Medikamentöse Therapie von Fettstoffwechselstörungen bei Patienten mit Typ-2-Diabetes

Diabetes ist meist mit einem deutlich erhöhten kardiovaskulären Risiko assoziiert. Atherogene Lipoproteine, wie z. B. LDL (Low Density Lipoprotein), sind ein kausaler Risikofaktor, und ihre Senkung mittels einer Erhöhung der hepatischen LDL-Rezeptoren durch Statine, Ezetimib und/oder PCSK-9-Antikörper ist mit einer Reduktion kardiovaskulärer Komplikationen assoziiert.

Kernaussagen

• Patienten mit Diabetes mellitus sind per se in aller Regel kardiovaskuläre Hochrisikopatienten.

• Eine risikobasierte, zielwertorientierte frühzeitige, effektive, gut verträgliche und sichere LDL-C senkende Therapiestrategie ist integraler Bestandteil einer leitlinienorientierten Diabetestherapie.

• Ziel ist – je nach Risiko – eine Senkung des LDL-C < 70 mg/dl (1,8 mmol/L) bzw. < 100 mg/dl (2,6 mmol/L) und eine mindestens 50 %ige Senkung vom Ausgangswert.

• Therapie der ersten Wahl ist eine Behandlung mit Statinen, dann Kombination mit Ezetimib.

• Bei vorbestehender kardiovaskulärer Erkrankung und klinischem Anhalt für extrem erhöhtes Risiko und einem LDL-Cholesterin, das trotz LDL senkender Kombinationstherapie noch deutlich vom Zielwert entfernt ist, sollte eine zusätzliche Behandlung mit einem PCSK9-Antikörper erwogen werden, wobei die Indikation durch einen Internisten mit Schwerpunkweiterbildung (z. B. Kardiologie, Angiologie, Nephrologie, Endokrinologie/Diabetologie) oder spezielle Lipid-Ambulanzen gestellt werden muss.

• Zur Senkung der Triglyzeride stehen therapeutische Lebensstilmaßnahmen und eine Optimierung der diabetischen Stoffwechsellage im Vordergrund.

• Literatur

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