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Diabetic retinopathy, atherosclerosis linked
Identifying patients with proliferative retinopathy may help prevent cardiovascular events.
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A strong association between diabetic retinopathy and coronary atherosclerosis was found in a Veterans Affairs study, indicating that this complication of diabetes may predict who is at greater risk of cardiovascular events.
“The aim of the study was to determine the cross-sectional relationship between diabetic retinopathy – and particularly proliferative retinopathy – and coronary atherosclerosis as assessed by coronary calcium,” said Peter D. Reaven, MD, director of the diabetes program at the Carl T. Hayden VA Medical Center in Phoenix. He presented study results at the American Diabetes Association 67th Annual Scientific Sessions in Chicago.
The study included 211 people (95% men) who took part in the Veterans Affairs Diabetes Trial (VADT); the average age of participants was 62.1 years and the mean diabetes duration was 12.5 years. Diabetic retinopathy was assessed using seven-field stereo fundus photography, and coronary artery calcium (Agatston score) was determined using CT.
Prevalence of retinopathy
“Severity of retinopathy in the substudy group was similar to the severity of retinopathy in the overall population of the VADT,” Dr. Reaven said.
In the substudy group, 34% had no retinopathy, 42% had mild, nonproliferative retinopathy, 17% had moderate or severe nonproliferative retinopathy and 7% had proliferative retinopathy.
Retinopathy was found to be correlated with coronary calcium by both absolute score (P = .008) and retinopathy categories. Among those patients with no retinopathy, the median calcium score was 197; for those with microaneurysms only, the median score was 262. Among those with mild nonproliferative retinopathy, the median was 364; for moderate to severe nonproliferative retinopathy, the median was 300; and those with proliferative retinopathy had a median score of 981. Dr. Reaven noted that a score higher than 400 has been shown to strongly increase the risk of adverse cardiovascular events.
Multivariable linear regression models were used to determine other risk factors that are predictive of coronary artery calcium. These factors included age, HDL cholesterol, insulin use, prior cardiovascular events, prior coronary revascularization and race. After adjustment for these factors, proliferative diabetic retinopathy was still associated with the coronary calcium score (P = .04); this association amounted to a 3.2-fold increase in calcium score when proliferative diabetic retinopathy was present.
Coronary calcium score
Because a coronary calcium score higher than 400 is associated with increased risk of adverse events, the researchers also analyzed what factors predicted a score higher than this cutoff. Individuals with proliferative diabetic retinopathy were about eight times more likely to have a score higher than 400 than those without it; this association remained even after adjustment for a variety of other cardiovascular disease risk factors.
“Retinopathy, and particularly pro-liferative diabetic retinopathy, is a strong predictor of coronary atherosclerosis and may indicate those individuals that may be at a particularly high risk for future cardiovascular events,” he said.
This article also appeared in Endocrine Today , a SLACK Incorporated publication.
For more information:
- Reaven PD, Moritz T, et al. Proliferative diabetic retinopathy is strongly related to coronary artery calcium in the Veterans Affairs Diabetes Trial (VADT). Presented at: American Diabetes Association 67th Annual Scientific Sessions; June 22-26, 2007; Chicago.