CV Risk Prediction

Question 1

general pathophysiology of MI due to hyperglycermia

Answer 1

1. predisposition to hyperglycemia (DM I or II, genetic)
2. oxidative stress rsults in endothelial injury via several mechanisms
3. injured endothelium becomes inflamed, permeable and prone to thrombosis and abnormal angiogenesis
4. Extravasation of oxidized lipid and activated monocytes lead
   smooth muscle cells and expansion of medial layer
   to foam cell formation and accumulation between endothelial and medial layer of the vessel
   • Presence of this inflammatory material leads to migration of

Question 3

in diabetes, which coronary vessels are more affected?

Answer 3

distal and multiple vessels are affected.

Question 4

Why is heart disease different in diabetes?

Answer 4

• Early onset CVD in diabetes; people with diabetes experience CVD events on average 15 years before age and sex matched peers

Question 5

acute vs chronic dysglycemia

Answer 5

chronic dysglycemia; level of glycemic control (or lack thereof) outside of vascular event

acute dysglycemia; hyperglycemia that occurs at the time of a vascular event (MI, Stroke)

Question 7

Glycemic control and CV risk

• Tight glycemic control in type 1 diabetes is
  associated with a 40-60% ___ in all
  cardiovascular events

– Myocardial infarction – Stroke – Cardiovascular related death

Whether tight control in type 2 diabetes offers
the same macrovascular protection is ___

Answer 7

40-60% reduction in cardiovascular events

Whether tight control in type 2 diabetes offers
the same macrovascular protection is unclear

Question 9

Glycemic Targets

• Type 1 and newly diagnosed Type 2- the target
should be__%

Answer 9

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

• Longstanding Type 2- 7% remains the ideal,
but duration of disease and other co-
morbidities may soften the target

Question 10

diabetes therapies that are CVD protective

diabetes therapies that are CVD neutral

Answer 10

protective: SGLT2 inhibitors, GLP-1s, Metformin, and healthy behaviour interventions
neutral: sulfonylureas, DDP-4s, Insulin, Pioglitazone (?)

Question 11

true BP lowering therapies for those with hypertension are better in improving CVD compared to glucose lowering strategies

Answer 11

true initially, but at the 10 year mark, its better to be lowering glucose

Question 12

treatment threshold, and treatment TARGET in terms of blood pressure levels in high risk, diabetes, moderate risk, and low risk groups

Answer 12

Question 13

Hypertension Rx in Diabetes
• Should target a blood pressure of

First line agest include:

Answer 13

<130/80

first lin agents include:

• ace inhibitors
• ARBs
• thiazide diuretics
• calcium channel blockers

Question 14

___ is the main atherogenic particle

• LDL-c ___ is the cornerstone of
dyslipidemia therapies to prevent CVD

• Low __ & high __ seem to contribute to CV
risk, but interventions that target these
particles are not consistently helpful

Answer 14

LDL-c is the main atherogenic particle

• LDL-c lowering is the cornerstone of
dyslipidemia therapies to prevent CVD

• Low HDL & high TGs seem to contribute to CV
risk, but interventions that target these
particles are not consistently helpful

Question 15

first line LDL lowering therpay

Answer 15

statins are first line (HMGCoa inhibitors)

Question 16

Statin therapy should be considered when:

Answer 16

Question 17

All persons with diabetes should be treated to
an LDL-c < ___.00 mmol/L

Answer 17

All persons with diabetes should be treated to
an LDL-c < 2.00 mmol/L

Question 18