Macrovascular complications

Question 1

List 4 macrovascular complications that arise in T2DM

Answer 1

Early widespread atherosclerosis (inc. renal artery stenosis)
Ischaemic heart disease
Cerebrovascular disease
Peripheral vascular disease

Question 2

Describe the 6 stages of atherosclerosis progression

Answer 2

Initial lesion: macrophage infiltration + isolated foam cells
Fatty streak: intracellular lipid accumulation
Intermediate lesion: small extracellular lipid pools
Atheroma: core of extracellular lipid
Fibroatheroma: fibrous surface with calcium in it
Complicated lesion: surface defect, haematoma, thrombosis

Question 3

List 8 risk factors for ischaemic heart disease

Answer 3

High fasting glucose
Hypertension
Hyperlipidaemia 
High waist circumference
Insulin resistance
Inflammation CRP
Adipocytokines
Urine microalbumin

Question 4

Why is macrovascular disease described as a systemic disease?

Answer 4

Its commonly present in multiple arterial beds

Question 5

What is the major cause of morbidity + mortality in T2DM?

Answer 5

Ischaemic heart disease

Question 6

Describe the characteristics of cerebrovascular disease arising in T2DM

Answer 6

At a younger age than without diabetes

More widespread infarcts

Question 7

What macrovascular disease contributes to diabetic foot problems with neuropathy?

Answer 7

Peripheral vascular disease

Question 8

What may result from renal artery stenosis?

Answer 8

Hypertension

Renal failure

Question 9

How is macrovascular disease prevented?

Answer 9

With aggressive management of multiple risk factors
Management of glucose alone does not reduce risk
Insulin resistance before hyperglycaemia contributes to risk

Question 10

List 4 modifiable risk factors for macrovascular disease

Answer 10

Dyslipidaemia
High BP
Smoking
Diabetes