Abstract
IMPORTANCE: Previous studies on the relationship between diabetic retinopathy (DR) and cardiovascular disease (CVD) focused on the early stages of DR. Understanding whether patients with type 2 diabetes and severe stages of DR (diabetic macular edema [DME] and proliferative diabetic retinopathy [PDR]) have a higher risk of CVD will allow physicians to more effectively counsel patients. OBJECTIVE: To examine the association of severe stages of DR (DME and PDR) with incident CVD in patients with type 2 diabetes. DATA SOURCES: English-language publications were reviewed for articles evaluating the relationship of DR and CVD in MEDLINE, EMBASE, Current Contents, and the Cochrane Library from inception (January 1, 1950) to December 31, 2014, using the search terms diabetic retinopathy OR macular edema AND stroke OR cerebrovascular disease OR coronary artery disease OR heart failure OR myocardial infarction OR angina pectoris OR acute coronary syndrome OR coronary arterydisease OR cardiomyopathy. STUDY SELECTION: Among 656 studies screened for eligibility, 7604 individuals were included from 8 prospective population-based studies with data on photographic-based DR grading, follow-up visits, and well-defined incident CVD end point. DATA EXTRACTION AND SYNTHESIS; Two independent reviewers conducted a systematic search of the 4 databases, and a single pooled database was developed. Incidence rate ratios (IRRs) were estimated for patients with DME, PDR, and vision-threatening DR, compared with persons without these conditions, by using individual participant data followed by a standard inverse-variance meta-analysis (2-step analysis). The review and analyses were performed from January 1, 2009, to January 1, 2017. MAIN OUTCOME AND MEASURES: Incident CVD, including coronary heart disease, stroke, or death from cardiovascular causes. RESULTS: Among 7604 patients with type 2 diabetes, the prevalence of DME was 4.6% and PDR, 7.4%. After a mean follow-up of 5.9 years (range, 3.2-10.1 years), 1203 incident CVD events, including 916 coronary heart disease cases, were reported. Persons with DME or PDR were more likely to have incident CVD (IRR, 1.39; 95% CI, 1.16-1.67) and fatal CVD (IRR, 2.33; 95% CI, 1.49-3.67) compared with those without DMEor PDR. CONCLUSIONS AND RELEVANCE: Patients with type 2 diabetes and DME or PDR have an increased risk of incident CVD, which suggests that these persons should be followed up more closely to prevent CVD.
| Original language | English |
|---|---|
| Pages (from-to) | 586-593 |
| Number of pages | 8 |
| Journal | JAMA Ophthalmology |
| Volume | 135 |
| Issue number | 6 |
| DOIs | |
| Publication status | Published - Jun 2017 |
| Externally published | Yes |
Bibliographical note
Funding Information:This meta-analysis was provided by Novartis and by grants STaR/0016/2013 and NMRC/CSA/038/2013 from the National Medical Research Council, Singapore. The Atherosclerosis Risks in Communities study has been performed as a collaborative study supported by contracts HHSN268201100005C, HHSN268201100006C, HHSN268201100007C, HHSN268201100008C, HHSN268201100009C, HHSN268201100010C, HHSN268201100011C, and HHSN268201100012C from the National Heart, Lung, and Blood Institute(NHLBI). The Australian Diabetes, Obesity and Lifestyle study was supported by grants 350448 and 233200 from the National Health and Medical Research Council and a Sylvia and Charles Viertel Charitable Foundation grant. The Beaver Dam Eye Study was supported by grant EY-06594 from the National Eye Institute, National Institutes of Health, and by Research to Prevent Blindness New York, New York. The Blue Mountains Eye Study was supported by grants 974159,991407, and 211069 from the Australian National Health & Medical Research Council. The Cardiovascular Health Study was supported by contracts HHSN268201200036C, HHSN268200800007C, N01HC55222, N01HC85079, N01HC85080, N01HC85081, N01HC85082, N01HC85083, N01HC85086, and grant U01HL080295 from the NHLBI, with additional contributions from the National Institute of Neurological Disorders and Stroke, and by grant R01AG023629 from the National Institute on Aging. The Multi-Ethnic Study of Atherosclerosis Study was supported by contracts N01-HC-95159, N01-HC-95160, N01-HC-95161, N01-HC-95162, N01-HC-95163, N01-HC-95164, N01-HC-95165, N01-HC-95167, N01-HC-95168, and N01-HC-95169 from the NHLBI and by grants UL1-RR-024156 and UL1-RR-025005 from the National Center for Research Resources at the National Institutes of Health; grant R01HL69979 from the National Institutes of Health; and award ZIAEY000403 from the Intramural Research Program at the National Eye Institute. The Wisconsin Epidemiologic Study of Diabetic Retinopathy was supported by grant EY016379 and Research Vision Core grant EY016665 from the National Institutes of Health and an unrestricted grant from Research to Prevent Blindness. The Beaver Dam Eye Study was supported by grant EY06594 from the National Institutes of Health and by Research to Prevent Blindness.
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