Severe diabetic retinopathy linked to increased cardiovascular risk
medwireNews: Individuals with diabetic macular edema (DME) or proliferative diabetic retinopathy (PDR) are more likely to develop and die from cardiovascular disease (CVD) than those without either condition, results of a systematic review and meta-analysis show.
“These data suggest that persons with type 2 diabetes and more severe stages of DR should be followed up more actively by their physicians, with interventions as appropriate, to prevent CVD complications,” Tien Yin Wong (Duke-NUS Medical School, Singapore) and co-authors remark.
They reviewed data for 7604 participants of eight prospective population-based studies evaluating the relationship between DR and CVD, including coronary heart disease (CHD), stroke, or death from cardiovascular causes.
The team found that the prevalence of DME among the study participants, who all had type 2 diabetes, was 4.6%, while that of PDR was 7.4%. During a mean follow-up period of 5.9 years, there were 1203 incident cases of first CVD events, including 916 cases of CHD. Among these, there were 286 CVD fatalities including 242 fatal cases of CHD.
The researchers report in JAMA Ophthalmology that individuals with DME or PDR, collectively known as vision-threatening (VT)DR, were a significant 1.4 times more likely to have incident CVD and 2.3 times more likely to have fatal CVD than those without DME or PDR.
The associations remained significant after multivariable adjustment for vascular risk factors, including smoking, systolic blood pressure, use of hypertension medication, total cholesterol level, and body mass index. However, when duration of diabetes, use of any treatment for diabetes, and glycated hemoglobin level were taken into account, only the association between VTDR and fatal CVD remained significant, at an incident rate ratio of 2.2.
Wong and team note that the loss of statistical significance for incident CVD in the fully adjusted models may be due to the smaller sample size available because some studies were missing data on key confounders.
Similar results were observed for incident and fatal CHD and when DME and PDR were analyzed separately, with slightly higher risks detected among patients with DME compared with PDR.
“Our findings suggest that the presence of DME or PDR may be a marker of generalized microvascular disease, which may contribute to the development of CVD in persons with diabetes,” Wong et al write.
They add: “These data are important because anti-VEGF [vascular endothelial growth factor] treatments for DME and possibly PDR are the current standard of care,” but these drugs can potentially increase the risk for CVD secondary to long-term systemic suppression of VEGF.
Although the studies were conducted prior to the introduction of anti-VEGF therapy for DR, the researchers say their data will “provide a foundation for future studies” investigating whether anti-VEGF use modifies the relationship between DR and CVD risk.
By Laura Cowen
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