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Häufigkeit der Störungen des Glukosestoffwechsels bei Patienten mit koronarer Herzkrankheit

Impaired glucose metabolism in patients with ischaemic heart disease

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Summary

Patients with ischaemic heart disease commonly have an impaired glucose tolerance. On the 2004 congress of the ESC, the 75-75-rule was announced, indicating that 75% of all diabetics die of cardiovascular complications, and that 75% of all patients with myocardial infarction have diabetes or an (often undiagnosed) impaired glucose tolerance. Data of our “Esslinger Koronarregister” confirm that diabetics and in particular women with diabetes have a higher mortality both after STEMI and NSTEMI. During acute myocardial infarction, a higher blood glucose level strongly correlates with increased mortality. This increased blood glucose level on the one hand is due to preexisting diabetes mellitus or metabolic syndrome, but on the other hand may be a marker of larger myocardial damage with excess katecholamine release. Recent data indicate that intensive glucose control results in a reduction of cardiovascular risk, e. g. the risk of sudden cardiac death. The data presented show that an early intervention in preclinical diabetics aiming at normalization of blood glucose control is necessary in order to reduce cardiovascular mortality.

Zusammenfassung

Patienten mit KHK weisen häufig eine gestörte Glukosetoleranz auf. In diesem Zusammenhang wurde auf dem ESC-Kongress 2004 die 75-75-Regel formuliert, die besagt, dass 75% aller Diabetiker an Herz-Kreislauf-Komplikationen sterben und 75% aller Herzinfarktpatienten Diabetiker sind oder eine meist unentdeckte gestörte Glukosetoleranz haben. Eigene Registerdaten („Das Esslinger Koronarregister“) bestätigen, dass Diabetiker und insbesondere Frauen mit Diabetes mellitus sowohl beim STEMI als auch insbesondere beim NSTEMI eine deutlich erhöhte Mortalität aufweisen. Beim akuten Myokardinfarkt korreliert ein erhöhter Blutzuckerwert eng mit einer erhöhten Mortalität. Dieser erhöhte Blutzuckerwert ist einerseits als Ausdruck eines Diabetes mellitus oder metabolischen Syndroms, andererseits als Folge einer verstärkten myokardialen Schädigung mit Katecholaminexzess zu sehen. Neuere Daten weisen darauf hin, dass eine verbesserte Glukosekontrolle mit einer Reduktion des kardiovaskulären Risikos, z. B. der Inzidenz des plötzlichen Herztods, einhergeht. Aus den vorgestellten Daten wird deutlich, dass schon bei prädiabetischen Stadien eine frühzeitige Intervention mit dem Ziel einer Normoglykämie notwendig ist, um die kardiovaskuläre Sterblichkeit zu senken.

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Authors and Affiliations

  1. Chefarzt der Klinik für Kardiologie, Pneumologie und Angiologie, Ärztlicher Direktor, Städtische Kliniken Esslingen, Hirschlandstr. 97, 73730, Esslingen, Germany

    M. Leschke, B. Schwenk, C. Bollinger & M. Faehling

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  1. M. Leschke
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  2. B. Schwenk
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  3. C. Bollinger
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  4. M. Faehling
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Correspondence to M. Leschke.

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Leschke, M., Schwenk, B., Bollinger, C. et al. Häufigkeit der Störungen des Glukosestoffwechsels bei Patienten mit koronarer Herzkrankheit. Clin Res Cardiol 95 (Suppl 1), i98–i102 (2006). https://doi.org/10.1007/s00392-006-1118-8

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  • DOI: https://doi.org/10.1007/s00392-006-1118-8

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