Castelblanco Esmeralda, Granado-Casas Minerva, Hernández Marta, Pinyol Montserrat, Correig Eudald, Julve Josep, Rojo-López Marina Idalia, Alonso Núria, Avogaro Angelo, Ortega Emilio, Mauricio Didac
Division of Endocrinology, Metabolism and Lipid Research, Washington University School of Medicine in St. Louis, St. Louis, MO, United States.
DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Barcelona, Spain.
Front Cardiovasc Med. 2022 Nov 3;9:945421. doi: 10.3389/fcvm.2022.945421. eCollection 2022.
Diabetic retinopathy (DR) and preclinical atherosclerosis are associated with higher cardiovascular risk. However, no studies have investigated the predictive role of DR and preclinical atherosclerosis jointly on cardiovascular events in subjects with type 2 diabetes (T2D). We aimed to assess the contribution of DR and subclinical atherosclerosis on the risk of adverse cardiovascular events in subjects with T2D without previous cardiovascular disease (CVD).
We included two prospective cohorts of subjects with T2D from the same geographical area. Assessment of subclinical atherosclerosis was performed by carotid ultrasound. An ophthalmologist classified DR according to standard criteria. Cardiovascular outcomes considered for analysis were the following: ischemic heart disease, stroke, heart failure, peripheral artery disease, revascularization procedures, and cardiovascular mortality. Bivariable and multivariable predictive models were performed.
From a total of 374 subjects with T2D 44 developed cardiovascular events during the 7.1 years of follow-up. Diabetes duration, total cholesterol, and glycated hemoglobin (HbA1c) at baseline were higher in subjects who developed cardiovascular outcomes ( < 0.001, = 0.026, and = 0.040, respectively). Compared with subjects without events, those developing cardiovascular events had higher prevalence of retinopathy (65.9% vs. 38.8%, = 0.001; respectively) and more than mild retinopathy (43.2% vs. 31.8%, = 0.002; respectively). Furthermore, all-cause mortality was higher in subjects with MACE than those without events (13.6% vs. 3.3%, = 0.009; respectively). The multivariable analyses showed that HbA1c and the presence of DR at baseline were predictive of cardiovascular outcomes ( = 0.045 and = 0.023, respectively). However, the burden of subclinical atherosclerosis was not ( = 0.783 and = 0.071, respectively).
DR is a strong predictor of cardiovascular events in T2D individuals at primary CVD prevention, even after accounting for the presence of preclinical carotid atherosclerosis. These results may help to individualize CVD prevention strategies in T2D.
糖尿病视网膜病变（DR）和临床前期动脉粥样硬化与较高的心血管风险相关。然而，尚无研究调查DR和临床前期动脉粥样硬化对2型糖尿病（T2D）患者心血管事件的联合预测作用。我们旨在评估DR和亚临床动脉粥样硬化对无既往心血管疾病（CVD）的T2D患者不良心血管事件风险的影响。
我们纳入了来自同一地理区域的两个T2D患者前瞻性队列。通过颈动脉超声评估亚临床动脉粥样硬化。眼科医生根据标准标准对DR进行分类。分析中考虑的心血管结局如下：缺血性心脏病、中风、心力衰竭、外周动脉疾病、血运重建手术和心血管死亡率。进行了双变量和多变量预测模型分析。
在总共374例T2D患者中，44例在7.1年的随访期间发生了心血管事件。发生心血管结局的患者基线时的糖尿病病程、总胆固醇和糖化血红蛋白（HbA1c）较高（分别为P<0.001、P=0.026和P=0.040）。与未发生事件的患者相比，发生心血管事件的患者视网膜病变患病率更高（分别为65.9%对38.8%，P=0.001），且中重度视网膜病变的比例更高（分别为43.2%对31.8%，P=0.002）。此外，发生主要不良心血管事件（MACE）的患者全因死亡率高于未发生事件的患者（分别为13.6%对3.3%，P=0.009）。多变量分析显示，HbA1c和基线时DR的存在可预测心血管结局（分别为P=0.045和P=0.023）。然而，亚临床动脉粥样硬化的负担则不能预测（分别为P=0.783和P=0.071）。
在T2D患者的一级CVD预防中，即使考虑到临床前期颈动脉粥样硬化的存在，DR仍是心血管事件的有力预测指标。这些结果可能有助于T2D患者CVD预防策略的个体化。
