Diabetic retinopathy as an independent predictor of subclinical cardiovascular disease: baseline results of the PRECISED study

Abstract

ObjectiveDetection of subclinical cardiovascular disease (CVD) has significant impact on the management of type 2 diabetes. We examined whether the assessment of diabetic retinopathy (DR) is useful for identifying patients at a higher risk of having silent CVD.Research design and methodsProspective case–control study comprising 200 type 2 diabetic subjects without history of clinical CVD and 60 age-matched non-diabetic subjects. The presence of subclinical CVD was examined using two parameters: (1) calcium coronary score (CACs); (2) composite of CACs >400 UA, carotid plaque ≥3 mm, carotid intima–media thickness ratio >1, or the presence of ECG changes suggestive of previous asymptomatic myocardial infarction. In addition, coronary angio-CT was performed. DR was assessed by slit-lamp biomicroscopy and retinography.ResultsType 2 diabetic subjects presented higher CACs than non-diabetic control subjects (p<0.01). Age, male gender, and the presence of DR were independently related to CACs >400 (area under the receiver operating characteristic curve (AUROC) 0.76). In addition, an inverse relationship was observed between the degree of DR and CACs <10 AU. The variables independently associated with the composite measurement of subclinical CVD were age, diabetes duration, the glomerular filtration rate, microalbuminuria, and the presence of DR (AUROC 0.71). In addition, a relationship (p<0.01) was observed between the presence and degree of DR and coronary stenosis.ConclusionsThe presence and degree of DR is independently associated with subclinical CVD in type 2 diabetic patients. Our results lead us to propose a rationalized screening for coronary artery disease in type 2 diabetes based on prioritizing patients with DR, particularly those with moderate–severe degree.

Risk factors for retinopathy in hemodialysis patients with type 2 diabetes mellitus

“…We had not expected, that patients without CAD were more prevalent to DR. Our findings are in contrast to Cheung et al 36 , who described that DR was associated with a two times higher risk of incident CAD events and a three times higher risk of fatal CHD and Simó et al 37 , who reported DR as an independent predictor of subclinical cardiovascular disease. Our finding may differ due to two reasons: Firstly, T2DM patients developing macrovascular disease might die before they develop significant DR or ESRD.…”

Retinopathy predicts stroke but not myocardial infarction in type 2 diabetes: the Fremantle Diabetes Study Phase II

“…A study comprising participants from a diabetes outpatient clinic found that the presence and number of microvascular complications was independently associated with all-cause mortality and cardiovascular events in type 1 diabetes during 10 years of follow-up [30]. The PRECISED study showed that DR presence and severity and microalbuminuria were associated with subclinical cardiovascular disease in people with type 2 diabetes [31]. Retinopathy has also been associated with subclinical carotid atherosclerosis in diabetes [32].…”

Diabetic retinopathy: looking beyond the eyes

“…There is epidemiological evidence showing that either diabetic retinopathy or diabetic macular oedema (DMO) independently predict incident coronary heart disease, fatal CVD, heart failure and stroke [2,3]. In addition, the presence and degree of diabetic retinopathy has recently been found to be an independent and powerful predictor of subclinical CVD [6]. Therefore, screening for CVD should be prioritised in patients with diabetic retinopathy.…”