18. Macrovascular complications Flashcards
What is the difference between macrovascular disease in diabetes and people without diabetes?
• The same
• Only difference is:
- the extent to which it occurs in all-vascular beds
- how much earlier it occurs
What are the different types of macrovascular diseases?
- Early widespread atherosclerosis
- Ischaemic heart disease
- Cerebrovascular disease
- Renal artery stenosis (causes hypertension and renal failure)
- Peripheral vascular disease
What is associated with atheroma and damaged arteries?
- Low HDL
- Fasting glucose >6.0mmol/l
- Hypertension
- High waist circumference
- Insulin resistance, inflammation, urine microalbumin
What are the stages of an atheroma formation and how is this related to insulin resistance?
Smooth muscle hypertrophy is associated with insulin resistance • Initial lesion • Fatty streak • Intermediate • Atheroma • Fibroatheroma • Complicated => thrombosis
What proportion of diabetic patients will die from an MI and stroke?
- 60% MI
* 25% stroke (younger age than general pop.)
How does the risk of an MI in diabetic patient compare to the general population?
- In the general pop, if you have an MI, you are more likely to have another and morbidity increases
- With diabetes, if you haven’t had an MI, you still have the same increased risk
How does the CHD mortality rate compare in South Asians and White Caucasians?
South Asians at a higher risk
How does peripheral vascular disease contribute to other problems from diabetes?
- Worsens neuropathy
* Contributes to diabetic foot problems
How effective are treatments just targeting hyperglycaemia in the prevention of macrovascular diseases?
- Minor effect on increased risk of CV disease
- Treating with insulin does improve lipids and slightly reduce the risk of CAD
- On their own, treatments tackling sugar don’t affect mortality
How effective are giving statins and antihypertensive drugs early on in diabetes in reducing the risk of a heart attack or stroke?
- Very significant reduction of risk with both
* Demonstrates importance of considering a multi-factorial risk reduction
What is canakinumab?
- New drug
- Reduces inflammation, without affecting lipids
- Monoclonal antibody that targets interleukin-1-beta
- Results in reduced HbA1c, and a lower risk of recurrent CV events
- However, causes risk of infection due to interference with antibodies
What proportion of NHS bed occupancy is due to foot disease?
- 10% due to diabete-related problems
* 50% of these are foot related
How much bigger is the risk of amputation in a diabetic patient?
60x bigger
What is the pathway to foot ulceration?
1) Sensory neuropathy
2) Motor neuropathy - for weight balance
3) Limited joint mobility
4) Autonomic neuropathy
5) Peripheral vascular disease
6) Trauma - repeated minor/discrete episodes
7) Reduced resistance to infection (athlete’s foot)
8) Other diabetic complications e.g. retinopathy - patients stub their feet when walking
What is angiopathy?
- Extensive atheroma blocking arteries
* Prevents blood from reaching the feet properly
