High cardiovascular disease mortality in subjects with visual impairment caused by diabetic retinopathy.

Abstract

OBJECTIVE: The aim of this study was to assess mortality and causes of death in subjects with visual impairment caused by diabetic retinopathy (DR). Only limited data are available concerning the mortality of subjects with DR, and to our knowledge, no data so far have been published on the mortality of subjects with visual impairment caused by DR. RESEARCH DESIGN AND METHODS: We identified 34 men and 73 women living in northern Finland with visual impairment caused by DR on 31 December 1993. The median age of the subjects was 71 years (range 27-88). The mortality of these 107 diabetic subjects was followed up for 4 years, until 31 December 1997, and compared with the mortality rates of 3 age- and sex-matched control groups. The first control group consisted of subjects treated for DR by laser coagulation from 1990 to 1993. The second control group consisted of diabetic subjects who had had fundus photographs taken from 1991 to 1992. The third control group comprised nondiabetic subjects selected from the population register. Information on deaths was obtained from official death certificates. RESULTS: A total of 91 diabetic and 10 nondiabetic subjects died during the follow-up. Of the deaths, 51 occurred in the subjects with visual impairment caused by DR, with a 4-year mortality rate of 477/1,000 (95% CI 382-571/1,000). Mortality rates were 224/1,000 (145-303/1,000) for the diabetic subjects with retinopathy treated by laser coagulation; 150/1,000 (82-217/1,000) for the diabetic subjects who had undergone fundus photography; and 94/1,000 (46-165/1,000) for the nondiabetic subjects. Cardiovascular diseases were the underlying cause of death in 55% of the subjects with visual impairment. Nephropathy was mentioned as the immediate cause of death for only 10% of the subjects. Compared with the nondiabetic control subjects, the odds ratios (ORs) for all-cause mortality were 5.1 (2.6-11) in the diabetic subjects with visual impairment caused by DR, and 5.6 (2.1-19) for mortality caused by diseases of the circulatory system. The ORs for all-cause mortality were 2.4 (1.1-5.6) in the diabetic subjects with retinopathy treated by laser coagulation and 1.6 (0.68-4.0) in the diabetic subjects with fundus photographs taken. CONCLUSIONS: The survival of diabetic subjects with visual impairment caused by DR was poor. The high mortality rate was attributed mainly to cardiovascular diseases. Therefore, severe retinopathy proves to be a risk marker of cardiovascular death in diabetic patients.

Proliferative Diabetic Retinopathy in Type 2 Diabetes Is Related to Coronary Artery Calcium in the Veterans Affairs Diabetes Trial (VADT)

“…In fact, substantial evidence now exists that both microalbuminuria and retinopathy are independent risk factors for CVD events and mortality (2)(3)(4)(5)(7)(8)(9)(10)(11)30). Although the studies in type 1 diabetes are limited in number (9,31), this relationship between retinopathy and CVD is present in both type 1 and type 2 diabetic populations and appears strongest for proliferative retinopathy (4,5,7-11).…”

“…This relationship appears to be present in both type 1 and type 2 diabetes (4 -11). Importantly, most (4,5,(7)(8)(9)(10)(11), but not all (9), of these studies have indicated that retinopathy may be independently associated with CVD events or mortality even after taking into account standard cardiovascular risk factors, diabetes duration, and/or glycemic control. Results from these studies suggest that there may be shared risk factors or mechanisms underlying both retinopathy and clinical CVD and that the relationship does not appear to be explained by standard cardiovascular risk factors or glycemic control.…”

Diabetic retinopathy is associated with insulin resistance and cardiovascular autonomic dysfunction in type 2 diabetic patients

“…This may explain why microangiopathy has been associated with macroangiopathy and mortality. 1,2 For example, diabetic retinopathy (DR) has been associated with increased cardiovascular and mortality risk from all causes, particularly in type 2 diabetes. 3,4 Impaired autonomic nervous activity has been recognized as a crucial component of cardiac dysfunction and is strongly associated with harmful events and overall mortality in diabetic patients.…”

Proliferative retinopathy and proteinuria predict mortality rate in type 1 diabetic patients from Fyn County, Denmark

“…This excess mortality is mainly caused by the more frequent development of macrovascular diseases among these patients [2,[6][7][8][9][10].…”