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 artery disease 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 DME or 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.
Conflict of interest statement
Is diabetic retinopathy related to subclinical cardiovascular disease?Ophthalmology. 2011 May;118(5):860-5. doi: 10.1016/j.ophtha.2010.08.040. Epub 2010 Dec 18. Ophthalmology. 2011. PMID: 21168222 Free PMC article. Clinical Trial.
Association of Abnormal Renal Profiles and Proliferative Diabetic Retinopathy and Diabetic Macular Edema in an Asian Population With Type 2 Diabetes.JAMA Ophthalmol. 2018 Jan 1;136(1):68-74. doi: 10.1001/jamaophthalmol.2017.5202. JAMA Ophthalmol. 2018. PMID: 29167896 Free PMC article. Clinical Trial.
Genome-wide association studies for diabetic macular edema and proliferative diabetic retinopathy.BMC Med Genet. 2018 May 8;19(1):71. doi: 10.1186/s12881-018-0587-8. BMC Med Genet. 2018. PMID: 29739359 Free PMC article.
Optical coherence tomography (OCT) for detection of macular oedema in patients with diabetic retinopathy.Cochrane Database Syst Rev. 2011 Jul 6;(7):CD008081. doi: 10.1002/14651858.CD008081.pub2. Cochrane Database Syst Rev. 2011. PMID: 21735421 Updated. Review.
Dyslipidemia and Diabetic Macular Edema: A Systematic Review and Meta-Analysis.Ophthalmology. 2015 Sep;122(9):1820-7. doi: 10.1016/j.ophtha.2015.05.011. Epub 2015 Jul 3. Ophthalmology. 2015. PMID: 26150053 Review.
Cited by 10 articles
MorbiNet: multimorbidity networks in adult general population. Analysis of type 2 diabetes mellitus comorbidity.Sci Rep. 2020 Feb 12;10(1):2416. doi: 10.1038/s41598-020-59336-1. Sci Rep. 2020. PMID: 32051506 Free PMC article.
Survival Time of Visual Gains after Diabetic Vitrectomy and Its Relationship with Ischemic Heart Disease.Int J Environ Res Public Health. 2020 Jan 2;17(1):310. doi: 10.3390/ijerph17010310. Int J Environ Res Public Health. 2020. PMID: 31906417 Free PMC article.
Expression of vascular infarction-related molecules after anti-vascular endothelium growth factor treatment for diabetic macular edema.Sci Rep. 2019 Aug 26;9(1):12373. doi: 10.1038/s41598-019-48869-9. Sci Rep. 2019. PMID: 31451777 Free PMC article.
Prediction of Proliferative Diabetic Retinopathy to Asymptomatic Obstructive Coronary Artery Disease in Chinese Type 2 Diabetes Individuals: An Exploratory Study.Metab Syndr Relat Disord. 2019 Sep;17(7):367-373. doi: 10.1089/met.2018.0140. Epub 2019 May 29. Metab Syndr Relat Disord. 2019. PMID: 31145036 Free PMC article.
The Association of Severe Diabetic Retinopathy With Cardiovascular Outcomes in Long-standing Type 1 Diabetes: A Longitudinal Follow-up.Diabetes Care. 2018 Dec;41(12):2487-2494. doi: 10.2337/dc18-0476. Epub 2018 Sep 26. Diabetes Care. 2018. PMID: 30257963 Free PMC article.
- Z01 EY000426-05/Intramural NIH HHS/United States
- Z99 EY999999/Intramural NIH HHS/United States
- ZIA EY000403-13/Intramural NIH HHS/United States
- ZIA EY000426-10/Intramural NIH HHS/United States
- ZIA EY000426-13/Intramural NIH HHS/United States
- ZIA EY000403-14/Intramural NIH HHS/United States
- ZIA EY000426-08/Intramural NIH HHS/United States
- ZIA EY000403-11/Intramural NIH HHS/United States
- Z01 EY000426-04/Intramural NIH HHS/United States
- ZIA EY000426-11/Intramural NIH HHS/United States
- ZIA EY000403-10/Intramural NIH HHS/United States
- ZIA EY000403-09/Intramural NIH HHS/United States
- Z01 EY000403-06/Intramural NIH HHS/United States
- ZIA EY000403-08/Intramural NIH HHS/United States
- Z01 EY000403-07/Intramural NIH HHS/United States
- ZIA EY000426-09/Intramural NIH HHS/United States
- ZIA EY000426-07/Intramural NIH HHS/United States
- ZIA EY000426-12/Intramural NIH HHS/United States
- ZIA EY000426-06/Intramural NIH HHS/United States
- ZIA EY000403-15/Intramural NIH HHS/United States
- ZIA EY000403-12/Intramural NIH HHS/United States