Diabetic macrovascular disease
Diabetic macrovascular disease – the generalized atherosclerotic changes developing in arteries of average and large caliber against the background of the long course of diabetes. The diabetic macrovascular disease leads to emergence of IBS, arterial hypertension, violations of brain blood circulation, okklyuzionny damages of peripheral arteries. Diagnosis of a diabetic macrovascular disease includes a research of lipidic exchange, carrying out UZDG of arteries of extremities, vessels of a brain, kidneys, the ECG, EhoKG, etc. The basic principles of treatment of a diabetic macrovascular disease are correction of a hyperglycemia, dislipidemiya, control HELL, improvement of rheological properties of blood.
Diabetic macrovascular disease
Diabetic macrovascular disease – the diabetes complication leading to primary damage of cerebral, coronary, renal and peripheral arteries. Clinically diabetic macrovascular disease is expressed in development of stenocardia, an infarakt of a myocardium, ischemic strokes, renovaskulyarny hypertensia, diabetic gangrene. Diffusion defeat of vessels has the defining value in the forecast of diabetes, increasing risk of development of a stroke and IBS by 2-3 times; gangrenes of extremities – by 20 times.
The atherosclerosis of vessels developing at diabetes has a number of specific features. At diabetics it arises for 10-15 years earlier, than at the persons who are not suffering from violation of carbohydrate exchange and progresses quicker. For a diabetic macrovascular disease typically generalized defeat of the majority of arteries (coronal, brain, visceral, peripheral). In this regard prevention and correction of a diabetic macrovascular disease gains paramount value in endocrinology.
Reasons of a diabetic macrovascular disease
At a diabetic macrovascular disease there is a thickening of a basal membrane of arteries of average and large caliber to education on it atherosclerotic plaques. Their subsequent kaltsifikation, an ulceration and a necrosis promote local formation of blood clots and occlusion of a gleam of vessels that leads to violation of blood circulation in certain areas.
At diabetes carry a hyperglycemia, a dislipidemiya, insulin resistance, obesity to specific risk factors of development of a diabetic macrovascular disease (especially on abdominal type), arterial hypertension, increase in fibrillation, endotelialny dysfunction, an oxidizing stress, a system inflammation. Traditional risk factors of atherosclerosis are smoking, professional intoxications, a hypodynamia, age (at men 45 years are more senior, at women – 55 years are more senior), heredity.
Classification of diabetic angiopatiya
Diabetic angiopatiya - the collective concept including defeat of small vessels - capillaries and prekapillyarny (mikroangiopatiya), arteries of average and large caliber (macrovascular disease). Diabetic angiopatiya belong to the late complications of diabetes developing on average in 10-15 years after the disease demonstration.
The diabetic macrovascular disease can be shown by a number of syndromes: atherosclerosis of coronary arteries and aortas, atherosclerosis of cerebral arteries and atherosclerosis of peripheral arteries. The diabetic mikroangiopatiya can include a retinopathy, a nephropathy, a mikroangiopatiya of the lower extremities. Also defeat of vessels can proceed in the form of the universal angiopatiya combining macro - and a mikroangaopatiya. In turn, the endoneural mikroangiopatiya promotes dysfunction of peripheral nerves, i.e. development of diabetic neuropathy.
Symptoms of a diabetic macrovascular disease
Atherosclerosis of coronary arteries and aorta at a diabetic macrovascular disease is shown by development of coronary heart disease with its sharp (myocardial infarction) and chronic (a cardiosclerosis, stenocardia) forms. IBS at diabetes can atypically proceed (by arhythmic or bezbolevy option), increasing thereby risk of sudden coronary death. The diabetic macrovascular disease often is followed by various postinfarction complications: aneurisms, arrhythmia, tromboemboliya, cardiogenic shock, heart failure. At a diabetic macrovascular disease the probability of development of repeated myocardial infarctions is extremely high. The risk of mortality from a heart attack at patients with diabetes is twice higher, than at the persons who do not have diabetes.
The atherosclerosis of cerebral arteries caused by a diabetic macrovascular disease occurs at 8% of patients. It can be shown by chronic ischemia of a brain or an ischemic stroke. The probability of vascular and brain complications of diabetes increases by 2−3 times in the presence of arterial hypertension.
From the obliterating atherosclerotic defeat of peripheral vessels (the obliterating atherosclerosis) 10% of patients with diabetes suffer. Clinical displays of a diabetic macrovascular disease in this case include a sleep and a chill of feet, the alternating lameness, hypostatic hypostasis of extremities, severe pain in muscles of a shin, hips, sometimes buttocks which amplifies at any physical activity. At sharp violation of a blood-groove in disteel departments of an extremity critical ischemia develops owing to what there can come the necrosis of tissues of shin and feet (gangrene). The necrosis of skin and hypodermic cellulose can arise without the additional mechanical damaging influences, however occurs against the background of the previous violation of integrity of skin more often (at a pedicure, foot cracks, fungal damage of skin and nails, etc.). At less expressed violations of a blood-groove at a diabetic macrovascular disease chronic trophic ulcers develop.
Diagnosis of a diabetic macrovascular disease
Diagnosis of a diabetic macrovascular disease is intended to find out extent of defeat of coronary, cerebral and peripheral vessels. For definition of an algorithm of inspection consultations of the endocrinologist, a diabetolog, the cardiologist, the vascular surgeon, the heart surgeon, the neurologist will be organized. The research of a biochemical profile of blood includes determination of level of a glycemia (blood glucose), indicators of a lipidic range (cholesterol, triglycerides, lipoproteid), platelets, a koagulogramma.
Inspection of cardiovascular system at a diabetic macrovascular disease provides registration of the ECG, daily monitoring of the ECG and HELL, load tests (the tredmil-test, a veloergometriya), EhoKG, aorta UZDG, a perfuzionny stsintigrafiya of a myocardium (for detection of the latent ischemia), coronary angiography, the KT-angiography.
Specification of the neurologic status is carried out by means of UZDG and duplex scanning of cerebral vessels, an angiography of vessels of a brain. For assessment of a condition of the peripheral vascular course at a diabetic macrovascular disease UZDG and duplex scanning of vessels of extremities, peripheral arteriography, a reovazografiya, a kapillyaroskopiya, an arterial oscillography is carried out.
Treatment of a diabetic macrovascular disease
Treatment of a diabetic macrovascular disease is directed to delay of progressing of the dangerous vascular complications threatening to the patient with an invalidization or death. The basic principles of therapy of a diabetic macrovascular disease are correction of syndromes of a hyperglycemia, dislipidemiya, hyper coagulation, an arterial hypertension.
For the purpose of achievement of compensation of carbohydrate exchange insulin therapy under control of level of glucose of blood is shown to patients with a diabetic macrovascular disease. Correction of violations of carbohydrate exchange is reached due to purpose of gipolipidemichesky medicines (statin, antioxidants, fibrat), and also the diet limiting intake of animal fats.
At the increased risk of tromboembolichesky complications purpose of antiagregantny medicines is expedient (acetilsalicylic acid, a dipiridamol, a pentoksifillin, heparin, etc.). The purpose of hypotensive therapy at a diabetic macrovascular disease is achievement and maintenance of target level HELL - 130/85 mm of mercury. Purpose of APF-inhibitors (captopril), diuretics is for this purpose preferable (furosemide, a spironolakton, a hydrochlorothiazide); to the patients who had a heart attack - beta (an atenolola, etc.).
Treatment of trophic ulcers of extremities is performed under observation of the surgeon. At sharp vascular accidents the corresponding intensive therapy is carried out. According to indications surgical treatment is carried out (AKSh, expeditious treatment of tserebrovaskulyarny insufficiency, an endarterektomiya, amputation of an extremity, etc.).
Forecast and prevention of a diabetic macrovascular disease
The lethality from cardiovascular complications at patients with diabetes reaches 35-75%. From them approximately in half of cases death occurs from a myocardial infarction, in 15% - from sharp ischemia of a brain.
Maintenance of optimum level of glucose of blood and HELL, observance of a diet, control of weight, refusal of addictions, implementation of all medical recommendations is the key to prevention of a diabetic macrovascular disease.