18 - Macrovascular Complications Flashcards
(27 cards)
What is macrovascular disease?
Early widespread atherosclerosis
Seen mostly in:
- cerebrovascular disease
- peripheral vascular disease
What are the main stages of atheroma development?
Initial lesion
Fatty streak
Intermediate lesion
Atheroma
Fibroatheroma
Complicated lesion
- ulcerate on the endothelial surface
- the irritant fat causes emboli to shower down further in the arterial bed
- this can cause occlusion of arteries
[see attached picture]
What is an atheroma comprised of?
Core of extracellular lipid
What is the age of onset of atheroma?
Many people aged 50-60 will have atheroma
What happens during atheroma development?
See picture attached
What are the risk factors for ‘Metabolic Syndrome’?
- Fasting Glucose
- > 6.0 mmol/l
- Waist Circumference (omental fat)
- Men >102
- Women >88
- Hypertension
- BP >135/80
- HDL
- Men <1.0
- Women <1.3
- Insulin Resistance
- Inflammation, elevated CRP
- Adipocytokines
- Urine Microalbumin
What is the link between macrovascular disease and metabolic syndrome?
All the risk factors associated with metabolic syndrome also are risk factors for insulin resistance
- e.g. hypertension and dyslipidaemia are risk factors for diabetes but also are important for atheroma development
This means that people with metabolic syndrome might also develop/have T2DM
Patients with diabetes can develop macrovascular symptoms
Is hyperglycaemia needed for atheroma development?
High sugar is not required
What is the main difference between occurrence of microvascular and macrovascular disease in diabetes?
Microvascular disease only occurs in diabetes
Macrovascular disease can occur with or without high sugar
What macrovascular complications can develop in diabetes?
Ischaemic Heart Disease
- Myocardial Infarction
Cerebrovascular
- Stroke
Renal Artery Stenosis
Peripheral Vascular Disease
What is the link between insulin sensitivity and risk of cardiovascular events?
The higher the insulin (the more resistant a person), the higher their risk of having a cardiovascular event occur
What is the correlation between hyperglycaemia and life expectancy?
Hyperglycaemia is associated with shorter life expectancy
The younger the diagnosis of diabetes, the shorter the average life expectancy
Who has higher relative risk of cardiovascular events with diabetes out of men and women?
Women
T2DM presents late
Women are protected from cardiovascular events by oestrogen before the menopause
However, after this, they have a higher risk than men if they have diabetes
What occurs if you intensively control sugars in diabetes?
You lower risk of complications from diabetes fairly significantly
Sugar also decreased
What is the incidence rate of microvascular and macrovascular disease in relation to HbA1c?
Risk of microvascular disease
- increases rapidly with higher sugar
Risk of macrovascular disease
- increases steadily with higher sugar
Ultimately, what can microvascular disease cause and what can macrovascular disease cause?
Microvascular disease causes morbidity
Macrovascular disease causes morbidity and mortality
What is the age adjusted mortality associated with T2DM?
T2DM gives a 3x age adjusted mortality compared to the healthy population
Is macrovascular disease systemic or local?
Systemic
What factors predict cerebrovascular disease?
- Age!!
- Smoking
- Diabetes
- Blood Pressure
- Cholesterol
Earlier presentation than without diabetes
How is diabetic foot caused?
Peripheral vascular disease with neuropathy
Peripheral vascular diseases worsens the state of diabetic foot
What can the systemic nature of macrovascular disease cause?
Ischaemic Heart Disease
- The major cause of morbidity and mortality in diabetes
- The mechanisms are similar with or without diabetes
Cerebrovascular Disease
- Earlier than without diabetes
- More widespread
- This is uncommon in people younger than 60
Peripheral Vascular Disease
- Contributes to diabetic foot problems with neuropathy
Renal Artery Stenosis
- May contribute to hypertension in some
What can treatment targeting blood glucose alone not do for macrovascular complications?
Treatment targeted to blood glucose alone does not significantly offset the increased risk of cardiovascular disease
- Intensive glucose control does improve coronary heart disease risk
- But it does not translate to much of a change in mortality
What does prevention of macrovascular disease require?
Prevention requires aggressive management of multiple risk factors
- Blood pressure and cholesterol also need to be managed in the treatment of diabetes and prevention of complications
- It was found that taking a statin had a significant reduction in macrovascular disease risk
- The patients were less likely to have a stroke/heart attack by nearly a half
- So if we treat cholesterol and blood pressure, you can achieve a dramatic reduction in macrovascular disease risk
What are the risk factors for macrovascular disease?
NON-MODIFIABLE
- Age
- Sex
- Birth Weight
- FH/Genes
MODIFIABLE
- Dyslipidaemia
- High Blood Pressure
- Smoking
- Diabetes
