Nutzen und Risiken oraler Antidiabetika hinsichtlich kardialer Endpunkte

Abstract

The reduction of cardiovascular risk in patients with type 2 diabetes poses a major challenge in internal medicine these days. The present review will focus on the role of glucose lowering therapies in this context and in particular elucidate the effect of oral anti-diabetic drugs on cardiovascular morbidity and mortality.

Kernaussagen

• Patienten mit einem Diabetes mellitus haben ein erhöhtes Risiko für die Entstehung einer koronaren Herzerkrankung mit ihren Folgen einer instabilen Angina pectoris und eines akuten Myokardinfarkts.

• Eine strenge Blutzuckersenkung alleine führt im Zeitraum bis zu 5 Jahren nicht zu einer signifikanten Reduktion kardiovaskulärer Mortalität und Morbidität.

• Metformin reduzierte in der Subgruppe übergewichtiger Patienten in der UKPDS-Studie die Myokardinfarkthäufigkeit.

• Pioglitazon verminderte in der PROactive-Studie bei Patienten mit Diabetes mellitus Typ 2 in der Sekundärprävention den „principal secondary endpoint” von Tod, Infarkt und Schlaganfall.

Ein kombinierter Therapieansatz mit strenger Einstellung der Lipide und des Blutdrucks, der Gabe von Aspirin und der zusätzlichen Applikation von ACE-Hemmern oder AT₁-Rezeptor-Antagonisten können das Risiko makrovaskulärer Ereignisse bei Typ-2-Diabetikern nachhaltig reduzieren.

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