Diabetic retinopathy: looking beyond the eyes

Type 2 diabetes in South Asians compared to Europeans: Higher risk and earlier development of major cardiovascular events irrespective of the presence and degree of retinopathy. Results from The HinDu The Hague Diabetes Study

“…For example, the INTERHEART study reported a population attributable risk for diabetes of 9.9% 16 . We do find the same relationship between severity of DR and more MACE as has been demonstrated in many studies that also stressed its implications for care 6‐10 . In the ACCORD EYE study 6 for example, a clear relationship was found between the progression of DR and the occurrence of incident CV events at 4‐year follow‐up, with a HR of 1.49 for mild and 2.35 for severe DR compared to no DR.…”

“…16 We do find the same relationship between severity of DR and more MACE as has been demonstrated in many studies that also stressed its implications for care. [6][7][8][9][10] In the ACCORD EYE study 6 for example, a clear relationship was found between the progression of DR and the occurrence of incident CV events at 4-year follow-up, with a HR of 1.49 for mild and 2.35 for severe DR compared to no DR. In our study, the prevalence of MACE in European participants increased from 35.2% in the no-DR group to 46% in the severe DR group (OR 1.3), whereas in South Asians it increased from 34.1 to 62% (OR 1.82) in the equivalent groups.…”

“…Although DR is generally considered to be a microvascular complication, both the severity of retinopathy and its progression are known to be determinants of incident cardiovascular outcomes, underlining the importance of its presence. [6][7][8][9][10] Furthermore, it has been suggested that changes in the retina reflect changes in other vascular beds, for example in the heart, kidney and brain, whilst people with the most rapid progression in retinal pathology may be the ones most likely to suffer incident CV outcomes. This hypothesis is further supported by data from Alonso et al which showed that patients with type 2 diabetes and DR, who are free of clinical atherosclerotic disease, already have an increased number of atherosclerotic plaques in the carotid artery, a known risk factor for myocardial infarction and stroke.…”

“…Numerous studies have shown a relationship between DR and both CVD and cardiovascular mortality. Although DR is generally considered to be a microvascular complication, both the severity of retinopathy and its progression are known to be determinants of incident cardiovascular outcomes, underlining the importance of its presence 6‐10 . Furthermore, it has been suggested that changes in the retina reflect changes in other vascular beds, for example in the heart, kidney and brain, whilst people with the most rapid progression in retinal pathology may be the ones most likely to suffer incident CV outcomes.…”

Low prevalence of diabetic retinopathy in patients with long-term type 1 diabetes and current good glycemic control - one-center retrospective assessment

“…In addition, other eye diseases, like glaucoma and cataracts, are more common and develop earlier in people with diabetes [3,4]. Interestingly, it was recently reported, that the presence and degree of DR was an independent predictor of subclinical cardiovascular disease (CVD) [5][6][7]. A meta-analysis of 35 studies conducted world-wide in 1980-2008 estimated the overall prevalence of DR at any stage at 34.6% in a large population with a mean disease duration <8 years [8].…”