Subscribe to RSS
DOI: 10.1055/s-2006-956284
© Georg Thieme Verlag KG Stuttgart · New York
Erfolge der Lipidsenkung bei Patienten mit Diabetes mellitus
Favorable effects of decreasing lipids in patients with diabetes mellitusPublication History
eingereicht: 22.2.2006
akzeptiert: 6.7.2006
Publication Date:
30 November 2006 (online)
![](https://www.thieme-connect.de/media/dmw/2006S8/lookinside/thumbnails/10.1055-s-2006-956284-1.jpg)
Zusammenfassung
Patienten mit Diabetes mellitus gelten als Hochrisikopatienten für kardiovaskuläre Ereignisse. Nur wenige Studien mit Lipidsenkern haben gezielt Diabetiker untersucht, so dass meist nur Subgruppenanalysen aus den großen Interventionsstudien vorliegen. Diabetiker profitieren von einer Therapie mit Statinen, unabhängig vom Ausgangswert des LDL-Cholesterins. Neue Daten sprechen dafür, dass möglichst niedrige LDL-Zielwerte angestrebt werden sollen. Die Lipidsenkung mit Fibraten ist in Bezug auf eine Verbesserung von Endpunkten (Morbidität, Mortalität) nicht in demselben Maße gesichert wie bei den Statinen. Deshalb kann für Fibrate bei Diabetikern keine allgemeine Empfehlung ausgesprochen werden.
Summary
Patients with diabetes mellitus are patients at high risk for cardiovascular events. There is only limited number of studies examining the effects of lipid lowering specifically in diabetics. The majority of evidence is derived from subgroup analyses of large intervention trials. Patients with diabetes mellitus benefit from a therapy with statins, independently from the starting LDL cholesterol concentrations. Furthermore, recent studies strongly suggest that for high risk patients such as diabetics regarding LDL „the lower is the better” The data for the benefits of fibrate therapy is not as robust as those available for statins. Therefore, at present no specific recommendation for treatment of diabetics with fibrates can be made.
Literatur
- 1 Amos A F, McCarty D J, Zimmet P. The rising global burden of diabetes and its complications: estimates and projections to the year 2010. Diabet Med. 1997; (suppl 5) 14 S1-S85
- 2 Haffner S M, Lehto K, Ronnemaa T, Pyorala K, Laakso M. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med. 1998; 339 229-234
- 3 UK Prospective Diabetes Study (UKPDS) Group . Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes. Lancet. 1998; 352 837-853
- 4 Heart Protection Study Collaborative Group . MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20.536 high-risk individuals. Lancet. 2002; 360 7-22
- 5 Collins R, Armitage J, Parish S, Sleigh P, Peto R. MRC/BHF Heart Protection Study of cholesterol-lowering with simvastatin in 5963 people with diabetes. Lancet. 2003; 361 2005-2016
- 6 Colhoun H M, Betteridge D J, Durrington P N. et al . Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS): multicentre randomized placebo-controlled trial. Lancet. 2004; 364 685-696
- 7 LaRosa J C, Grundy S M, Waters D D. et al . Intensive lipid lowering with atorvastatin in patients with stable coronary disease. N Engl J Med. 2005; 352 1425-1435
- 8 Cannon C P, Braunwald E, McCabe C H. et al . Intensive versus moderate lipid lowering with statins after acute coronary syndromes. N Engl J Med. 2004; 350 1495-1504
- 9 Wiviott S D, Cannon C P, Morrow D A, Ray K K, Pfeffer M A, Braunwald E. Can low-density lipoprotein be too low? The safety and efficacy of achieving very low low-density lipoprotein with intensive statin therapy. J Am Coll Cardiol. 2005; 46 1411-1416
- 10 The FIELD study investigators . Effects of long-term fenofibrate therapy on cardiovascular events in 9795 people with type 2 diabetes mellitus (the FIELD study): randomised controlled trial. Lancet. 2005; 366 1849-1861
Priv.-Doz. Dr. I. Gouni-Berthold
Klinik II und Poliklinik für Innere Medizin der Universität zu Köln
Joseph-Stelzmann-Straße 9
50924 Köln
Phone: 0221/4784088
Fax: 0221/4784179
Email: ioanna.berthold@uni-koeln.de