Endocrinology 19 - Macrovascular Complications

Question 1

List the macrovascular diseases

Answer 1

• Early widespread atherosclerosis
• Ischaemic heart disease
• Cerebrovascular disease (stroke)
• Peripheral vascular disease

Question 2

What is the major cause of morbidity and mortality in diabetes?

Answer 2

• Ischaemic heart disease

- Similar mechanisms with or without diabetes

Question 3

How is cardiovascular disease affected by T2DM?

Answer 3

• Earlier in T2DM patients

- More widespread

Question 4

What is the result of peripheral vascular disease?

Answer 4

Diabetic neuropathy contributions - foot disease

Question 5

What is the result of renal artery stenosis?

Answer 5

Hypertension and renal failure

Question 6

List the rick factors for macrovascular disease

Answer 6

Non-modifiable

• Age
• Sex
• Birth weight
• FH/genes

Modifiable - Metabolic syndrome

• Dyslipidaemia (low HDL <1)
• High BP (higher risk of MI and retinopathy)
• Smoking
• Diabetes (elevated glucose, insulin resistance, inflammation CRP, adipocytokines, microaluminurea)
• Waist circumference (M over 102, F over 88)

Question 7

Describe the development of atheroma

Answer 7

• Within the wall of the artery there are macrophages and foam cells with collection of lipid
• Develops into fatty streaks
• Gradually develops into intracellular accumulation and small extracellular lipid pools
• Atheroma with core of extracellular lipid
• Forms fibroatheroma - surface is fibrous with calcium in it
• Complicated lesion - surface defect, haemorrhage and thrombosis
• Lipids very important

Question 8

How does CHD relate to diabetes?

Answer 8

Higher insulin resistance means greater risk of coronary heart disease

Question 9

What is the main difference between microvascular and macrovascular disease?

Answer 9

Macrovascular disease also causes mortality as well as morbidity

Question 10

How is post MI survival affected by diabetes?

Answer 10

• Decreased

- Diabetes with no previous MI has same survival as non-diabetic who has had previous MI

Question 11

What is the effect of renal artery stenosis?

Answer 11

Decreased kidney function due to low blood flow to the kidney - also increases blood flow

Question 12

How does treatment of hyperglycaemia affect risk of coronary heart disease?

Answer 12

• Has little effect on mortality, although risk of coronary heat disease is decreased
• Cholesterol treatment is most important to reduce events

Question 13

How are macrovascular complications prevented?

Answer 13

• Treatment of BP and lipids (all modifiable risk factors)
• Give statins early (greatly reduces risk of MI and stroke)
• All parts of metabolic syndrome should be assessed
• Also manage glucose (this alone does not address risk)

Question 14

How does hyperglycaemia significantly lower life expectancy?

Answer 14

• Earlier diagnosis = lower expected age of death
• Low insulin resistance means fewer CHD events
• Higher HbA1c indicates greater risk of microvascular complications and MI

Question 15

What is a key concept of macrovascular disease?

Answer 15

• Systemic - multiple arterial beds
• Ischaemic heart disease major cause of morbidity and mortality
• Cerebrovascular disease occurs earlier and more widespread in diabetes
• Peripheral vascular disease results in diabetic foot problems
• Renal artery stenosis contributes to hypertension and renal failure

Question 16

What is metabolic syndrome?

Answer 16

• Dyslipidaemia (low HDL <1)
• High BP (higher risk of MI and retinopathy)
• Diabetes (elevated glucose, insulin resistance, inflammation CRP, adipocytokines, microaluminurea)
• Waist circumference (M over 102, F over 88)