Early atherosclerosis is associated with retinal microvascular changes in adolescents with type 1 diabetes

Peña, Alexia S; Liew, Gerald; Anderson, Jemma; Giles, Lynne C.; Gent, Roger; Wong, Tien Yin; Couper, Jennifer

doi:10.1111/pedi.12764

Cited by 14 publications

(15 citation statements)

References 15 publications

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“…Diabetic retinopathy has also been shown to increase cardiovascular disease risk [36], and the severity and progression of DR was associated with cardiovascular disease in the ACCORD study [37]. A significant association between carotid disease and changes in the retinal microvasculature has also been found in adolescents with T1D [38]. Diabetic retinopathy has also been associated with other markers of peripheral arterial disease [39], peripheral vascular disease in T1D [40], and arterial stiffness [41].…”

Section: Discussionmentioning

confidence: 93%

The relationship between carotid disease and retinopathy in diabetes: a systematic review

Drinkwater

Davis

2020

Cardiovasc Diabetol

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Background: Since studies of the relationship between carotid disease and diabetic retinopathy (DR) have shown apparent inconsistencies, the aim of this study was to conduct a systematic review of available published data. Methods: Electronic databases were searched independently by two reviewers, according to an iterative protocol, for relevant articles. The search term used was "diabetes AND (carotid disease OR intima-media OR carotid plaque OR carotid stenosis OR carotid arterial disease OR carotid artery disease OR carotid atherosclerosis) AND (retinopathy OR diabetic retinopathy)". Results: From 477 publications, 14 studies were included. There were differences in the variables used as markers of carotid disease and DR across the included studies. Ten studies used carotid disease as the dependent variable, and the remainder used DR. All but one study involved cross-sectional data. Most studies reported a statistically significant association between at least one parameter of carotid disease as assessed by ultrasound and DR presence or severity. Only four studies reported no significant association. A common limitation was the use of convenience participant sampling. Conclusions: There appears to be an increased likelihood of DR when there is ultrasonographic evidence of carotid disease, and vice versa. The available studies suggest that there may be a direct relationship between DR and carotid macrovascular disease and/or that these complications co-exist due to shared risk factors. If carotid disease is detected, retinal assessment should be performed. If DR is identified, intensive cardiovascular disease risk management should be considered. Additional longitudinal studies are needed to assess the directionality of the association.

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Section: Discussionmentioning

confidence: 93%

The relationship between carotid disease and retinopathy in diabetes: a systematic review

Drinkwater

Davis

2020

Cardiovasc Diabetol

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“…[19][20][21][81][82][83][84][85][86][87] Except for the biochemical changes, physiological changes also play a role in the process of DR. Hemodynamic dysfunction has been found in DR and may precede clinical DR. [88][89][90][91][92] Hemodynamic parameters, wall shear rate and wall shear stress are suggested reduced in the early stage of DR, as well as retinal blood velocity and ow, which could be markers of microvasculopathy. 88,93,94 Atherosclerosis has also been considered associated with the severity of DR, manifesting increased macrovascular artery intima-media wall thickness and accompanied by wider retinal vessel diameter in DR. [95][96][97] These studies emphasize the vital role of hemodynamic changes in the early stage of DR. CDDP in TCM theory is characterized by improving blood circulation (Pharmacopoeia of the People's Republic of China). The early application of CDDP in NPDR patients can signi cantly shorten the retinal circulation time and reduce capillary hemangioma, hard exudates, retinal hemorrhaging.…”

Section: Discussionmentioning

confidence: 96%

A Network Pharmacology Based Analysis of The Potential Mechanisms of Compound Danshen Dripping Pill for Treatment of Diabetic Retinopathy

Zhang¹,

Wang²,

Huang³

et al. 2020

Preprint

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Background: Diabetic retinopathy (DR) has become a worldwide concern in recent years because of the high prevalence and vision-threat. The limited therapies have been in stark contrast to its high prevalence. On top of that, almost all the treatments, like laser, are applied only at the end stage of this disease. However, with the development of network pharmacology, a traditional Chinese medicine (TCM), Compound Danshen Dripping Pill (CDDP), may bring some new insights into the early intervention of DR. Methods: The active compounds and potential targets of CDDP and DR-related targets were collected from the TCMSP, UniProt, GeneCards and OMIM databases. And protein-protein interactions (PPI) information was achieved from the STRING database. The gene enrichment analysis of GO and KEGG was carried out by “clusterProfiler” in R software. The collected data was then used to form network maps of compound-target and PPI, or visualized by the software of Cytoscape. Results: 54 compounds and 50 targets were identified for CDDP against DR. Among the predicted effective compounds, 29 tanshinones from Radix Salviae (Danshen) were identified. And the core targets might be estrogen receptor (ESR1), androgen receptor (AR), caspase-3 (CASP3), Interleukin-6 (IL6) and vascular endothelial growth factor A (VEGFA) in 50 targets. There were 266 significantly correlated biological processes such as steroid hormone response, oxidative stress and apoptosis enriched out. Besides, The 50 targets significantly participate in 97 pathways and mainly enriched in advanced glycation end products (AGE)-receptor for advanced glycation end products (RAGE), fluid shear stress and atherosclerosis, apoptosis and VEGF signal pathway et al.Conclusions: The mechanisms of CDDP for treating DR may involve multi-compound, multi-target and multi-pathway synergistic effects. It may participate in the regulation of steroid hormone response, oxidative stress, apoptosis and hemodynamics in diabetic retina. Tanshinones and luteolin from Radix Salviae were probably responsible for the effectiveness of CDDP on DR.

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“…Consistent with our findings, Romney et al (4) noted that vascular compliance was reduced in both large and small arteries in type 1 DM before clinically apparent microvascular complications. Järvisalo et al (17) and Pena et al (18) found that the intima-to-media ratio thickness of the carotid artery was significantly higher in type 1 DM patients in comparison with healthy individuals. It is not clear whether microvascular changes trigger macrovascular changes, or if they progress simultaneously; however, it has been clearly established that the presence of DR predicts and increases the risk of macrovascular complications (19)(20)(21).…”

Section: Discussionmentioning

confidence: 97%

“…Many factors, such as age, race, duration of DM, glycemic control, site of measurement, and measurement technique, may affect ocular hemodynamics and lead to conflicting results (14)(15)(16). Although there is no consensus on changes in ocular hemodynamics before the development of DR, clear evidence has demonstrated that both micro-and macrovascular changes occur even if there is no clinical sign of DR (17).…”

Section: Discussionmentioning

confidence: 99%

Early Changes of Blood Flow Parameters of Ophthalmic Artery in Patients with Type 1 Diabetes Mellitus

Özateş¹

2020

Beyoglu Eye J

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The aim of this study was to assess initial changes in blood flow parameters of the ophthalmic artery (OA) in pediatric patients with type 1 diabetes mellitus (DM). Methods: Sixty-three subjects were included in this prospective, cross-sectional, observational study. Thirty-one (49.2%) patients with type 1 DM without diabetic retinopathy formed the DM group. The control group comprised 32 (50.8%) healthy subjects. The OA of all of the patients was examined with Doppler ultrasonography. The main outcomes were peak systolic velocity (PSV), end diastolic velocity (EDV), pulsatility index (PI), and resistivity index (RI) measurements. Results: The mean age at onset of type 1 DM was 10.7±2.0 years and the mean duration was 11.4±11.0 months. The mean PSV and EDV outcomes in both eyes were significantly higher in the control group than in the DM group, whereas, the mean PI and RI outcomes in both eyes were significantly higher in the DM group (p<0.05). A mean RI of ≥0.75 indicated vascular hemodynamic changes associated with type 1 DM with a sensitivity of 72% and a specificity of 65% (area under the curve: 0.702; p=0.007). A mean PI of ≥1.69 predicted vascular hemodynamic changes associated with type 1 DM with a sensitivity of 79% and a specificity of 71% (area under the curve: 0.742; p=0.001). Conclusion: The results of this study revealed that disturbances in ocular hemodynamics might be present as early as the first year after a type 1 DM diagnosis. Changes in ocular hemodynamic parameters could be used to predict or screen for the development of vascular changes.

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Early atherosclerosis is associated with retinal microvascular changes in adolescents with type 1 diabetes

Cited by 14 publications

References 15 publications

The relationship between carotid disease and retinopathy in diabetes: a systematic review

The relationship between carotid disease and retinopathy in diabetes: a systematic review

A Network Pharmacology Based Analysis of The Potential Mechanisms of Compound Danshen Dripping Pill for Treatment of Diabetic Retinopathy

Early Changes of Blood Flow Parameters of Ophthalmic Artery in Patients with Type 1 Diabetes Mellitus

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