糖尿病教育权威英文52Macrovasculardisease.ppt

Macrovascular disease Macrovascular disease Coronary heart disease Cerebrovascular disease Peripheral vascular disease What is an “event”? Macrovascular disease Major cause of increased morbidity and mortality in diabetes Underlying abnormality: atherosclerosis What is atherosclerosis? Process in which?deposits of fatty substances, cholesterol, cellular waste products and calcium build up in the wall of an artery. This build up is called plaque Plaques can grow large enough to significantly reduce the blood flow through an artery. An acute event occurs when they?become fragile and rupture Plaques that rupture cause?blood clots?that can block blood flow or break off and travel to another part of the body causing a heart attack and stroke Coronary heart disease Known risk factors Age Gender Family history Lipid abnormalities Hypertension Smoking Diabetes Coronary heart disease in diabetes It is more common and occurs earlier than in people without diabetes Ethnic differences Caucasians: more myocardial infarctions Chinese/Japanese: more strokes Women lose gender protection Myocardial infarction is often painless (silent) Albuminuria increases risk of vascular event Coronary heart disease in diabetes Compared to people without diabetes, people with type 2 diabetes have: The same risk of heart attack as those who have already had a heart attack Two- to three-fold higher risk of heart failure Sudden death occurs: - 50% more often in men - 300% more often in women than in peers without diabetes but of the same age Myocardial infarction and diabetes People with diabetes have poor prognosis even after adjustments for infarct size and risk factors Controlling risk factors Research shows the benefits of reducing the controllable risk factors for atherosclerosis Controllable risk factors are: Dyslipidaemia (especially LDL or bad cholesterol) Smoking and exposure to tobacco smoke High blood pressure Diabetes Obesity Physical inactivity Case discussion