Macrovascular Complications

Question 1

what is caused by macrovascular disease in diabetes?

Answer 1

• early widespread atherosclerosis
• ischemic heart disease
• cerebrovascular disease
• peripheral vascular disease

Question 2

beginnings of artherosclerosis

Answer 2

• isolated foam cells in wall of the artery

- develops into fatty streaks by the third decade

Question 3

what about diabetes leads to artherosclerosis?

Answer 3

diabetic dyslipidemia, increased LDL cholesterol

Question 4

the names of each stage of atherosclerosis (6)

Answer 4

• initial lesion
• fatty streak
• intermediate
• atheroma
• fibroatheroma
• complicated

Question 5

what does the first 3 stages of atherosclerosis

(- initial lesion, - fatty streak, - intermediate) grow with?

Answer 5

lipid

Question 6

what does the atheroma stage of atherosclerosis grow with?

Answer 6

smooth muscle

Question 7

what does the firboatheroma stage of atherosclerosis grow with?

Answer 7

collagen

Question 8

what does the complicated stage of atherosclerosis grow with?

Answer 8

thrombosis/haematoma

Question 9

markers for risk factors for coronary artery disease?

Answer 9

• fasting glucose >6mmol/l
• wait circumference >102 for men of >88 for women
• insulin resistance
• inflammation CRP
• Adipocytokines
• urine microalbumin
• hypertension BP>135/80
• HDL Men<1 women<1.3

Question 10

what does macrovascular disease cause

Answer 10

morbidity and mortality

Question 11

whose mortality is equivalent to someone with diabetes who hasn’t had an MI?

Answer 11

a ‘normal’ person who had an MI

Question 12

do south asians have a significantly higher risk of CHD for given lipid than white caucasians

Answer 12

• yes

Question 13

are diabetic men more or less likely to survive an MI?

Answer 13

less

Question 14

what does macrovascular disease affect multiple vascular structures of?

Answer 14

• arterial beds

Question 15

are the mechanisms of iscahemic heart disease different with/without diabetes?

Answer 15

they’re similar

- major cuase of morbidity and mortality in diabetes

Question 16

does cerebrovascular disease (stroke) occur earlier in people with diabetes?

Answer 16

yes

- more widespread too

Question 17

occlusion is

Answer 17

the blockage/closing of a blood vessel/hollow organ

Question 18

what does peripheral vascular disease in diabetes lead to to in the feet?

Answer 18

foot problems - diabetic foot (checked regularly by nurses)

Question 19

what can renal artery stenosis contribute towards?

Answer 19

renal failure

Question 20

targeted treatment for hyperglycaemia alone has a ___ effect on the heightened risk of cardiovascular disease in diabetes

Answer 20

minor

Question 21

non-modifiable risk factors for macrovascular disease-

Answer 21

• age
• sex
• birthweight
• FHx/genes

Question 22

modifiable risk factors for macrovascular disease-

Answer 22

• dyslipidemia
• hypertension
• smoking
• diabetes

Question 23

what is the primary endpoint in a study?

Answer 23

the main result that is measured at the end of a study to see if a given treatment worked (e.g., the number of deaths or the difference in survival between the treatment group and the control group).`

Question 24

is treating lipids beneficial for treating macrovascular disease?

Answer 24

• yes

- endpoint risk reduction of 37%

Question 25

is multifactorial intervention more effective in reducing mortality for type 2 diabetes?

Answer 25

• yes - significantly reduced cardiovascular events

- macrovascular risk reduced to 60% of what had been previously

Question 26

how many agents may be required to manage BP in diabetes?

Answer 26

3 or more

Question 27

what can be given to manage lipids?

Answer 27

statins (single tablet)

Question 28

metabolic syndrome

Answer 28

• hyperglycaemia
• dyslipidaemia
• hypertension
• central adiposity
  (with/without diabetes)

Question 29

arteries affected in widespread macrovascular disease

Answer 29

• coronary
• cerebral
• peripheral
• renal artery stenosis