# Investigation of the Potential Association Between Atherosclerotic Cardiovascular Disease Risk Score and Diabetic Retinopathy in Patients with Type 2 Diabetes: A Cross-Sectional Study

## TL;DR

This study found no link between a heart disease risk score and diabetic retinopathy in type 2 diabetes patients, but identified high blood sugar levels and disease duration as risk factors.

## Contribution

The study is the first to investigate the association between the ASCVD risk score and diabetic retinopathy in type 2 diabetes patients.

## Key findings

- ASCVD risk score was not significantly correlated with diabetic retinopathy.
- Higher HbA1c levels, longer diabetes duration, and neuropathy were independently associated with diabetic retinopathy.
- Proliferative diabetic retinopathy was strongly linked to elevated HbA1c levels.

## Abstract

Purpose: To examine the association between diabetic retinopathy (DR) and the atherosclerotic cardiovascular disease (ASCVD) risk score using the “ASCVD Risk Estimator Plus” tool in patients with type 2 diabetes mellitus (DM) and to assess risk factors potentially associated with DR. Methods: Participants in the study included 181 patients with type 2 DM who underwent a thorough ophthalmic examination, including a best-corrected visual acuity (BCVA) measurement, a dilated fundoscopy, fundus photography, an optical coherence tomography (OCT), and an OCT-angiography (OCT-A). DR was graded as no apparent retinopathy (NDR), mild non-proliferative (NPDR), moderate NPDR, severe NPDR, or proliferative DR (PDR). In addition, a detailed medical history of patients was recorded, while the “ASCVD Risk Estimator Plus” tool by the American College of Cardiology was used to calculate the ASCVD risk. Results: The ASCVD score, derived by the “ASCVD Risk Estimator Plus”, was not found to be significantly correlated with DR (p = 0.191). Multivariable logistic regression analysis showed that factors associated with DR independently included DM duration (multivariable OR = 3.16, 95% CI: 1.55–6.44, p = 0.002), HbA1c levels (multivariable OR = 2.94, 95% CI: 1.37–6.32, p = 0.006), and the presence of neuropathy (multivariable OR = 3.59, 95% CI: 1.43–9.05, p = 0.007). In the multivariable multinomial logistic regression analysis, NPDR development was associated with duration of DM (multivariable RR = 3.31, 95% CI: 1.57–6.97, p = 0.002), HbA1c levels (multivariable RR = 2.24, 95% CI: 1.00–5.02, p = 0.050), and neuropathy (multivariable RR: 3.94, 95% CI: 1.54–10.11, p = 0.004), while PDR development was only associated with HbA1c levels (multivariable RR = 6.88, 95% CI: 2.19–21.63, p = 0.001). Conclusions: The ASCVD score, as it was calculated using the “ASCVD Risk Estimator Plus” tool, was not found to be significantly associated with DR. Factors significantly associated with DR were DM duration, HbA1c levels, and the presence of neuropathy.