Macrovascular complications (boring ass lecture given by the same boring ass lecturer)

Question 1

What is macrovascular disease?

Answer 1

Early widespread atherosclerosis. We see it mostly in ischaemic heart disease and cerebral vascular disease

Question 2

Describe the progression of an atheroma?

Answer 2

Stage - growth with…

Initial lesion - lipid (this is caused by IR, dyslipidaemia and BP)
Fatty streak - lipid
Intermediate lesion - lipid
Atheroma - smooth muscle (IR)
Fibroatheroma - smooth muscle + collagen
Complicated lesion - thrombosis/haemotoma

Question 3

What is metabolic syndrome?

Answer 3

High fasting glucose
Poor Lipid profile
Waist circumference
Hypertension

Insulin resistance
Inflammation CRP
Adipocytokines
Urine microalbumin

All facets of metabolic syndrome is associated with macrovascular disease

Question 4

Key concept 1 - What is hyperglycemia associated with?

Answer 4

Reduced life expectancy.

Diabetes = increased risk of CV disease

Question 5

What is key concept 2?

Answer 5

Microvascular disease causes morbidity; Macrovascular disease causes morbidity and mortality
Linked to heart disease and heart attacks

Question 6

What is key concept 3?

Answer 6

Macrovascular disease is a systemic disease and is commonly present in multiple arterial beds.

Question 7

Describe ischaemic heart disease

Answer 7

This is a macrovascular disease. The major cause of morbidity and mortality in diabetes. The mechanisms are similar with and without diabetes

Question 8

Describe cerebrovascular disease

Answer 8

This is a macrovascular disease. Predicted far more by age as those with this disease have it earlier without diabetes. More widespread cerebral vascular disease.

Question 9

Describe peripheral vascular disease

Answer 9

Contributes to diabetic foot problems with neuropathy

Question 10

Describe renal stenosis

Answer 10

Less common - may contribute to hypertension and renal failure

Question 11

What is key concept 4?

Answer 11

Treatment targeted to hyperglycaemia alone has minor effect on increased risk of cardiovascular disease. It doesn’t have that much effect on controlling macrovascular disease

Question 12

What is key concept 5?

Answer 12

Prevention of macrovascular disease requires aggressive management of multiple risk factors. Insluin resistance before hyperglycaemia itself contributes

Question 13

What are the risk factors for macrovascular disease?

Answer 13

Non-modifiable

• Age
• Sex
• Birth weight (lighter is better)
• FH/Genes

Modifiable

• Dyslipidaemia (treating lipids works really well in diabetes; use a statin)
• High blood pressure
• Smoking
• Diabetes

For people with diabetes we treat BP, glucose and lipids more aggressively than in the general population

Question 14

What are the complications of diabetes predisposing to foot disease?

Answer 14

Neuropathy; sensory, motor and autonomic

Peripheral vascular disease

Question 15

What is the pathway to foot ulceration?

Answer 15

1. Sensory neuropathy (microvascular disease)
2. Motor neuropathy
3. Limited joint motality
4. Autonomic neuropathy - results in dry feet. Glands are not secreting oils
5. Peripheral vascular disease
6. Trauma - repeated damage to feet because they can’t feel pain or sensory information
7. Reduced resistance to infection
8. Other diabetic complications e.g retinopathy