Cheung Ning, Wang Jie J, Rogers Sophie L, Brancati Frederick, Klein Ronald, Sharrett A Richey, Wong Tien Y
Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia.
J Am Coll Cardiol. 2008 Apr 22;51(16):1573-8. doi: 10.1016/j.jacc.2007.11.076.
The purpose of this study was to examine the association of diabetic retinopathy with incident heart failure (HF).
Microvascular disease might play a more prominent role in the pathogenesis of diabetic cardiomyopathy, a major cause of HF in diabetes. Whether diabetic retinopathy, a microvascular complication of diabetes, predicts HF is unclear.
A population-based study included 1,021 middle-aged type 2 diabetic persons with normal renal function and free of clinical coronary heart disease or HF at baseline. Diabetic retinopathy signs were graded from retinal photographs. Incident HF events were prospectively identified from hospital stay and death records.
There were 125 (12.8%) participants with diabetic retinopathy. After 9-year follow-up, 106 (10.1%) participants developed incident HF events. Persons with retinopathy were more likely to develop HF (cumulative incidence of 21.6%) than those without retinopathy (cumulative incidence of 8.5%). After controlling for age, gender, race, smoking, diabetes duration, insulin use, blood pressure, lipid profile, and other risk factors, participants with retinopathy had more than 2.5-fold higher risk of developing HF than those without retinopathy (hazard ratio [HR] 2.71; 95% confidence interval [CI] 1.46 to 5.05). This association remained significant after further adjustments for glycemic control, carotid atherosclerosis, and serum markers of endothelial dysfunction (HR 2.20, 95% CI 1.08 to 4.47).
The presence of diabetic retinopathy signifies an excess risk of HF, independent of known risk factors. This further supports a contribution of microvascular disease to the development of HF in people with diabetes.
本研究旨在探讨糖尿病视网膜病变与新发心力衰竭（HF）之间的关联。
微血管疾病可能在糖尿病性心肌病的发病机制中发挥更突出的作用，而糖尿病性心肌病是糖尿病患者发生HF的主要原因。糖尿病视网膜病变作为糖尿病的一种微血管并发症，能否预测HF尚不清楚。
一项基于人群的研究纳入了1021名中年2型糖尿病患者，这些患者肾功能正常，基线时无临床冠心病或HF。根据视网膜照片对糖尿病视网膜病变体征进行分级。通过住院和死亡记录前瞻性地确定新发HF事件。
有125名（12.8%）参与者患有糖尿病视网膜病变。经过9年的随访，106名（10.1%）参与者发生了新发HF事件。患有视网膜病变的人比没有视网膜病变的人更易发生HF（累积发病率分别为21.6%和8.5%）。在控制年龄、性别、种族、吸烟、糖尿病病程、胰岛素使用、血压、血脂谱和其他危险因素后，患有视网膜病变的参与者发生HF的风险比没有视网膜病变的参与者高2.5倍以上（风险比[HR]2.71；95%置信区间[CI]1.46至5.05）。在进一步调整血糖控制、颈动脉粥样硬化和内皮功能障碍的血清标志物后，这种关联仍然显著（HR 2.20，95%CI 1.08至4.47）。
糖尿病视网膜病变的存在意味着HF风险增加，且独立于已知危险因素。这进一步支持了微血管疾病在糖尿病患者发生HF过程中的作用。
