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Aktuelle Kardiologie 2020; 9(04): 340-345
DOI: 10.1055/a-1223-1699
Kurzübersicht

Neue Antidiabetika

New Antidiabetic Drugs
Victoria Johnson
1   Klinik für Kardiologie und Angiologie, Universitätsklinikum Gießen
,
Christoph Maack
2   Deutsches Zentrum für Herzinsuffizienz, Universitätsklinikum Würzburg
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Zusammenfassung

Diabetes steigert das Risiko für Herz-Kreislauf-Erkrankungen und hat eine zunehmende Prävalenz. Die Therapie des Diabetes stellte bisher ein Dilemma dar, da viele Therapien zwar den Blutzucker, aber nicht kardiovaskuläre Ereignisse reduzierten. Erst Glukagon-like Peptid-1-Rezeptor-Agonisten (GLP1) und Natrium/Glukose-Cotransporter-2(SGLT2)-Inhibitoren senkten deutlich kardiovaskuläre Endpunkte, und SGLT2-Inhibitoren beugten darüber hinaus der Entwicklung einer Herzinsuffizienz vor. Die Glukosesenkung an sich ist daher nicht entscheidend für den Schutz vor Herz-Kreislauf-Erkrankungen. Die neuen Leitlinien der Europäischen Gesellschaft für Kardiologie stellen daher bei Patienten mit Diabetes und hohem kardiovaskulären Risiko die Verwendung von GLP1-Rezeptor-Agonisten und SGLT2-Inhibitoren der Behandlung mit Metformin voran. Die neuen Studiendaten eröffnen zudem neue metabolische Ansatzpunkte für die Behandlung von Herz-Kreislauf-Erkrankungen auch unabhängig vom Vorliegen eines Diabetes.

Abstract

Diabetes increases the risk for cardiovascular diseases and rises in prevalence. The treatment of diabetes has so far been a therapeutic dilemma, since most treatments reduced blood glucose, but not cardiovascular events. In recent trials, glucagon-like peptide 1 (GLP1) receptor agonists or sodium/glucose-cotransporter 2 (SGLT2) inhibitors reduced cardiovascular endpoints, and SGLT2-inhibitors also prevented the development of heart failure. Therefore, lowering blood glucose per se is not sufficient to optimize cardiovascular risk. The recent Guidelines of the European Society of Cardiology suggest to treat patients with diabetes and a high cardiovascular risk with either GLP1-receptor agonists or SGLT2-inhibitors before the initiation of metformin, which remains treatment of first choice for patients at low or moderate cardiovascular risk. Furthermore, metabolic treatments may improve the prognosis of cardiovascular patients independent of the presence of diabetes.

Was ist wichtig?

  • GLP1-Rezeptor-Agonisten und SGLT2-Inhibitoren sind die einzigen Antidiabetika, die kardiovaskuläre Endpunkte reduzieren.

  • SGLT2-Inhibitoren beugen zusätzlich der Entwicklung einer Herzinsuffizienz vor.

  • SGLT2-Inhibitoren verbessern die Prognose bei Herzinsuffizienz auch unabhängig vom Vorliegen eines Diabetes.

  • In den neuen Europäischen Leitlinien werden daher GLP1-Rezeptor-Agonisten und SGLT2-Inhibitoren der Therapie mit Metformin bei Patienten mit Diabetes und hohem Risiko vorangestellt.

Schlüsselwörter

Diabetes mellitus Typ 2 - kardiovaskuläres Risiko - Herzinsuffizienz - SGLT2-Inhibitoren - GLP1-Rezeptor-Agonisten

Key words

cardiovascular risk - SGLT2-inhibitors - GLP1-receptor agonists - heart failure - type 2 diabetes


Publication History

Article published online:
14 August 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Stuttgart · New York

 

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