Hyperglykämie und kardiovaskuläre Erkrankungen

Zusammenfassung

Neben den klassischen, beeinflussbaren kardiovaskulären Risikofaktoren wie arterielle Hypertonie, Hypercholesterinämie und Zigarettenrauchen werden Glukosestoffwechselstörungen (z. B. Insulinresistenz, pathologische Glukosetoleranz, Diabetes mellitus) in den nächsten Jahren zunehmend an Bedeutung gewinnen. Epidemiologische Untersuchungen zeigen, dass bereits jetzt bei ca. 8 % der Bevölkerung und bei bis zu 60 % der Patienten mit akutem Koronarsyndrom ein manifester Diabetes mellitus oder latente Glukosestoffwechselstörungen bestehen. Durch eine alternde Gesellschaft und die Zunahme des Übergewichtes wird die Prävalenz dieser Störungen in den nächsten Jahren drastisch zunehmen. Erhöhte Glukosewerte schädigen das Endothel unter anderem durch verstärkten oxidativen Stress, chronisch subklinische Entzündung, Expression von Leukozytenadhäsionsmolekülen, Anstieg prothrombogener Faktoren im Blut und eine gesteigerte Aggregation und Adhäsion von Thrombozyten. Die Hinweise, dass eine blutzuckernormalisierende Therapie die Inzidenz kardiovaskulärer Ereignisse vermindert, häufen sich. Bei Patienten mit akutem Myokardinfarkt verbessert die Normalisierung erhöhter Blutglukosewerte durch eine frühe Insulintherapie die Prognose dieser Patienten. Zusammengefasst unterstreichen diese Daten die Notwendigkeit einer frühen Diagnose und Therapie von manifesten und latenten Störungen des Glukosestoffwechsels für die Reduktion prognostisch bedeutsamer kardiovaskulärer Ereignisse.

Summary

Besides classical, modifiable risk factors (hypercholesterolemia, hypertension, smoking) abnormalities of the glucose metabolism (diabetes mellitus, impaired glucose tolerance) are strong emerging cardiovascular risk factors. Epidemiological data indicate that 8 % of the population and up to 60 % of patients with coronary artery disease have abnormalities of glucose metabolism. The prevalence of these abnormalities will increase as the population ages and the mean body weight increases. An abnormal glucose concentration damages the endothelium in several ways: increased oxidative stress, inflammatory processes and an activation of procoagulant factors all impair endothelial function. A blood glucose normalising therapy is thought to decrease the incidence of cardiovascular events in these patients. In patients with an acute myocardial infarction and diabetes mellitus an early intensive insulin therapy improves the outcome of these patients. In summary, the early detection and treatment of abnormalities of glucose metabolism reduces cardiac events.

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