Abstract
BackgroundMicroangiopathy in type 2 diabetes (T2D) is associated with cardiovascular disease (CVD), but most relevant studies were performed > 10 years ago. CVD risk factor management has since improved. The aim of this study was to determine whether diabetic retinopathy (DR) and its severity increases stroke and myocardial infarction (MI) risk in a contemporary cohort.MethodsFremantle Diabetes Study Phase II participants with T2D had DR graded from fundus photography at baseline between 2008 and 2011. Subsequent hospitalizations and mortality for MI or stroke were ascertained through validated data linkage to end-2016. Cox regression modelling identified predictors of first stroke and MI including DR presence and severity.ResultsThe 1521 participants with T2D and known DR status (mean age 65.6 years, 52.1% males, median diabetes duration 9.0 years) were followed for a mean of 6.6 years. After excluding those with prior MI/stroke, there were 126 incident MIs among 1393 eligible participants and 53 incident strokes in 1473 eligible participants, respectively. Moderate non-proliferative DR (NPDR) or worse was significantly and independently associated with an increased risk of incident stroke (adjusted hazard ratio 2.55 (95% CI 1.19, 5.47), p = 0.016). Retinopathy presence and severity increased the risk of incident MI in unadjusted models (p ≤ 0.001), but these associations were no longer statistically significant after adjusting for other risk factors.ConclusionsModerate NPDR or worse was associated with an increased risk of first stroke in Australians with T2D. Intensified CVD risk factor management should be considered for patients with at least moderate NPDR.
Highlights
Microangiopathy in type 2 diabetes (T2D) is associated with cardiovascular disease (CVD), but most relevant studies were performed > 10 years ago
One participant who had diabetic retinopathy (DR) documented in the medical record but without classification of severity was conservatively assumed to have mild DR
Diabetic retinopathy status was not available for 30 (1.9%) participants, who were excluded from analyses
Summary
Microangiopathy in type 2 diabetes (T2D) is associated with cardiovascular disease (CVD), but most relevant studies were performed > 10 years ago. The aim of this study was to determine whether diabetic retinopathy (DR) and its severity increases stroke and myocardial infarction (MI) risk in a contemporary cohort. Diabetic retinopathy (DR) is a microvascular complication characterized by microaneurysms, exudates and hemorrhages [1]. Knowledge of the relationship between the microvascular and macrovascular complications of T2D has important implications for screening and risk factor management [16]. In light of this and the recent marked changes in CVD epidemiology in T2D, the aim of the present study was to determine whether the presence and/or severity of DR is associated with incident stroke and myocardial infarction (MI) in a well characterized, contemporary Australian community-based cohort
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