Note that cardiovascular disease in diabetes mellitus
Posted on October 15, 2009
Filed Under Dilated cardiomyopathy | Leave a Comment
Patients with diabetes, chronic high blood sugar due to the long-term status. Its lipid and protein glycation and oxidation process is bound to intensify, and this process is also involved in the pathogenesis of diabetic heart disease. Many type 2 diabetic patients newly diagnosed with type 2 diabetes, coronary heart disease when it already has. Susceptible populations in diabetes, insulin resistance is the earliest change. It can occur before clinical diabetes, 15 to 25 years. Induced insulin resistance and atherosclerosis risk factors related to. It could be many years before the advent of clinical diabetes, to promote the formation of atherosclerosis.
”Diabetes is a cardiovascular disease,” “Diabetes is a ’sugar, heart disease”‘. More and more scientific studies have been confirmed and public acceptance.
Why should there be “sugar heart disease”
Pathological anatomical studies have shown that patients with diabetes in both coronary arteries or cerebral arteries, renal arteries, peripheral arteries. There are more of the same age non-diabetic patients with more severe atherosclerosis.
After the atherosclerosis. Some or all of the lumen was blocked, leading to target organ ischemia and hypoxia cause a pathological change. If blockage in coronary artery disease, that is caused by coronary atherosclerotic heart disease (CHD). Of coronary heart disease in patients with diabetes and coronary heart disease compared with patients without diabetes. The former general multivessel coronary vessel involvement, and diffuse lesions widespread, more plaque ulceration and thrombosis. Diabetes of any age can accelerate the phase of the progression of atherosclerosis. This is similar to countries in the world.
Diabetes caused by atherosclerosis of the mechanism are manifold. High blood sugar alone is concerned, both the formation of irreversible lipoprotein glycated protein and glycosylated to increase the extent of oxidative damage may also cause blood vessel wall and endothelial damage. Promote thrombosis.
Diabetes can also be caused by microvascular disease, there endothelial damage, basement membrane thickening, protein non-enzymatic glycation, free radical activity increased, prostaglandin anomalies and so on.
”Sugar Heart Disease,” What are the early signs of
”Sugar heart disease”, including the heart and great vessels on the microvascular disease, heart disease, cardiac autonomic neuropathy and coronary heart disease. Especially coronary heart disease is more common. Was diverse clinical manifestations. Resting tachycardia may be an early manifestation of a common. Patients may wake up in the morning when the self-test heart rate. Diabetes, heart involvement in the resting heart rate, often more than 90 times per minute
This is because the heart have been affected by two kinds of sympathetic and parasympathetic nerves. Sympathetic heart rate accelerated to enable the parasympathetic heart rate, which regulate and coordinate the heart rate, to meet the human needs under different physiological states. Diabetic often the first heart attack early parasympathetic damage, so sympathetic in a relatively excited state. Fast heart rate gradually increased. By the late diabetes. Both sympathetic and parasympathetic damage to the heart is almost completely lost their nerve. Heart rate is relatively fixed.
Orthostatic hypotension are more common. Normal position changes, the body can increase vascular tone and cardiac output, so that blood pressure remained normal. Diabetes orthostatic hypotension is due to autonomic control of blood vessels, especially the sympathetic nerve damage, can not effectively regulate vascular tone. If you measure a patient from a supine immediate effect of blood pressure, systolic blood pressure drop greater than 30 mm Hg, diastolic blood pressure decreased more than 20 mm Hg when. Can be diagnosed as orthostatic hypotension.
Atypical angina pectoris caused by coronary artery spasm caused by myocardial ischemia and hypoxia. Diabetic patients often are not typical symptoms of angina, or even without any symptoms, a greater danger.
Anti-rule as early as early as multiplier
Diabetes, cardiovascular complications in type 2 diabetes, a major cause of death. Early detection of asymptomatic cardiovascular disease is very important, because early detection of high-risk populations can take effective preventive measures to reduce the incidence of cardiovascular disease and mortality rates. For some there is evidence of cardiovascular disease can begin with the anti-ischemic medication. Early screening can also identify the need revascularization surgery in patients with cardiovascular complications. From a number of secondary prevention study found. Aggressive treatment measures can effectively reduce the incidence of cardiovascular disease and mortality. With type 2 diabetes in the following circumstances should be carefully examined in order to identify whether the coronary artery disease and its severity.
1. There are typical or atypical symptoms of cardiovascular disease.
2. The basis of ECG myocardial ischemia or infarction prompted.
3. There are peripheral vascular or carotid artery occlusive disease.
4. A long-term sit-in way of life. The age of 35 years of age. Plans to begin intense physical exercise, when.
5. In addition to diabetes, more than two kinds of things have the following risk factors exist in patients with:
① total cholesterol ≥ 6.24 mmol, l, low-density lipoprotein (LDL) cholesterol ≥ 4.16 mmol, l, or high-density lipoprotein (HDL) cholesterol,
② blood pressure, “a
40/90 mm Hg.
③ smoking.
④ a family history of coronary heart disease.
⑤ traces of urine albumin, or a large number of persons.
For type 2 diabetes risk factor for coronary artery disease in patients with early preventive treatment should be to reduce the incidence of coronary heart disease. Lipid-lowering, blood pressure and giving aspirin to be effective means of strict blood glucose control can reduce the incidence of coronary heart disease. For existing coronary heart disease. And impaired left ventricular function. Even in patients with normal blood pressure and urinary albumin excretion, the application of angiotensin-converting enzyme inhibitors are also useful. If the patient is a clear diagnosis of asymptomatic coronary heart disease should be treated as soon as possible. Prevention of myocardial ischemia.
”Sugar heart disease,” the general treatment
1. Smoking Cessation
2. The appropriate physical activity under the condition permits, preferably three or more times per week lasted 30-60 minutes of moderate activity (such as walking, cycling, etc.).
3. Control of body weight Body Mass Index (BMI) should be controlled at 25 kg / square meters. Particularly in patients with high blood pressure and blood lipid disorders.
4. Controlling blood sugar fasting blood glucose should be “6.1 mmol / liter. HBA1C should be ≤ 6%.
5. Control the primary objective of lipids LDL ≤ 2.6 mmol, l. Fight for HDL> 0.91 mmol, l, triglycerides (TG) <2.2 mmol / liter.
First, to diet. On blood LDL and cholesterol should be limited to patients with elevated cholesterol and saturated fatty acid content of foods that are high, such as fat and liver, brain, kidneys, lungs and other offal. Bone marrow, egg yolks, rich roe, roe, animal fats and their products, coconut oil, cocoa oil, cuttlefish, eel and so on. Pairs of patients with elevated serum TG while limiting the total calorie intake, eating less sugar and sweets. Recommended to eat garlic, onions, mushrooms, seaweed, vegetables, beans and so on. Such as diet control is invalid, it should use lipid-regulating drugs.
6. Control of blood pressure blood pressure should be controlled at 120/80 mm Hg or less.
7. Details of life should not be fullness, reduce the mental burden. Avoid over exertion. Do not drink.
8. Antiplatelet and anticoagulation can choose aspirin. Day 75-150 mg in patients after myocardial infarction who can not use aspirin. Can be used warfarin.
9. Application of angiotensin-converting enzyme inhibitor on high-risk patients after myocardial infarction (anterior wall myocardial infarction, recurrent myocardial infarction, cardiac function is poor, there are symptoms of heart failure, arrhythmia) suggested that the application may be used as the treatment of patients with essential hypertension.
As the occurrence and development of diabetes, heart disease is a very slow and hidden process. Clinical symptoms appear before the damage already have a function. Therefore, once type 2 diabetes was diagnosed. Diabetes, heart disease should be conducted on the prevention and treatment of serious about controlling risk factors such as hypertension, hyperlipidemia, obesity, smoking, high blood sugar, etc., so as to ensure that patients with diabetes to enjoy their later years.
”Sugar heart disease,” the clinical features of
1, resting tachycardia, due to early stage of diabetes involving the cardiac autonomic nerve, heart rate, often tend to increase faster. In general, all resting heart rate greater than 90 times per minute, shall consider possible cardiac autonomic nerve dysfunction.
2, painless myocardial infarction, diabetes, acute myocardial infarction in patients with far more than non-diabetic patients, case fatality rate as high as 30% a 50%. Because autonomic neuropathy is not sensitive to pain, myocardial infarction was often painless, because the typical symptoms often missed or misdiagnosed easily.
3, orthostatic hypotension, diabetic cardiac autonomic neuropathy due to regulation of blood pressure, reflex disorders, prone to orthostatic hypotension, the patient from a supine or squatting effect immediately because of the sudden reduction in blood pressure, dizziness and even loss of consciousness, etc. .
4, sudden death due to cardiac autonomic neuropathy and functional disorders, diabetes, heart disease may be due to a variety of stress, infection, anesthesia, etc. lead to sudden death, manifested as severe arrhythmia or cardiogenic shock, patients feel only a short-lived chest tightness, palpitations After the rapid development of a serious shock or coma and even death.
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