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Proliferative diabetic retinopathy points to increased CVD risk in type 1 diabetes
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Even more than chronic kidney disease, presence of proliferative diabetic retinopathy increased the risk for cardiovascular disease in adults with long-standing type 1 diabetes, according to findings published in Diabetes Care.
George L. King, MD, chief scientific officer at Joslin Diabetes Center and professor of medicine at Harvard Medical School, and colleagues evaluated data from the Joslin 50-Year Medalist study on 762 U.S. adults with type 1 diabetes of at least 50 years (55% women; median age, 65 years; median diabetes duration, 53 years) to determine the associations of CKD and proliferative diabetic retinopathy with CVD. Data from the Finnish Diabetic Nephropathy Study (FinnDiane) on 675 adults with type 1 diabetes (45.2% women; median age, 44.9 years; median diabetes duration. 32.7 years) were also evaluated to validate the findings.
CKD was defined as estimated glomerular filtration rate less than 45 mL/min/1.73 m2, and proliferative diabetic retinopathy was defined using the Early Treatment Diabetic Retinopathy Study protocol. Questionnaires and/or hospital discharge registers were used to determine associations with CVD.
In the Joslin 50-Year Medalist study, the prevalence of CKD was 12.9%, proliferative diabetic retinopathy 53.3% and CVD 38.9%. Participants were divided in four groups based on CKD and proliferative diabetic retinopathy status: CKD and no proliferative diabetic retinopathy (n = 30), no CKD and no proliferative diabetic retinopathy (n = 327), CKD and proliferative diabetic retinopathy (n = 66), and no CKD and proliferative diabetic retinopathy (n = 339).
Prevalence of CVD was lower in the CKD and no proliferative diabetic retinopathy group (34.5%) compared with the CKD and proliferative diabetic retinopathy group (68.2%) and no CKD and proliferative diabetic retinopathy group (42.8%). The no CKD and no proliferative diabetic retinopathy group had the lowest prevalence of CVD (28.8%). CVD was not associated with CKD alone without proliferative diabetic retinopathy (CKD and no proliferative diabetic retinopathy, 34.5% vs. no CKD and no proliferative diabetic retinopathy, 28.8%; P = .51).
Evaluation of the FinnDiane cohort revealed similar findings. The prevalence of CKD was 28.3%, proliferative diabetic retinopathy was 63.1% and CVD was 18.1%. Participants were divided into the same four groups as the Joslin 50-Year Medalist study participants: CKD and no proliferative diabetic retinopathy (n = 21), no CKD and no proliferative diabetic retinopathy (n = 228), CKD and proliferative diabetic retinopathy (n = 170) and no CKD and proliferative diabetic retinopathy (n = 256).
Prevalence of CVD was highest in the CKD and proliferative diabetic retinopathy group (37.1%) followed by the CKD and no proliferative diabetic retinopathy group (19.1%), the no CKD and proliferative diabetic retinopathy group (15.1%) and the no CKD and no proliferative diabetic retinopathy group (6.6%).
“Our study showed that in people with very long duration of type 1 diabetes, the presence of nephropathy alone did not significantly increase the risk of CVD as expected,” King told Endocrine Today. “However, the addition of severe retinopathy, or proliferative retinopathy, to nephropathy, greatly increased the risk of CVD in people with type 1 diabetes. Thus, it is important to follow eye or retinal changes in people with type 1 diabetes of long duration, especially if they have nephropathy, for signs of CVD, the major cause of mortality in type 1 diabetes.
“We are not searching for systemic factors which could be protecting people with type 1 diabetes from severe retinopathy and CVD or factors that are formed by the presence of nephropathy and more severe retinopathy to elevate the risks of CVD in people with type 1 diabetes,” King said. – by Amber Cox
For more information:
George L. King, MD, can be reached at george.king@joslin.harvard.edu.
Disclosures: King reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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