Retinopathy Is Related to the Angiographically Detected Severity and Extent of Coronary Artery Disease in Patients With Type 2 Diabetes Mellitus

Abstract

SUMMARYDiabetic retinopathy (DR) is an early and frequent marker of other vascular complications of diabetes and its relation with coronary ischemia is known. The aim of the present study was to evaluate the association between DR and indices of coronary artery disease (CAD) severity and extent determined by coronary angiography.Sixty-nine diabetic patients undergoing coronary angiography for suspected CAD were evaluated. The severity and extent of CAD were scored from coronary angiograms by using 3 scores. Retinopathy was graded by fundus examination.There were differences in the severity score, extent score, number of vessels with disease, duration of diabetes, diabetes therapy, history of previous myocardial infarction (MI), and serum creatinine level among patients with and without DR. CAD severity was associated with the presence of DR (r: 0.53, P < 0.001), grade of DR (r: 0.52, P < 0.001), duration of diabetes (r: 0.28, P: 0.019), history of previous MI (r: 0.36, P: 0.002); and serum creatinine level (r: 0.24, P: 0.049) where the presence of DR was the only independent factor related to the severity score in multivariate analysis (r: 0.48, P < 0.001). The parameters related to the extent score were the presence of DR (r: 0.50, P < 0.001); grade of DR (r: 0.48, P < 0.001); previous MI (r: 0.37, P: 0.002) and age of the patient (r: 0.26, P: 0.033). Factors independently related to the extent score in multivariate analysis were the presence of DR (r: 0.37, P: 0.001), previous MI (r: 0.30, P: 0.006), and age of the patient (r: 0.22, P: 0.003).Among diabetics who are suspected of having CAD, those with retinopathy have more diffuse and severe coronary atherosclerosis, compared with diabetics without retinopathy. This cannot be explained by a longer duration or inferior control of the disease. (Int Heart J 2005; 46: 639-646)

Diabetic Retinopathy and the Risk of Coronary Heart Disease

“…Studies have shown that diabetic individuals with retinopathy are more likely to have myocardial perfusion defects (11,31,32), poorer coronary flow reserve (33), and lower coronary collateral score (34) than those without retinopathy. Moreover, diabetic retinopathy has also been associated with higher degrees of coronary calcification (35) and more diffuse and severe coronary artery stenosis on angiograms (36). These observations, in conjunction with ours, support the concept that micro-and macrovascular complications of diabetes share common pathogenic mechanisms (16,37) beyond those related to the risk factors adjusted for in our multivariate models.…”

Association of retinopathy with coronary atherosclerosis determined by coronary 64-slice multidetector computed tomography angiography in type 2 diabetes

“…The differences in results between studies may be attributable to the study methods. The association found between DR and CAS in this study is similar to the association discovered in the previous studies, 6,28 but not consistent with data from a recent study. 8 A previous study about association of DR with CAD demonstrated that the mean coronary artery calcium (CAC) score, a quantitative marker of CAS burden, measured by electron beam CT and multidetector CT, was significantly greater in T1DM patients with DR than in those without DR. 28 This study was only limited to T1DM and had no evaluation of noncalcified coronary plaques, an early and basic pathologic change of CAD, which have been suggested to be associated with CAS compared to calcified plaques when detected by multislice computed tomography (MSCT).…”

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

“…Of note, this association remained robust and significant using several different approaches to analyze CAC. Only one other study, comprised of a small group of patients preselected for suspected CVD, has explored the relationship between retinopathy and coronary atherosclerosis and demonstrated a relationship between retinopathy, assessed during opthalmoscopic fundus exams, and coronary angiogram severity (32).…”