University Medical Center Ljubljana, Ljubljana, Slovenia.
Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
Diabetes Care. 2018 Dec;41(12):2487-2494. doi: 10.2337/dc18-0476. Epub 2018 Sep 26.
It is well established that diabetic nephropathy increases the risk of cardiovascular disease (CVD), but how severe diabetic retinopathy (SDR) impacts this risk has yet to be determined.
The cumulative incidence of various CVD events, including coronary heart disease (CHD), peripheral artery disease (PAD), and stroke, retrieved from registries, was evaluated in 1,683 individuals with at least a 30-year duration of type 1 diabetes drawn from the Finnish Diabetic Nephropathy Study (FinnDiane). The individuals were divided into four groups according to the presence of diabetic kidney disease (DKD) and/or SDR (+DKD/+SDR, +DKD/-SDR, -DKD/+SDR, and -DKD/-SDR) at baseline visit. Furthermore, age-specific incidences were compared with 4,016 control subjects without diabetes. SDR was defined as laser photocoagulation and DKD as estimated glomerular filtration rate <60 mL/min/1.73 m.
During 12,872 person-years of follow-up, 416 incident CVD events occurred. Even in the absence of DKD, SDR increased the risk of any CVD (hazard ratio 1.46 [95% CI 1.11-1.92]; < 0.01), after adjustment for diabetes duration, age at diabetes onset, sex, smoking, blood pressure, waist-to-hip ratio, history of hypoglycemia, and serum lipids. In particular, SDR alone was associated with the risk of PAD (1.90 [1.13-3.17]; < 0.05) and CHD (1.50 [1.09-2.07; < 0.05) but not with any stroke. Moreover, DKD increased the CVD risk further (2.85 [2.13-3.81]; < 0.001). However, the risk was above that of the control subjects without diabetes also in patients without microvascular complications, until the patients reached their seventies.
SDR alone, even without DKD, increases cardiovascular risk, particularly for PAD, independently of common cardiovascular risk factors in long-standing type 1 diabetes. More remains to be done to fully understand the link between SDR and CVD. This knowledge could help combat the enhanced cardiovascular risk beyond currently available regimens.
糖尿病肾病会增加心血管疾病（CVD）的风险，这一点已得到充分证实，但严重糖尿病视网膜病变（SDR）对这种风险的影响尚未确定。
从芬兰糖尿病肾病研究（FinnDiane）中抽取了 1683 名至少有 30 年 1 型糖尿病病史的患者，根据基线检查时是否存在糖尿病肾病（DKD）和/或 SDR（+DKD/+SDR、+DKD/-SDR、-DKD/+SDR 和 -DKD/-SDR），将其分为四组。从登记处检索到各种 CVD 事件（包括冠心病、PAD 和中风）的累积发生率，并进行评估。此外，还将年龄特异性发病率与 4016 名无糖尿病的对照者进行了比较。SDR 定义为激光光凝，DKD 定义为估计肾小球滤过率<60 mL/min/1.73 m。
在 12872 人年的随访期间，发生了 416 例 CVD 事件。即使没有 DKD，SDR 也会增加任何 CVD 的风险（危险比 1.46 [95% CI 1.11-1.92]；<0.01），这在调整了糖尿病病程、糖尿病发病年龄、性别、吸烟、血压、腰臀比、低血糖史和血脂后仍然如此。特别是，SDR 单独与 PAD 的风险相关（1.90 [1.13-3.17]；<0.05）和 CHD（1.50 [1.09-2.07]；<0.05），但与任何中风无关。此外，DKD 进一步增加了 CVD 风险（2.85 [2.13-3.81]；<0.001）。然而，即使没有微血管并发症，在没有糖尿病的患者中，其 CVD 风险也高于对照组，直到患者达到 70 岁以上。
即使没有 DKD，SDR 本身也会增加心血管风险，特别是对于 PAD，这与长期 1 型糖尿病患者的常见心血管危险因素独立相关。在充分了解 SDR 与 CVD 之间的联系方面，还有很多工作要做。这一知识可以帮助对抗目前治疗方案之外的增强型心血管风险。
