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11-10-2018 | Retinopathy | Article

Diabetic retinopathy grade as a predictive marker of severity of cardiovascular disease and mortality: DIVERSE Study Group

Journal: International Journal of Diabetes in Developing Countries

Authors: Kiran Shah, Sundaram Natarajan, Milind Phadke, Onkar C Swami

Publisher: Springer India

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Abstract

Patients with diabetic retinopathy (DR) are more likely to have subclinical cardiovascular disease. Objective of this study was to assess the prevalence and association of DR grades along with comorbidities in patients with established cardiovascular disease (CVD); association of DR grades beyond ocular morbidity, i.e., long-term outcomes among established CVD; influence of DR grades on prognosis in patients undergoing coronary revascularization. This was a single center, retrospective, data analysis of T2DM patients with established CVD. Goodness of fit was analyzed using Pearson’s chi-square test. DR was observed in 64% (n = 2560) of patients (non-proliferative diabetic retinopathy [NPDR] 37%; proliferative diabetic retinopathy [PDR] 27%). DR and CVD were strongly associated; highest association was observed for congestive heart failure (CHF) (n = 1325), followed by myocardial infarction (MI) (n = 795), unstable angina (UA) (n = 275), and cardiomyopathy (n = 165) (p < 0.00001). Patients with NPDR have greater risk of CHF, MI, UA, and cardiomyopathy vs. PDR [HR 1.32, 1.44, 1.2, and 1.75 respectively]. Five-year all-cause mortality was significantly higher in patients with DR (94.2%; n = 766) vs. that in patients with non-DR (5.78%; n = 47) (p < 0.00001). NPDR patients undergoing CABG (n = 765) had lower 5-year mortality than those underwent PTCA (n = 615) (8.36% vs. 25.85%, p < 0.00001).Three times lower 5-year mortality rate was noted in patients with PDR undergoing CABG vs. that in patients undergoing PTCA (n = 265) (25.3 vs. 72.2%, p < 0.00001). DR was strongly associated with CVD with highest association with CHF, followed by MI, UA, and cardiomyopathy. Cardiovascular events, cerebrovascular events, mortality, and all-cause mortality were higher in patients with DR. Higher risk of mortality was noted in NPDR patients who underwent PTCA than in NPDR patients who underwent CABG.
Literature
1.
Camici PG, Crea F. Coronary microvascular dysfunction. N Engl J Med. 2007;356(8):830–40. CrossRefPubMed
2.
Klein R, Klein BE, Moss SE, Cruickshanks KJ. Association of ocular disease and mortality in a diabetic population. Arch Ophthalmol. 1999;117:1487–95. CrossRefPubMed
3.
The BARI Investigators. Seven year outcome in the Bypass Angioplasty Revascularization Investigation (BARI) by treatment and diabetic status. J Am CollCardiol. 2000;35:1122–9. CrossRef
4.
King SB, Kosinski AS, Guyton RA, Lembo NJ, Weintraub WS, for Emory Angioplasty versus Surgery Trial (EAST) investigators. Eight-year mortality in the Emory Angioplasty Versus Surgery Trial (EAST). J Am CollCardiol. 2000;35:1116–21. CrossRef
5.
Niles NW, McGrath PD, Malenka D, Quinton H, Wennberg D, Shubrooks SJ, et al. Survival of patients with diabetes and multi-vessel coronary artery disease after surgical or percutaneous coronary revascularization: results of large regional prospective study. J Am CollCardiol. 2001;37:1008–15. CrossRef
6.
Bailey CC, Sparrow LM. Co-morbidity in patients with sight-threatening diabetic retinopathy. Eye. 2001;15:719–22. CrossRefPubMed
7.
Sullivan P, Caldwell G, Alexander N, Kohner E. Long-term outcome after photocoagulation for proliferative diabetic retinopathy. Diabet Med. 1990;7:788–94. CrossRefPubMed
8.
Uchio E, Inamura M, Ohno S, Taguchi H, Saeki K. Survival rate after vitreous surgery in patients with diabetic retinopathy. Opthalmologica. 1993;206:83–8. CrossRef
9.
Hanis CL, Chu HH, Lawson K, Hewett-Emmett D, Barton SA, Schull WJ, et al. Mortality of Mexican Americans with NIDDM. Diabetes Care. 1993;16:82–9. CrossRefPubMed
10.
Gollamuddi SR, Smidydy WE, Schachat AP, et al. Long-term survival rate after vitreous surgery for complications of diabetic retinopathy. Opthalmology. 1991;98:18–22. CrossRef
11.
Laakso M. Heart in diabetes: a microvascular disease. Diabetes Care. 2011;34:S145–9. CrossRefPubMedPubMedCentral
12.
FilipoCrea C, BaireyMerz N, et al. The parallel tales of microvascular angina and heart failure with preserved ejection fraction: a paradigm shift. Eur Heart J. 2017;38:473–7.
13.
Cheung N, Liew G, Wonga TY. Current approaches to retinopathy as a predictor of cardiovascular risk. Experimental approaches to diabetic retinopathy. Front Diabetes Basel, Karger. 2010;20:203–19. CrossRef
14.
Naito R, Miyauchi K. Coronary artery disease and type 2 diabetes mellitus. Int Heart J. 2017;58:475–80. CrossRefPubMed
15.
Wong TY, Mcintosh R. Systemic associations of retinal vascular signs: a review of recent population-based studies. Opthalmic Physiol Opt. 2005;25:195–204. CrossRef
16.
Wong TY, Mcintosh R. Hypertensive retinopathy signs as risk indicators of cardiovascular morbidity and mortality. Br Med Bull. 2005;73-74:57–70. CrossRefPubMed
17.
The BARI Investigators. Comparison of coronary bypass surgery with angioplasty in patients with multi-vessel disease. N Engl J Med. 1996;335:217–25. CrossRef
18.
The BARI Investigators. The final 10-year follow-up results from the BARI randomization trial. J Am Coll Cardiol. 2007;49:1600–6. CrossRef
19.
Brownrigg JR, Hughes CO, Burleigh D, Karthikesalingam A, Patterson BO, Holt PJ, et al. Microvascular disease and risk of cardiovascular events among individuals with type 2 diabetes: a population-level cohort study. Lancet Diabetes Endocrinol. 2016;4(7):588–97. CrossRefPubMed
20.
Shah K, Gandhi A, Natarajan S. Diabetic retinopathy awareness and associations with multiple comorbidities. Insights from DIAMOND Study. Indian J Endocr Metab. 2018;22:30–5.
21.
Cheung N, Wang JJ, Klein R, Couper DJ, Sharret AY, Wong TY. Diabetic retinopathy and the risk of coronary heart disease: the Atherosclerosis Risk in Communities Study. Diabetes Care. 2007;30:1742–6. CrossRefPubMed
22.
Walraveran I, van den Hurk K, et al. Low grade inflammation and endothelial dysfunction explain the association between retinopathy and left ventricular ejection fraction in men: an 8-year follow-up of the HOORN Study. J Diabetes Complications. 2014;28:819–23. CrossRef
23.
Bonapace S, Rossi A, Lipari P, Bertolini L, Zenari L, Lanzoni L, et al. Relationship between increased left atrial volume and microvascular complications in patients with type 2 diabetes. J Diabetes Complicat. 2015;29(6):822–8. CrossRef
24.
Cheung N, Wang JJ, Rogers SL, Brancati F, Klein R, Sharrett AR, et al. Diabetic retinopathy and risk of heart failure. J Am Coll Cardiol. 2008;51(16):1573–8. CrossRefPubMed
25.
Ohno T, Takamoto S, Ando J, Morita T, Fujita H, Hirata Y, et al. Diabetic retinopathy and coronary stent implantation of sirolimus-eluting stents. J IntervenCardiol. 2007;20:122–31.
26.
Park SJ, Kang SJ, Virmani R, Nakano M, Ueda Y. In-stent neoatherosclerosis: a final common pathway of late stent failure. J Am Coll Cardiol. 2012;59(23):2051–7. CrossRefPubMed
27.
Ohno T, Takamoto S, Motomura N. Diabetic retinopathy and coronary artery disease from the cardiac surgeon's perspective. Ann Thorac Surg. 2008;85(2):681–9. CrossRefPubMed
28.
Ohno T, Ando J, Ono M, et al. The beneficial effect of coronary-artery-bypass surgery on survival in patients with diabetic retinopathy. Eur J Cardio-Thoracic Surg. 2006;30:881–6. CrossRef
29.
Ohno T, Kobayashi J, Sasako Y, et al. The impact of diabetic retinopathy on long- term outcomes following coronary artery bypass graft surgery. J Am Coll Cardiol. 2002;40:428–36. CrossRef

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