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M.K. Lovestam Adrian, C. Hansson–Lundblad, O. Torffvit; Type 2 Diabetic Patients Who Developed Sight–Threatening Retinopathy Had a Longer Survival Time Than Those Who Did Not Develop Sight–Threatening Retinopathy . Invest. Ophthalmol. Vis. Sci. 2005;46(13):3268.
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Purpose: To study associations between diabetic retinopathy and development of stroke, myocardial infarction and death. Methods: During a 10yr observation period, 363 Type 2 diabetic patients (diagnosis≥30 yrs) attending an outpatient clinic were studied regarding the prevalence and incidence of retinopathy and associated risk factors (HbA1c, blood pressure, albuminuria, creatinine, age, sex and duration) in relation to the development of myocardial infarction, stroke and death. The degree of retinopathy was classified as no retinopathy, background or sight–threatening retinopathy, i.e. clinically significant macular edema, severe nonproliferative or proliferative retinopathy. Results: During the study period 62 patients had had mycocardial infarction, 54 stroke and 99 patients died. Patients with sight–threatening retinopathy at baseline (n=41) had 2.2 (P<0.01) times higher risk for death than patients with no or background retinopathy, even when controlled for medical riskfactors (Cox regression analysis). Patients with no retinopathy at baseline (n=226) who developed no or background retinopathy (n=187) had 5.4 times higher risk for death (P=0.007), (adjusted for medical riskfactors), compared to patients who developed sight–threatening retinopathy (n=39), and patients who developed no or background retinopathy had higher incidence of myocardial infarction (P=0.049) (disappeared when adjusted for medical riskfactors), than patients who developed sight–threatening retinopathy. More patients who developed sight–threatening retinopathy were treated with ACE inhibitors for hypertension than patients who did not (41% vs.24%; P=0.030). Conclusions: In spite of higher levels of medical riskfactors, patients who developed sight–threatening retinopathy had lower risk for myocardial infarction or death compared to patients with no or background retinopathy at follow–up. ACE inhibitors might contribute to the longer survival.
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