Macrovascular complications of diabetes Flashcards
What are the macro-vascular complications of diabetes?
Early widespread atherosclerosis
Ischaemic heart disease
Cerebrovascular disease
Peripheral vascular disease
What is different about macro-vascular complications in those with diabetes?
Occurs more widespread and earlier in diabetes
What are the features of the stages of macro-vascular disease (atherosclerosis)?
Isolated foam cells first develop causing fatty streaks within arteries
Intermediate lesion where there is intra-cellular lipid
Atheroma: Inta-cellular lipid accumulation and core of extra cellular lipid
Fibroatheroma
Complicated lesion
What are the stages of macro-vascular disease (atherosclerosis)?
Initial lesion Fatty Streak Intermediate Atheroma Fibroatheroma Complicated
What are the mechanisms for each stage of macro-vascular disease (arthersclerosis)?
Initial lesion - Macrophage Fatty Streak - Intracellular lipid Intermediate - extra-cellular lipid Atheroma - core of extra cellular lipid Fibroatheroma - fibrotic/calcific layers Complicated - surface defect/thrombosis
What are the markers of diabetes?
Hypertensions Fasting Glucose Waist Circumference Insulin resistance Inflammation CRP Adipocytokines Urine Microalbumin HDL
What is the relationship between insulin and cardiovascular risk?
Insulin resistance with increased insulin in associated with increased risk of cardiovascular event
What is the difference between the general population and those with diabetes and death from IHD?
General population 30% will die of IHD
Over 50% in those with diabetes
T2D 3x age adjusted mortality
What are the key factors relating to macro-vascular complications?
Hyperglycaemia is associated with significantly reduced life expectancy
Microvascular disease causes morbidity;
macro-vascular disease causes morbidity and mortality
Macro-vascular Disease is a systemic disease and is commonly present in multiple arterial beds
Treatment targeted to hyperglycaemia alone has minor effect on increased risk of cardiovascular disease
Prevention of macrovascular disease requires aggressive management of multiple risk factors
Insulin resistance before hyperglycaemia itself contributes
What is renal artery stenosis?
Atheroma affecting the renal artery that may contribute to renal failure
Contributes to hypertension
What are the non-modifiable for macro-vascular disease?
Age
Sex
Birth weight
FH/Genes
What are the modifiable risk factors for macro-vascular disease?
Dyslipidaemia
High blood pressure
Smoking
Diabetes
