Macrovascular complications of diabetes Flashcards
What are the 4 macrovascular diabetes diseases?
Early widespread atherosclerosis
Ischaemic heart disease
Cerebrovascular disease
Peripheral vascular disease
Renal artery stenosis
What is hyperglycaemia associated with?
Significantly reduced life expectancy
Define macrovascular disease
Systemic disease of multiple arterial beds
What is required to prevent/remedy macrovascular disease?
Aggressive management of all modifiable risk factors.
Is glucose management alone enough to curtail vascular risk?
No
How is cardiovascular mortality in diabetics different?
It’s elevated
What can be measured to detect the progression of an atheroma?
Calcium on a CT
How are atheromas and atherosclerosis related?
Atheromas cause atherosclerosis (Systemic arterial plaque build up)
Describe the progression of atheromas
Initial lesion - histologically normal, macrophage infiltration, isolated foam cells
Fatty streak - Mainly intracellular lipid accumulation
Intermediate lesion - intracellular lipid accumulation, small extracellular lipid pools
Atheroma - Intracellular lipid accumulation, core of extracellular fat
Fibroatheroma - Single/multiple lipid cores, fibrotic/calcific layers
Complicated lesion - surface defect, haematoma-haemorrhage, thrombosis
How can you differntiate differnt parts of the progression of an atheroma?
What are the 4 modifiable risk factors associated with ischaemic heart disease?
Fasting glucose of greater than 6mmol/l
Waist circumference men>102, women>88
HDL Men<1 and Women<1.3
Hypertension >135/80
What are the research tools that can be employed to learn about management/risk of ischaemic disease/macrovascular disease in general?
Insulin resistance
Inflammation c-reative protein
Adipocytokines
Urine microalbumin
What is a marker of insulin resistance?
Area under the curve insulin
The more insulin resistant you are the shorter the lifespan
What is a key concept regarding macro and microvascular disease?
Microvascular disease causes morbidity whereas, macrovascular disease causes both morbidity and mortality.
Also microvascular disease is more specific to diabetes and sugar control unlike macrovascular disease.
People without diabetes have relatively no risk to microvascular disease
Why does the risk of CVD seem to have a greater increase in women than men?
During fertile years women are protected from atheroma but with diabetes this protective effect is removed and benefit is lost.
How is cause of death different for normal population and T2DM patients?
Increased IHD death
Increased CVD death
Reduction in cancer however, this is not thought to be causative simply that diabetics dont get the opportunity to get cancer beacuse of the reduced life expectancy etc.
Describe the relationship between HBA1C and macrovascular disease
What is the major cause of morbidity and mortality in diabetics?
IHD
The mechanisms are similair with or without diabetes
How does the mortality of a diabetic compare to normal population?
Same mortality as someone who has already had a heart attack
Once you have one heart attack you are more likely to have the second
How can ethnicity play a role in all this?
For a given cholesterol, south asians have an increased risk of coronary heart disease mortality.
How does cerebrovascular disease in diabetes compare to normal?
Earlier onset
More widespread
What problem does peripheral vascular disease contribute to?
Diabetic foot problems with neuropathy
What can renal artety stenosis contribute to?
Hypertension and renal failure
What is a key concept regarding the treatment of macrovascular disease?
Treatement targetting just hyperglycaemia has a minor effect on increased risk of cardiovascular disease.
Did not change mortality
Does improve coronary heart disease risk
What does prevention of macrovascular disease require?
Aggressive management of multiple risk factors
Insulin resistance contributes before hyperglycaemia.
What are the modifiable and non-modifiable risk factors?
Non-modifiable: Age, sex, birth weight, FH/genes
Modifiable: smoking, diabetes, hypertension, dyslipidaemia
What is the Framingham risk score?
Gender specific algorithm to estimate 10 year CVD risk of an individual
Taking a statin had a great reduction in macrovascular disease risk
