Retinal vessel caliber and microvascular and macrovascular disease in type 2 diabetes: XXI: the Wisconsin Epidemiologic Study of Diabetic Retinopathy

Ophthalmology. 2007 Oct;114(10):1884-92. doi: 10.1016/j.ophtha.2007.02.023. Epub 2007 May 30.


Objective: To describe the relationship of retinal arteriolar and venular calibers to the long-term incidence of microvascular and macrovascular complications in people with type 2 diabetes.

Design: Population-based prospective study.

Participants: One thousand three hundred seventy persons diagnosed to have diabetes at > or =30 years of age in south central Wisconsin participated in the baseline examination from 1980 to 1982, 987 in the 4-year follow-up, and 533 in the 10-year follow-up.

Methods: Computer-assisted grading was used to determine the average caliber of retinal arterioles (central retinal arteriolar equivalent [CRAE]) and retinal venules (central retinal venular equivalent [CRVE]) at all examinations.

Main outcome measures: Incidence and progression of diabetic retinopathy; incidence of proliferative diabetic retinopathy and macular edema; incidence of nephropathy, neuropathy, and lower extremity amputation; and ischemic heart disease, stroke, and overall mortality.

Results: While adjusting for other factors, smaller CRAE was associated with the 14-year cumulative incidence of lower extremity amputation (odds ratio [OR], first vs. second to fourth quartiles, 2.20; 95% confidence interval [CI], 1.14-4.24; P = 0.02), 22-year all-cause mortality (hazard ratio [HR], 1.18; 95% CI, 1.02-1.38; P = 0.03), and 22-year stroke mortality (HR, 1.47; 95% CI, 1.04-2.07; P = 0.03) but not with the other end points. Larger CRVE was associated with the 14-year incidence of diabetic nephropathy (OR, fourth vs. first to third quartiles, 2.08; 95% CI, 1.47-2.94; P<0.001) and 22-year stroke mortality (HR, 1.71; 95% CI, 1.20-2.44; P = 0.003) but with none of the other end points.

Conclusions: Retinal vessel caliber is independently associated with risk of incident nephropathy, lower extremity amputation, and stroke mortality in persons with type 2 diabetes. Measurement of retinal vessel caliber from photographs may provide additional information for the prediction of these events.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Amputation / statistics & numerical data
  • Arterioles / pathology
  • Cause of Death
  • Diabetes Mellitus, Type 2 / diagnosis
  • Diabetes Mellitus, Type 2 / epidemiology*
  • Diabetic Nephropathies / diagnosis
  • Diabetic Nephropathies / epidemiology
  • Diabetic Nephropathies / physiopathology
  • Diabetic Neuropathies / diagnosis
  • Diabetic Neuropathies / epidemiology
  • Diabetic Neuropathies / physiopathology
  • Diabetic Retinopathy / diagnosis
  • Diabetic Retinopathy / epidemiology*
  • Diabetic Retinopathy / physiopathology
  • Disease Progression
  • Follow-Up Studies
  • Humans
  • Incidence
  • Macular Edema / diagnosis
  • Macular Edema / epidemiology
  • Macular Edema / physiopathology
  • Middle Aged
  • Myocardial Ischemia / mortality
  • Prospective Studies
  • Retinal Artery / pathology*
  • Retinal Vein / pathology*
  • Risk Factors
  • Stroke / mortality
  • Venules / pathology
  • Wisconsin / epidemiology