Department of Ophthalmology, Yamagata University Faculty of Medicine, Yamagata, Japan; Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia; Osaka Medical Center for Health Science and Promotion, Osaka, Japan.
Department of Clinical Trial Design and Management, Translational Research Center, Kyoto University Hospital, Kyoto, Japan.
Ophthalmology. 2013 Mar;120(3):574-582. doi: 10.1016/j.ophtha.2012.08.029. Epub 2012 Nov 20.
Diabetic retinopathy (DR) is linked to cardiovascular risk in diabetic patients. This study examined whether mild-stage DR is associated with risk of coronary heart disease (CHD) and stroke in type 2 diabetic patients of the Japan Diabetes Complications Study (JDCS).
Prospective cohort study.
In the JDCS, there were 2033 Japanese persons with type 2 diabetes free of cardiovascular diseases at baseline.
Diabetic retinopathy was ascertained from clinical and photographic grading (70%) following the international clinical diabetic retinopathy and diabetic macular edema disease severity scales. Incident CHD and stroke were followed up prospectively annually up to 8 years.
Eight-year incidence of CHD and stroke compared between persons with or without DR.
After adjusting for traditional cardiovascular risk factors, persons with mild to moderate nonproliferative DR had a higher risk of CHD (hazard ratio [HR], 1.69; 95% confidence interval [CI], 1.17-2.97) and stroke (HR, 2.69; 95% CI, 1.03-4.86). Presence of retinal hemorrhages or microaneurysms was associated with risk of CHD (HR, 1.63; 95% CI, 1.04-2.56) but was not associated with stroke (P = 0.06). Presence of cotton-wool spots was associated with risk of incident stroke (HR, 2.39; 95% CI, 1.35-4.24) but was not associated with CHD (P = 0.66). When information about DR was added in the prediction models for CHD and stroke based on traditional cardiovascular risk factors, the area under the receiver operating curve improved from 0.682 to 0.692 and 0.640 to 0.677, and 9% and 13% of persons were reclassified correctly for CHD and stroke, respectively.
Type 2 diabetic patients with even a mild stage of DR, such as dot hemorrhages, are already at higher risk of CHD and stroke independent of traditional risk factors.
糖尿病视网膜病变（DR）与糖尿病患者的心血管风险相关。本研究旨在探讨 2 型糖尿病患者中轻度 DR 是否与冠心病（CHD）和卒中风险相关。
前瞻性队列研究。
在日本糖尿病并发症研究（JDCS）中，共有 2033 名基线时无心血管疾病的 2 型糖尿病患者。
通过临床和照相分级（70%）确定糖尿病视网膜病变，采用国际临床糖尿病视网膜病变和糖尿病性黄斑水肿疾病严重程度分级标准。前瞻性随访 8 年，每年记录 CHD 和卒中的发病情况。
比较有无 DR 的患者 8 年 CHD 和卒中的发生率。
在调整了传统心血管危险因素后，轻度至中度非增殖性 DR 患者的 CHD 风险更高（危险比[HR]，1.69；95%置信区间[CI]，1.17-2.97）和卒中（HR，2.69；95%CI，1.03-4.86）。视网膜出血或微动脉瘤的存在与 CHD 风险相关（HR，1.63；95%CI，1.04-2.56），但与卒中无关（P=0.06）。棉絮斑的存在与卒中发病风险相关（HR，2.39；95%CI，1.35-4.24），但与 CHD 无关（P=0.66）。当在基于传统心血管危险因素的 CHD 和卒中预测模型中加入 DR 信息时，曲线下面积从 0.682 提高到 0.692 和 0.640 提高到 0.677，CHD 和卒中分别有 9%和 13%的患者得到正确分类。
即使是糖尿病视网膜病变的轻度阶段，如点状出血，2 型糖尿病患者的 CHD 和卒中风险也已经升高，独立于传统危险因素。
