Download PDF
Diabetes aktuell 2024; 22(06): 247-252
DOI: 10.1055/a-2401-3884
Schwerpunkt

Lipidmanagement bei Typ-2-Diabetes mellitus

Strategien zur Risikoreduktion
Julia Brandts
1   Klinik für Innere Medizin I, Universitätsklinikum RWTH Aachen, Deutschland
2   Imperial Centre for Cardiovascular Disease Prevention, Imperial College London School of Public Health, London, United Kingdom of Great Britain and Northern Ireland
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

ZUSAMMENFASSUNG

Patienten mit Typ-2-Diabetes (T2 D) weisen ein doppelt so hohes Risiko für kardiovaskuläre Ereignisse auf wie die Allgemeinbevölkerung, ein Risiko, das teilweise durch Senkung von Apolipoprotein-B100-haltigen Lipoproteinen reduziert werden könnte. Allerdings erreichen wenige die empfohlenen LDL-Cholesterin-Zielwerte aufgrund hoher Ausgangswerte, Therapieunverträglichkeiten und ärztlicher Risikounterschätzung. Der SCORE2-Diabetes bietet eine präzise Risikobewertung, indem er konventionelle und diabetesspezifische Faktoren einbezieht. Behandlungsbasis bilden weiterhin Statine, doch oft sind Kombinationstherapien mit Ezetimib oder Bempedoinsäure nötig. PCSK9-Inhibitoren sind eine effektive Option für Hochrisikopatienten. Durch den strategischen Einsatz dieser Therapieansätze kann das Management von Lipiden bei T2D-Patienten erheblich verbessert und damit das Risiko für kardiovaskuläre Ereignisse reduziert werden.



Publication History

Article published online:
18 October 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • Literatur

  • 1 Brownrigg JR, Hughes CO, Burleigh D. et al Microvascular disease and risk of cardiovascular events among individuals with type 2 diabetes: a population-level cohort study. Lancet Diabetes Endocrinol 2016; 4: 588-597
    CrossrefPubMedSearch in Google Scholar
  • 2 Brandts J, Tittel SR, Bramlage P. et al Low-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol in type 1 diabetes and type 2 diabetes: Lipid goal attainment in a large German-Austrian diabetes registry. Diabetes Obes Metab 2023; 25: 3700-3708
    CrossrefPubMedSearch in Google Scholar
  • 3 Ray KK, Haq I, Bilitou A. et al Cardiovascular risk assessment by physicians and lipid-lowering therapy prescribing in high- and very high-risk patients: Results from the multinational observational santorini study. Atherosclerosis 2022; 355: 249
    CrossrefSearch in Google Scholar
  • 4 Marx N, Federici M, Schütt K. et al 2023 ESC Guidelines for the management of cardiovascular disease in patients with diabetes: Developed by the task force on the management of cardiovascular disease in patients with diabetes of the European Society of Cardiology (ESC). Eur Heart J 2023; 44: 4043-4140
    CrossrefPubMedSearch in Google Scholar
  • 5 SCORE2-Diabetes Working Group and the ESC Cardiovascular Risk Collaboration. SCORE2-Diabetes: 10-year cardiovascular risk estimation in type 2 diabetes in Europe. Eur Heart J 2023; 44: 2544-2556
    CrossrefPubMedSearch in Google Scholar
  • 6 Cholesterol Treatment Trialists’ (CTT) Collaborators, Mihaylova B, Emberson J, Blackwell L. et al The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: meta-analysis of individual data from 27 randomised trials. Lancet 2012; 380: 581-590
    CrossrefPubMedSearch in Google Scholar
  • 7 Ray KK, Reeskamp LF, Laufs U. et al Combination lipid-lowering therapy as first-line strategy in very high-risk patients. Eur Heart J 2022; 43: 830-833
    CrossrefPubMedSearch in Google Scholar
  • 8 Reith C, Baigent C, Blackwell L. et al Cholesterol Treatment Trialists’ Collaboration. Effect of statin therapy on muscle symptoms: an individual participant data meta-analysis of large-scale, randomised, double-blind trials. Lancet 2022; 400: 832-845
    CrossrefPubMedSearch in Google Scholar
  • 9 Sattar N, Preiss D, Murray HM. et al Statins and risk of incident diabetes: a collaborative meta-analysis of randomised statin trials. Lancet 2010; 375: 735-742
    CrossrefPubMedSearch in Google Scholar
  • 10 Preiss D, Seshasai SRK, Welsh P. et al Risk of incident diabetes with intensive-dose compared with moderate-dose statin therapy: a meta-analysis. JAMA 2011; 305: 2556-2564
    CrossrefPubMedSearch in Google Scholar
  • 11 Cannon CP, Blazing MA, Giugliano RP. et al Ezetimibe Added to Statin Therapy after Acute Coronary Syndromes. N Engl J Med 2015; 372: 2387-2397
    CrossrefPubMedSearch in Google Scholar
  • 12 Nissen SE, Lincoff AM, Brennan D. et al Bempedoic acid and cardiovascular outcomes in statin-intolerant patients. N Engl J Med 2023; 388: 1353-1364
    CrossrefPubMedSearch in Google Scholar
  • 13 Ray KK, Nicholls SJ, Li N. et al Efficacy and safety of bempedoic acid among patients with and without diabetes: prespecified analysis of the CLEAR Outcomes randomised trial. Lancet Diabetes Endocrinol 2024; 12: 19-28
    CrossrefPubMedSearch in Google Scholar
  • 14 Ballantyne CM, Laufs U, Ray KK. et al Bempedoic acid plus ezetimibe fixed-dose combination in patients with hypercholesterolemia and high CVD risk treated with maximally tolerated statin therapy. Eur J Prev Cardiol 2020; 27: 593-603
    CrossrefPubMedSearch in Google Scholar
  • 15 Ray KK, Stoekenbroek RM, Kallend D. et al Effect of 1 or 2 Doses of Inclisiran on Low-Density Lipoprotein Cholesterol Levels: One-Year Follow-up of the ORION-1 Randomized Clinical Trial. JAMA Cardiol 2019; 4: 1067-1075
    CrossrefPubMedSearch in Google Scholar
  • 16 Sabatine MS, Giugliano RP, Keech AC. et al FOURIER Steering Committee and Investigators. Evolocumab and Clinical Outcomes in Patients with Cardiovascular Disease. N Engl J Med 2017; 376: 1713-1722
    CrossrefPubMedSearch in Google Scholar
  • 17 Schwartz GG, Steg PG, Szarek M. et al Alirocumab and Cardiovascular Outcomes after Acute Coronary Syndrome. N Engl J Med 2018; 379: 2097-2107
    CrossrefPubMedSearch in Google Scholar