Herzinsuffizienz und blutzuckersenkende Medikamente

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

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