Statine und erhöhte Inzidenz an Diabetes – Was ist in der Praxis zu beachten?

Statine senken die Inzidenz und Mortalität an Herz-Kreislauf-Erkrankungen erheblich. Außer Nebenwirkungen an den Muskeln wurde in den letzten Jahren auch das Neuauftreten eines Typ-2-Diabetes beschrieben. Sowohl Daten aus Populationsstudien als auch aus Interventionsstudien mit Statinen liefern Hinweise darauf, dass das Diabetesrisiko um 9–48 % steigen könnte, im Vergleich zu Patienten, die keine Statine erhalten haben. Intensiver wirksame Statine wie Atorvastatin und Rosuvastatin sind mehr diabetogen, insbesondere in höheren Dosen. Pravastatin wirkt offenbar nicht diabetesfördernd. Es zeigte sich, dass das Diabetesrisiko insbesondere bei Patienten mit Komponenten des Metabolisch-vaskulären Syndroms (gestörte Nüchternglukose, Adipositas, erhöhter Triglyzeridspiegel, Hypertonie) ansteigt. Deshalb sollten diese Patienten besonders sorgfältig überwacht und zu Lebensstiländerungen angeregt werden. Insgesamt überwiegt aber eindeutig der protektive Effekt der Statine. In der Sekundärprävention sind die Statine ein wesentlicher Bestandteil der erforderlichen intensivierten Therapie.

Statins significantly decrease the incidence and mortality of cardio-vascular diseases. Besides adverse effects at the muscles in the last years the new development of a type 2 diabetes mellitus has been described. Both data from population studies as well as from intervention studies with statins provide evidence that the diabetes risk could increase by 9 to 48 % when comparing with patients who were not given statins. More intensively acting statins like atorvastatin and rosuvastatin appear to be more diabetogenic, especially in higher doses. Evidently pravastatin does not promote the diabetes development. It could be shown that the diabetes risk especially increases in patients with components of the metabolic-vascular syndrome (impaired fasting glucose, obesity, elevated triglyceride levels, hypertension). That is why these patients should be especially thoroughly cared for and should be induced to improve their life style. As a whole the protective effect of statins prevails without any doubt. Within the framework of a secondary prevention statins represent an essential part of the needed intensified therapy.

Key words

statins - non-HDL-cholesterol - LDL-cholesterol - type 2 diabetes mellitus - metabolic-vascular syndrome - cardiovascular diseases - lipoprotein apheresis

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