macrovascular complications of dm Flashcards
what are the main macrovascualr complications *
early widespread aterosclerosis
ischemic hheart disease
CVD
PVD
renal artery stenosis
describe the development of an atheroma *
initatial lesion - histophatologically normal, macrophage infiltration, foam cells
fatty streak - symptomless and harmless, intracellular lipid accumulation
intermediate lesion - visible to naked eye, intracellular lipid accumulation and extracellular lipid pools
atheroma - intracellular lipid accumulation and core of extracellular lipid - symptoms late because earlier stages are silent
fibroatheroma - single or multiple lipid cores, fibrotic/calcific layers (ca stores measured on CT to assess extent of atheroma)
complicated lesion - surface defect, haematoma/haemorrhage, thrombosis - lining of te artery is lost, fat is in contact with blood = thrombosis = blocked artery = pump failiure or ellectrical arrhythmia - block heart. this is rare <50yrs age. partial blcokage of artery = TIA or angina, full block = MI or stroke
what are te risk factors for ischemic heart disease *
fasting glucose >6mmol/L - elevated sugar
HDL - men <1, women <1.3
hypertension >135/80 = damage to arteries
insulin resistance, inflammation CRP, adipocytokines, urine microalbumin - these are important in macrovascualr risk but not measured in clinical practice
waist circumference - men >102, women 88
metabolic syndrome is a combination of conditions that increases risk of IHD and dm
all processes important in insuil resistance, dm and atheroma (before even have dm/raised sugar - is non-diabetic macrovascualr disease)
wat are te risk factors for different stages of atheroma development *
initial lesion, fatty streak and intermediate - hig lipids, bp, insulin resistance
atheroma - sm hypertrophy and insulin resistance
complicated lesion - thrombosis (associated with insulin resistance)
wy does hyperglycaemia reduce lidfe expectancy *
macrovascular disease
how does life expecancy relate to the age of diagnosis
younger diagnosed = more loss of life
what is a surrogate marker for insulin resistance *
measuring insulin
more insulin = more resistant
is insulin resistance important to CHD, ow do we now *
yes
more insuilin (and so resistance) means iger cance of developing CHD
what is the risk of CHD in diabetes *
it is increased
and is higher in women than men
what does it mean that dm is a progressive disease
even with intensive treatment, HbA1c gets worse as patients age
effect of HbA1c on microvascular and microvascular complications *
complications increase wit HbA1c increases
what is te difference between the micro and macrovascular correlation wit HbA1c *
microvascualr increase is much sharper - only get it wit dm
macro is more linear - have risk even if dont have dm
why is there a higer deat rate from CVD in diabetics tan in the normal population *
people with dm have a higher chance of getting CVD than general population
teh CVD kills people with dm before they can develop malignancies
in normal population atheroma kill 1/2 pop under 70years
how does the survival in diabeteic relate to people who have or havent had previous MI *
general pop who have never had MI - high survival
general pop with prior MI = reduced survival
dm without prior mi = similar survival to general WITH prior mi
dm with prior mi - very low survival
compare the response after mi of people with dm and general pop *
people with dm haave worse outcomes - dm interfers with the response to treatment and so mi is less suseptible to correction
is the risk for cHD the same in all ethnic groups *
no
south asians have a higer risk
what does it mean that macrovascular disease is a systemic disease *
that it is present inb lots of arterial beds eg coronary, in brain, in peripheries, in kidneys
what is the major cause of morbidity and mortality in dm 8
ihd
are the mechanisms of ihd similar or diff in dm to general pop 8
similar
what is the difference in cerebrovascular disease in dm than in general pop *
earlier in dm
more widespread in dm
when otehr parts of brain try to compensate for lost parts - dont do it as well
occur younger
more likely to have more small infarcts as well
consequence of peripheral vascular disease in dm *
contribute to diabetic foot problems wit neuropathy
arteries are narrowed because of atheroma
this blocks off arteries/showers emboli and blocks arteries further down
this causes gangrene and so lose toes
attempts made to recover blood flow and bypass blockage but very hard to recover when a bit of tissue has died
what is the effect of renal artery stenosis *
artery blocked = restricted flow = hypertension = progression to renal failure
this is common
is good glucose control effective agaibst the increased risk of cardiovascular disease in dm *
not really
it does reduce the risk of chd
but doesnt affect mortality
need to address the lipid and blood pressure too
what are the risk factors for macrovascular disease *
modifiable: dyslipidaemia, hypertension, smoking, dm, insulin resistance before dm - can adjust these to reduce death risk
nonpmodifiable - age, sex (male higehr risk), birth weight (light at birth predict ihd)
