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Diabetes Care Publish Ahead of Print published online ahead of print March 26, 2007
DOI: 10.2337/dc07-0264
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Original Research

Diabetic Retinopathy and the Risk of Coronary Heart Disease: The Atherosclerosis Risk in Communities Study

Ning Cheung, MBBS1, Jie Jin Wang, PhD1,2, Ronald Klein, MD, MPH3, David J Couper, PhD4, A Richey Richey Sharrett, MD, DrPH5 and Tien Y. Wong, MBBS, PhD1,6

1Centre for Eye Research Australia, University of Melbourne, Australia
2Centre for Vision Research, University of Sydney, Australia
3Department of Ophthalmology & Visual Science, University of Wisconsin, Madison, WI
4Department of Biostatistics, University of North Carolina, Chapel Hill, NC
5Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
6Singapore Eye Research Institute, Yong Loo Lin School of Medicine, National University of Singapore

twong{at}unimelb.edu.au

ABSTRACT

Objective:: To examine the relation of diabetic retinopathy to incident coronary heart disease (CHD).

Research Design and Methods:: A population-based, prospective cohort study consisting of 1,524 middle-aged persons with type 2 diabetes without prevalent CHD and stroke at baseline. Diabetic retinopathy signs were graded from retinal photographs according to the Early Treatment for Diabetic Retinopathy Severity Scale. Incident CHD events (myocardial infarction, fatal CHD or coronary revascularization) were identified and validated following standardized protocols.

Results:: In our study, 214 (14.7%) participants had diabetic retinopathy. Over an average follow-up of 7.8 years, there were 209 (13.7%) incident CHD events. After controlling for age, gender, race, study center, fasting glucose, glycosylated hemoglobin, duration of diabetes, blood pressure, anti-hypertensive treatment, cigarette smoking, body mass index and lipid profile, the presence of diabetic retinopathy was associated with a two-fold higher risk of incident CHD events (Hazard rate ratios [HR] 2.07, 95% confidence interval [CI]: 1.38-3.11) and a three fold higher risk of fatal CHD (HR 3.35; 95% CI: 1.40-8.01). Further adjustments for inflammatory markers, carotid artery intima-media thickness or nephropathy had minimal impact on the association. The increased risk of CHD was significant in both men (HR 1.89; 95% CI: 1.08-3.31) and women (HR 2.16; 95% CI: 1.16-4.02) with diabetic retinopathy.

Conclusions:: In persons with type 2 diabetes, the presence of retinopathy signifies an increased CHD risk, independent of known risk factors. Our data support the role of microvascular disease in the pathogenesis of CHD in diabetes.


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