Diabetes, Metabolic Syndrome and CVD - Athero...Agenda Diabetes Implications Overview Natural...
Transcript of Diabetes, Metabolic Syndrome and CVD - Athero...Agenda Diabetes Implications Overview Natural...
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Diabetes, Metabolic Syndrome and CVD
Dr Noor AL BusaidiFebruary 2015
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Agenda
Diabetes Implications Overview
Natural history of Diabetes
Diabetes and CVD
Definition of Metabolic syndrome
Pathophysiology of CVD in Diabetes and
Metabolic syndrome
Management concept
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Diabetes statistical figures have always been alarming, reflecting health threats across the globe
387 million people have diabetes; by 2035
this will rise to 592 million
77% of people with diabetes live in low- and
middle-income countries
The greatest number of people with diabetes
are between 40 and 59 years of age
179 million people with diabetes
are undiagnosed
Diabetes caused 4.9 million deaths in 2014;
Every seven seconds a person dies from
diabetes
Diabetes caused at least USD 612 billion
dollars in health expenditure in 2014 – 11% of
total spending on adults
More than 79,000 children developed type 1
diabetes in 2013
More than 21 million live births were affected
by diabetes during pregnancy in 2013
Latest IDF Statistics
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IDF Regions and global projections of the number of people with diabetes ( 20-79 years ) 2013 and 2035
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Diabetes is a deadly disease and very costly
Economical Burden of Diabetes
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Agenda
Diabetes Implications Overview
Natural history of Diabetes
Diabetes and CVD
Definition of Metabolic syndrome
Pathophysiology of CVD in Diabetes and
Metabolic syndrome
Management concept
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The changes leading to Macrovascular complications occur way before the diagnosis of diabetes (1/2)
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The changes leading to Macrovascular complications occur way before the diagnosis of diabetes (2/2)
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Ischemic heart disease is the leading cause of diabetes related death
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Agenda
Diabetes Implications Overview
Natural history of Diabetes
Diabetes and CVD
Definition of Metabolic syndrome
Pathophysiology of CVD in Diabetes and
Metabolic syndrome
Management concept
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Insulin resistance is the link between Diabetes and Metabolic syndrome
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Definitions of Metabolic Syndrome consist of three out of five criteria based on WHO, NCEP ATP III and IDF
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Agenda
Diabetes Implications Overview
Natural history of Diabetes
Diabetes and CVD
Definition of Metabolic syndrome
Pathophysiology of CVD in Diabetes and
Metabolic syndrome
Management concept
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Pathophysiology of CVD in Diabetes and Metabolic Syndrome
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Macrovascular complication due to atherosclerosis (dyslipidemia and
endothelial dysfunction)
Microvascular complication due to dysregulation of vascular tone
Inflammation
Oxidative stress
Hypercoagulability
Pathophysiology of CVD in Diabetes and Metabolic Syndrome
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Blood vessel tone
thrombogenesis
Platelet activation
inflammation Leukocyte adhesion
Anti-atherogenic
Anti-inflammatory
Vasodilatory
Healthy endothelium
In Diabetes, an endothelial dysfunction is present leading to the increase in atherogenicity, resulting in Macrovascular disease
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LDL glycationLDL oxidation
Atherosclerotic plaque
HDL glycation
Dyslipidemia Insulin
resistance
Insulin deficiency and insulin resistance promote dyslipidemia, which causes atherosclerosis
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Diabetes Microvascular complication
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retinopathy
Small vessels in brain , heart
,PVD Nephropathy
Neuropathy
Microcirculation
Diabetes contributes to defects in Autonomic Nervous System, Endothelium and local Metabolism, all of which can result in Microvascular disease
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Microcirculation
Central regulation
Local products of metabolism
Parasympathetic Sympathetic
DAN associated with impaired auto regulation of blood flow
The Microcirculation is regulated by central and local regulatory mechanisms. The central regulation is via autonomic sympathetic and parasympathetic nerves
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Dysregulation of vascular tone caused by atomic neuropathy
Decreased bioavailability of NO, a potent vasodilator
Increased secretion of the vasoconstrictor endothelin-1
At microvascular level , the vasculature usually at hyper-constricted state
Summary of the changes at microcirculation
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Diabetes is a state of chronic, low-level inflammation
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pro-inflammatory cytokines can enhance the production of ROS
The term ROS refers to a subset of molecules called “free radicals.”
ROS can directly damage a number of cell components, such as plasma
membranes and organelles
Oxidative stress occurs when the cellular production of ROS exceeds the
capacity of anti-oxidant defenses within cells
Hyperglycemia and dyslipidemia cause oxidative stress
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Hyperglycemia-induced mitochondrial ROS production activates each of the four major pathways of hyperglycemic damage …
… oxidative stress is a crucially important concept in the pathophysiology of the cardiovascular complications in diabetes
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Up to 80% of patients with diabetes die a thrombotic death
75% of these deaths are the result of an MI, and the remainder are the
result of cerebrovascular events and complications related to PVD
The first defense against a thrombotic event is the vascular endothelium
Diabetes has abnormal endothelium and has hypercoagulable state
Hypercoagulability
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The pathophysiology of the link between diabetes and cardiovascular disease (CVD) is complex and multifactorial
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Agenda
Diabetes Implications Overview
Natural history of Diabetes
Diabetes and CVD
Definition of Metabolic syndrome
Pathophysiology of CVD in Diabetes and
Metabolic syndrome
Management concept
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Health for all and at all level
Allocate budget for prevention of Diabetes and metabolic syndrome
Community based primary prevention programs
Create educational program for patients and families
mass media campaign
Training of health care professional
Apply evidence based practice for early intervention targeting high risk group
Training programs, guideline, evidence based information
Establish a research environment to obtain a clear picture about the health system, disease patterns, epidemiological studies, genetic epidemiology of diabetes, basic scientific studies, and clinical trials…
Quality management intervention
Prevention and Education Early Intervention Research/Quality Management
An integrated system is needed to combat this epidemic complex disease
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Thank You…