Division of Cardiovascular Medicine, University of Miami, Miami, Florida.
Sulpizio Cardiovascular Center, University of California at San Diego, San Diego, California.
Am J Cardiol. 2021 Jun 15;149:1-8. doi: 10.1016/j.amjcard.2021.03.026. Epub 2021 Apr 20.
Retinopathy is a microvascular complication of diabetes mellitus (DM); however, it is also increasingly recognized in persons without DM. The microvascular diseases may play a prominent role in coronary heart disease (CHD) development in individuals with DM. We performed the study to evaluate the relation between non-DM retinopathy and CHD and also the association between baseline retinopathy and incidence and progression of CHD in individuals with and without DM. We included 5709 subjects with and without DM from the Multi-Ethnic Study of Atherosclerosis, who had retinal photos and coronary artery calcium score (CACS) available. We studied the association between baseline retinopathy and incidence and progression of coronary artery calcification (CAC) in subjects with and without DM. In DM group, the presence of retinopathy was significantly associated with an increased rate of CAC (RR 1.3 (95% CI [1.02, 1.66]) after adjusting for age, sex, race, follow-up time, and CHD risk factors. In non-DM group, the presence of retinopathy was not significantly associated with increased risk of CAC, however, the interaction between presence of retinopathy and DM status was not statistically significant. Within the DM group with CAC present at baseline, the presence of retinopathy was significantly associated with greater CAC progression (113 Agatson units (AU) greater, (95% CI [51-174]). In the non-DM group with present CAC at baseline; the presence of retinopathy was associated with 24 (95% CI [-0.69, 48.76]) AU higher CAC progression. All findings were adjusted for CHD risk factors. In conclusion, after adjustment for major CHD risk factors, retinopathy was associated with progression of CAC in both DM and non-DM individuals. However, the association was stronger in those with DM.
视网膜病变是糖尿病（DM）的一种微血管并发症; 然而，它也越来越多地在没有 DM 的人中被发现。微血管疾病可能在 DM 患者的冠心病（CHD）发展中起重要作用。我们进行了这项研究，以评估非 DM 性视网膜病变与 CHD 的关系，以及基线视网膜病变与 DM 和非 DM 个体 CHD 的发生和进展之间的关联。我们纳入了来自多民族动脉粥样硬化研究的 5709 例有或无 DM 的患者，这些患者有视网膜照片和冠状动脉钙评分（CACS）。我们研究了基线视网膜病变与 DM 和非 DM 患者冠状动脉钙化（CAC）发生和进展之间的关系。在 DM 组中，视网膜病变的存在与 CAC 发生率增加显著相关（RR 1.3（95%CI [1.02, 1.66]），校正年龄、性别、种族、随访时间和 CHD 危险因素后。在非 DM 组中，视网膜病变的存在与 CAC 风险增加无显著相关性，但视网膜病变的存在与 DM 状态之间的交互作用无统计学意义。在基线时存在 CAC 的 DM 组中，视网膜病变的存在与 CAC 进展显著相关（113 个 Agatson 单位（AU）更高，（95%CI [51-174]）。在基线时存在 CAC 的非 DM 组中，视网膜病变的存在与 CAC 进展相关 24 个 AU（95%CI [-0.69, 48.76]）。所有发现均经过 CHD 危险因素调整。总之，在调整主要 CHD 危险因素后，DM 和非 DM 个体的视网膜病变与 CAC 进展相关。然而，在 DM 患者中这种相关性更强。
