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T.Y. Wong, R. Klein, A.R. Sharrett, D.J. Couper, L.D. Hubbard, B.E. K. Klein, F. Brancati; Diabetic Retinopathy and Risk of Ischemic Stroke: The Atherosclerosis Risk in Communities Study . Invest. Ophthalmol. Vis. Sci. 2004;45(13):5242.
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Purpose: To determine the relationship between retinopathy and risk of ischemic stroke in people with diabetes. Methods: A population–based, prospective cohort study of 1,763 middle–aged persons with diabetes was conducted, as part of the Atherosclerosis Risk In Communities Study. Retinal photographs were obtained from these persons and graded for presence of retinopathy according to the Early Treatment of Diabetic Retinopathy Study protocol. Severity of retinopathy was defined as none (level 10), mild (level 20) and moderate–severe (level 35 and higher). Incident ischemic stroke was identified prospectively and validated via case record review. Results: After 6 years of follow–up, 69 persons developed an incident ischemic stroke. The incidence of stroke was higher with more severe retinopathy at baseline (3.2% for no retinopathy, 7.9% for mild retinopathy and 9.1% for moderate–severe retinopathy). After controlling for age, gender, race, serum glucose levels, mean arterial blood pressure, total cholesterol levels, cigarette smoking and other stroke risk factors, persons with diabetic retinopathy at baseline had a two–fold higher risk of ischemic stroke than persons without retinopathy (relative risk 2.27, 95% confidence interval, 1.29, 4.01). This association was similar for both mild (relative risk 2.48, 95% confidence interval, 1.14, 5.42, compared to none) and moderate–severe (relative risk 2.15, 95% confidence interval, 1.10, 4.19, compared to none) levels of retinopathy. Conclusions: Diabetic retinopathy is associated with an increased risk of ischemic stroke, independent of glycemia levels and standard stroke risk factors. The elevated risk is seen even for mild non–proliferative retinopathy. These data suggest that persons with diabetic retinopathy may benefit from a stroke risk assessment.
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