Boala cardiovasculara la pacientii cu diabet zaharat

Diabetic macrovascular disease (atherosclerotic cardiovascular disease in diabetic patients)Assist. lect. dr. Ariel FlorentiuMACROVASCULAR COMPLICATIONSMICROVASCULAR COMPLICATIONS

DiabeticretinopathyLeading causeof blindnessin adults1DiabeticnephropathyLeading cause of endstage renaldisease2Cardiovascular diseaseStrokeTwo- to four-fold increase in CV mortality and stroke2Diabetic neuropathyLeading cause of non-traumatic lower extremity amputations265%of individuals with diabetes die from CV events2

Most complications arise from damage to small blood vessels and narrowing of large arteries (atherosclerosis) associated with chronic hyperglycaemia. Tight control of glycaemia may prevent these complications.Peripheralarterial DiseasePrevalence of 29% in diabetic people > 50 years3

Cardiovascular risk evaluation and primary cardiovascular prevention in diabetic patientsThe concept of riskRisk: the probability a (healthy) person will be afected by a certain condition over a period of time (short-term10 yrs)Absolute riskRelative risk: expressed as a ratio of the persons absolute risk to a certain baseline/comparatorResidual risk: the persistent risk after maximal treatment of modifiable risk factorsCardiovascular risk factorsCharacteristics (variables) present in the healthy population that are independently and non-randomly associated with the risk of developing cardiovascular diseaseExamplesAnthropometric determinations (e.g. weight, waist circumference)Diseases (e.g. arterial hypertension, diabetes)Life style factors (e.g. smoking)Genetic or environmental The purpose of indentifying risk factors is to modify them in order to prevent disease

Modifiable risk factorsDiabetes mellitus/prediabetesInsulin resistanceArterial hypertensionHyperlipidemiaObesitySmokingSedentary lifestyleNutritional factors

Non-modifiable risk factorsAgeMale sexFamily history of premature cardiovascular disease (genetic background)Diabetes duration

Novel cardiovascular risk factorsAbdominal obesityMicroalbuminuriaReduced renal function (glomerular filtration rate)Endothelial dysfunctionBiomarkers of chronic low-grade inflamation and plasmatic viscosity (e.g. hsCRP)

Identification of risk factors and risk estimationHistory taking (including family history, hystory of smoking, duration of diabetes)Physical examination (including BMI, waist circumference, BP)Biochemistry: blood lipids, HbA1c, serum creatinine (eGFR), albuminuriaAbsolute risk estimation using risk scores/engines

Framingham risk scoreAmerican populationTakes into account 6 risk factors: sex, age, smoking, total and HDL-cholesterol, SBPEstimates the absolute 10-yrs risk of coronary death and non-fatal MIRisk: low(20%)

15YearsPoints20-34-735-39-340-44045-49350-54655-59860-641065-691270-741475-7916Step 2: Total Cholesterol

15 ATP III Framingham RISK SCORINGAssessing CHD Risk in WOMENn The third Adult Treatment Panel (ATP III) of the National Cholesterol Education Program (NCEP) has incorporated Framingham projections of 10-year absolute risk for hard CHD (MI and coronary death) into its guideline recommendations. n ATP III recommends using Framingham scoring for persons with multiple (2) risk factors to identify their short-term risk. Target LDL-C levels, to be achieved through therapeutic life changes (TLC) or drug therapy, are assigned in ATP III according to risk category: 20% risk;