Macrovascular Complications Flashcards
what is caused by macrovascular disease in diabetes?
- early widespread atherosclerosis
- ischemic heart disease
- cerebrovascular disease
- peripheral vascular disease
beginnings of artherosclerosis
- isolated foam cells in wall of the artery
- develops into fatty streaks by the third decade
what about diabetes leads to artherosclerosis?
diabetic dyslipidemia, increased LDL cholesterol
the names of each stage of atherosclerosis (6)
- initial lesion
- fatty streak
- intermediate
- atheroma
- fibroatheroma
- complicated
what does the first 3 stages of atherosclerosis
(- initial lesion, - fatty streak, - intermediate) grow with?
lipid
what does the atheroma stage of atherosclerosis grow with?
smooth muscle
what does the firboatheroma stage of atherosclerosis grow with?
collagen
what does the complicated stage of atherosclerosis grow with?
thrombosis/haematoma
markers for risk factors for coronary artery disease?
- 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
what does macrovascular disease cause
morbidity and mortality
whose mortality is equivalent to someone with diabetes who hasn’t had an MI?
a ‘normal’ person who had an MI
do south asians have a significantly higher risk of CHD for given lipid than white caucasians
- yes
are diabetic men more or less likely to survive an MI?
less
what does macrovascular disease affect multiple vascular structures of?
- arterial beds
are the mechanisms of iscahemic heart disease different with/without diabetes?
they’re similar
- major cuase of morbidity and mortality in diabetes
does cerebrovascular disease (stroke) occur earlier in people with diabetes?
yes
- more widespread too
occlusion is
the blockage/closing of a blood vessel/hollow organ
what does peripheral vascular disease in diabetes lead to to in the feet?
foot problems - diabetic foot (checked regularly by nurses)
what can renal artery stenosis contribute towards?
renal failure
targeted treatment for hyperglycaemia alone has a ___ effect on the heightened risk of cardiovascular disease in diabetes
minor
non-modifiable risk factors for macrovascular disease-
- age
- sex
- birthweight
- FHx/genes
modifiable risk factors for macrovascular disease-
- dyslipidemia
- hypertension
- smoking
- diabetes
what is the primary endpoint in a study?
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).`
is treating lipids beneficial for treating macrovascular disease?
- yes
- endpoint risk reduction of 37%
is multifactorial intervention more effective in reducing mortality for type 2 diabetes?
- yes - significantly reduced cardiovascular events
- macrovascular risk reduced to 60% of what had been previously
how many agents may be required to manage BP in diabetes?
3 or more
what can be given to manage lipids?
statins (single tablet)
metabolic syndrome
- hyperglycaemia
- dyslipidaemia
- hypertension
- central adiposity
(with/without diabetes)
arteries affected in widespread macrovascular disease
- coronary
- cerebral
- peripheral
- renal artery stenosis
