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Diabetic Retinopathy and the Risk of Coronary Heart Disease
Open accessAbstract
OBJECTIVE— We sought 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 individuals with type 2 diabetes without prevalent CHD and stroke at baseline was conducted. Diabetic retinopathy signs were graded from retinal photographs according to the Early Treatment for Diabetic Retinopathy Study 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, sex, race, study center, fasting glucose, A1C, duration of diabetes, blood pressure, antihypertensive treatment, cigarette smoking, BMI, and lipid profile, the presence of diabetic retinopathy was associated with a twofold higher risk of incident CHD events (hazard rate ratio [HR] 2.07 [95% CI 1.38–3.11]) and a threefold higher risk of fatal CHD (3.35 [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 (1.89 [1.08–3.31]) and women (2.16 [1.16–4.02]) with diabetic retinopathy. CONCLUSIONS— In individuals 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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“The presence of microvascular complications such as diabetic nephropathy792, 793) or retinopathy794) is a predictive factor for CAD.”
From Japan Atherosclerosis Society (JAS) guidelines for prevention of atherosclerotic cardiovascular diseases 2017 (2018) · cites this paper as [792]
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Self-citation
Metadata
- Authors
- Cheung, N., Wang, J. J., Klein, R., Couper, D. J., Sharrett, A. R., & Wong, T. Y.
- Affiliations
- The University of Melbourne (AU)
- The University of Sydney (AU)
- University of Wisconsin–Madison (US)
- University of North Carolina at Chapel Hill (US)
- Johns Hopkins University (US)
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2007-07-01
- Volume
- 30
- Issue
- 7
- Pages
- 1742-1746
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- OpenAlex
- W2109045647
- Cited by
- 267
- References
- 42
- Citations by year
- 2026: 7 · 2025: 17 · 2024: 9 · 2023: 14 · 2022: 21 · 2021: 13 · 2020: 12 · 2019: 7 · 2018: 16 · 2017: 7 · 2016: 16 · 2015: 15 · 2014: 17 · 2013: 14 · 2012: 14
- FWCI
- 16.04
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Diabetes Care (publishedVersion)
- PubMed (publishedVersion)
- National University of Singapore (submittedVersion)
- The HKU Scholars Hub (University of Hong Kong) (submittedVersion)
- Funders
- National Institutes of Health (n01hc55021-47-0-1, n01hc55020-39-0-0, n01hc55016-37-0-0, n01hc055022-024, n01hc55019-35-0-1, n01hc55018-38-0-1, n01hc55015-48-0-1)
- National Heart, Lung, and Blood Institute (N01-HC55022, N01-HC-55018, N01 HC 55020, N01-HC-55015, N01-HC-55016, N01-HC-55018, N01-HC-55019, N01-HC-55020, N01-HC-55021, and N01-HC-55022, N01 HC 55019, N01-HC55016, N01‐HC‐55015, N01-HC55021)
- Topics
- Health Sciences › Medicine › Ophthalmology › Retinal Diseases and Treatments
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Keywords
- diabetic retinopathy, coronary artery disease, type 2 diabetes, myocardial infarction, coronary heart disease mortality, coronary revascularization, microangiopathy, cardiovascular risk, sex differences, retinopathy grading
- MeSH terms
- Aged, Coronary Disease, Diabetes Mellitus, Type 2, Diabetic Retinopathy, Female, Follow-Up Studies, Humans, Male, Middle Aged, Prospective Studies, Risk, Comorbidity, Incidence
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