April 18, 2016 - CV Risk Prediction & Targets

Question 1

Diabetes and Endothelium

Answer 1

Prematurely ages your endothelium through wear and tear.

Similiar to a non-diabetic that is 15 years senior.

Question 2

Hyperglycemia and Endothelial Damage

Answer 2

1. Accumulation of glycolytic intermediates that lead to altered cell function. This also causes intreased intracellular omsmoles that cause cellular edema and damage
2. Glycation of protein that alter its structure and function
3. Alteration in cell’s reductive capability and is more susceptable to oxidative damage

Question 3

Diabetes and Atherosclerosis

Answer 3

Due to the damage caused by the endothelium, it becomes leaky and permeable. Infammatory cells and junk can make its way in there and cause plaques to form.

Question 4

MI in Diabetics

Answer 4

1/4 will not have any pain symptoms

Twice is likely to present with fulminant heart failure (diabetic cardiomyopathy)

Autonomic symptoms may be altered because of neuropathy

Metabolic abnormalities (if a patient with diabetes comes in with severe hyperglycemia or DKA, you always need to screen for ischemia because this is a known precipitant)

Question 5

Diabetes and Stroke

Answer 5

3-10x more likely

Increases the risk of recurrent strokes, and stroke-related dementia, and stroke-related mortality

Question 6

Recovery From Stroke

Answer 6

Poorer recovery after a stroke due to diabetes and its complications such as concomitant neuropathies, peripheral vascular disease, obesity, osteoarthritis etc.

Having a stroke affects one’s quality of life, but having a stroke for a diabetic even further decreases their quality of life

Screen for depression

Question 7

Diabetes and PVD

Answer 7

Lib ischemia is more common and more severe in individuals with diabetes (2-4x)

Foot-related complications are the most common reason for hospital admission

50% of those who undergo amputation are diabetics

Question 8

Diabetes and Other CV Risk Factors

Answer 8

Hypertension occurs at twice the rate (40%) than in the general population

55% of patients will have dyslipidemia

Diabetes by itself can amplify the risk of CV disease, without any other risk factors, however many other risk factors are also present. It is critically important to manage CV risk factors in order to get the best possible outcome.

Question 9

Chronic Hyperglycemia

Answer 9

Level of glycemic control (or lack therof) is outside of a vascular event.

This is opposed to acute hyperglycemia where the hyperglycemia that occurs at the time of a vascular event such as an MI or stroke.

Question 10

Acute Hyperglycemia

Answer 10

Patients presenting with an acute event have a higher risk of death

1.5x higher in patients with diabetes, and 4x higher than patients without diabetes

This seems counter-intuitive, but it all comes down to relative hyperglycemia

When patients present with high sugar during an acute event, be worried about that

Question 11

HbA1C and CV Risk

Answer 11

Every 1% increase in HbA1C correlates to approximately a 20% increase in risk for a cardiovascular event.

Question 12

Glycemic Targets

Answer 12

Type 1 and newly diagnosed Type 2 the target should be 7%

Longstanding Type 2 diabetes, 7% remains ideal, but duration of the disease and other comorbidities may soften the target