorbidities is associated with a worse prognosis. Therefore, it is of utmost importance to detect heart failure early in patients with diabetes and, conversely, to screen all patients with heart failure for the presence of diabetes mellitus. This is particularly important because the presence of heart failure in patients with diabetes often requires adjustment of antidiabetic therapy. Overall, implementation of guideline-directed therapies to reduce cardiovascular risk in this high-risk population is critical. This article explains the special features of the therapy of patients with heart failure and concomitant diabetes mellitus.

Was ist wichtig?

  • Patienten mit Diabetes mellitus haben ein 2- bis 5-fach erhöhtes Risiko, eine Herzinsuffizienz zu entwickeln, und das Vorliegen beider Komorbiditäten geht mit einer deutlich schlechteren Prognose einher.

  • Patienten mit bekannter Herzinsuffizienz sollten auf das Vorliegen eines Diabetes mellitus gescreent werden.

  • Um herzinsuffizienzbedingte Endpunkte zu reduzieren, sollten alle Patienten mit Typ-2-Diabetes und einer Herzinsuffizienz mit erhaltener (HFpEF), mäßig reduzierter (HFmrEF), reduzierter (HFrEF) Ejektionsfraktion einen SGLT2-Inhibitor unabhängig vom HbA1c-Wert und der begleitenden glukosesenkenden Medikation im Rahmen der Standard-Herzinsuffizienzmedikation erhalten.

  • Bei Patienten mit Typ-1-Diabetes sind SGLT2-Inhibitoren kontraindiziert.

  • Bei Patienten mit Herzinsuffizienz und Diabetes mellitus ist eine Therapie mit Pioglitazon oder Saxagliptin kontraindiziert.

Schlüsselwörter

Herzinsuffizienz - Diabetes - kardiovaskuläres Risiko

Keywords

cardiovascular risk - heart failure - diabetes


Publication History

Article published online:
31 July 2024

© 2024. Thieme. All rights reserved.

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