Association of Diabetic Retinopathy and Arterial Stiffness With Cardiovascular Disease in Type 2 Diabetes

TL;DR

This study finds that diabetic retinopathy is strongly linked to cardiovascular disease in type 2 diabetes patients, and higher arterial stiffness is associated with more severe retinopathy.

Contribution

The study establishes a novel association between diabetic retinopathy severity and arterial stiffness metrics in type 2 diabetes patients.

Findings

Diabetic retinopathy is significantly associated with higher odds of cardiovascular disease.

Higher pulse wave velocity is significantly associated with more severe diabetic retinopathy.

Diabetic macular edema is not associated with cardiovascular disease.

Abstract

Background: Diabetic retinopathy (DR) and diabetic macular edema (DME) are well-established microvascular complications of type 2 diabetes mellitus (T2DM), resulting from chronic hyperglycemia-induced damage to retinal vasculature that, in their advanced forms, are associated with an increased risk of cardiovascular disease (CVD).

Objective: This study aims to estimate the potential association between DR or DME and CVD, as well as systemic vascular metrics.

Methods: In a cross-sectional design study, 73 patients with T2DM were recruited. Demographic data and clinical characteristics of patients regarding their diabetes status and comorbidities were recorded. Patients underwent a thorough ocular examination, as well as endothelial function and arterial stiffness evaluation. Specifically, central systolic blood pressure (cSBP), central diastolic blood pressure (cDBP), pulse wave velocity (PWV), augmentation index (Aix), and the perfused boundary region of the sublingual arterial microvessels (PBR5-25) were measured. Multivariate binary logistic regression and mixed linear regression models were used to examine the associations between CVD, as well as systemic vascular metrics, and DR or DME.

Results: In a model adjusted for age, sex, BMI, smoking status, HbA1c levels, and hypertension, DR was significantly associated with higher odds for CVD (OR=13.3; 95% CI: 1.5-115.0, p=0.019). The presence of DME was not associated with CVD. Furthermore, higher PWV was significantly associated with more severe DR (b=0.09; 95% CI: 0.01-0.16, p=0.031).

Conclusions: There is a strong association between DR and CVD, while higher PWV was significantly associated with more severe DR. These findings suggest that screening for CVD is crucial in patients with DR, especially in cases of greater severity of DR.