Der koronarkranke Diabetiker: moderne Therapieansätze und Behandlungspfade

Zusammenfassung

Patienten mit koronarer Herzerkrankung (KHK) und Diabetes mellitus Typ 2 (T2D) weisen ein besonders hohes Risiko für (rezidivierende) kardiovaskuläre Ereignisse (CVE) auf; in der Sekundärprävention wirkt sich eine suffiziente Kontrolle der kardiovaskulären Risikofaktoren prognostisch besonders günstig aus. Für diese Patientengruppe konnte in den letzten Jahren der kardioprotektive Nutzen der SGLT2-Inhibitoren und GLP-1-Rezeptor-Agonisten nachgewiesen werden, sodass diese Substanzgruppen mittlerweile bei der Initiierung einer medikamentösen antidiabetischen Therapie zu bevorzugen sind. Auch lipidmodifizierende Medikamente wie die PCSK9-Inhibitoren oder Icosapent-Ethyl haben sich insbesondere bei Patienten mit KHK und T2D als vorteilhaft erwiesen. Zudem haben sich zuletzt die Empfehlungen zum Management der Koronarrevaskularisation bei Patienten mit stabiler KHK und T2D verändert. So sollte bei Mehrgefäß-KHK und komplexer Koronarmorphologie zwar weiterhin eine chirurgische Koronarrevaskularisation (CABG) bevorzugt empfohlen werden; bei einem niedrigen SYNTAX-Score kann die interventionelle Koronarrevaskularisation jedoch eine gleichwertige Alternative zur CABG darstellen.

Abstract

Patients with coronary artery disease (CAD) and type 2 diabetes mellitus (T2D) face an increased risk of (recurrent) cardiovascular events (CVE). Consequently, sufficient control of all cardiovascular risk factors and lifestyle measures should be aimed for. Recently, cardioprotective benefits of SGLT2 inhibitors and GLP-1 receptor agonists have been demonstrated in these patients. In addition, medications such as PCSK9 inhibitors and icosapent ethyl have also proven to be advantageous. Furthermore, recommendations for the management of coronary revascularization in patients with stable CAD and T2D have recently been updated. Although surgery (CABG) should still be preferred in patients with multivessel CAD and complex coronary morphology, percutaneous coronary intervention represents an alternative to CABG if SYNTAX score is low.

Schlüsselwörter

Koronare Herzerkrankung - Diabetes mellitus Typ 2 - SGLT2-Inhibitoren - GLP-1-Rezeptor-Agonisten

Keywords

coronary artery disease - type 2 diabetes mellitus - SGLT2 inhibitors - GLP-1 receptor agonists

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