Download PDF
Dtsch Med Wochenschr 2012; 137(09): 437-441
DOI: 10.1055/s-0031-1298982
Übersicht | Review article
Kardiologie, Endokrinologie
© Georg Thieme Verlag KG Stuttgart · New York

Diabetes und Herzinsuffizienz: eine praxisorientierte, kritische Bestandsaufnahme

Diabetes and heart failure: a practically oriented critical appraisal
M. Halle
1   Zentrum für Prävention und Sportmedizin an der TU München
10   Munich Heart Alliance, München
,
A. K. Gitt
2   Institut für Herzinfarktforschung Ludwigshafen an der Universität Heidelberg
,
M. Hanefeld
3   Zentrum für Klinische Studien, GWT, TU Dresden
,
M. Kellerer
4   Zentrum für Innere Medizin I, Marienhospital Stuttgart
,
N. Marx
5   Department of Internal Medicine I – Cardiology, University of Aachen
,
J. J. Meier
6   Department of Medicine I, St. Josef-Hospital, Ruhr-University Bochum
,
P.-M. Schumm-Draeger
7   Med. Klinik 3, Endokrinologie, Diabetologie und Angiologie, Klinikum München-Bogenhausen
,
P. Bramlage
8   Institut für Pharmakologie und präventive Medizin, Mahlow
,
D. Tschoepe
9   Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen
› Author Affiliations
Further Information

Publication History

13 May 2011

27 October 2011

Publication Date:
21 February 2012 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Patienten mit Typ-2-Diabetes weisen ein erhöhtes Risiko auf, Symptome einer Herzinsuffizienz zu entwickeln. Diese können zusammen mit einer reduzierten (HFREF, systolische Herzinsuffizienz) oder einer erhaltenen (‚preserved‘) linksventrikulären Funktion (HFPEF, diastolische Herzinsuffizienz) auftreten. Die Pathophysiologie beider Entitäten ist unterschiedlich und beinhaltet eine Störung des kardialen Metabolismus und gleichzeitig der koronaren Zirkulation. Obwohl Diabetes und Herzinsuffizienz oft gemeinsam miteinander auftreten, ist das Management dieser Patienten im Hinblick auf den spezifischen Nutzen oder mögliche Risiken einer antidiabetischen Therapie unzureichend untersucht. Aus diesem Grund sollten sowohl aus pathophysiologischer wie auch klinischer Sicht 1) Diabetiker mit Symptomen einer Herzinsuffizienz mit Hilfe von Herzecho und Gewebe-Doppler hinsichtlich der systolischen wie auch diastolischen linksventrikulären Funktion differenziert werden. 2) Die Herzinsuffizienz bei Diabetikern verdient aufgrund ihrer schlechten Prognose und ihrer Interaktionen ein besonderes Maß an Aufmerksamkeit. 3) Eine optimierte Blutzuckersenkung ist in Kombination mit einer Reduktion anderer kardiovaskulärer Risikofaktoren bewiesenermaßen bei systolischer Herzinsuffizienz sinnvoll und vermutlich ebenfalls nützlich beim Vorliegen einer diastolischen Herzinsuffizienz. 4) Antidiabetische Medikamente sollten spezifisch auf beide Entitäten ausgerichtet sein. Es existieren jedoch leider nur wenige prospektive kontrollierte Studien. Daher sollten zukünftige Interventionsstudien besonders auf die Reduktion klinischer Ereignisse und die Verbesserung der Lebenserwartung diabetischer Patienten mit verschiedenen Formen einer Herzinsuffizienz zielen.

Abstract

Patients with type 2 diabetes have an increased risk for developing symptoms of heart failure. These can be accompanied by a reduction of left ventricular ejection fraction (HFREF, systolic heart failure) or by a preserved function (HFPEF, diastolic heart failure). The pathophysiology of both entities is distinct and involves impairment of myocardial metabolism and coronary circulation alike. Although diabetes and heart failure often coincide, the management of these patients particularly with respect to the specific benefits or possible hazards of antidiabetic treatment is vague. Therefore, from a pathophysiological as well as clinical viewpoint, 1) diabetic patients with symptoms of heart failure have to be differentiated regarding systolic as well as diastolic left ventricular function by echocardiography and tissue doppler imaging. 2) Heart failure in diabetic patients needs similar attention due to a prognosis and interactions. 3) Optimized blood glucose lowering in combination with improvement of other cardiovascular risk factors is evident for HFREF and is assumed to be beneficial for HFPEF. 4) Antidiabetic medication has to be specifically adapted for both entities. As prospective, controlled studies are scarce, future interventional studies should specifically focus on clinical outcome in diabetic patients with different entities of heart failure.

Schlüsselwörter

Herzinsuffizienz - Diabetes mellitus - Pathogenese - diabetische Kardiomyopathie - antidiabetische Behandlung

Keywords

heart failure - diabetes mellitus - pathogenesis - diabetic cardiomyopathy - antidiabetic treatment
 

  • Literatur

  • 1 Aguilar D, Chan W, Bozkurt B et al. Metformin use and mortality in ambulatory patients with diabetes and heart failure. Circ Heart Fail 2011; 4: 53-58
    CrossrefPubMedGoogle Scholar
  • 2 Boudina S, Abel ED. Diabetic cardiomyopathy revisited. Circulation 2007; 115: 3213-3223
    CrossrefPubMedGoogle Scholar
  • 3 Boyer JK, Thanigaraj S, Schechtman KB et al. Prevalence of ventricular diastolic dysfunction in asymptomatic, normotensive patients with diabetes mellitus. Am J Cardiol 2004; 93: 870-875
    CrossrefPubMedGoogle Scholar
  • 4 Courreges JP, Vilsboll T, Zdravkovic M et al. Beneficial effects of once-daily liraglutide, a human glucagon-like peptide-1 analogue, on cardiovascular risk biomarkers in patients with Type 2 diabetes. Diabet Med 2008; 25: 1129-1131
    CrossrefPubMedGoogle Scholar
  • 5 Dargie HJ, Hildebrandt PR, Riegger GA et al. A randomized, placebo-controlled trial assessing the effects of rosiglitazone on echocardiographic function and cardiac status in type 2 diabetic patients with New York Heart Association Functional Class I or II Heart Failure. J Am Coll Cardiol 2007; 49: 1696-1704
    CrossrefPubMedGoogle Scholar
  • 6 Dickstein K, Cohen-Solal A, Filippatos G et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the diagnosis and treatment of acute and chronic heart failure 2008 of the European Society of Cardiology. Eur J Heart Fail 2008; 10: 933-989
    CrossrefPubMedGoogle Scholar
  • 7 Edelmann F, Gelbrich G, Düngen HD et al. Exercise training improves exercise capacity, diastolic function and quality of life in patients with mild diastolic heart failure – Results of the Ex-DHF pilot study. J Am Coll Cardiol 2011; 58: 1780-1791
    CrossrefPubMedGoogle Scholar
  • 8 Eurich DT, Majumdar SR, McAlister FA et al. Improved clinical outcomes associated with metformin in patients with diabetes and heart failure. Diabetes Care 2005; 28: 2345-2351
    CrossrefPubMedGoogle Scholar
  • 9 Eurich DT, McAlister FA, Blackburn DF et al. Benefits and harms of antidiabetic agents in patients with diabetes and heart failure: systematic review. BMJ 2007; 335: 497
    CrossrefPubMedGoogle Scholar
  • 10 Fang ZY, Prins JB, Marwick TH. Diabetic cardiomyopathy: evidence, mechanisms, and therapeutic implications. Endocr Rev 2004; 25: 543-567
    CrossrefPubMedGoogle Scholar
  • 11 Fonarow GC, Srikanthan P. Diabetic cardiomyopathy. Endocrinol Metab Clin North Am 2006; 35: 575-599, ix
    CrossrefPubMedGoogle Scholar
  • 12 Frye RL, August P, Brooks MM et al. A randomized trial of therapies for type 2 diabetes and coronary artery disease. N Engl J Med 2009; 360: 2503-2515
    CrossrefPubMedGoogle Scholar
  • 13 Giles TD, Miller AB, Elkayam U et al. Pioglitazone and heart failure: results from a controlled study in patients with type 2 diabetes mellitus and systolic dysfunction. J Card Fail 2008; 14: 445-452
    PubMedGoogle Scholar
  • 14 Gustafsson I, Brendorp B, Seibaek M et al. Influence of diabetes and diabetes-gender interaction on the risk of death in patients hospitalized with congestive heart failure. J Am Coll Cardiol 2004; 43: 771-777
    CrossrefPubMedGoogle Scholar
  • 15 Halbirk M, Norrelund H, Moller N et al. Cardiovascular and metabolic effects of 48-h glucagon-like peptide-1 infusion in compensated chronic patients with heart failure. Am J Physiol Heart Circ Physiol 2010; 298: H1096-1102
    CrossrefPubMedGoogle Scholar
  • 16 Hambrecht R, Fiehn E, Weigl C et al. Regular physical exercise corrects endothelial dysfunction and improves exercise capacity in patients with chronic heart failure. Circulation 1998; 98: 2709-2715
    CrossrefPubMedGoogle Scholar
  • 17 Hanefeld M, Cagatay M, Petrowitsch T et al. Acarbose reduces the risk for myocardial infarction in type 2 diabetic patients: meta-analysis of seven long-term studies. Eur Heart J 2004; 25: 10-16
    CrossrefPubMedGoogle Scholar
  • 18 Hunt SA, Baker DW, Chin MH et al. ACC/AHA Guidelines for the Evaluation and Management of Chronic Heart Failure in the Adult: Executive Summary A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1995 Guidelines for the Evaluation and Management of Heart Failure). Circulation 2001; 104: 2996-3007
    CrossrefPubMedGoogle Scholar
  • 19 Kannel WB, Hjortland M, Castelli WP. Role of diabetes in congestive heart failure: the Framingham study. Am J Cardiol 1974; 34: 29-34
    CrossrefPubMedGoogle Scholar
  • 20 Lago RM, Singh PP, Nesto RW. Congestive heart failure and cardiovascular death in patients with prediabetes and type 2 diabetes given thiazolidinediones: a meta-analysis of randomised clinical trials. Lancet 2007; 370: 1129-1136
    CrossrefPubMedGoogle Scholar
  • 21 Leung AA, Eurich DT, Lamb DA et al. Risk of heart failure in patients with recent-onset type 2 diabetes: population-based cohort study. J Card Fail 2009; 15: 152-157
    CrossrefPubMedGoogle Scholar
  • 22 Masoudi FA, Inzucchi SE, Wang Y et al. Thiazolidinediones, metformin, and outcomes in older patients with diabetes and heart failure: an observational study. Circulation 2005; 111: 583-590
    CrossrefPubMedGoogle Scholar
  • 23 Mayer J. Über den Zusammenhang des Diabetes mellitus mit Erkrankungen des Herzens. Z Klin Med 1881; 14: 212-239
    PubMedGoogle Scholar
  • 24 McAlister FA, Eurich DT, Majumdar SR et al. The risk of heart failure in patients with type 2 diabetes treated with oral agent monotherapy. Eur J Heart Fail 2008; 10: 703-708
    CrossrefPubMedGoogle Scholar
  • 25 Merck. Fachinformation Glucophage. Februar 2007
    PubMedGoogle Scholar
  • 26 Miche E, Herrmann G, Nowak M et al. Effect of an exercise training program on endothelial dysfunction in diabetic and non-diabetic patients with severe chronic heart failure. Clin Res Cardiol 2006; 95: i117-i124
    CrossrefPubMedGoogle Scholar
  • 27 Murcia AM, Hennekens CH, Lamas GA et al. Impact of diabetes on mortality in patients with myocardial infarction and left ventricular dysfunction. Arch Intern Med 2004; 164: 2273-2279
    CrossrefPubMedGoogle Scholar
  • 28 Nikolaidis LA, Mankad S, Sokos GG et al. Effects of glucagon-like peptide-1 in patients with acute myocardial infarction and left ventricular dysfunction after successful reperfusion. Circulation 2004; 109: 962-965
    CrossrefPubMedGoogle Scholar
  • 29 O'Connor CM, Whellan DJ, Lee KL et al. Efficacy and safety of exercise training in patients with chronic heart failure: HF-ACTION randomized controlled trial. JAMA 2009; 301: 1439-1450
    CrossrefPubMedGoogle Scholar
  • 30 Paulus WJ, Tschope C, Sanderson JE et al. How to diagnose diastolic heart failure: a consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the Heart Failure and Echocardiography Associations of the European Society of Cardiology. Eur Heart J 2007;
    PubMedGoogle Scholar
  • 31 Roussel R, Travert F, Pasquet B et al. Metformin use and mortality among patients with diabetes and atherothrombosis. Arch Intern Med 2010; 170: 1892-1899
    CrossrefPubMedGoogle Scholar
  • 32 Rubler S, Dlugash J, Yuceoglu YZ et al. New type of cardiomyopathy associated with diabetic glomerulosclerosis. Am J Cardiol 1972; 30: 595-602
    CrossrefPubMedGoogle Scholar
  • 33 Scuteri A, Najjar SS, Muller DC et al. Metabolic syndrome amplifies the age-associated increases in vascular thickness and stiffness. J Am Coll Cardiol 2004; 43: 1388-1395
    CrossrefPubMedGoogle Scholar
  • 34 Stratmann B, Gawlowski T, Tschoepe D. Diabetic cardiomyopathy--to take a long story serious. Herz 2010; 35: 161-168
    CrossrefPubMedGoogle Scholar
  • 35 UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998; 352: 837-853
    CrossrefPubMedGoogle Scholar
  • 36 Varela-Roman A, Grigorian Shamagian L, Barge Caballero E et al. Influence of diabetes on the survival of patients hospitalized with heart failure: a 12-year study. Eur J Heart Fail 2005; 7: 859-864
    CrossrefPubMedGoogle Scholar
  • 37 Widlansky ME, Gokce N, Keaney Jr JF et al. The clinical implications of endothelial dysfunction. J Am Coll Cardiol 2003; 42: 1149-1160
    CrossrefPubMedGoogle Scholar
  • 38 Wilkinson IB, Franklin SS, Cockcroft JR. Nitric oxide and the regulation of large artery stiffness: from physiology to pharmacology. Hypertension 2004; 44: 112-116
    CrossrefPubMedGoogle Scholar