Macrovascular Diabetic Complications Flashcards
What is a macrovascular disease in Diabetes?
Early widespread atheroscerosis:
Causing problems with ischaemic heart disease, cerebrovascular disease and peripheral vascular disease - earlier in those with diabetes
What is the process for the development of atheroma?
Isolated foam cells
Then there is fatty streak
Can progress to intermediate lesions - intracellular lipid accumulation and a core of extracellular lipid (visible to the naked eye)
Develops into fibro atheroma - multiple lipid cores
Eventually = complicated lesion (ulceration into the artery, so showers of platelet emboli go on to block smaller arteries)
Why is atheroma associated with diabetes?
Diabetics = associated with increased LDL and decreased HDL concentrations
Smooth muscle atrophy is important in the
complicated lesions = thrombosis showering further down
What is a metabolic syndrome?
Constellation of risk factors for coronary artery disease:
Slightly elevated sugar Low HDL cholesterol Hypertension (BP >135/ something) Central adipocity Insulin resistance Inflammation CRP Adipocytokines Urine microalbumin
What are the macrovascular complications of diabetes?
Ischaemic heart disease
Cerebrovascular disease
Renal artery disease
Peripheral vascular disease
Why is hyperglycaemia is associated with a significantly lower life expectancy?
Esp. in young people = lowered longevity
Due to complications from diabetes - more affected in women than men
The higher the HbA1c, the higher the risk for MI
Compared to the general population, diabetics have a greater risk of dying from IHD and CVD
In terms for morbidity and mortality, what do macro and micro vascular diseases cause?
Microvascular = morbidity Macrovascular = morbidity and mortality
Why type of disease is a macrovascular disease?
Systemic or localised disease?
Macrovascular disease is a systemic disease and is commonly present in multiple arterial beds
What is ischaemic heart disease?
Narrowed / blocked coronary arteries supplying the heart, lack of blood and oxygen supply to heart causes heart muscle to die
What is cerebrovascular disease?
Conditions and disorders that affect the blood vessels and blood supply to the brain - blockages, malformations, haemorrhages etc.
What is peripheral vascular disease?
Blood circulation disorder that causes the blood vessels outside of your heart and brain to narrow, block, or spasm
What is Renal Artery Stenosis
Affects the renal artery
Initially contributes to hypertension
May contribute to renal failure
Why does only treating hyperglycaemia have a minor effect on increased CVD risk?
Treatment targeted to hyperglycaemia alone has minor effect on increased risk of CVD
Treating sugar levels alone does not reduce ischaemic heart disease - must also treat risk factors esp. treating lipids
Prevention of macrovascular disease requires what?
Aggressive management of multiple risk factors
Risk factors for macrovascular disease?
Non-modifiable: Age Sex Birth weight Family history / genes
Modifiable: Dyslipidaemia High blood pressure Smoking Diabetes
