CVD and Diabetes

Question 1

what is the prevalence of CVD among those with diabetes?

Answer 1

65%+ of people with diabetes die of CVD

Question 2

Why are people with diabetes at increased risk for CVD?

Answer 2

Adults with diabetes are two to four times more likely to have heart disease or suffer a stroke than people without diabetes.
· High blood glucose in adults with diabetes increases the risk for heart attack, stroke, angina, and coronary artery disease.
· People with type 2 diabetes also have high rates of high blood pressure, cholesterol, lipid problems, and obesity, which contribute to their high rates of CVD.
· Smoking doubles the risk of CVD in people with diabetes
Lack of physical activity
Poorly controlled blood sugar levels (protein glycation)

also… an augmented inflammatory response also appears to take place in the atherosclerotic plaque of diabetic patients

Question 3

how does insulin resistance cause elevated BP?

Answer 3

Insulin can increase blood pressure via several mechanisms: increased renal sodium reabsorption, activation of the sympathetic nervous system, alteration of trans-membrane ion transport, and hypertrophy of resistance vessels.

Hypertension can cause insulin resistance by altering the delivery of insulin and glucose to skeletal muscle cells, resulting in impaired glucose uptake

Question 4

what are the effects of smoking on diabetes?

Answer 4

doubles risk of developing diabetes
smoking increases the risk of cvd 2x in those with diabetes
Increases blood pressure/blood clotting and platelet aggregation

With diabetes in addition-4 x risk of hardening of the arteries

Question 5

what can people with diabetes do to lower their risk of CVD?

Answer 5

Plan implemented to reach goals set for:
a) A1C-glycated haemoglobin
b) blood pressure
c) cholestrol
the plan will usually include ways to:
-Reach and stay at a healthy weight. 
-Get at least 30 to 60 minutes of physical activity
-improved diet
-more fiber
-Stop smoking
-medication- daily asprin

Question 6

describe the plaque formation which occurs after glycation/oxidation of LDLs

Answer 6

Metabolic and biochemical abnormalities such as glycation/glycosylation and oxidation of low density lipoprotein (LDL) and the formation of “large” very low density lipoprotein (VLDL) promote the accumulation of monocytes and macrophages, leading to the formation of foam cells.

Question 7

describe the plaque formation which occurs after glycation of HDLs

Answer 7

Glycosylation /glycation of high density lipoprotein (HDL) impairs its anti-atherogenic action. These abnormalities may enhance the extracellular (core) lipid content of the atherosclerotic plaque, rendering it softer.

Question 8

what are AGEs in relation to atherosclerotic plaque?

Answer 8

AGE= advanced glycation endproducts

AGEs are present within atherosclerotic plaques

Related to plaque vulnerability-e.g. increased (carboxymethyl)lysine (CML)-and independently linked to symptomatic disease.

Question 9

How do AGEs affect tissues?

Answer 9

affect function and mechanical properties of tissue e.g. through cross-linking (creating vascular stiffness in collagen for example and calcification)

Modulate cell processes and signalling via the RAGE-AGE pathways

See-http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3342583/