Interní Med. 2004; 6(4): 189-193

Chronické srdeční selhání a diabetes mellitus

prof. MUDr. Jiří Vítovec CSc1, prof. MUDr. Jindřich ©pinar CSc2
1 I. interní kardioangiologická klinika FN u sv. Anny v Brně
2 II. interní klinika FN u sv. Anny LF MU, Brno

Keywords: diabetes mellitus, heart failure, prognosis, treatment.

Published: December 31, 2004  Show citation

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Vítovec J, ©pinar J. Chronické srdeční selhání a diabetes mellitus. Interní Med. 2004;6(4):189-193.

Diabetes mellitus je jeden z významných rizikových faktorů mnoha kardiovaskulárních onemocnění a jeho přítomnost současně zhorąuje prognózu daného onemocnění. U nemocných se srdečním selháním je výskyt diabetes mellitus 3-4x větąí neľ u nemocných bez srdečního selhání. Vznik srdeční selhání u diabetes mellitus se výrazněji neliąí od ostatní populace a hlavní příčinou je ischemická choroba srdeční. Diabetická kardiomyopatie je pojem, který vyjadřuje vztah mezi diabetes mellitus a onemocněním srdce, není vąak pravděpodobně samostatnou morfologickou jednotkou.

V léčbě srdečního selhání nemocných s diabetes mellitus platí obecné zásady léčby srdečního selhání. Efekt ACE-inhibitorů byl ve větąině studií srovnatelný u diabetiků i nediabetiků, díky vyąąí mortalitě diabetiků vąak absolutní počet zachráněných ľivotů je vyąąí. Efekt betablokátorů je taktéľ srovnatelný. Základem léčby je dobrá kompenzace metabolických parametrů, krevního tlaku, titrace ACE-inhibitorů do doporučených dávek a optimální dávka betablokátoru. Diabetici II. typu se srdečním selháním z důvodů zhorąené resorpce a metabolizmu budou častěji potřebovat inzulin neľ diabetici bez srdečního selhání.

Chronic heart failure and diabetes mellitus

Diabetes mellitus is one of the important risk factors of many cardiovascular diseases and its presence worsens the prognosis of particular disorder. There is 3-4 times greater incidence of diabetes mellitus in patients with heart failure than in those without it. The aetiology of heart failure in a diabetes mellitus doesn-t differ more significantly from the general population and the main reason is ischemic heart disease. Diabetic cardiomyopathy is a term describing the relationship between diabetes mellitus and heart disease, but it is probably not an independent unit.

General principles of heart failure-s treatment are valid for a management of heart failure in patients with diabetes mellitus. The efficacy of ACE inhibitors has been comparable in the majority of studies in diabetics and non-diabetics, but thanks to increased mortality of diabetics the absolute number of saved lives is larger. Also the beta-blockers- efficacy is comparable. The fundamental of treatment is an appropriate compensation of metabolic parameters, blood pressure, ACE inhibitors titration up to recommended doses and an optimal dose of beta-blocker. Patients with type II diabetes with and heart failure will need insulin more often than diabetics without it due to the impaired resorption and metabolism.

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