Arterial Stiffness is Associated With Diabetic Retinopathy in Korean Type 2 Diabetic Patients

Abstract

ObjectivesWe evaluated the association between common carotid artery intima-media thickness (CCA-IMT), brachial-ankle pulse wave velocity (baPWV), carotid plaque, and peripheral arterial disease (PAD) as indicators of macroangiopathy and diabetic retinopathy as an indicator of microangiopathy in type 2 diabetic patients.MethodsWe analyzed 605 type 2 diabetic patients registered at a public health center in Korea. Following overnight fasting, venous blood and urine samples were collected and analyzed. The CCA-IMT, levels of carotid plaque, baPWV, and ankle-brachial index (ABI) of the subjects were assessed. We used non-mydriatic fundus photography to diagnose diabetic retinopathy. Multiple logistic regression analyses were used to evaluate the association between macroangiopathy and diabetic retinopathy. CCA-IMT and baPWV were divided into tertiles: CCA-IMT, 0.39 to 0.65 mm, 0.66 to 0.78 mm, and 0.79 to 1.30 mm; baPWV, 9.9 to 15.8 m/s, 15.9 to 18.9 m/s, and 19.0 to 38.0 m/s.ResultsThe association between baPWV and diabetic retinopathy remained significant after adjustment, with an increasing odds ratio (OR) in the second tertile (OR, 2.41; 95% confidence interval [CI], 1.27 to 4.55) and the third tertile (OR, 4.63; 95% CI, 2.33 to 9.21). No significant differences were observed in carotid plaque, PAD, and each tertile of CCA-IMT.ConclusionsBaPWV was associated with diabetic retinopathy, while CCA-IMT, carotid plaque, and PAD were not. This study suggests that the association between macroangiopathy and microangiopathy may be attributable to functional processes rather than structural processes within the vascular system.

Arterial Stiffness Is Associated With Cardiovascular, Renal, Retinal, and Autonomic Disease in Type 1 Diabetes

“…These associations are suggestive of PWV being related to vascular dysfunction (20) and large artery alterations, thereby possibly engaging in the development of kidney impairment (21). Arterial stiffness also is associated with autonomic neuropathy in type 1 diabetes (22,23) and retinopathy in type 2 diabetes (24), further illustrating the association between arterial stiffness and microvascular disease.…”

Relationship between Stage of Diabetic Retinopathy and Pulse Wave Velocity in Japanese Patients with Type 2 Diabetes

“…In addition, microangiopathy is a strong predictor of the development of the more serious long-term complications of diabetes such as blindness, end-stage renal disease, amputation [5], and cardiovascular disease [6]. Previous studies have shown that PWV, a marker of arterial stiffness, is associated with the presence of diabetic retinopathy [7–11]. …”

Early Assessment of the Risk Factors for Diabetic Retinopathy Can Reduce the Risk of Peripheral Arterial and Cardiovascular Diseases in Type 2 Diabetes

“…However, there is still a lack of a consensus amongstr both ophthalmologists and physicians to apply these risk factors to assess the onset of PAD and CVD in patients with DR. Additionally, an abnormal ABI value and the duplex ultrasonograph can help to confirm the association between PAD and DR [21,22]. On the one hand, ophthalmologists tend to focus on the diagnosis and treatment of DR, but ignore the importance of these risk factors in the assessment of PAD and CVD.…”