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Ning Cheung, Yih Chung Tham, Miao Li Chee, Paul Mitchell, Tien Yin Wong, Gavin Tan, Charumathi Sabanayagam, Ching-Yu Cheng; Retinopathy Signs and Risk of Cardiovascular Disease in Asians with and without Diabetes. Invest. Ophthalmol. Vis. Sci. 2018;59(9):2603.
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© ARVO (1962-2015); The Authors (2016-present)
Retinopathy signs have been linked to risk of cardiovascular disease (CVD), but population-based longitudinal data are still lacking in Asians. Our study examined the relation of retinopathy signs to risk of CVD in a multi-ethnic Asian population with and without diabetes.
We conducted a 6-year prospective population-based cohort study of 6,077 ethnic Asians comprised of Chinese, Malays and Indians, aged 40 years or older, with no history of CVD at baseline, residing in the general communities of Singapore. Retinopathy signs were ascertained from retinal photographs according to the modified Airlie House Classification. Incident CVD events were defined based on self-reported myocardial infarction (MI), angina pectoris or stroke ascertained from a standardized questionnaire.
Over the 6 years of follow-up, there were 240 (3.9%) incident cases of CVD. During this period, participants with retinopathy signs were more likely to have developed CVD than those without retinopathy (9.0% vs. 3.4%; p<0.001). After adjusting for age, gender and ethnicity, among persons with diabetes, retinopathy was associated with increased risk of incident stroke (Relative Risk [RR] 2.92; 95% Confidence Interval [CI]: 1.58, 5.39) or MI (RR 1.70; 95% CI: 1.01, 2.84). In multivariable analysis with additional adjustments for other risk factors such as diabetes duration, glycemic control, blood pressure and smoking, retinopathy remained significantly associated with incident stroke (RR 3.10; 95% CI: 1.54, 6.23) but not with incident MI (RR 1.09; 95% CI: 0.58, 2.02). Clinically significant macular edema was also associated with risk of stroke (RR 4.28; 95% CI: 1.39, 13.17) or MI (RR 3.71; 95% CI: 1.51, 9.08) after adjusting for age, gender and ethnicity, but only the association with stroke (RR 3.03; 95% CI: 1.03, 9.89) remained significant in multivariable analysis. In persons without diabetes, retinopathy was not significantly associated with risk of CVD outcomes in multivariable analysis.
Both retinopathy signs and macular edema were associated with higher risk of CVD among Asian persons with diabetes. In particular, their presence may signal a 3-fold increased risk of developing stroke within 6 years. These findings may have clinical implication in the context of ocular anti-angiogenic therapy as an increasingly popular treatment for the vision-threatening forms of diabetic retinopathy.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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