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

Abstract

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.

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

“…Moreover, higher cfPWV was found to be strongly associated with the severity of T2DM retinopathy. [ 4 6 ] However, few studies did not find any association between central aortic stiffness and T2DM retinopathy. [ 13 14 ] In the present study, baPWV was found to be significantly higher in T2DM patients with retinopathy than in T2DM patients without retinopathy.…”

“…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.…”

Orthostatic response in patients with type 2 diabetes mellitus evaluated through acceleration photoplethysmogram

“…23,24 The absence of changes in d/a and APG-AI indices here observed in DM2 patients under orthostatic stress may indicate an initial lacking response due to arterial stiffness. 25,26…”

Cardiovascular Risk Stratification in Diabetic Retinopathy via Atherosclerotic Pathway in COVID-19/Non-COVID-19 Frameworks Using Artificial Intelligence Paradigm: A Narrative Review

“…Several studies by Drinkwater et al showed that carotid artery disease is independently associated with the retinal microvascular disease as assessed by OCTA in type 2 diabetes [135][136][137]. In another study, by Lu et al [138], a link between time in range (TIR) and macrovascular disease was suggested after seeing an increase in cIMT associated with TIR.…”