Macrovascular complications of diabetes

Question 1

What are the 4 macrovascular diabetes diseases?

Answer 1

Early widespread atherosclerosis

Ischaemic heart disease

Cerebrovascular disease

Peripheral vascular disease

Renal artery stenosis

Question 2

What is hyperglycaemia associated with?

Answer 2

Significantly reduced life expectancy

Question 3

Define macrovascular disease

Answer 3

Systemic disease of multiple arterial beds

Question 4

What is required to prevent/remedy macrovascular disease?

Answer 4

Aggressive management of all modifiable risk factors.

Question 5

Is glucose management alone enough to curtail vascular risk?

Answer 5

No

Question 6

How is cardiovascular mortality in diabetics different?

Answer 6

It’s elevated

Question 7

What can be measured to detect the progression of an atheroma?

Answer 7

Calcium on a CT

Question 8

How are atheromas and atherosclerosis related?

Answer 8

Atheromas cause atherosclerosis (Systemic arterial plaque build up)

Question 9

Describe the progression of atheromas

Answer 9

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

Question 10

How can you differntiate differnt parts of the progression of an atheroma?

Answer 10

Question 11

What are the 4 modifiable risk factors associated with ischaemic heart disease?

Answer 11

Fasting glucose of greater than 6mmol/l

Waist circumference men>102, women>88

HDL Men<1 and Women<1.3

Hypertension >135/80

Question 12

What are the research tools that can be employed to learn about management/risk of ischaemic disease/macrovascular disease in general?

Answer 12

Insulin resistance

Inflammation c-reative protein

Adipocytokines

Urine microalbumin

Question 13

What is a marker of insulin resistance?

Answer 13

Area under the curve insulin

The more insulin resistant you are the shorter the lifespan

Question 14

What is a key concept regarding macro and microvascular disease?

Answer 14

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

Question 15

Why does the risk of CVD seem to have a greater increase in women than men?

Answer 15

During fertile years women are protected from atheroma but with diabetes this protective effect is removed and benefit is lost.

Question 16

How is cause of death different for normal population and T2DM patients?

Answer 16

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.

Question 17

Describe the relationship between HBA1C and macrovascular disease

Question 18

What is the major cause of morbidity and mortality in diabetics?

Answer 18

IHD

The mechanisms are similair with or without diabetes

Question 19

How does the mortality of a diabetic compare to normal population?

Answer 19

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

Question 20

How can ethnicity play a role in all this?

Answer 20

For a given cholesterol, south asians have an increased risk of coronary heart disease mortality.

Question 21

How does cerebrovascular disease in diabetes compare to normal?

Answer 21

Earlier onset

More widespread

Question 22

What problem does peripheral vascular disease contribute to?

Answer 22

Diabetic foot problems with neuropathy

Question 23

What can renal artety stenosis contribute to?

Answer 23

Hypertension and renal failure

Question 24

What is a key concept regarding the treatment of macrovascular disease?

Answer 24

Treatement targetting just hyperglycaemia has a minor effect on increased risk of cardiovascular disease.

Did not change mortality

Does improve coronary heart disease risk

Question 25

What does prevention of macrovascular disease require?

Answer 25

Aggressive management of multiple risk factors

Insulin resistance contributes before hyperglycaemia.

Question 26

What are the modifiable and non-modifiable risk factors?

Answer 26

Non-modifiable: Age, sex, birth weight, FH/genes

Modifiable: smoking, diabetes, hypertension, dyslipidaemia

Question 27

What is the Framingham risk score?

Answer 27

Gender specific algorithm to estimate 10 year CVD risk of an individual

Taking a statin had a great reduction in macrovascular disease risk