Zusammenfassung
Kinder mit Diabetes mellitus sind in erhöhtem Maße gefährdet, in späteren Jahren Komplikationen einer akzelerierten und generalisierten Atherosklerose zu erleiden. Myokardinfarkt, ischämischer Insult, Nierenversagen und die periphere arterielle Verschlusskrankheit sind als Endpunkte der diabetischen Makroangiopathie zu sehen – deren Wurzeln jedoch in einem über Jahre verlaufenden Umbauprozess der Gefäßwand zu sehen sind. Das heutige Verständnis chronischer Erkrankungen wie Diabetes mellitus sieht nicht nur eine möglichst optimale Therapie des Grundleidens vor, sondern liegt in einem multidisziplinären Ansatz zur Optimierung der Lebensqualität dieser Kinder. Es gilt daher, die kardiovaskulären Risikofaktoren bei diesen Kindern frühzeitig zu diagnostizieren, deren Auswirkungen möglichst zuverlässig darzustellen und entsprechend präventiv tätig zu werden. Zusätzlich zu den klassischen Risikofaktoren wie Übergewicht, Hypertonie, Dyslipidämie und Rauchen wurden in den letzten Jahren zahlreiche mögliche kardiovaskuläre Risikofaktoren untersucht. Daneben wurden nicht invasive Methoden wie die Messung der Intima-Media-Dicke oder die Messung der Endothelfunktion entwickelt, welche auch im Kindesalter den Gefäßstatus zuverlässig abbilden. Diese neue Sicht des kardiovaskulären Risikos hat dazu geführt, dass Kinder mit Diabetes mellitus in die Gruppe chronisch kranker Kinder mit dem höchsten Risiko für atherosklerotische Erkrankungen eingruppiert werden. Die aktuelle Literatur sowie die zu erwartenden kardiovaskulären Aspekte in der Betreuung von Kindern mit Diabetes mellitus werden in dieser Übersicht zusammengefasst. Anhand eigener Daten werden biochemische und bildgebende diagnostische Möglichkeiten zur Abschätzung des kardiovaskulären Risikos des Kindes mit Diabetes mellitus präsentiert. Schließlich geben wir einen Überblick über die aktuellen Therapieempfehlungen, welche zur Optimierung der kardiovaskulären Gesundheit berücksichtigt werden sollten.
Abstract
Children with diabetes mellitus show a markedly increased cardiovascular risk. Coronary artery disease, stroke, renal failure or peripheral vascular disease are among the complications which occur more frequently in diabetic patients and are the consequence of diabetic macroangiopathy. The current guidelines on the management of children with chronic diseases recommend not only to optimize the therapy of the underlying disease, but also to improve the quality of life. Thus, vascular disease should be diagnosed as early as possible to prevent atherosclerotic complications. Beyond the classical atherosclerotic risk factors such as obesity, hypertension, dyslipidemia and tobacco smoking some newer risk factors have been evaluated during the past years. Non invasive diagnostic methods such as the measurement of the intima medial thickening of the arteries or of endothelial function have emerged and have been validated also for children. According to these findings, the recommendations for the management of children with diabetes mellitus have changed. The actual guidelines enclose these children in the group with the highest risk for cardiovascular disease. The actual literature and the cardiovascular aspects of the management of these children are presented. The possibilities using biochemical and imaging diagnostic methods for the cardiovascular risk assessment of the patients are illustrated using also data of our own patient group. We give an overview regarding the actual therapeutic recommendations which should be taken into account in the multidisciplinary approach for the best care for children with diabetes mellitus.
Schlüsselwörter
Diabetes mellitus - Intima-Media-Dicke - Atherosklerose
Key words
diabetes mellitus - intima-medial-thickness - atherosclerosis
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R. Dalla Pozza
Abteilung für Kinderkardiologie und Pädiatrische Intensivmedizin · Klinikum Großhadern · Ludwig-Maximilians-Universität München
Marchioninistr. 15
81377 München
Email: Robert.DallaPozza@med.lmu.de
