Diabetes mellitus Typ 2 und koronare Herzkrankheit

Zusammenfassung

Diabetes mellitus zählt zu den Hauptrisikofaktoren für die Entstehung der koronaren Herzkrankheit, welche bei Diabetikern akzeleriert verläuft und mit einer schlechten Prognose assoziiert ist. Wenngleich bei stabiler koronarer Herzkrankheit durch eine Revaskularisierung mittels Bypass-Operation oder interventionelle Stentimplantation eine schnelle Beschwerdefreiheit erzielt werden kann, so hat dies keinen wesentlichen Einfluss auf die Prognose. Lediglich bei Patienten mit Haupstammstenose oder hochgradiger Stenose des proximalen Ramus interventricularis anterior konnte die Prognose günstig beeinflusst werden. Durch eine multifaktorielle Intervention, die neben Diät, Blutzucker- und Blutdruckeinstellung auch regelmäßiges körperliches Training beinhaltet, kommt es zu einer Verbesserung der modifizierbaren Risikofaktoren und einer Steigerung der beschwerde- und ischämiefreien Belastbarkeit, so dass die multifaktorielle Intervention eine alternative Therapiestrategie darstellt.

Summary

Diabetes mellitus is a major risk factor for coronary artery disease and is associated with accelerated disease progression and adverse prognosis. Although relief of symptoms can quickly be obtained by percutaneous intervention or bypass surgery, it does not change patients’ prognoses, with the exception of stenoses of the left main stem or left anterior descending artery. A multifactorial intervention, which consists of a low-fat diet, glucose and arterial blood pressure control, smoking cessation and regular physical exercise, emerges as an alternative strategy since it leads to improvement of the modifiable risk factors, exercise tolerance and quality of life.

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