Coronary artery diseaseAbility of Retinopathy to Predict Cardiovascular Disease in Patients With Type 2 Diabetes Mellitus
Section snippets
Methods
The study design has been previously reported.9 Briefly, we included patients with type 2 DM who consecutively attended the outpatient endocrinology service of Alcañiz Hospital (Teruel, Spain) from 1994 to 1998 (n = 463) after obtaining an informed consent. Inclusion criteria were the presence of diabetes diagnosed according to World Health Organization criteria prevailing at the time,10 age >35 years at time of diagnosis, and insulin independence for ≥1 year after diagnosis of the disease.
Results
A total of 458 patients (181 men and 277 women) were included in the study. Vital status could be ascertained for 456 patients (99.6%). Baseline characteristics of the cohort are listed in Table 1.
Mean follow-up time was 6.7 ± 2.6 years. There were 131 cardiovascular events, 28 fatal and 103 nonfatal, including 23 unstable anginas, 27 nonfatal myocardial infarctions, 12 fatal myocardial infarctions, 2 deaths due to chronic heart failure, 10 sudden deaths, 17 transient ischemic attacks, 30
Discussion
In our cohort of type 2 diabetic patients, we have shown that baseline retinopathy was associated with incident CVD irrespective of other well-established cardiovascular risk factors. Interestingly, this association was also significant after adjusting for other micro- and macrovascular complications.
In epidemiologic studies adjusted for proteinuria, the independent contribution of retinopathy to incident CVD has not been universally demonstrated. Studies by Targher et al1, 2 showed how the
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The degree of retinopathy is equally predictive for renal and macrovascular outcomes in the ACCORD Trial
2014, Journal of Diabetes and its ComplicationsCitation Excerpt :In prospective observational cohorts of people with type 2 diabetes, the presence of any DR versus no DR is associated with an adjusted hazard ratios of 2.3 for stroke, (Cheung, Rogers, Couper, et al., 2007) 2.5 for heart failure, (Cheung, Wang, Rogers, et al., 2008) and 2.2–3.3 for cardiovascular death (Cheung, Wang, Klein, et al., 2007; Liew, Wong, Mitchell, et al., 2009). Longitudinal studies have found more severe retinopathy to result in adjusted hazard ratios of 1.7–3.8 for combined fatal and nonfatal ischemic CV endpoints (Cheung, Wang, Klein, et al., 2007; Gerstein, Ambrosius, Danis, et al., 2012; Gimeno-Orna, Faure-Nogueras, Castro-Alonso, et al., 2009; Targher, Bertolini, Zenari, et al., 2008). The similarity in risk estimates for diabetic kidney and CV outcomes in the setting of retinopathy might suggest a similar or shared pathogenesis for micro- and macrovascular complications of diabetes.
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2012, Egyptian Heart JournalCitation Excerpt :80% of patients with PDR and 70% of patients with nonPDR had significant stenotic CAD lesion. This is coinciding with many recent studies.28,7,29,30 In the present study; old age, longer duration of DM and uncontrolled hyperglycemic state were significantly evident in the stenotic lesion when compared to the nonstenotic group.
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2012, Journal of ProteomicsCitation Excerpt :The elevated levels of retinoids lead to the production of more retinoid binding proteins [42] and the increased serum retinol-binding protein 4 [25] and plasma and vitreous apelin levels [26] were already demonstrated as possible biomarkers in diabetic retinopathy. Prediction of proliferative stage would be critical for the prevention of vision loss and as soon as the proliferative stage was shown to be an independent risk marker for cardiovascular disease in patients with type 2 diabetes it would be an important factor which could classify these diabetic patients as high risk groups for the incidence of cardiovascular disease [43]. The following are the supplementary materials related to this article.
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2011, Diabetes Research and Clinical PracticeCitation Excerpt :Our findings agree with the concept that the pathogenic mechanisms responsible for the association between diabetic nephropathy and CVD risk and between diabetic retinopathy and CVD risk may be dissimilar. Instead, diabetic retinopathy may serve as an independent predictor of CVD risk in type 2 diabetes [29]. The exact mechanisms underlying the association between diabetic retinopathy and atherosclerotic disease are poorly understood, but it is suggested that diabetic micro- and macro-angiopathy in the early stage of diabetes could be induced by endothelial dysfunction.
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