Diabetic retinopathy is associated with the presence and burden of subclinical carotid atherosclerosis in type 1 diabetes

Abstract

BackgroundCardiovascular (CV) disease due to atherosclerosis is a major cause of morbidity and mortality in adult patients with diabetes, either type 1 or type 2 diabetes. The aim of the study was to assess the association of the frequency and the burden of subclinical carotid atherosclerotic disease in patients with type 1 diabetes according to the presence and severity of diabetic retinopathy (DR).MethodsA cross-sectional study was conducted in 340 patients with type 1 diabetes (41.5% with DR), and in 304 non-diabetic individuals. All participants were free from previous CV disease and chronic kidney disease (CKD). B-mode carotid ultrasound imaging was performed in all the study subjects. Patients with type 1 diabetes underwent a full eye examination, and DR patients were divided into two groups: mild disease and advanced disease.ResultsIn the group of patients with type 1 diabetes, the percentage of patients with carotid plaques was higher in those with DR compared with those without DR (44.7% vs. 24.1%, p < 0.001). Patients with DR also presented a higher incidence of ≥ 2 carotid plaques (25.5% vs. 11.1%, p < 0.001). Apart from other traditional cardiovascular risk factors, the presence of advanced stages of DR was independently associated with the presence (p = 0.044) and the burden (≥ 2 carotid plaques; p = 0.009) of subclinical carotid atherosclerosis.ConclusionsIn patients with type 1 diabetes without previous CV disease or established CKD, the presence of advanced stages of DR is associated with a higher atherosclerotic burden in the carotid arteries. The presence of DR identifies patients at risk for carotid atherosclerotic disease.Electronic supplementary materialThe online version of this article (10.1186/s12933-018-0706-z) contains supplementary material, which is available to authorized users.

Monocyte to HDL ratio as an indicator of subclinical atherosclerosis in diabetic retinopathy

“…There was an increased cardiovascular risk in patients with diabetic retinopathy. In these patients, CIMT was an important non-invasive method to determine subclinical cardiovascular risk (6,11). Also in our study, CIMT was significantly high in PDR group.…”

“…In several studies, diabetic retinopathy has been reported as an independent predictor of all cause mortality and cardiovascular events in patients with type 1 and 2 diabetes (6). Many potential mechanisms including oxidative and glycemic stress, chronic inflammation and defective vascular tissue repair mechanisms are suggested to clarify the pathophysiological relation between diabetic micro-and macroangiopathy (7).…”

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

“…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]. While there are few studies that have assessed the association between diabetes and carotid disease, some have found a significant association [33][34][35][36] but others did not [37][38][39][40].…”

Diabetic retinopathy and its’ association with carotid intima media thickness.

“…20 In a European study presence of retinopathy predicted the extent of atherosclerosis and the occurrence of carotid plaques. 21 Atherosclerosis starts early in life and runs a long sub-clinical course. It is detected usually after the occurrence of a cardiovascular event at a time when it is quite extensive.…”