HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Extract Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Targher, G. Articles by Zenari, L. Search for Related Content PubMed PubMed Citation Articles by Targher, G. Articles by Zenari, L. Social Bookmarking                What's this?

Retinopathy Predicts Cardiovascular Mortality in Type 2 Diabetic Men and Women

Response to Juutilainen et al.

¹ Diabetes Unit, "Sacro Cuore" Hospital of Negrar, Negrar, Verona, Italy
² Section of Endocrinology, Department of Biomedical and Surgical Sciences, University Hospital of Verona, Verona, Italy
³ Section of Clinical Chemistry, Department of Biomedical and Morphological Sciences, University Hospital of Verona, Verona, Italy

Address correspondence to Giovanni Targher, MD, Diabetes Unit, Ospedale "Sacro Cuore –don Calabria", Via Sempreboni, 5, 37024 Negrar (VR), Italy. E-mail: targher{at}sacrocuore.it

We read with interest the recent article by Juutilainen et al. (1) showing that proliferative retinopathy in both sexes and nonproliferative retinopathy in women independently predict all-cause and cardiovascular disease (CVD)-associated death. The authors have cautiously concluded that the sex difference observed in the association between nonproliferative retinopathy and cardiovascular death needs to be confirmed in larger studies. Indeed, I think the relatively low frequency of retinopathy (23%) and the relatively high cut-off chosen for diagnosing hypertension (blood pressure 160/95 mmHg or treatment) could be some possible explanations for these apparently unexpected results.

Previously, we found that retinopathy is associated with an increased CVD incidence among 744 type 2 diabetic patients followed for 5 years (2). This association was largely explained by occurrence of traditional risk factors, especially hypertension (defined as blood pressure 130/85 mmHg or treatment) and proteinuria. However, in this study no separate statistical analyses had been made for men and women (2).

Recently, we have reevaluated the CVD outcomes among 2,103 type 2 diabetic participants of the Valpolicella Heart Diabetes Study during an extended follow-up of 6.5 years. A total of 384 participants (63% men, mean age 62 ± 4 years, with diabetes duration 16 ± 3 years) developed incident CVD events (myocardial infarction, ischemic stroke, coronary revascularization, or cardiovascular death), whereas 1,719 participants remained free of diagnosed CVD during follow-up. At baseline, a single ophthalmologist diagnosed retinopathy after pupillary dilation, according to a clinical disease severity scale (3).

Overall, 987 (46.9%) participants had retinopathy, of whom 798 had nonproliferative and 189 had proliferative retinopathy (confirmed by fluorescein angiography). After adjustment for age, BMI, smoking status, lipids, A1C, and diabetes duration and treatment, those with nonproliferative or proliferative retinopathy had a higher risk (P < 0.001) of incident CVD than those without retinopathy (hazard ratio 1.57 [95% CI 1.18–2.51] and 3.72 [2.11–7.58] for men; 1.63 [1.23–2.56] and 3.77 [2.15–7.83] for women, respectively). Further adjustment for hypertension (blood pressure 130/85 mmHg or treatment) and macroalbuminuria (urinary albumin-to-creatinine ratio 25 mg/mmol) considerably attenuated these associations, particularly among those with nonproliferative retinopathy; the risk of incident CVD remained approximately twofold greater—but statistically nonsignificant (P > 0.07)—among men (1.95 [0.89–4.41]) and women (1.99 [0.94–4.82]) with proliferative retinopathy.

These results extend our previous findings showing that retinopathy is associated with an increased CVD incidence in people with type 2 diabetes. However, this association appears to be principally explained by occurrence of hypertension and proteinuria. Moreover, our results do not support any significant sex difference in the adverse impact of retinopathy on incident CVD events.

References

1. Juutilainen A, Letho S, Ronnemaa T, Pyorala K, Laakso M: Retinopathy predicts cardiovascular mortality in type 2 diabetic men and women. Diabetes Care 30:292–299, 2007[Abstract/Free Full Text]
   
2. Targher G, Bertolini L, Tessari R, Zenari L, Arcaro G: Retinopathy predicts future cardiovascular events among type 2 diabetic patients: the Valpolicella Heart Diabetes Study (Letter). Diabetes Care 29:1178, 2006[Free Full Text]
   
3. Wilkinson CP, Ferris FL, Klein RE, Lee PP, Agardh CD, Davis M, Dills D, Kampik A, Pararajasegaram R, Verdaguer JT, the Global Diabetic Retinopathy Project Group: Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales. Ophthalmology 110:1677–1682, 2003[Medline]
   

CiteULike

Del.icio.us

Digg

Reddit

Technorati

This article has been cited by other articles:

				H. Hemingway, C. Langenberg, J. Damant, C. Frost, K. Pyorala, and E. Barrett-Connor Prevalence of Angina in Women Versus Men: A Systematic Review and Meta-Analysis of International Variations Across 31 Countries Circulation, March 25, 2008; 117(12): 1526 - 1536. [Abstract] [Full Text] [PDF]

				A. Juutilainen, S. Lehto, T. Ronnemaa, K. Pyorala, and M. Laakso Retinopathy Predicts Cardiovascular Mortality in Type 2 Diabetic Men and Women: Response to Targher et al. Diabetes Care, June 1, 2007; 30(6): e52 - e52. [Full Text] [PDF]

This Article Extract Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Targher, G. Articles by Zenari, L. Search for Related Content PubMed PubMed Citation Articles by Targher, G. Articles by Zenari, L. Social Bookmarking                What's this?