Prediction of risk of diabetic retinopathy for all-cause mortality, stroke and heart failure

Abstract

To examine and quantify the potential relation between diabetic retinopathy (DR) and risk of all-cause mortality, stroke and heart failure (HF).The resources of meta-analysis of epidemiological observational studies were from Pub-med, EMBASE, CINAHL, Cochrane Library, conference, and proceedings.Random/fixed effects models were used to calculate pooled subgroup analysis stratified by different grades of DR was performed to explore the potential source of heterogeneity. Statistical manipulations were undertaken using program STATA.Of the included 25 studies, comprising 142,625 participants, 19 studies were concluded to find the relation of DR to all-cause mortality, 5 for stroke, and 3 for HF. Risk ratio (RR) for all-cause mortality with the presence of DR was 2.33 (95% CI 1.92–2.81) compared with diabetic individuals without DR. Evidences showed a higher risk of all-cause mortality associated with DR in patients with T2D or T1D (RR 2.25, 95% CI 1.91–2.65. RR 2.68, 95% CI 1.34–5.36). According to different grades of DR in patients with T2D, RR for all-cause mortality varied, the risk of nonproliferative diabetic retinopathy (NPDR) was 1.38 (1.11–1.70), while the risk of proliferative diabetic retinopathy (PDR) was 2.32 (1.75–3.06). There was no evidence of significant heterogeneity (Cochran Q test P = 0.29 vs 0.26, I2 = 19.6% vs 22.6%, respectively). Data from 5 studies in relation to DR and the risk of stroke showed that DR was significantly associated with increased risk of stroke (RR = 1.74, 95%CI: 1.35–2.24), compared with patients without DR. Furthermore, DR (as compared with individuals without DR) was associated with a marginal increased risk of HF in patients with diabetes mellitus (DM) (n = 3 studies; RR 2.24, 95% CI 0.98–5.14, P = 0.056).Our results showed that DR increased the risk of all-cause mortality, regardless of the different stages, compared with the diabetic individuals without DR. DR predicted increased risk of stroke and HF. Although only 3 studies about HF were available, the association between DR and HF should be careful.

Effect of duration and burden of microvascular complications on mortality rate in type 1 diabetes: an observational clinical cohort study

“…Retinopathy did not appear to be associated with mortality risk in type 1 diabetes. Based on the literature, we would have expected to find a higher mortality rate in the individuals with type 1 diabetes and retinopathy compared with individuals without this complication [25][26][27]. In a previous study, we found retinopathy to be predictive of the occurrence of diabetic kidney disease and neuropathy in type 1 diabetes [28].…”

Association between diabetic eye disease and other complications of diabetes: Implications for care. A systematic review

“…The consequences of delayed detection of DR extend beyond suboptimal visual acuity outcomes; increasing evidence links retinopathy to other microvascular complications of diabetes, most notably nephropathy and cardiac autonomic neuropathy (CAN) . Retinopathy has also been linked to macrovascular comorbidities, including stroke, myocardial infarction and, potentially, heart failure . Additionally, a recent meta‐analysis of epidemiological observational studies found that patients with diabetes who have DR are at increased risk of all‐cause mortality, compared with patients with diabetes who do not have retinopathy (risk ratio [RR], 2.33; 95% CI, 1.92‐2.81) …”

“…Retinopathy has also been linked to macrovascular comorbidities, including stroke, myocardial infarction and, potentially, heart failure . Additionally, a recent meta‐analysis of epidemiological observational studies found that patients with diabetes who have DR are at increased risk of all‐cause mortality, compared with patients with diabetes who do not have retinopathy (risk ratio [RR], 2.33; 95% CI, 1.92‐2.81) …”

“…[13][14][15][16] Retinopathy has also been linked to macrovascular comorbidities, including stroke, myocardial infarction and, potentially, heart failure. [17][18][19] Additionally, a recent meta-analysis of epidemiological observational studies found that patients with diabetes who have DR are at increased risk of all-cause mortality, compared with patients with diabetes who do not have retinopathy (risk ratio [RR], 2.33; 95% CI, 1.92-2.81). 19 With regard to the link between DR and cardiovascular events, Alonso et al conducted a cross-sectional study of patients with T2DM who did not have renal deficits or prior history of cardiovascular disease (CVD).…”

“…[17][18][19] Additionally, a recent meta-analysis of epidemiological observational studies found that patients with diabetes who have DR are at increased risk of all-cause mortality, compared with patients with diabetes who do not have retinopathy (risk ratio [RR], 2.33; 95% CI, 1.92-2.81). 19 With regard to the link between DR and cardiovascular events, Alonso et al conducted a cross-sectional study of patients with T2DM who did not have renal deficits or prior history of cardiovascular disease (CVD). They found that the percentage of patients with carotid plaques, a risk factor for ischaemic stroke, 20 was higher among those with DR than among those without DR (68.0% vs 52.2%; P = 0.0045).…”