Skip to main content
Erschienen in: Current Hypertension Reports 3/2011

01.06.2011

Stress and Its Role in Sympathetic Nervous System Activation in Hypertension and the Metabolic Syndrome

verfasst von: Elisabeth A. Lambert, Gavin W. Lambert

Erschienen in: Current Hypertension Reports | Ausgabe 3/2011

Einloggen, um Zugang zu erhalten

Abstract

Stress in several guises is evident in individuals with hypertension and in those with the metabolic syndrome and may account, at least in part, for the extent and pattern of sympathetic nervous activation. Importantly, elevated activity of the sympathetic nervous system is related to the development of obesity-related illnesses including hypertension, insulin resistance, and renal, cardiac, and vascular impairment. Notably, evidence of subclinical organ damage is evident even in young, normotensive, overweight persons, thereby reinforcing the need to develop and implement effective early intervention.
Literatur
1.
Zurück zum Zitat Anagnostis P, Athyros VG, Tziomalos K, et al. Clinical review: the pathogenetic role of cortisol in the metabolic syndrome: a hypothesis. J Clin Endocrinol Metab. 2009;94:2692–701.PubMedCrossRef Anagnostis P, Athyros VG, Tziomalos K, et al. Clinical review: the pathogenetic role of cortisol in the metabolic syndrome: a hypothesis. J Clin Endocrinol Metab. 2009;94:2692–701.PubMedCrossRef
2.
Zurück zum Zitat Dimsdale JE. Psychological stress and cardiovascular disease. J Am Coll Cardiol. 2008;51:1237–46.PubMedCrossRef Dimsdale JE. Psychological stress and cardiovascular disease. J Am Coll Cardiol. 2008;51:1237–46.PubMedCrossRef
3.
Zurück zum Zitat Esler M, Eikelis N, Schlaich M, et al. Chronic mental stress is a cause of essential hypertension: presence of biological markers of stress. Clin Exp Pharmacol Physiol. 2008;35:498–502.PubMedCrossRef Esler M, Eikelis N, Schlaich M, et al. Chronic mental stress is a cause of essential hypertension: presence of biological markers of stress. Clin Exp Pharmacol Physiol. 2008;35:498–502.PubMedCrossRef
4.
Zurück zum Zitat Chandola T, Brunner E, Marmot M. Chronic stress at work and the metabolic syndrome: prospective study. BMJ. 2006;332:521–5.PubMedCrossRef Chandola T, Brunner E, Marmot M. Chronic stress at work and the metabolic syndrome: prospective study. BMJ. 2006;332:521–5.PubMedCrossRef
5.
Zurück zum Zitat Esler M, Jennings G, Lambert G. Measurement of overall and cardiac norepinephrine release into plasma during cognitive challenge. Psychoneuroendocrinology. 1989;14:477–81.PubMedCrossRef Esler M, Jennings G, Lambert G. Measurement of overall and cardiac norepinephrine release into plasma during cognitive challenge. Psychoneuroendocrinology. 1989;14:477–81.PubMedCrossRef
6.
Zurück zum Zitat Grassi G, Seravalle G, Dell’Oro R, et al. Adrenergic and reflex abnormalities in obesity-related hypertension. Hypertension. 2000;36:538–42.PubMed Grassi G, Seravalle G, Dell’Oro R, et al. Adrenergic and reflex abnormalities in obesity-related hypertension. Hypertension. 2000;36:538–42.PubMed
7.
Zurück zum Zitat Lambert E, Straznicky N, Eikelis N, et al. Gender differences in sympathetic nervous activity: influence of body mass and blood pressure. J Hypertens. 2007;25:1411–9.PubMedCrossRef Lambert E, Straznicky N, Eikelis N, et al. Gender differences in sympathetic nervous activity: influence of body mass and blood pressure. J Hypertens. 2007;25:1411–9.PubMedCrossRef
8.
Zurück zum Zitat •• Lambert E, Sari CI, Dawood T, et al. Sympathetic nervous system activity is associated with obesity-induced subclinical organ damage in young adults. Hypertension. 2010;56:351–8. This article documents the association between sympathetic nervous activation and preclinical signs of end-organ damage in young, overweight, yet normotensive individuals, thereby highlighting the need for early detection and possible intervention.PubMedCrossRef •• Lambert E, Sari CI, Dawood T, et al. Sympathetic nervous system activity is associated with obesity-induced subclinical organ damage in young adults. Hypertension. 2010;56:351–8. This article documents the association between sympathetic nervous activation and preclinical signs of end-organ damage in young, overweight, yet normotensive individuals, thereby highlighting the need for early detection and possible intervention.PubMedCrossRef
9.
Zurück zum Zitat Rumantir MS, Jennings GL, Lambert GW, et al. The ‘adrenaline hypothesis’ of hypertension revisited: evidence for adrenaline release from the heart of patients with essential hypertension. J Hypertens. 2000;18:717–23.PubMedCrossRef Rumantir MS, Jennings GL, Lambert GW, et al. The ‘adrenaline hypothesis’ of hypertension revisited: evidence for adrenaline release from the heart of patients with essential hypertension. J Hypertens. 2000;18:717–23.PubMedCrossRef
10.
Zurück zum Zitat Micutkova L, Krepsova K, Sabban E, et al. Modulation of catecholamine-synthesizing enzymes in the rat heart by repeated immobilization stress. Ann NY Acad Sci. 2004;1018:424–9.PubMedCrossRef Micutkova L, Krepsova K, Sabban E, et al. Modulation of catecholamine-synthesizing enzymes in the rat heart by repeated immobilization stress. Ann NY Acad Sci. 2004;1018:424–9.PubMedCrossRef
11.
Zurück zum Zitat Wallin BG, Esler M, Dorward P, et al. Simultaneous measurements of cardiac noradrenaline spillover and sympathetic outflow to skeletal muscle in humans. J Physiol. 1992;453:45–58.PubMed Wallin BG, Esler M, Dorward P, et al. Simultaneous measurements of cardiac noradrenaline spillover and sympathetic outflow to skeletal muscle in humans. J Physiol. 1992;453:45–58.PubMed
12.
Zurück zum Zitat Lucini D, Di Fede G, Parati G, Pagani M. Impact of chronic psychosocial stress on autonomic cardiovascular regulation in otherwise healthy subjects. Hypertension. 2005;46:1201–6.PubMedCrossRef Lucini D, Di Fede G, Parati G, Pagani M. Impact of chronic psychosocial stress on autonomic cardiovascular regulation in otherwise healthy subjects. Hypertension. 2005;46:1201–6.PubMedCrossRef
13.
Zurück zum Zitat • Flaa A, Aksnes TA, Kjeldsen SE, et al. Increased sympathetic reactivity may predict insulin resistance: an 18-year follow-up study. Metabolism. 2008;57:1422–7. Sympathetic reactivity was shown to be predictive of subsequent development of insulin resistance. PubMedCrossRef • Flaa A, Aksnes TA, Kjeldsen SE, et al. Increased sympathetic reactivity may predict insulin resistance: an 18-year follow-up study. Metabolism. 2008;57:1422–7. Sympathetic reactivity was shown to be predictive of subsequent development of insulin resistance. PubMedCrossRef
14.
Zurück zum Zitat Marmot MG, Bosma H, Hemingway H, et al. Contribution of job control and other risk factors to social variations in coronary heart disease incidence. Lancet. 1997;350:235–9.PubMedCrossRef Marmot MG, Bosma H, Hemingway H, et al. Contribution of job control and other risk factors to social variations in coronary heart disease incidence. Lancet. 1997;350:235–9.PubMedCrossRef
15.
Zurück zum Zitat Rosengren A, Hawken S, Ounpuu S, et al. Association of psychosocial risk factors with risk of acute myocardial infarction in 11119 cases and 13648 controls from 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364:953–62.PubMedCrossRef Rosengren A, Hawken S, Ounpuu S, et al. Association of psychosocial risk factors with risk of acute myocardial infarction in 11119 cases and 13648 controls from 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364:953–62.PubMedCrossRef
16.
17.
Zurück zum Zitat Vicennati V, Pasqui F, Cavazza C, et al. Stress-related development of obesity and cortisol in women. Obesity (Silver Spring). 2009;17:1678–83.CrossRef Vicennati V, Pasqui F, Cavazza C, et al. Stress-related development of obesity and cortisol in women. Obesity (Silver Spring). 2009;17:1678–83.CrossRef
18.
Zurück zum Zitat Zhang J, Niaura R, Dyer JR, et al. Hostility and urine norepinephrine interact to predict insulin resistance: the VA normative aging study. Psychosom Med. 2006;68:718–26.PubMedCrossRef Zhang J, Niaura R, Dyer JR, et al. Hostility and urine norepinephrine interact to predict insulin resistance: the VA normative aging study. Psychosom Med. 2006;68:718–26.PubMedCrossRef
19.
Zurück zum Zitat Fowler-Brown AG, Bennett GG, Goodman MS, et al. Psychosocial stress and 13-year BMI change among blacks: the Pitt county study. Obesity (Silver Spring). 2009;17:2106–9.CrossRef Fowler-Brown AG, Bennett GG, Goodman MS, et al. Psychosocial stress and 13-year BMI change among blacks: the Pitt county study. Obesity (Silver Spring). 2009;17:2106–9.CrossRef
20.
Zurück zum Zitat Block JP, He Y, Zaslavsky AM, et al. Psychosocial stress and change in weight among US adults. Am J Epidemiol. 2009;170:181–92.PubMedCrossRef Block JP, He Y, Zaslavsky AM, et al. Psychosocial stress and change in weight among US adults. Am J Epidemiol. 2009;170:181–92.PubMedCrossRef
21.
Zurück zum Zitat van Jaarsveld CH, Fidler JA, Steptoe A, et al. Perceived stress and weight gain in adolescence: a longitudinal analysis. Obesity (Silver Spring). 2009;17:2155–61.CrossRef van Jaarsveld CH, Fidler JA, Steptoe A, et al. Perceived stress and weight gain in adolescence: a longitudinal analysis. Obesity (Silver Spring). 2009;17:2155–61.CrossRef
22.
Zurück zum Zitat Zhao G, Ford ES, Dhingra S, et al. Depression and anxiety among US adults: associations with body mass index. Int J Obes (Lond). 2009;33:257–66.CrossRef Zhao G, Ford ES, Dhingra S, et al. Depression and anxiety among US adults: associations with body mass index. Int J Obes (Lond). 2009;33:257–66.CrossRef
23.
Zurück zum Zitat Kopf D, Westphal S, Luley CW, et al. Lipid metabolism and insulin resistance in depressed patients: significance of weight, hypercortisolism, and antidepressant treatment. J Clin Psychopharmacol. 2004;24:527–31.PubMedCrossRef Kopf D, Westphal S, Luley CW, et al. Lipid metabolism and insulin resistance in depressed patients: significance of weight, hypercortisolism, and antidepressant treatment. J Clin Psychopharmacol. 2004;24:527–31.PubMedCrossRef
24.
Zurück zum Zitat Ljung T, Ahlberg AC, Holm G, et al. Treatment of abdominally obese men with a serotonin reuptake inhibitor: a pilot study. J Intern Med. 2001;250:219–24.PubMedCrossRef Ljung T, Ahlberg AC, Holm G, et al. Treatment of abdominally obese men with a serotonin reuptake inhibitor: a pilot study. J Intern Med. 2001;250:219–24.PubMedCrossRef
25.
Zurück zum Zitat Barton DA, Dawood T, Lambert EA, et al. Sympathetic activity in major depressive disorder: identifying those at increased cardiac risk? J Hypertens. 2007;25:2117–24.PubMedCrossRef Barton DA, Dawood T, Lambert EA, et al. Sympathetic activity in major depressive disorder: identifying those at increased cardiac risk? J Hypertens. 2007;25:2117–24.PubMedCrossRef
26.
Zurück zum Zitat Luppino FS, de Wit LM, Bouvy PF, et al. Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies. Arch Gen Psychiatry. 2010;67:220–9.PubMedCrossRef Luppino FS, de Wit LM, Bouvy PF, et al. Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies. Arch Gen Psychiatry. 2010;67:220–9.PubMedCrossRef
27.
Zurück zum Zitat Vogelzangs N, Suthers K, Ferrucci L, et al. Hypercortisolemic depression is associated with the metabolic syndrome in late-life. Psychoneuroendocrinology. 2007;32:151–9.PubMedCrossRef Vogelzangs N, Suthers K, Ferrucci L, et al. Hypercortisolemic depression is associated with the metabolic syndrome in late-life. Psychoneuroendocrinology. 2007;32:151–9.PubMedCrossRef
28.
Zurück zum Zitat Vogelzangs N, Kritchevsky SB, Beekman AT, et al. Depressive symptoms and change in abdominal obesity in older persons. Arch Gen Psychiatry. 2008;65:1386–93.PubMedCrossRef Vogelzangs N, Kritchevsky SB, Beekman AT, et al. Depressive symptoms and change in abdominal obesity in older persons. Arch Gen Psychiatry. 2008;65:1386–93.PubMedCrossRef
29.
Zurück zum Zitat Skilton MR, Moulin P, Terra JL, Bonnet F. Associations between anxiety, depression, and the metabolic syndrome. Biol Psychiatry. 2007;62:1251–7.PubMedCrossRef Skilton MR, Moulin P, Terra JL, Bonnet F. Associations between anxiety, depression, and the metabolic syndrome. Biol Psychiatry. 2007;62:1251–7.PubMedCrossRef
30.
Zurück zum Zitat Lambert GW, Straznicky NE, Lambert EA, et al. Sympathetic nervous activation in obesity and the metabolic syndrome-causes, consequences and therapeutic implications. Pharmacol Ther. 2010;126:159–72.PubMedCrossRef Lambert GW, Straznicky NE, Lambert EA, et al. Sympathetic nervous activation in obesity and the metabolic syndrome-causes, consequences and therapeutic implications. Pharmacol Ther. 2010;126:159–72.PubMedCrossRef
31.
Zurück zum Zitat Kuo LE, Kitlinska JB, Tilan JU, et al. Neuropeptide Y acts directly in the periphery on fat tissue and mediates stress-induced obesity and metabolic syndrome. Nat Med. 2007;13:803–11.PubMedCrossRef Kuo LE, Kitlinska JB, Tilan JU, et al. Neuropeptide Y acts directly in the periphery on fat tissue and mediates stress-induced obesity and metabolic syndrome. Nat Med. 2007;13:803–11.PubMedCrossRef
32.
Zurück zum Zitat Morris MJ, Cox HS, Lambert GW, et al. Region-specific neuropeptide Y overflows at rest and during sympathetic activation in humans. Hypertension. 1997;29:137–43.PubMed Morris MJ, Cox HS, Lambert GW, et al. Region-specific neuropeptide Y overflows at rest and during sympathetic activation in humans. Hypertension. 1997;29:137–43.PubMed
33.
Zurück zum Zitat Grassi G, Seravalle G, Cattaneo BM, et al. Sympathetic activation in obese normotensive subjects. Hypertension. 1995;25:560–3.PubMed Grassi G, Seravalle G, Cattaneo BM, et al. Sympathetic activation in obese normotensive subjects. Hypertension. 1995;25:560–3.PubMed
34.
Zurück zum Zitat Straznicky NE, Lambert EA, Lambert GW, et al. Effects of dietary weight loss on sympathetic activity and cardiac risk factors associated with the metabolic syndrome. J Clin Endocrinol Metab. 2005;90:5998–6005.PubMedCrossRef Straznicky NE, Lambert EA, Lambert GW, et al. Effects of dietary weight loss on sympathetic activity and cardiac risk factors associated with the metabolic syndrome. J Clin Endocrinol Metab. 2005;90:5998–6005.PubMedCrossRef
35.
Zurück zum Zitat Straznicky NE, Eikelis N, Lambert EA, Esler MD. Mediators of sympathetic activation in metabolic syndrome obesity. Curr Hypertens Rep. 2008;10:440–7.PubMedCrossRef Straznicky NE, Eikelis N, Lambert EA, Esler MD. Mediators of sympathetic activation in metabolic syndrome obesity. Curr Hypertens Rep. 2008;10:440–7.PubMedCrossRef
36.
Zurück zum Zitat Lambert E, Straznicky N, Schlaich M, et al. Differing pattern of sympathoexcitation in normal-weight and obesity-related hypertension. Hypertension. 2007;50:862–8.PubMedCrossRef Lambert E, Straznicky N, Schlaich M, et al. Differing pattern of sympathoexcitation in normal-weight and obesity-related hypertension. Hypertension. 2007;50:862–8.PubMedCrossRef
37.
Zurück zum Zitat Alvarez GE, Beske SD, Ballard TP, Davy KP. Sympathetic neural activation in visceral obesity. Circulation. 2002;106:2533–6.PubMedCrossRef Alvarez GE, Beske SD, Ballard TP, Davy KP. Sympathetic neural activation in visceral obesity. Circulation. 2002;106:2533–6.PubMedCrossRef
38.
Zurück zum Zitat Straznicky NE, Grima MT, Eikelis N, et al: The effects of weight loss versus weight loss maintenance on sympathetic nervous system activity and metabolic syndrome components. J Clin Endocrinol Metab 2010 Dec 22 (Epub ahead of print). Straznicky NE, Grima MT, Eikelis N, et al: The effects of weight loss versus weight loss maintenance on sympathetic nervous system activity and metabolic syndrome components. J Clin Endocrinol Metab 2010 Dec 22 (Epub ahead of print).
39.
Zurück zum Zitat Mathieu P, Poirier P, Pibarot P, et al. Visceral obesity: the link among inflammation, hypertension, and cardiovascular disease. Hypertension. 2009;53:577–84.PubMedCrossRef Mathieu P, Poirier P, Pibarot P, et al. Visceral obesity: the link among inflammation, hypertension, and cardiovascular disease. Hypertension. 2009;53:577–84.PubMedCrossRef
40.
Zurück zum Zitat Grassi G. Sympathetic overdrive and cardiovascular risk in the metabolic syndrome. Hypertens Res. 2006;29:839–47.PubMedCrossRef Grassi G. Sympathetic overdrive and cardiovascular risk in the metabolic syndrome. Hypertens Res. 2006;29:839–47.PubMedCrossRef
41.
Zurück zum Zitat Wirtz PH, Ehlert U, Bartschi C, et al. Changes in plasma lipids with psychosocial stress are related to hypertension status and the norepinephrine stress response. Metabolism. 2009;58:30–7.PubMedCrossRef Wirtz PH, Ehlert U, Bartschi C, et al. Changes in plasma lipids with psychosocial stress are related to hypertension status and the norepinephrine stress response. Metabolism. 2009;58:30–7.PubMedCrossRef
42.
Zurück zum Zitat •• Lambert E, Dawood T, Straznicky N, et al. Association between the sympathetic firing pattern and anxiety level in patients with the metabolic syndrome and elevated blood pressure. J Hypertens. 2010;28:543–50. This paper highlights the importance of psychosocial stress in influencing the pattern of sympathetic nerve firing. PubMedCrossRef •• Lambert E, Dawood T, Straznicky N, et al. Association between the sympathetic firing pattern and anxiety level in patients with the metabolic syndrome and elevated blood pressure. J Hypertens. 2010;28:543–50. This paper highlights the importance of psychosocial stress in influencing the pattern of sympathetic nerve firing. PubMedCrossRef
43.
Zurück zum Zitat Lambert E, Hotchkin E, Alvarenga M, et al. Single-unit analysis of sympathetic nervous discharges in patients with panic disorder. J Physiol. 2006;570:637–43.PubMedCrossRef Lambert E, Hotchkin E, Alvarenga M, et al. Single-unit analysis of sympathetic nervous discharges in patients with panic disorder. J Physiol. 2006;570:637–43.PubMedCrossRef
44.
Zurück zum Zitat Lambert E, Dawood T, Schlaich M, et al. Single-unit sympathetic discharge pattern in pathological conditions associated with elevated cardiovascular risk. Clin Exp Pharmacol Physiol. 2008;35:503–7.PubMedCrossRef Lambert E, Dawood T, Schlaich M, et al. Single-unit sympathetic discharge pattern in pathological conditions associated with elevated cardiovascular risk. Clin Exp Pharmacol Physiol. 2008;35:503–7.PubMedCrossRef
45.
Zurück zum Zitat Macefield VG, Rundqvist B, Sverrisdottir YB, et al. Firing properties of single muscle vasoconstrictor neurons in the sympathoexcitation associated with congestive heart failure. Circulation. 1999;100:1708–13.PubMed Macefield VG, Rundqvist B, Sverrisdottir YB, et al. Firing properties of single muscle vasoconstrictor neurons in the sympathoexcitation associated with congestive heart failure. Circulation. 1999;100:1708–13.PubMed
46.
Zurück zum Zitat Shibao C, Gamboa A, Diedrich A, et al. Autonomic contribution to blood pressure and metabolism in obesity. Hypertension. 2007;49:27–33.PubMedCrossRef Shibao C, Gamboa A, Diedrich A, et al. Autonomic contribution to blood pressure and metabolism in obesity. Hypertension. 2007;49:27–33.PubMedCrossRef
47.
Zurück zum Zitat Rumantir MS, Vaz M, Jennings GL, et al. Neural mechanisms in human obesity-related hypertension. J Hypertens. 1999;17:1125–33.PubMedCrossRef Rumantir MS, Vaz M, Jennings GL, et al. Neural mechanisms in human obesity-related hypertension. J Hypertens. 1999;17:1125–33.PubMedCrossRef
48.
Zurück zum Zitat Schlaich MP, Sobotka PA, Krum H, et al. Renal sympathetic-nerve ablation for uncontrolled hypertension. N Engl J Med. 2009;361:932–4.PubMedCrossRef Schlaich MP, Sobotka PA, Krum H, et al. Renal sympathetic-nerve ablation for uncontrolled hypertension. N Engl J Med. 2009;361:932–4.PubMedCrossRef
49.
Zurück zum Zitat Straznicky NE, Lambert EA, Nestel PJ, et al. Sympathetic neural adaptation to hypocaloric diet with or without exercise training in obese metabolic syndrome subjects. Diabetes. 2010;59:71–9.PubMedCrossRef Straznicky NE, Lambert EA, Nestel PJ, et al. Sympathetic neural adaptation to hypocaloric diet with or without exercise training in obese metabolic syndrome subjects. Diabetes. 2010;59:71–9.PubMedCrossRef
Metadaten
Titel
Stress and Its Role in Sympathetic Nervous System Activation in Hypertension and the Metabolic Syndrome
verfasst von
Elisabeth A. Lambert
Gavin W. Lambert
Publikationsdatum
01.06.2011
Verlag
Current Science Inc.
Erschienen in
Current Hypertension Reports / Ausgabe 3/2011
Print ISSN: 1522-6417
Elektronische ISSN: 1534-3111
DOI
https://doi.org/10.1007/s11906-011-0186-y

Weitere Artikel der Ausgabe 3/2011

Current Hypertension Reports 3/2011 Zur Ausgabe

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

„Überwältigende“ Evidenz für Tripeltherapie beim metastasierten Prostata-Ca.

22.05.2024 Prostatakarzinom Nachrichten

Patienten mit metastasiertem hormonsensitivem Prostatakarzinom sollten nicht mehr mit einer alleinigen Androgendeprivationstherapie (ADT) behandelt werden, mahnt ein US-Team nach Sichtung der aktuellen Datenlage. Mit einer Tripeltherapie haben die Betroffenen offenbar die besten Überlebenschancen.

So sicher sind Tattoos: Neue Daten zur Risikobewertung

22.05.2024 Melanom Nachrichten

Das größte medizinische Problem bei Tattoos bleiben allergische Reaktionen. Melanome werden dadurch offensichtlich nicht gefördert, die Farbpigmente könnten aber andere Tumoren begünstigen.

CAR-M-Zellen: Warten auf das große Fressen

22.05.2024 Onkologische Immuntherapie Nachrichten

Auch myeloide Immunzellen lassen sich mit chimären Antigenrezeptoren gegen Tumoren ausstatten. Solche CAR-Fresszell-Therapien werden jetzt für solide Tumoren entwickelt. Künftig soll dieser Prozess nicht mehr ex vivo, sondern per mRNA im Körper der Betroffenen erfolgen.

Frühzeitige HbA1c-Kontrolle macht sich lebenslang bemerkbar

22.05.2024 Typ-2-Diabetes Nachrichten

Menschen mit Typ-2-Diabetes von Anfang an intensiv BZ-senkend zu behandeln, wirkt sich positiv auf Komplikationen und Mortalität aus – und das offenbar lebenslang, wie eine weitere Nachfolgeuntersuchung der UKPD-Studie nahelegt.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.