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

Drinkwater, Jocelyn J.; Davis, Timothy; Hellbusch, Valentina; Turner, Angus; Bruce, David; Davis, Wendy A.

doi:10.1186/s12933-020-01018-3

Cited by 19 publications

(29 citation statements)

References 45 publications

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“…They assumed the correlation between DR and CHD may be due to similar pathophysiological backgrounds. Drinkwater et al [ 22 ] also claimed the intensified CVD risk factor management should be considered for patients with at least moderate NPDR. However, the Age, Gene/Environment Susceptibility-Reykjavik Study (AGES-RS) explores the impact of retinopathy on mortality, and declares even minimal retinopathy is a significant predictor of increased mortality in older persons, irrespective of diabetes status [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Diabetic retinopathy predicts cardiovascular mortality in diabetes: a meta-analysis

Sun

Zhong

et al. 2020

BMC Cardiovasc Disord

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Background The prognostic significance of diabetic retinopathy (DR) for cardiovascular diseases (CVD) remained unclear. Therefore, we performed this meta-analysis to assess whether DR predicted CVD mortality in diabetic patients. Methods We searched PubMed, Embase, Web of Science and Cochrane Library for cohort studies reporting the association of DR and CVD mortality. Then we pooled the data for analysis. Results After screening the literature, 10 eligible studies with 11,239 diabetic subjects were finally included in quantitative synthesis. The pooled risk ratio (RR) of DR, mild DR, and severe DR for CVD mortality was 1.83 (95% confidence interval (CI): 1.42, 2.36; p < 0.001), 1.13 (95% CI 0.81, 1.59; p = 0.46), and 2.26 (1.31, 3.91; p = 0.003), respectively, compared to those without DR. In type 2 DM, the patients with DR had a significantly higher CVD mortality (RR: 1.69; 95% CI 1.27, 2.24; p < 0.001). Subgroup analysis also showed a significantly higher CVD mortality in DR according to various regions, study design, data source, and follow-up period (all RR > 1; all P values < 0.05). Data from 2 studies showed no significant correlation of DR and CVD mortality in diabetic patients receiving cardiovascular surgery (RR: 2.40; 95% CI 0.63, 9.18; P = 0.200). Conclusions DR is a risk marker of cardiovascular death, and severe DR predicts a doubled mortality of CVD in diabetes. These findings indicate the importance of early identification and management of diabetic patients with DR to reduce the risk of death.

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Section: Discussionmentioning

confidence: 99%

Diabetic retinopathy predicts cardiovascular mortality in diabetes: a meta-analysis

Sun

Zhong

et al. 2020

BMC Cardiovasc Disord

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“…Since no reply was received from the authors of two studies (20, 21) after three contact attempts, and the author of one study (22) replied that they did not have the resources at that time to rerun the models, these three publications have been excluded. Finally, 19 studies (23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41) were included in the present meta-analysis.…”

Section: Literature Search and Selection Resultsmentioning

confidence: 99%

“…Among these studies, the fraction of males per studies varied from 37.9 to 77.1%. Ten studies ( 26 , 27 , 32 – 36 , 38 – 41 ) included only T2DM patients, one study ( 28 ) included only T1DM patients, and the remaining eight studies ( 23 – 25 , 29 – 31 , 37 ) included patients with both types of diabetes.…”

Section: Resultsmentioning

confidence: 99%

“…Two studies (24,31) reported RR as effect size, and two (40,41) reported only the incidence of stroke in the exposure and control groups, from which we calculated the crude RR for data synthesis. In 15 of the 19 studies (23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(35)(36)(37)(38), the data were adjusted appropriately.…”

Section: Characteristics Of Studies and Participantsmentioning

confidence: 99%

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Association of Diabetic Retinopathy With Stroke: A Systematic Review and Meta-Analysis

Jiang

Zhou

et al. 2021

Front. Neurol.

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Background: The population-based studies conducted thus far do not provide conclusive evidence of the link between diabetic retinopathy (DR) and stroke. The aim of the present systematic review was to determine whether DR is specifically associated with stroke.Methods: MEDLINE, Embase, and Web of Science were systematically searched from their inception to July 31, 2020. All cohort studies that reported associations between the presence of DR and incident stroke were included. The pooled hazard ratios (HRs), pooled risk ratios (RRs), and 95% confidence intervals (CIs) were calculated.Results: The meta-analysis included 19 cohort studies involving 81,452 diabetic patients. The pooled effect size of any DR related to stroke was 1.25 for HR (95% CI: 1.12–1.39; P < 0.0001) and 1.96 for RR (95% CI: 1.60–2.39; P < 0.0001). Subgroup analysis for the type of diabetes yielded pooled HR of 1.29 (95% CI: 1.10–1.50; P = 0.001) in patients with type 2 diabetes mellitus (T2DM). The pooled RR was 2.29 (95% CI: 1.77–2.96; P < 0.0001) in patients with T2DM. Two studies addressed the DR-related stroke among type 1 diabetes mellitus (T1DM) patients. One study found a significant association between DR and stroke (OR: 1.6; 95% CI: 1.1–2.3; P < 0.01), while the other did not identify an association between these two conditions (RR: 1.40; 95% CI: 0.62–2.18; P = 0.178).Conclusions: The presence of DR is associated with an increased risk of stroke in diabetic patients. This correlation is robust in T2DM patients but uncertain in T1DM patients. Our findings indicate that DR is an important biomarker for the prediction of stroke. To further validate the role of DR in stroke-risk stratification, additional research is required on the association between the stage of DR and stroke risk, and more studies including T1DM patients are necessary.

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“…They assumed the correlation between DR and CHD may be due to similar pathophysiological backgrounds. Drinkwater et al [22] also claimed the intensi ed CVD risk factor management should be considered for patients with at least moderate NPDR. However, the Age, Gene/Environment Susceptibility-Reykjavik Study (AGES-RS) explores the impact of retinopathy on mortality, and declares even minimal retinopathy is a signi cant predictor of increased mortality in older persons, irrespective of diabetes status [23].…”

Section: Discussionmentioning

confidence: 99%

Diabetic Retinopathy Predicts Cardiovascular Mortality in Diabetes: A Meta-analysis

Sun

Zhong

et al. 2020

Preprint

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Background: The prognostic significance of diabetic retinopathy (DR) for cardiovascular diseases (CVD) remained unclear. Therefore, we performed this meta-analysis to assess whether DR predicted CVD mortality in diabetic patients.Methods: We searched PubMed, Embase, Web of Science and Cochrane Library for cohort studies reporting the association of DR and CVD mortality. Then we pooled the data for analysis.Results: After screening the literature, 10 eligible studies with 11,239 diabetic subjects were finally included in quantitative synthesis. The pooled risk ratio (RR) of DR, mild DR, and severe DR for CVD mortality was 1.83 (95% confidence interval (CI): 1.42, 2.36; P < 0.001), 1.13 (95% CI: 0.81, 1.59; P = 0.46), and 2.26 (1.31, 3.91; P = 0.003), respectively, compared to those without DR. In type 2 DM, the patients with DR had a significantly higher CVD mortality (RR: 1.69; 95% CI: 1.27, 2.24; P < 0.001). Subgroup analysis also showed a significantly higher CVD mortality in DR according to various regions, study design, data source, and follow-up period (all RR > 1; all P values < 0.05). Data from 2 studies showed no significant correlation of DR and CVD mortality in diabetic patients receiving cardiovascular surgery (RR: 2.40; 95% CI: 0.63, 9.18; P = 0.200). Conclusions: DR is a risk marker of cardiovascular death, and severe DR predicts a doubled mortality of CVD in diabetes. These findings indicate the importance of early identification and management of diabetic patients with DR to reduce the risk of death.

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

Cited by 19 publications

References 45 publications

Diabetic retinopathy predicts cardiovascular mortality in diabetes: a meta-analysis

Diabetic retinopathy predicts cardiovascular mortality in diabetes: a meta-analysis

Association of Diabetic Retinopathy With Stroke: A Systematic Review and Meta-Analysis

Diabetic Retinopathy Predicts Cardiovascular Mortality in Diabetes: A Meta-analysis

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