Herzinsuffizienz bei Patienten mit Diabetes mellitus

Zusammenfassung

Patienten mit Diabetes haben ein erhöhtes Risiko, eine Herzinsuffizienz zu entwickeln, und das Vorliegen beider Komorbiditäten geht mit einer schlechteren Prognose einher. Daher ist es von größter Bedeutung, eine Herzinsuffizienz bei Patienten mit Diabetes frühzeitig zu erkennen und umgekehrt alle Patienten mit Herzinsuffizienz auf das Vorhandensein eines Diabetes mellitus zu screenen. Dies ist besonders wichtig, da das Vorliegen einer Herzinsuffizienz bei Patienten mit Diabetes häufig eine Anpassung der antidiabetischen Therapie notwendig macht. Insgesamt ist die Umsetzung der leitliniengerechten Therapien zur Reduzierung des kardiovaskulären Risikos in dieser Hochrisikopopulation von entscheidender Bedeutung. Der vorliegende Artikel legt die Besonderheiten bei der Therapie von Patienten mit Herzinsuffizienz und begleitendem Diabetes mellitus dar.

Abstract

Patients with diabetes are at increased risk of developing heart failure, and the presence of both comorbidities is associated with a worse prognosis. Therefore, it is of utmost importance to detect heart failure early in patients with diabetes and, conversely, to screen all patients with heart failure for the presence of diabetes mellitus. This is particularly important because the presence of heart failure in patients with diabetes often requires adjustment of antidiabetic therapy. Overall, implementation of guideline-directed therapies to reduce cardiovascular risk in this high-risk population is critical. This article explains the special features of the therapy of patients with heart failure and concomitant diabetes mellitus.

Was ist wichtig?

• Patienten mit Diabetes mellitus haben ein 2- bis 5-fach erhöhtes Risiko, eine Herzinsuffizienz zu entwickeln, und das Vorliegen beider Komorbiditäten geht mit einer deutlich schlechteren Prognose einher.

• Patienten mit bekannter Herzinsuffizienz sollten auf das Vorliegen eines Diabetes mellitus gescreent werden.

• Um herzinsuffizienzbedingte Endpunkte zu reduzieren, sollten alle Patienten mit Typ-2-Diabetes und einer Herzinsuffizienz mit erhaltener (HFpEF), mäßig reduzierter (HFmrEF), reduzierter (HFrEF) Ejektionsfraktion einen SGLT2-Inhibitor unabhängig vom HbA_1c-Wert und der begleitenden glukosesenkenden Medikation im Rahmen der Standard-Herzinsuffizienzmedikation erhalten.

• Bei Patienten mit Typ-1-Diabetes sind SGLT2-Inhibitoren kontraindiziert.

• Bei Patienten mit Herzinsuffizienz und Diabetes mellitus ist eine Therapie mit Pioglitazon oder Saxagliptin kontraindiziert.

Schlüsselwörter

Herzinsuffizienz - Diabetes - kardiovaskuläres Risiko

Keywords

cardiovascular risk - heart failure - diabetes

Publication History

Article published online:
31 July 2024

• Literatur

• 1 Nichols GA, Hillier TA, Erbey JR. et al. Congestive heart failure in type 2 diabetes: prevalence, incidence, and risk factors. Diabetes Care 2001; 24: 1614-1619 DOI: 10.2337/diacare.24.9.1614. (PMID: 11522708)
• 2 Boonman-de Winter LJ, Rutten FH, Cramer MJ. et al. High prevalence of previously unknown heart failure and left ventricular dysfunction in patients with type 2 diabetes. Diabetologia 2012; 55: 2154-2162 DOI: 10.1007/s00125-012-2579-0.
• 3 Amato L, Paolisso G, Cacciatore F. et al. Congestive heart failure predicts the development of non-insulin-dependent diabetes mellitus in the elderly. The Osservatorio Geriatrico Regione Campania Group. Diabetes Metab 1997; 23: 213-218 (PMID: 9233998)
• 4 Kistorp C, Galatius S, Gustafsson F. et al. Prevalence and characteristics of diabetic patients in a chronic heart failure population. Int J Cardiol 2005; 100: 281-287 DOI: 10.1016/j.ijcard.2004.10.024. (PMID: 15823636)
• 5 Thrainsdottir IS, Aspelund T, Thorgeirsson G. et al. The association between glucose abnormalities and heart failure in the population-based Reykjavik study. Diabetes Care 2005; 28: 612-616
• 6 Yusuf S, Pitt B, Davis CE. et al. Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. N Engl J Med 1991; 325: 293-302 DOI: 10.1056/NEJM199108013250501. (PMID: 2057034)
• 7 McMurray JJ, Ostergren J, Swedberg K. et al. Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function taking angiotensin-converting-enzyme inhibitors: the CHARM-Added trial. Lancet 2003; 362: 767-771 DOI: 10.1016/s0140-6736(03)14283-3. (PMID: 13678869)
• 8 McMurray JJ, Packer M, Desai AS. et al. Angiotensin-neprilysin inhibition versus enalapril in heart failure. N Engl J Med 2014; 371: 993-1004 DOI: 10.1056/NEJMoa1409077. (PMID: 25176015)
• 9 Kristensen SL, Preiss D, Jhund PS. et al. Risk Related to Pre-Diabetes Mellitus and Diabetes Mellitus in Heart Failure With Reduced Ejection Fraction: Insights From Prospective Comparison of ARNI With ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure Trial. Circ Heart Fail 2016; 9: e002560 DOI: 10.1161/CIRCHEARTFAILURE.115.002560. (PMID: 26754626)
• 10 Ahmed A, Rich MW, Fleg JL. et al. Effects of digoxin on morbidity and mortality in diastolic heart failure: the ancillary digitalis investigation group trial. Circulation 2006; 114: 397-403 DOI: 10.1161/CIRCULATIONAHA.106.628347. (PMID: 16864724)
• 11 Dauriz M, Targher G, Temporelli PL. et al. Prognostic Impact of Diabetes and Prediabetes on Survival Outcomes in Patients With Chronic Heart Failure: A Post-Hoc Analysis of the GISSI-HF (Gruppo Italiano per lo Studio della Sopravvivenza nella Insufficienza Cardiaca-Heart Failure) Trial. J Am Heart Assoc 2017; 6: e005156 DOI: 10.1161/JAHA.116.005156. (PMID: 28679559)
• 12 Pfeffer MA, Swedberg K, Granger CB. et al. Effects of candesartan on mortality and morbidity in patients with chronic heart failure: the CHARM-Overall programme. Lancet 2003; 362: 759-766 DOI: 10.1016/s0140-6736(03)14282-1. (PMID: 28255009)
• 13 Dauriz M, Targher G, Laroche C. et al. Association Between Diabetes and 1-Year Adverse Clinical Outcomes in a Multinational Cohort of Ambulatory Patients With Chronic Heart Failure: Results From the ESC-HFA Heart Failure Long-Term Registry. Diabetes Care 2017; 40: 671-678 DOI: 10.2337/dc16-2016. (PMID: 28255009)
• 14 Cavender MA, Steg PG, Smith jr SC. et al. Impact of Diabetes Mellitus on Hospitalization for Heart Failure, Cardiovascular Events, and Death: Outcomes at 4 Years From the Reduction of Atherothrombosis for Continued Health (REACH) Registry. Circulation 2015; 132: 923-931 DOI: 10.1161/CIRCULATIONAHA.114.014796. (PMID: 26152709)
• 15 Johansson I, Dahlström U, Edner M. et al. Prognostic Implications of Type 2 Diabetes Mellitus in Ischemic and Nonischemic Heart Failure. J Am Coll Cardiol 2016; 68: 1404-1416 DOI: 10.1016/j.jacc.2016.06.061. (PMID: 27659462)
• 16 Kristensen SL, Mogensen UM, Jhund PS. et al. Clinical and Echocardiographic Characteristics and Cardiovascular Outcomes According to Diabetes Status in Patients With Heart Failure and Preserved Ejection Fraction: A Report From the I-Preserve Trial (Irbesartan in Heart Failure With Preserved Ejection Fraction). Circulation 2017; 135: 724-735 DOI: 10.1161/CIRCULATIONAHA.116.024593. (PMID: 28052977)
• 17 MacDonald MR, Petrie MC, Varyani F. et al. Impact of diabetes on outcomes in patients with low and preserved ejection fraction heart failure: an analysis of the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) programme. Eur Heart J 2008; 29: 1377-1385 DOI: 10.1093/eurheartj/ehn153. (PMID: 18413309)
• 18 Yusuf S, Pfeffer MA, Swedberg K. et al. Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction: the CHARM-Preserved Trial. Lancet 2003; 362: 777-781 DOI: 10.1016/s0140-6736(03)14285-7. (PMID: 13678871)
• 19 Kristensen SL, Jhund PS, Lee MMY. et al. Prevalence of Prediabetes and Undiagnosed Diabetes in Patients with HFpEF and HFrEF and Associated Clinical Outcomes. Cardiovasc Drugs Ther 2017; 31: 545-549 DOI: 10.1007/s10557-017-6754-x. (PMID: 28948430)
• 20 Mentz RJ, Kelly JP, von Lueder TG. et al. Noncardiac comorbidities in heart failure with reduced versus preserved ejection fraction. J Am Coll Cardiol 2014; 64: 2281-2293 DOI: 10.1016/j.jacc.2014.08.036. (PMID: 25456761)
• 21 Marx N, Federici M, Schütt K. et al. 2023 ESC Guidelines for the management of cardiovascular disease in patients with diabetes. Eur Heart J 2023; 44: 4043-4140 DOI: 10.1093/eurheartj/ehad192. (PMID: 37622663)
• 22 McDonagh TA, Metra M, Adamo M. et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2021; 42: 3599-3726 DOI: 10.1093/eurheartj/ehab368. (PMID: 34447992)
• 23 Anker SD, Butler J, Filippatos G. et al. Empagliflozin in Heart Failure with a Preserved Ejection Fraction. N Engl J Med 2021; 385: 1451-1461 DOI: 10.1056/NEJMoa2107038. (PMID: 34449189)
• 24 Solomon SD, McMurray JJV, Claggett B. et al. Dapagliflozin in Heart Failure with Mildly Reduced or Preserved Ejection Fraction. N Engl J Med 2022; 387: 1089-1098 DOI: 10.1056/NEJMoa2206286. (PMID: 36027570)
• 25 Vaduganathan M, Docherty KF, Claggett BL. et al. SGLT-2 inhibitors in patients with heart failure: a comprehensive meta-analysis of five randomised controlled trials. Lancet 2022; 400: 757-767 DOI: 10.1016/S0140-6736(22)01429-5. (PMID: 36041474)
• 26 McDonagh TA, Metra M, Adamo M. et al. 2023 Focused Update of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2023; 44: 3627-3639 DOI: 10.1093/eurheartj/ehad195. (PMID: 37622666)
• 27 CONSENSUS Trial Study, Group. Effects of enalapril on mortality in severe congestive heart failure. Results of the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS). N Engl J Med 1987; 316: 1429-1435 DOI: 10.1056/NEJM198706043162301. (PMID: 2883575)
• 28 Garg R, Yusuf S. Overview of randomized trials of angiotensin-converting enzyme inhibitors on mortality and morbidity in patients with heart failure. Collaborative Group on ACE Inhibitor Trials. JAMA 1995; 273: 1450-1456 (PMID: 7654275)
• 29 Gustafsson I, Torp-Pedersen C, Køber L. et al. Effect of the angiotensin-converting enzyme inhibitor trandolapril on mortality and morbidity in diabetic patients with left ventricular dysfunction after acute myocardial infarction. Trace Study Group. J Am Coll Cardiol 1999; 34: 83-89 DOI: 10.1016/s0735-1097(99)00146-1. (PMID: 10399995)
• 30 Moyé LA, Pfeffer MA, Wun CC. et al. Uniformity of captopril benefit in the SAVE Study: subgroup analysis. Survival and Ventricular Enlargement Study. Eur Heart J 1994; 15 (Suppl. B): 2-8 DOI: 10.1093/eurheartj/15.suppl_b.2. (PMID: 8076658)
• 31 Shekelle PG, Rich MW, Morton SC. et al. Efficacy of angiotensin-converting enzyme inhibitors and beta-blockers in the management of left ventricular systolic dysfunction according to race, gender, and diabetic status: a meta-analysis of major clinical trials. J Am Coll Cardiol 2003; 41: 1529-1538 DOI: 10.1016/s0735-1097(03)00262-6. (PMID: 12742294)
• 32 Seferovic JP, Claggett B, Seidelmann SB. et al. Effect of sacubitril/valsartan versus enalapril on glycaemic control in patients with heart failure and diabetes: a post-hoc analysis from the PARADIGM-HF trial. Lancet Diabetes Endocrinol 2017; 5: 333-340 DOI: 10.1016/s2213-8587(17)30087-6. (PMID: 28330649)
• 33 The Cardiac Insufficiency Bisoprolol Study II (CIBIS-II): a randomised trial. Lancet [Anonym]. 1999; 353: 9-13
• 34 Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (MERIT-HF). Lancet [Anonym]. 1999; 353: 2001-2007
• 35 Packer M, Coats AJ, Fowler MB. et al. Effect of carvedilol on survival in severe chronic heart failure. N Engl J Med 2001; 344: 1651-1658 DOI: 10.1056/NEJM200105313442201. (PMID: 11386263)
• 36 Packer M, Bristow MR, Cohn JN. et al. The effect of carvedilol on morbidity and mortality in patients with chronic heart failure. U.S. Carvedilol Heart Failure Study Group. N Engl J Med 1996; 334: 1349-1355 DOI: 10.1056/NEJM199605233342101. (PMID: 8614419)
• 37 Bobbio M, Ferrua S, Opasich C. et al. Survival and hospitalization in heart failure patients with or without diabetes treated with beta-blockers. J Card Fail 2003; 9: 192-202 DOI: 10.1054/jcaf.2003.31. (PMID: 13680555)
• 38 Deedwania PC, Giles TD, Klibaner M. et al. Efficacy, safety and tolerability of metoprolol CR/XL in patients with diabetes and chronic heart failure: experiences from MERIT-HF. Am Heart J 2005; 149: 159-167 DOI: 10.1016/j.ahj.2004.05.056. (PMID: 15660048)
• 39 Erdmann E, Lechat P, Verkenne P. et al. Results from post-hoc analyses of the CIBIS II trial: effect of bisoprolol in high-risk patient groups with chronic heart failure. Eur J Heart Fail 2001; 3: 469-479 DOI: 10.1016/s1388-9842(01)00174-x. (PMID: 11511434)
• 40 Packer M, Fowler MB, Roecker EB. et al. Carvedilol Prospective Randomized Cumulative Survival (COPERNICUS) Study Group. Effect of carvedilol on the morbidity of patients with severe chronic heart failure: results of the carvedilol prospective randomized cumulative survival (COPERNICUS) study. Circulation 2002; 106: 2194-2199 DOI: 10.1161/01.cir.0000035653.72855.bf. (PMID: 12390947)
• 41 Hirst JA, Farmer AJ, Feakins BG. et al. Quantifying the effects of diuretics and β-adrenoceptor blockers on glycaemic control in diabetes mellitus – a systematic review and meta-analysis. Br J Clin Pharmacol 2015; 79: 733-743 DOI: 10.1111/bcp.12543. (PMID: 25377481)
• 42 Pitt B, Zannad F, Remme WJ. et al. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators. N Engl J Med 1999; 341: 709-717 DOI: 10.1056/NEJM199909023411001. (PMID: 10471456)
• 43 Zannad F, McMurray JJ, Krum H. et al. Eplerenone in patients with systolic heart failure and mild symptoms. N Engl J Med 2011; 364: 11-21 DOI: 10.1056/NEJMoa1009492. (PMID: 21073363)
• 44 McMurray JJV, Solomon SD, Inzucchi SE. et al. Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction. N Engl J Med 2019; 381: 1995-2008 DOI: 10.1056/NEJMoa1911303. (PMID: 31535829)
• 45 Docherty KF, Jhund PS, Bengtsson O. et al. Effect of Dapagliflozin in DAPA-HF According to Background Glucose-Lowering Therapy. Diabetes Care 2020; 43: 2878-2881 DOI: 10.2337/dc20-1402. (PMID: 33082245)
• 46 Packer M, Anker SD, Butler J. et al. Cardiovascular and Renal Outcomes with Empagliflozin in Heart Failure. N Engl J Med 2020; 383: 1413-1424 DOI: 10.1056/NEJMoa2022190. (PMID: 32865377)
• 47 Anker SD, Butler J, Filippatos G. et al. Effect of Empagliflozin on Cardiovascular and Renal Outcomes in Patients With Heart Failure by Baseline Diabetes Status: Results From the EMPEROR-Reduced Trial. Circulation 2021; 143: 337-349 DOI: 10.1161/CIRCULATIONAHA.120.051824. (PMID: 33175585)
• 48 Zannad F, Ferreira JP, Pocock SJ. et al. SGLT2 inhibitors in patients with heart failure with reduced ejection fraction: a meta-analysis of the EMPEROR-Reduced and DAPA-HF trials. Lancet 2020; 396: 819-829 DOI: 10.1016/s0140-6736(20)31824-9. (PMID: 32877652)
• 49 Pitt B, Filippatos G, Agarwal R. et al. Cardiovascular Events with Finerenone in Kidney Disease and Type 2 Diabetes. N Engl J Med 2021; 385: 2252-2263 DOI: 10.1056/NEJMoa2110956. (PMID: 34449181)
• 50 Bakris GL, Agarwal R, Anker SD. et al. Effect of Finerenone on Chronic Kidney Disease Outcomes in Type 2 Diabetes. N Engl J Med 2020; 383: 2219-2229 DOI: 10.1056/NEJMoa2025845. (PMID: 33264825)
• 51 Agarwal R, Filippatos G, Pitt B. et al. Cardiovascular and kidney outcomes with finerenone in patients with type 2 diabetes and chronic kidney disease: the FIDELITY pooled analysis. Eur Heart J 2022; 43: 474-484 DOI: 10.1093/eurheartj/ehab777. (PMID: 35023547)
• 52 Rossing P, Anker SD, Filippatos G. et al. Finerenone in Patients With Chronic Kidney Disease and Type 2 Diabetes by Sodium-Glucose Cotransporter 2 Inhibitor Treatment: The FIDELITY Analysis. Diabetes Care 2022; 45: 2991-2998 DOI: 10.2337/dc22-0294. (PMID: 35972218)
• 53 Filippatos G, Anker SD, Böhm M. et al. A randomized controlled study of finerenone vs. eplerenone in patients with worsening chronic heart failure and diabetes mellitus and/or chronic kidney disease. Eur Heart J 2016; 37: 2105-2114 DOI: 10.1093/eurheartj/ehw132. (PMID: 27206819)
• 54 Basal Insulin and Cardiovascular and Other Outcomes in Dysglycemia. N Engl J Med [Anonym]. 2012; 367: 319-328 DOI: 10.1056/NEJMoa1203858.
• 55 Marso SP, McGuire DK, Zinman B. et al. Efficacy and Safety of Degludec versus Glargine in Type 2 Diabetes. N Engl J Med 2017; 377: 723-732 DOI: 10.1056/NEJMoa1615692. (PMID: 28605603)
• 56 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 DOI: 10.1161/CIRCHEARTFAILURE.110.952556. (PMID: 20952583)
• 57 McGuire DK, Alexander JH, Johansen OE. et al. Linagliptin Effects on Heart Failure and Related Outcomes in Individuals With Type 2 Diabetes Mellitus at High Cardiovascular and Renal Risk in CARMELINA. Circulation 2019; 139: 351-361 DOI: 10.1161/CIRCULATIONAHA.118.038352. (PMID: 30586723)
• 58 Rosenstock J, Kahn SE, Johansen OE. et al. Effect of Linagliptin vs Glimepiride on Major Adverse Cardiovascular Outcomes in Patients With Type 2 Diabetes: The CAROLINA Randomized Clinical Trial. JAMA 2019; 322: 1155-1166 DOI: 10.1001/jama.2019.13772.
• 59 Dormandy JA, Charbonnel B, Eckland DJ. et al. Secondary prevention of macrovascular events in patients with type 2 diabetes in the PROactive Study (PROspective pioglitAzone Clinical Trial In macroVascular Events): a randomised controlled trial. Lancet 2005; 366: 1279-1289
• 60 Scirica BM, Bhatt DL, Braunwald E. et al. Saxagliptin and cardiovascular outcomes in patients with type 2 diabetes mellitus. N Engl J Med 2013; 369: 1317-1326 DOI: 10.1056/NEJMoa1307684.
• 61 Scirica BM, Braunwald E, Raz I. et al. Heart failure, saxagliptin, and diabetes mellitus: observations from the SAVOR-TIMI 53 randomized trial. Circulation 2014; 130: 1579-1588 DOI: 10.1161/circulationaha.114.010389.
• 62 Green JB, Bethel MA, Armstrong PW. et al. Effect of Sitagliptin on Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med 2015; 373: 232-242 DOI: 10.1056/NEJMoa1501352. (PMID: 26052984)
• 63 McGuire DK, Van de Werf F, Armstrong PW. et al. Association Between Sitagliptin Use and Heart Failure Hospitalization and Related Outcomes in Type 2 Diabetes Mellitus: Secondary Analysis of a Randomized Clinical Trial. JAMA Cardiol 2016; 1: 126-135 DOI: 10.1001/jamacardio.2016.0103.
• 64 White WB, Cannon CP, Heller SR. et al. Alogliptin after acute coronary syndrome in patients with type 2 diabetes. N Engl J Med 2013; 369: 1327-1335 DOI: 10.1056/NEJMoa1305889.
• 65 Sattar N, Lee MMY, Kristensen SL. et al. Cardiovascular, mortality, and kidney outcomes with GLP-1 receptor agonists in patients with type 2 diabetes: a systematic review and meta-analysis of randomised trials. Lancet Diabetes Endocrinol 2021; 9: 653-662 DOI: 10.1016/s2213-8587(21)00203-5.