Diabetic Retinopathy May Be a Predictor of Stroke in Patients With Diabetes Mellitus

Abstract

BACKGROUND To investigate a conclusive relationship between diabetic retinopathy (DR) and the risk of stroke, we performed a meta-analysis of the available relevant studies. METHODS After a systematic search of studies in electronic databases, we screened all studies reporting the risk of DR status and stroke incidence and calculated their odds ratios (ORs) and hazard ratios (HRs). The effects of type of diabetes and severity of DR were also considered for subgroup analysis. RESULTS We included a total of 19 studies involving 45,495 patients. A pooled HR=1.62 (1.28, 2.06) were found for the risk of DR and stroke in diabetic patients. In a subgroup analysis performed on the type of diabetes, the results showed a significant association between stroke incidence and DR status in patients with T2D (OR: 1.78; 95% CL: 1.53, 2.08), but this association was not conclusive in T1D (OR: 1.77; 95% CL: 0.48, 6.61). The results of the subgroup analysis with diabetes severity showed that both mild and moderate NPDR status and severe NPDR and worse status significantly increased the risk of stroke with HRs of 2,01 (1.45, 2.78) and 2.27 (1.52, 3.39), respectively. CONCLUSION DR status in diabetic patients is associated with an increased risk of stroke. This correlation was robust in patients with T2D, but uncertain in T1D. Based on this result, we have perhaps found the new factor for stroke management, so we analyzed the necessity and advantages of considering DR as a factor for stroke screening and risk management in our studies.

Diabetic retinopathy as the leading cause of blindness and early predictor of cascading complications—risks and mitigation

“…blindness [8]. Moreover, it has to be noted that PDR is considered an independent predictor of other severe diabetic complications such as ischemic stroke [9][10][11]. Contextually, a "domino effect" is characteristic for the cascading DM complications with a key role of DR as the early indicator of impaired molecular and visual signaling (Fig.…”

“…Diabetes-related microvascular complications are widely acknowledged as a risk factor for the macrovascular sequelae of stroke [9]. Moreover, it has to be noted that according to the metaanalysis of 19 studies involving 45,495 patients, people with diabetes who have DR have an elevated stroke risk-a relationship that was significant for patients with T2D but inconclusive for patients with T1D [10]. Studies reviewed by Hu et al have demonstrated that stroke risk increases as DR stage and lesion severity increase [52].…”

Diabetic Retinopathy May Covariate With Stroke in Diabetes Mellitus

“…According to particular research, persons with diabetes have a much higher risk of stroke than those who do not have the disease. Additionally, several analysts concluded that having DR increases the risk of stroke in people living with diabetes [8]. Consequently, routine DR screening should be carried out.…”

“…Consequently, routine DR screening should be carried out. Optical coherence tomography (OCT) helps assess and control the risk of stroke; additional ophthalmological procedures include angiography and scanning laser ophthalmoscopy examination [8]. The stages of DR and its clinical findings are mentioned in Table 1.…”

“…Diabetes retinopathy will be enclosed in a routine examination for chronic complications of diabetes. There is evidence that microvascular illness contributes significantly to stroke, and as DR is considered a diabetic microvascular consequence, it is the only ocular component associated with stroke [8]. During the early stage of the disease, patients are usually asymptomatic; however, there is a progression over time with the development of microaneurysm and microvascular haemorrhages in brain anomalies.…”