Macrovascular Complications

Question 1

What does macrovascualr disease include?

Answer 1

early widespread atherosclerosis

ischaemic heart disease (IHD)

cerebrovascular disease

peripheral vascular disease

Question 2

What is the association between hyperglycaemia and life expectancy?

Answer 2

associated with significantly lower life expectancy

If you present with diabetes earlier in life, you will have a shorter life expectancy

Women lose the protection of their gender when they have diabetes in atheroma formation; they suffer more than men. Thus, the relative risk in women is much more than men

The metabolic syndrome has been associated with hyperglycaemia.#

Even people without diabetes have a high risk of macrovascular disease BUT diabetics have a sharp high risk increase

Intensive treatment of diabetes greatly reduces the risk of complications in diabetes

Question 3

Describe the link between microvascular disease and morbidity & mortality

Answer 3

MD causes both

IHD is a big cause of mortality in diabetics (much more than the general population)

Malignancy tends to be reduced as a cause of death but this is because many diabetics die before cancer has a chance to manifest

People with diabetes that have NOT had a heart attack have the same mortality as people without diabetes that HAVE had a heart attack

Diabetics that appear well are also likely to have ischaemic heart disease

Framingham risk score – gender-specific algorithm to estimate 10-year cardiovascular event risk

South Asians have a worse mortality for coronary heart disease than white Caucasians

Question 4

How does microvascular disease affect different arterial beds?

Answer 4

Ischaemic heart disease – major cause of morbidity and mortality in diabetes
- The mechanisms are similar with and without diabetes

Cerebrovascular disease – earlier than without diabetes
- More widespread and uncommon in people younger than 60

Peripheral vascular disease – contributes to diabetic foot problems

Renal artery stenosis – may contribute to hypertension in some

Question 5

What is the effects of treatment targeted to hyperglycaemia alone on increased risk of CVD?

Answer 5

minor effect

Question 6

What are risk factors for microvascular disease?

Answer 6

non-modifiable:

• age
• sex
• birth weight
• FH/genes

modifiable:

• dyslipidaemia
• high blood pressure
• smoking
• diabetes

Question 7

What are the treatment goals?

Answer 7

Blood-glucose lowering therapy – via metformin, sulphonylurea, insulin, etc

Blood pressure management – if damage is to kidneys, eyes or cerebrovascular damage, lower considerably (<130/80mmHg) but other targets and lower less (<140/80mmHg). Constant monitoring

Management of blood lipids – review CV risk annually