Abstract
Background/AimsTo determine the association between aspirin use and diabetic retinopathy (DR) among persons with diabetes, in a population-based, cross-sectional study.MethodsSubjects with diabetes aged >40 years from the Singapore Epidemiology of Eye Diseases Study were enrolled in this study. Retinal photographs were graded for DR according to the modified Airlie House classification system. Vision threatening diabetic retinopathy (VTDR) was defined as the presence of severe non-proliferative DR, or proliferative DR, or clinically significant macular oedema. The association between aspirin use and the presence of DR or VTDR was assessed using multivariable logistic regression models including age, gender, ethnicity, socioeconomic status, HbA1c, systolic blood pressure, anti-hypertension medicine, total cholesterol, anti-cholesterol medicine, BMI, current smoking status, diabetes duration, history of cardiovascular disease (CVD) and chronic kidney disease (CKD.).ResultsA total of 2,061 participants with diabetes and complete record of relevant systemic and DR data were included. Of these, 711 (34.5%) had any stage of DR, and among these 177 (8.6%) had VTDR. After adjusting for co-variables listed, the association between aspirin use and VTDR was significant (OR = 1.69, P = 0.019), while the association between aspirin use and any DR was borderline (OR = 1.31, P = 0.063). Aspirin use was not associated with either DR or VTDR after additional adjustment of CVD and CKD. Further stratification by history of CVD or CKD showed no association between aspirin use and DR/VTDR in either subgroup.ConclusionAspirin use was not significantly associated with DR but might be an indicator of diabetic complications (CVD, CKD) that were co-present with more severe DR type. Future longitudinal studies are warranted to confirm our findings.
Highlights
Diabetic retinopathy (DR) is a common microvascular complication of diabetes and is the leading cause of preventable vision loss among adult populations worldwide.[1]
Aspirin use was not associated with either DR or vision-threatening DR (VTDR) after additional adjustment of cardiovascular disease (CVD) and Chronic kidney disease (CKD)
Further stratification by history of CVD or CKD showed no association between aspirin use and DR/VTDR in either subgroup
Summary
Diabetic retinopathy (DR) is a common microvascular complication of diabetes and is the leading cause of preventable vision loss among adult populations worldwide.[1] Globally, 34.6% persons with diabetes have DR. Aspirin is commonly used as a primary or secondary prevention to reduce the risk of CVD events and its related mortality[5,6]. While some investigators reported strong association between aspirin use and higher DR incidence[7], others showed that aspirin alone was not associated with risk of DR-related retinal or vitreous hemorrhage[8,9], and that aspirin use may even slow down progression of DR[10]. Observed association between aspirin use and DR by other investigators[7] could be the result of confounding by CVD condition, a concern that has not been examined thoroughly previously
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