MACROVASCULAR SEQUELA OF DM

• The largest killer of DM individuals is not the triopathy described above, but the subsequent dysregulation of metabolism that promotes aetherosclerotic risk described below:

• CAD is 2x more likely in DM men, 4x more likely in DM women (protective effect of female sex with respect to vascular dz. Is lost). The average Joe with DM dies about 5 years younger than non-diabetics, usually of vascular disease.

• Peripheral vessel (PVD) and cerebral (stroke) circulation also affected, widening the scope of DM vascular problems.

• PATHOGENESIS: related to hyperlipidemia, coag. abnormalities, HTN, smoking, high insulin, endothelial dysfxn.

  • Increased lipids (Increased triglycerides, Lower HDL). Goals should be as if DM individual has had a heart attack (Framingham 10-yr. risk >20%) LDL<100,> 45.

  • Coag. problems: Increased factor VIII, PAI-1 (plasminogen activator inhibitor 1), fibrinogen; Increased platelet aggregation.

  • HTN: control with lifestyle modification for 3 m., then drugs. Goal <>

  • Smoking: #1 cause of erectile dysfunction in men.

  • Decreased insulin: assn. with vascular disorders. Normal vasodilatory response lost, correlated with Increased CVD risk.

  • Obesity: another risk factor assn. with DM and CVD. Often related to sedentary lifestyle.

Category: Endocrinology Notes