Diabetic Retinopathy and Risk of Cardiovascular Disease: A Systematic Review and Meta-Analysis

Abstract

Purpose: : To review the relationship of diabetic retinopathy (DR) and risk of cardiovascular disease (CVD) in people with diabetes.

Methods: : A systematic review of four databases (Medline, Embase, Current Contents and Cochrane Library) was performed for prospective cohort studies that have examined the association between DR and cardiovascular events up to July 2008. The reference list of relevant articles was also reviewed and pertinent articles retrieved. Two reviewers independently reviewed all the citations, articles and selected studies using pre-specified standardized criteria. Count data from each included study was extracted and pooled relative risk estimates were calculated using random-effects model.

Results: : Of 1631 citations identified, 14 publications were included in our meta-analyses. The presence of DR was associated with a more than three-fold higher risk of non-fatal coronary heart disease (CHD) (relative risk [RR] 3.14; 95% confidence interval [CI]: 2.00-4.94), fatal CHD (RR 3.87; 95% CI:0. 99-15.16) and any CHD (RR 3.66; 95% CI 0.69-19.28), a more than two-fold higher risk of non-fatal stroke (RR 2.97; 95% CI 1.04-8.50) and fatal stroke (RR 2.40; 95% CI 0.29-19.87) and a more than two-fold higher risk of non-fatal CVD (RR 2.51; 95% CI: 1.82-3.45), fatal CVD (RR 2.36; 95% CI: 1.61-3.46) and any CVD (RR 2.39; 95% CI: 1.93-2.95).

Keywords: diabetic retinopathy • clinical (human) or epidemiologic studies: prevalence/incidence • clinical (human) or epidemiologic studies: outcomes/complications