Macrovascular complications

Question 1

How do macrovascular complications develop?

Answer 1

• Small accumulations of extracellular lipid lead to atheroma –> fibroatheroma
• Could then lead to complicated lesion
• Lesion can ulcerate, exposing fat underneath
• This can either thrombose entirely or send emboli further down circulation
• Progressed to involved smooth muscle: hypertrophy, fibrosis, calcification

Question 2

What are the risk factors for macrovascular complications of DM?

Answer 2

Non-modifiable:

• Sex- female
• Age - older
• Birth weight - low
• FH/genes

Modifiable:

• Insulin resistance
• Higher HbA1c (more poorly controlled)
• Fasting glucose >6 mmol/l
• Dyslipidaemia: HDL <1 (M)/1.3(F)
• Hypertension
• Microalbumin
• Waist circumference >102(M)/88(F)
• Smoking

Question 3

Where is macrovascular disease commonly present?

Answer 3

Multiple arterial beds

Question 4

What are the different types of macrovascular disease?

Answer 4

1. Ischaemic heart disease
2. Cerebrovascular disease
3. Peripheral vascular disease
4. Renal artery stenosis

Question 5

Which complication of diabetes does peripheral vascular disease contribute to?

Answer 5

Diabetic foot

Question 6

Which complication of diabetes does renal artery stenosis contribute to?

Answer 6

Hypertension

Question 7

How does treatment targeted to blood glucose affect risk of CVD in diabetics?

Answer 7

Does not significantly offset increased risk of cardiovascular disease

• but does improve CHD risk
• doesn’t really change mortality

Question 8

How can macrovascular disease be prevented?

Answer 8

• Aggressive management of multiple risk factors
• BP AND cholesterol must be managed
• Stains reduced risk significantly (halved risk of stroke/MI)