There is a high prevalence of type 2 diabetes mellitus in the population over 70 years old in industrial countries. This article provides recommendations for the diagnosis, prevention and treatment targets of older diabetic patients according to the current scientific evidence.

Es besteht eine hohe Prävalenz an Diabetes mellitus Typ 2 bei über 70-Jährigen in industrialisierten Ländern. Dieser Artikel enthält Empfehlungen für Diagnose, Prävention und Therapieziele in der Behandlung des älteren diabetischen Patienten anhand der aktuellen Evidenzlage.

Die Hyperglykämie ist wesentlich an der Entstehung der Folgeerkrankungen bei Menschen mit Diabetes mellitus Typ 2 beteiligt. Während Lebensstilmaßnahmen die Eckpfeiler jeder Diabetestherapie bleiben, benötigen die meisten Menschen mit Typ-2-Diabetes im Verlauf eine medikamentöse Therapie. Bei der Definition individueller Behandlungsziele stellen die Therapiesicherheit, die Effektivität sowie substanzspezifische, organprotektive Effekte der Therapie die wichtigsten Faktoren dar. Diese nationale Leitlinie fasst die Evidenz aus der aktuellen Datenlage für die klinische Praxis zusammen.

Die wechselseitigen Beziehungen von Diabetes mellitus, kardiovaskulärer Erkrankung und Herzinsuffizienz erfordern einen ganzheitlichen Behandlungsansatz. Bei der Erstmanifestation einer kardiovaskulären Erkrankung sollte stets ein aktives Screening auf Diabetes mellitus erfolgen. Umgekehrt muss bei bereits diagnostiziertem Diabetes mellitus die kardiovaskuläre Risikostratifizierung unter Berücksichtigung aller relevanten Risikofaktoren, Biomarker sowie des klinischen Gesamtbildes erfolgen und um ein optimales individuell abgestimmtes Management zu gewährleisten. Ein interdisziplinäres Vorgehen, das diabetologische, kardiologische und weitere Fachkompetenzen integriert, ist unerlässlich, um kardiovaskuläre Komplikationen bei Menschen mit Diabetes frühzeitig zu erkennen und effektiv zu behandeln.

Erectile dysfunction coexists with a spectrum of health issues and is a significant experience in a man’s life. In young men, erectile dysfunction is considered a predictor of silent coronary artery disease, highlighting its potential as a simple and accessible marker. The overall health status of patients with and without erectile dysfunction undergoing an elective coronary angiography is unclear and is addressed in this publication. A total of 700 patients were recruited to this study, of whom 419 male patients were evaluated for health issues related to erectile dysfunction. All participants underwent elective coronary angiography based on clinical indications to assess established or suspected stable coronary artery disease. Particular attention was given to current medication use, medication adherence, health literacy, and health-related quality of life. Erectile dysfunction was present in 43

Hypertension is one of the most important comorbidities of diabetes, significantly contributing to increased mortality and leading to macrovascular and microvascular complications. When assessing the medical priorities for patients with diabetes, treating hypertension should be a primary consideration. In the present review practical approaches to hypertension in diabetes, including individualized targets for preventing specific complications are discussed according to the current evidence and guidelines. Blood pressure values of 120-129/70-79 mm Hg are associated with the best outcome; most importantly, at least blood pressure values < 140/90 mm Hg should be achieved in most patients. Most patients with diabetes require combination therapy to achieve blood pressure goals; agents with clear evidence of cardiovascular risk reduction should be used (including, besides angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, dihydropyridine calcium channel antagonists and thiazide diuretics), preferable in single pill combinations. Once the target is achieved, antihypertensive drugs should be continued. The use of SGLT‑2 inhibitors and GLP‑1 receptor agonists contribute to blood pressure lowering in diabetes. This also holds true für the newly available combined GLP-1/GIP receptor agonist tirzepatide. Since the last release of these guidelines evidence from clinical trials has become available that supports more stringent blood pressure control in diabetes, which is reflected in international guidelines and has also been adopted in these recommendations. The individualization of blood pressure management, however, remains a core recommendation of the Austrian Diabetes Association.

Hyperlipidemia and dyslipidemia make a substantial contribution to cardiovascular morbidity and mortality in people with diabetes mellitus. Pharmacotherapy with statins, ezetimibe, proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors and bempedoic acid has convincingly been shown to reduce the cardiovascular risk of people with diabetes. The present article presents the treatment recommendations of the Austrian Diabetes Association for the use of lipid-lowering drugs in people with diabetes according to current scientific evidence.

Hyperglycemia is substantially involved in the occurrence of complications in people with type 2 diabetes mellitus. While lifestyle interventions remain the cornerstones of diabetes treatment, most people with type 2 diabetes will eventually require pharmacotherapy for improved glycemic management. The definition of individual treatment targets regarding optimal therapeutic efficacy and safety as well as organ-protective effects are the most important factors. These national guidelines summarize the most current evidence-based recommendations for the clinical practice.

Hypertonie ist eine sehr häufige Komorbidität bei Diabetes mellitus, die – wenn unzureichend behandelt – signifikant zur erhöhten Mortalität und zum Auftreten von mikrovaskulären und makrovaskulären Komplikationen beiträgt. Blutdruckzielwerte um 120–129/70–79 mm Hg waren in den Studien mit der besten Prognose assoziiert, wobei die Blutdruckzielwerte je nach Alter und Komorbiditäten individualisiert werden sollten; besonders wichtig ist, dass ein Blutdruck < 140/90 mm Hg erreicht wird. Für die meisten Menschen mit Diabetes ist eine Kombinationstherapie notwendig, wobei Medikamente mit gut evidenzbasierter Reduktion des kardiovaskulären Risikos (neben ACE-Hemmern und Angiotensinrezeptorblockern Dihydropyridin-Calciumantagonisten und Thiaziddiuretika) eingesetzt werden sollten, präferenziell als Kombinationspräparate. Nach Erreichung der Zielwerte muss die antihypertensive Therapie fortgeführt werden, wobei regelmäßige Selbstmessungen des Blutdrucks für die Optimierung der Blutdruckeinstellung sehr hilfreich sind. SGLT-2-Inhibitoren oder GLP-1-Rezeptoragonisten tragen ebenfalls zur Blutdrucksenkung bei Diabetes bei. Dies gilt auch für den seit der letzten Auflage der Leitlinien neu verfügbaren kombinierten GLP-1/GIP-Rezeptoragonisten Tirzepatid. Seit der letzten Auflage der Leitlinien zeigten Interventionsstudien Vorteile einer intensiveren Blutdrucksenkung bei Typ-2-Diabetes, was sich in den aktuellen Leitlinien internationaler Gesellschaften widerspiegelt und auch in die vorliegenden Empfehlungen übernommen wird; die Individualisierung der Blutdrucktherapie bleibt aber eine Kernempfehlung der Österreichischen Diabetes-Gesellschaft.

BACKGROUND:Human epididymis protein 4 (HE4) has emerged as a biomarker linked to fibrosis and cardiovascular disease. However, its prognostic relevance in peripheral artery disease (PAD) remains unclear. We therefore investigated the association of circulating HE4 with long-term outcomes in patients with PAD. METHODS:In this prospective cohort study, 291 patients with symptomatic PAD were enrolled and followed for 10 years. Serum HE4 concentrations were measured by ELISA at baseline. Primary endpoints were all-cause mortality and major adverse cardiovascular events (MACE); secondary endpoints were cardiovascular and non-cardiovascular mortality. RESULTS:During follow-up, 44.7% of patients died and 41.2% experienced MACE. In univariable models, higher HE4 levels were associated with all-cause mortality and MACE. These associations remained significant after adjustment for established cardiovascular risk factors and renal function: HR 1.35 (95% CI 1.14-1.58; p < 0.001) for all-cause mortality and HR 1.24 (95% CI 1.05-1.46; p = 0.010) for MACE per doubling of HE4. In secondary analyses, HE4 was independently associated with both cardiovascular and non-cardiovascular mortality. Addition of HE4 to established risk factors significantly improved risk discrimination and reclassification for all-cause mortality (NRI = 0.412, p < 0.001; IDI = 0.028, p = 0.004), whereas incremental prognostic value for MACE was not statistically significant. CONCLUSION:Circulating HE4 is a robust and independent predictor of long-term mortality and MACE in patients with PAD, with incremental prognostic value for mortality, primarily in terms of risk reclassification.

The interplay between diabetes mellitus, cardiovascular disease and heart failure requires a holistic treatment approach. At the first manifestation of any cardiovascular disease, active screening for diabetes mellitus should always be performed. Conversely, in patients with established diabetes mellitus cardiovascular risk stratification must comprise relevant risk factors, biomarkers and the clinical situation to ensure an optimal individualized management. The integration of diabetological, cardiological and additional specialist expertise is essential to detect cardiovascular complications early in people with diabetes and to treat them effectively.

Hyper- und Dyslipidämie tragen maßgeblich zur kardiovaskulären Morbidität und Mortalität von Menschen mit Diabetes mellitus bei. Überzeugende Daten zeigen, dass eine medikamentöse Therapie mit Statinen, Ezetimib, PCSK9-Hemmern und Bempedoinsäure das kardiovaskuläre Risiko von Menschen mit Diabetes senken kann. Der vorliegende Artikel stellt die Behandlungsvorschläge der Österreichischen Diabetes Gesellschaft zum Einsatz lipidsenkender Medikamente dar.

BACKGROUND AND AIMS:Leucine-rich α-2 glycoprotein 1 (LRG1) is a pro-inflammatory signaling molecule that is highly upregulated in various pathological conditions, including cardiovascular disease. We tested the hypothesis whether LRG1 levels are associated with incident all-cause mortality, vascular mortality, and major adverse cardiovascular events (MACE) in coronary angiography patients. METHODS:A total of 695 patients referred for elective coronary angiography were included in the study. During a 10-year observational period, the incidence of all-cause mortality, vascular mortality, and MACE was recorded. Serum LRG1 levels were measured using an enzyme-linked immunosorbent assay. RESULTS:LRG1 showed highly significant correlations with increased age and C-reactive protein, as well as decreased estimated glomerular filtration rate, left ventricular ejection fraction, and triglycerides. LRG1 was higher in females compared to males and was elevated in patients with significant coronary artery disease (CAD) compared to those without CAD. Prospectively, higher LRG1 levels, analyzed in tertiles, significantly predicted incident all-cause mortality, vascular mortality, and MACE, independent of traditional risk factors. Adjusted hazard ratios [95 % confidence intervals] comparing the highest to the lowest tertile were 2.39 [1.58-3.62]; p < 0.001 for all-cause mortality, 2.05 [1.08-3.92]; p = 0.029 for vascular mortality, and 1.80 [1.19-2.75]; p = 0.006 for MACE. C-statistics and net reclassification improvement analyses demonstrated that LRG1 provided additional predictive value for all-cause mortality, beyond conventional risk factors. CONCLUSIONS:Serum LRG1 is a promising new predictor of all-cause mortality, vascular mortality, and MACE in coronary angiography patients.

Introduction and Objective: The rise of Big Data necessitates artificial intelligence-driven analyses to extract valuable insights, particularly for risk prediction in high-risk patient populations. This observational study applied machine learning (ML) algorithms to predict 5-year overall mortality in heart failure patients with type 2 diabetes mellitus (T2DM) or prediabetes. Methods: A cohort of 290 heart failure patients with T2DM or prediabetes was followed for 5 years, during which 54% of participants died. The dataset comprised 470 variables, e.g. anthropometric, clinical, social, family history, and lifestyle factors. After preprocessing, the data were analyzed using ML techniques implemented in R’s caret package. The dataset was split into training (75%) and test (25%) subsets. Results: Among the ML models tested, the Random Forest algorithm demonstrated the best predictive performance, with a sensitivity of 82%, specificity of 89%, and overall accuracy of 85%. Clinical parameters were the most significant predictors, with the multimorbidity marker Glypican-4, hemoglobin, and glomerular filtration rate identified as the top three contributors. Conclusion: In conclusion, ML-based Big Data analysis holds great potential for predicting mortality risk in pre-/diabetic heart failure patients, paving the way for personalized and timely interventions. Disclosure A. Leiherer: None. A. Muendlein: None. L. Schnetzer: None. S. Mink: None. C. Heinzle: None. E. Brandtner: None. K. Geiger: None. S. Gaenger: None. B. Bermeitinger: None. T. Plattner: None. A. Vonbank: None. A. Mader: None. B. Larcher: None. C.H. Saely: None. P. Fraunberger: None. H. Drexel: None.

Introduction and Objective: The waist circumference-to-body-mass-ratio (W/BMI-Ratio) has attracted interest as a predictor of cardiovascular risk. Its power to predict cardiovascular events in patients with established coronary artery disease (CAD) is not known and is addressed in the present study. Methods: We prospectively recorded cardiovascular events in 1329 patients with angiographically verified coronary artery disease. The mean follow-up time was 8.7±5.5 years. Results: At baseline, the W/BMI-Ratio did not differ significantly between patients with metabolic syndrome (MetS) and those without MetS (3.6±0.4 vs. 3.6±0.3; p=0.243). Prospectively, the W/BMI-Ratio significantly predicted the incidence of cardiovascular events (n=707) both univariately (standardized HR 1.12 [1.03-1.22]; p=0.006) and after adjustment for age, gender, smoking, LDL-C, HDL-C, hypertension and MetS (standardized adjusted HR=1.10 [1.01-1.21]; p=0.023). The MetS univariately predicted cardiovascular events (1.20 [1.04-1.40]; p=0.014), whereas it did not predict cardiovascular events independently in an adjusted model including the W/BMI-Ratio (HR=1.03 [0.87-1.23], p=0.704). Conclusion: We conclude that the W/BMI-Ratio predicts cardiovascular events beyond the MetS. T. Plattner: None. A. Vonbank: None. B. Larcher: None. A. Mader: None. L. Schnetzer: None. M. Neyer: None. J. Vogel: None. P. Elsner: None. A. Leiherer: None. A. Muendlein: None. A. Festa: None. H. Drexel: None. C.H. Saely: None.

BACKGROUND AND AIMS:Despite high global vaccination coverage and widespread statin use, it remains unclear how the interplay of anti-SARS-CoV-2-antibodies and statin treatment (ST) affect inflammation levels in COVID-19. It is further unclear whether the combination of ST and antibody levels affect COVID-19-related mortality risk. METHODS:We conducted a prospective, propensity-score-matched, multicenter-cohort study including 1144 COVID-19 patients hospitalized August 2021-April 2022. Anti-SARS-CoV-2-spike antibodies, interleukin-6, and CRP were measured on hospital admission. The pre-specified primary endpoint was all-cause in-hospital mortality. RESULTS:Median follow-up was 90 days (IQR48-90). In matched patients, mortality risk increased incrementally from the lowest risk group of patients on ST exhibiting high antibody levels to the highest risk group of patients without ST and low antibody levels. The highest risk group also presented with the highest inflammation levels. After adjusting for potential confounders, matched patients not receiving statins with low antibody levels were approximately 7.9 times more likely to die than patients on ST with high antibody levels (aHR 7.922, 95 %CI 2.777-22.605, p < 0.001). CONCLUSION:Hospitalized COVID-19 patients with low antibody levels and lack of statin treatment exhibited the highest mortality risks. The combination of ST and antibodies showed a stronger association with mortality risk than either factor individually.

CKD has been recognized as an independent risk factor for severe disease and death in COVID-19. Given the high variability in humoral responses, their general decrease in strength, quality, and durability with age, and the decline of antibody levels over time, personalized vaccination regimes would ensure optimal protection of patients with CKD. This prospective, multicenter cohort study included 1112 hospitalized COVID-19 patients from five study centers. Anti-SARS-CoV-2-spike antibodies and eGFR were measured on hospital admission. The primary outcome was all-cause in-hospital mortality. Reduced kidney function combined with anti-SARS-CoV-2 spike antibody levels was a stronger predictor of COVID-19 mortality than either parameter separately. After adjusting for potential confounders, patients with an eGFR of 60-89 ml/min, 30-59 ml/min, and < 30 ml/min had 4.5, 8.5, and 8.4 times higher odds of dying if antibody levels were below the Youden index of 182BAU/ml (aOR 4.468, 95%CI 1.599-12.486, p = 0.004; 8.528, 3.190-22.793, p < 0.001; 8.400, 2.571-27.442, p < 0.001). Mortality rates did not differ significantly by renal function in CKD patients with antibody levels > 1200BAU/ml. In patients with impaired kidney function, survival is strongly associated with sufficiently high antibody levels. Additional booster vaccinations should be considered in CKD patients with antibody levels < 1200BAU/ml.

Introduction and Objective: This study aims to investigate the single and joint effects of T2DM and albuminuria on major cardiovascular events (MACE) in patients with established cardiovascular disease (CVD). Methods: We prospectively investigated 854 patients with CVD (743 with coronary artery disease and 111 with peripheral artery disease) over 9.3±4.5 years. Albuminuria was defined as urine albumin/creatinine ratio >30 mg/g Results: MACE occurred more frequently in T2DM patients (n=253) than in non-diabetic subjects (59.7% vs 45.9%, p<0.001) and in patients with albuminuria (n=289) than in those without albuminuria (64.0% vs 42.7%, p<0.001). When both T2DM and albuminuria were considered, 432 subjects had neither T2DM nor albuminuria, 131 had T2DM but not albuminuria, 167 did not have diabetes but had albuminuria, and 124 had both T2DM and albuminuria. Compared to the incidence of MACE among patients with neither T2DM nor albuminuria (40.7%), MACE occurred more frequently in patients with T2DM who did not have albuminuria (49.2%; p=0.041) as well as in non-diabetic patients with albuminuria (59.0%; p<0.001); the incidence of MACE was highest in patients with T2DM and albuminuria (70.7%; p<0.001), in whom it was higher than in those with T2DM but not albuminuria (p<0.001) or those without T2DM but with albuminuria (p=0.001); the incidence of MACE did not differ significantly between non-diabetic patients with albuminuria and T2DM patients who did not have albuminuria (p=0.156). In Cox regression analysis, T2DM (HR 1.43 [1.11-1.85]; p=0.007) and albuminuria (HR 1.91 [1.49-2.45]; p<0.001) proved to be mutually independent predictors of MACE after multivariate adjustment for age, sex, BMI, history of smoking, hypertension, LDL-C and HDL-C. Conclusion: We conclude that T2DM and albuminuria in patients with established CVD are mutually independent predictors of MACE. CVD patients with both Albuminuria and T2DM are at an extremely high risk for MACE. T. Plattner: None. A. Vonbank: None. B. Larcher: None. A. Mader: None. L. Schnetzer: None. M. Neyer: None. J. Vogel: None. P. Elsner: None. A. Leiherer: None. A. Muendlein: None. A. Festa: None. H. Drexel: None. C.H. Saely: None.