Does retinopathy predict stroke recurrence in type 2 diabetes patients: A retrospective study?

Hjelmgren, Ola; Strömberg, Ulf; Gellerman, Karl; Thurin, Anders; Zetterberg, Madeleine; Bergström, Göran

doi:10.1371/journal.pone.0210832

Cited by 8 publications

(24 citation statements)

References 33 publications

(44 reference statements)

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“…Retinopathy has also been associated with subclinical carotid atherosclerosis in diabetes [32]. While there are few studies that have assessed the association between diabetes and carotid disease, some have found a significant association [33][34][35][36] but others did not [37][38][39][40]. Although the Rio de Janeiro type 2 diabetes cohort study found no association between carotid disease and new or worsening DR, participants with carotid disease and microvascular disease at baseline were more likely to have a cardiovascular event than those with carotid disease without microvascular complications [38].…”

Section: The Association Between Microvascular and Macrovascular Disementioning

confidence: 99%

Retinopathy predicts stroke but not myocardial infarction in type 2 diabetes: the Fremantle Diabetes Study Phase II

Drinkwater

Davis

Hellbusch

et al. 2020

Cardiovasc Diabetol

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Background: Microangiopathy 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. Methods: Fremantle 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. Results: The 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. Conclusions: Moderate 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.

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Section: The Association Between Microvascular and Macrovascular Disementioning

confidence: 99%

Retinopathy predicts stroke but not myocardial infarction in type 2 diabetes: the Fremantle Diabetes Study Phase II

Drinkwater

Davis

Hellbusch

et al. 2020

Cardiovasc Diabetol

View full text Add to dashboard Cite

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“…The results from the cross-sectional studies suggest that there is some association between the two complications (see Table 4). In general, there was a statistically significant relationship between one or more measure of carotid disease and DR. Four of the 14 studies reported no statistically significant association between any carotid disease variable and any DR variable [10,23,30,32].…”

Section: Resultsmentioning

confidence: 93%

“…While most studies showed a significant association between carotid disease and DR, four studies reported no significant relationship. Three of these were of good quality [10,23,30], while one was of poor quality [32]. The study by Araszkiewicz et al had a small sample size compared to the other studies and excluded those with carotid stenosis > 50%; this probably also excluded those with a high common carotid artery (CCA) IMT which may explain the lack of association [30].…”

Section: Resultsmentioning

confidence: 98%

“…The methods, results and limitations of these studies are summarised in Table 3. Ten studies used carotid disease as the dependent variable in analysis [7,10,23,[27][28][29][31][32][33][34] and the remaining four used DR as the dependent variable [8][9][10]30]. However, as only one study had a longitudinal component (with carotid disease as dependent variable), the directionality of any association was not able to be determined.…”

Section: Resultsmentioning

confidence: 99%

“…The study by Araszkiewicz et al had a small sample size compared to the other studies and excluded those with carotid stenosis > 50%; this probably also excluded those with a high common carotid artery (CCA) IMT which may explain the lack of association [30]. Hjelmgren et al assessed the relationship with stenosis and defined stenosis as a narrowing of > 50%, excluding less severe cases [32]. In the study by Yun et al, CCA IMT was analysed by tertiles, the highest of which ranged from 0.79 to 1.30 mm, including those without clinically significant intima-media thickening of ≥ 1 mm [10].…”

Section: Resultsmentioning

confidence: 99%

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The relationship between carotid disease and retinopathy in diabetes: a systematic review

Drinkwater

Davis

2020

Cardiovasc Diabetol

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Background: Since studies of the relationship between carotid disease and diabetic retinopathy (DR) have shown apparent inconsistencies, the aim of this study was to conduct a systematic review of available published data. Methods: Electronic databases were searched independently by two reviewers, according to an iterative protocol, for relevant articles. The search term used was "diabetes AND (carotid disease OR intima-media OR carotid plaque OR carotid stenosis OR carotid arterial disease OR carotid artery disease OR carotid atherosclerosis) AND (retinopathy OR diabetic retinopathy)". Results: From 477 publications, 14 studies were included. There were differences in the variables used as markers of carotid disease and DR across the included studies. Ten studies used carotid disease as the dependent variable, and the remainder used DR. All but one study involved cross-sectional data. Most studies reported a statistically significant association between at least one parameter of carotid disease as assessed by ultrasound and DR presence or severity. Only four studies reported no significant association. A common limitation was the use of convenience participant sampling. Conclusions: There appears to be an increased likelihood of DR when there is ultrasonographic evidence of carotid disease, and vice versa. The available studies suggest that there may be a direct relationship between DR and carotid macrovascular disease and/or that these complications co-exist due to shared risk factors. If carotid disease is detected, retinal assessment should be performed. If DR is identified, intensive cardiovascular disease risk management should be considered. Additional longitudinal studies are needed to assess the directionality of the association.

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The association between carotid disease, arterial stiffness and diabetic retinopathy in type 2 diabetes: the Fremantle Diabetes Study Phase II

et al. 2020

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Aim To determine whether macrovascular disease assessed by carotid ultrasonography and arterial stiffness by pulse wave velocity are independently associated with diabetic retinopathy in type 2 diabetes. Methods A random subgroup of surviving participants with type 2 diabetes from the Fremantle Diabetes Study Phase II were invited to take part in this sub‐study in 2018–2019. In addition to standardized questionnaires, a physical examination and fasting biochemical tests, each underwent dilated colour fundus photography, carotid arterial ultrasonography with measurement of the intima–media thickness (IMT) and quantification of the degree of stenosis, and pulse wave analysis calculation of the carotid–femoral pulse wave velocity (cfPWV). The cross‐sectional association between arterial disease parameters and diabetic retinopathy was assessed using generalized estimating equation models which enabled both eyes to be included in the analysis. Results Some 270 participants [mean ± sd age 72 ± 9 years, 153 (57%) men and median (IQR) diabetes duration 15 (11–22) years] were included in analysis. Of 524 assessable eyes, 82 (16%) had diabetic retinopathy. In multivariable analysis, significant independent associates of diabetic retinopathy were age at diabetes diagnosis (inversely), HbA1c, insulin treatment and urinary albumin to creatinine ratio (all P ≤ 0.022), as well as cfPWV [odds ratio (OR) 1.13, 95% confidence interval (CI) 1.03, 1.23 per 1 m/s increase; P = 0.008] and common carotid artery (CCA) IMT ≥1 mm (OR 2.95, 95% CI 1.21, 7.23; P = 0.018). Conclusions The association between diabetic retinopathy and CCA IMT suggests that carotid disease may share cardiovascular risk factors with diabetic retinopathy. The association between diabetic retinopathy and cfPWV may reflect the consequences of altered intravascular haemodynamics.

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Does retinopathy predict stroke recurrence in type 2 diabetes patients: A retrospective study?

Cited by 8 publications

References 33 publications

Retinopathy predicts stroke but not myocardial infarction in type 2 diabetes: the Fremantle Diabetes Study Phase II

Retinopathy predicts stroke but not myocardial infarction in type 2 diabetes: the Fremantle Diabetes Study Phase II

The relationship between carotid disease and retinopathy in diabetes: a systematic review

The association between carotid disease, arterial stiffness and diabetic retinopathy in type 2 diabetes: the Fremantle Diabetes Study Phase II

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