Increased Arterial Stiffness as a Predictor for Onset and Progression of Diabetic Retinopathy in Type 2 Diabetes Mellitus

Abstract

Introduction. Brachial–ankle pulse wave velocity (baPWV), an indicator of arterial stiffness, has been demonstrated to be associated with type 2 diabetes mellitus (T2DM) and its vascular complications. This study was aimed at investigating the correlations of baPWV with both the presence and severity of diabetic retinopathy (DR) at baseline and at exploring the predictive role of baPWV in the new onset/progression of DR in the follow-up analysis. Methods. The prospective cohort study recruited 2,473 Chinese patients with T2DM, of whom 663 participants were finally included in the follow-up analysis. The presence and grading of DR were performed by the modified Early Treatment Diabetic Retinopathy Study. Uni- or multivariate linear and logistic regression models and Cox proportional-hazards regression analysis were conducted. Results. Of 2,473 patients with T2DM at baseline, 734 individuals were assessed to have DR and further categorized into 630 with non-sight-threatening DR (NSTDR) and 104 with STDR. In addition to the positive relationship between increased baPWV and the presence of DR, multinominal logistic regression analysis revealed that higher tertiles of baPWV were significantly related to the NSTDR (T2: OR = 1.62 (1.22, 2.15), p < 0.001 , and T3: OR = 2.58 (1.86, 3.58), p < 0.001 ) and STDR group (T3: OR = 3.87 (1.87, 8.02), p < 0.001 ). During a follow-up (mean period of 16.4 months), 111 participants had new onset/progression of DR. The cox regressions showed that high baseline baPWV was correlated with increased risk of development/progression of DR ( HR = 2.24 , 95% CI (1.24, 4.03), p = 0.007 , for T2 baPWV and HR = 2.90 , 95% CI (1.49, 5.64), p = 0.002 , for T3 baPWV) after adjustments for multiple factors. Conclusions. Our results demonstrated that baseline baPWV might be an independent predictor in new onset/worsening of DR, suggesting that increased arterial stiffness might be involved in the development of DR. Follow-up studies with a longer duration are needed.

Intermittent supplementation with fisetin improves arterial function in old mice by decreasing cellular senescence

“…Increases in large elastic artery stiffness (i.e., increased aortic PWV and intrinsic mechanical wall stiffness) with aging is a major independent predictor of age‐associated clinical CVD (Vasan et al., 2022 ), impaired glucose tolerance (Zheng et al., 2023 ), kidney dysfunction (Ford et al., 2010 ), cognitive impairment (Thorin‐Trescases et al., 2018 ), and diabetic retinopathy (An et al., 2021 ). Fisetin supplementation reduced arterial stiffness (aortic PWV) in old wild‐type mice by reducing aortic intrinsic mechanical wall stiffness.…”

Global trends and performances in diabetic retinopathy studies: A bibliometric analysis

“…In addition, reviews suggest that the most significant risk factors for the initiation and progression of DR include smoking, a high body mass index, insufficient glycemic control, hypertension, a long history of diabetes, dyslipidemia, and microalbuminuria ( 24 , 25 ). Arterial stiffness has also been proposed as a risk factor related to DR in recent years ( 26 ). Although the exact role of these factors in the pathogenesis of DR is not well-defined, they are important in guiding DR screening and the development of public healthcare strategies.…”

Assessment of the relationship of systemic vascular dysfunction and cardiac autonomic neuropathy (CAN) with diabetic retinopathy

“…Moreover, a positive association of baPWV with the T2DM retinopathy group was found. A previous study reported that higher baPWV values are associated with the presence and severity of DR, and baseline baPWV may be an independent predictor in new-onset DR.[ 5 ] Liu Sung-Chen et al (2020) reported that ‘high baPWV is strongly associated with risk of severe DR, especially PDR’. [ 15 ] It can be inferred from the present study that increased systemic arterial stiffness is present in diabetic retinopathy patients and as systemic vascular stiffness increases, the chance of the existence of diabetic retinopathy also increases.…”

“…Arterial stiffness may decrease intra-arterial wave reflection and increase pulsatile pressure, which may cause damage to retinal microcirculation. [ 4 ] Several studies tried to understand the association of arterial stiffness and endothelial dysfunction with DR or the severity of DR.[ 5 6 7 ] But there is no conclusive answer to it. Moreover, the prevalence of cardiac autonomic neuropathy (CAN) at the time of diagnosis of T2DM is around 7%, and it increases with the duration of diabetes by 4.6– 6% per year.…”