Type 2 diabetes-associated carotid plaque burden is increased in patients with retinopathy compared to those without retinopathy

Abstract

BackgroundCardiovascular disease (CVD) is the leading cause of mortality among subjects with type 2 diabetes (T2D), and diabetic retinopathy (DR) has been associated with an increased risk for CVD. The present study was designed to test the concept that T2D patients with DR, but without previous cardiovascular (CV) events and with normal renal function, have an increased atherosclerotic burden compared with patients without DR.MethodsA cross-sectional study was performed using patients with normal renal function (estimated glomerular filtration rate (eGFR) >60 ml/min) and without previous CV events. A total of 312 patients (men, 51%; mean age, 57 yrs; age range 40–75 yrs) were included in the study; 153 (49%) of the patients had DR. B-mode carotid ultrasound imaging was performed for all of the study subjects to measure the carotid intima-media thickness (cIMT) and carotid plaques in the common carotid artery (CCA), bifurcation and internal carotid artery (ICA).ResultsThe percentage of carotid plaques in T2D patients with DR was higher than in T2D patients without DR (68% vs. 52.2%, p = 0.0045), and patients with DR had a higher prevalence of ≥2 carotid plaques (44.4% vs. 21.4%; p < 0.0001). No differences were observed in the cIMT measured at different carotid regions between the patients with or without DR. Using multivariate logistic regression (adjustment for major risk factors for atherosclerosis), DR was independently associated with mean-internal cIMT (p = 0.0176), with the presence of carotid plaques (p = 0.0366) and with carotid plaque burden (≥2 plaques; p < 0.0001).ConclusionsThe present study shows that DR in T2D patients without CVD and with normal renal function is associated with a higher atherosclerotic burden (presence and number of plaques) in the carotid arteries. These patients may be at a higher risk for future CV events; therefore, an ultrasound examination of the carotid arteries should be considered in patients with DR for more careful and individualised CV assessment and follow-up.

Association of statin use and hypertriglyceridemia with diabetic macular edema in patients with type 2 diabetes and diabetic retinopathy

“…Many epidemiological studies showed that DR is associated with macrovascular diseases in patients with type 2 diabetes [47]. Patients with type 2 diabetes and DR have an increased presence and number of plaques in the carotid territory [48]. The presence of dyslipidemia (elevated triglycerides and decreased HDL cholesterol) is associated with silent myocardial ischemia or angiographic coronary artery disease in asymptomatic patients with type 2 diabetes [49].…”

Increased Burden of Cerebral Small Vessel Disease in Patients With Type 2 Diabetes and Retinopathy

“…The study design and assessment of the cohort participants have been described previously by our group in a previous study (20) in which the presence and extension of carotid plaques were analyzed in patients with type 2 diabetes with and without DR. The inclusion criteria for both groups were as follows: age range 40-75 years; absence of established impaired renal function (calculated glomerular filtration rate ,60 mL/min); and absence of known CV disease.…”

“…The clinical examination and review of patients' clinical records ruled out heart failure, any previously known CV events or associated revascularization procedures (coronary heart disease, cerebrovascular disease, and peripheral vascular disease, including previous diabetic foot disease). The general clinical, laboratory, and carotid ultrasound procedures have been described in detail elsewhere (20). Briefly, 312 patients with type 2 diabetes without previous CV events and with normal renal function were recruited from the outpatient clinic at our center.…”

Association between diabetic eye disease and other complications of diabetes: Implications for care. A systematic review

“…The consequences of delayed detection of DR extend beyond suboptimal visual acuity outcomes; increasing evidence links retinopathy to other microvascular complications of diabetes, most notably nephropathy and cardiac autonomic neuropathy (CAN) . Retinopathy has also been linked to macrovascular comorbidities, including stroke, myocardial infarction and, potentially, heart failure . Additionally, a recent meta‐analysis of epidemiological observational studies found that patients with diabetes who have DR are at increased risk of all‐cause mortality, compared with patients with diabetes who do not have retinopathy (risk ratio [RR], 2.33; 95% CI, 1.92‐2.81) …”

“…With regard to the link between DR and cardiovascular events, Alonso et al conducted a cross‐sectional study of patients with T2DM who did not have renal deficits or prior history of cardiovascular disease (CVD). They found that the percentage of patients with carotid plaques, a risk factor for ischaemic stroke, was higher among those with DR than among those without DR (68.0% vs 52.2%; P = 0.0045) . Other research has demonstrated that, not only is DR associated with future cardiovascular events, but also that the risk of these events increases with increasing severity of DR (hazard ratio [HR], 1.49; 95% CI, 1.12‐1.97 for mild retinopathy and HR, 2.35; 95% CI, 1.47‐3.76 for severe retinopathy) .…”