Diabetic retinopathy predicts cardiovascular disease independently of subclinical atherosclerosis in individuals with type 2 diabetes: A prospective cohort study

Background: Diabetic retinopathy (DR) and preclinical atherosclerosis are associated with higher cardiovascular risk. However, no studies have investigated the predictive role of DR and preclinical atherosclerosis jointly on cardiovascular events in subjects with type 2 diabetes (T2D). We aimed to a...

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Autores: Castelblanco Echavarría, Esmeralda, Granado Casas, Minerva, Hernández García, Marta, Pinyol, Montserrat, Correig, Eudald, Julve, Josep, Rojo López, Marina Idalia, Alonso, Núria, Avogaro, Angelo, Ortega, Emilio, Mauricio Puente, Dídac
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2022
País:España
Institución:Universitat de Lleida (UdL)
Repositorio:Repositori Obert UdL
OAI Identifier:oai:repositori.udl.cat:10459.1/84486
Acceso en línea:https://doi.org/10.3389/fcvm.2022.945421
http://hdl.handle.net/10459.1/84486
Access Level:acceso abierto
Palabra clave:Cardiovascular disease
Diabetic retinopathy
Major adverse cardiovascular events
Subclinical atherosclerosis
Type 2 diabetes
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spelling Diabetic retinopathy predicts cardiovascular disease independently of subclinical atherosclerosis in individuals with type 2 diabetes: A prospective cohort studyCastelblanco Echavarría, EsmeraldaGranado Casas, MinervaHernández García, MartaPinyol, MontserratCorreig, EudaldJulve, JosepRojo López, Marina IdaliaAlonso, NúriaAvogaro, AngeloOrtega, EmilioMauricio Puente, DídacCardiovascular diseaseDiabetic retinopathyMajor adverse cardiovascular eventsSubclinical atherosclerosisType 2 diabetesBackground: Diabetic retinopathy (DR) and preclinical atherosclerosis are associated with higher cardiovascular risk. However, no studies have investigated the predictive role of DR and preclinical atherosclerosis jointly on cardiovascular events in subjects with type 2 diabetes (T2D). We aimed to assess the contribution of DR and subclinical atherosclerosis on the risk of adverse cardiovascular events in subjects with T2D without previous cardiovascular disease (CVD). Methods: We included two prospective cohorts of subjects with T2D from the same geographical area. Assessment of subclinical atherosclerosis was performed by carotid ultrasound. An ophthalmologist classified DR according to standard criteria. Cardiovascular outcomes considered for analysis were the following: ischemic heart disease, stroke, heart failure, peripheral artery disease, revascularization procedures, and cardiovascular mortality. Bivariable and multivariable predictive models were performed. Results: From a total of 374 subjects with T2D 44 developed cardiovascular events during the 7.1 years of follow-up. Diabetes duration, total cholesterol, and glycated hemoglobin (HbA1c) at baseline were higher in subjects who developed cardiovascular outcomes (p < 0.001, p = 0.026, and p = 0.040, respectively). Compared with subjects without events, those developing cardiovascular events had higher prevalence of retinopathy (65.9% vs. 38.8%, p = 0.001; respectively) and more than mild retinopathy (43.2% vs. 31.8%, p = 0.002; respectively). Furthermore, all-cause mortality was higher in subjects with MACE than those without events (13.6% vs. 3.3%, p = 0.009; respectively). The multivariable analyses showed that HbA1c and the presence of DR at baseline were predictive of cardiovascular outcomes (p = 0.045 and p = 0.023, respectively). However, the burden of subclinical atherosclerosis was not (p = 0.783 and p = 0.071, respectively). Conclusion: DR is a strong predictor of cardiovascular events in T2D individuals at primary CVD prevention, even after accounting for the presence of preclinical carotid atherosclerosis. These results may help to individualize CVD prevention strategies in T2D.This study was supported by grants PS09/01035 and PI11/01723 from the Instituto de Salud Carlos III, Ministry of Economy and Competitiveness and FEDER, Spain. CIBER for Diabetes and Associated Metabolic Diseases (CIBERDEM) and CIBEROBN were initiatives of Instituto de Salud Carlos III, Spain. MR-L held a predoctoral fellowship from the Departament de Salut, SLT017/20/000107. JJ was recipient of a Miguel Servet Type 2 contract (CPII18/00004; ISCIII). JJ was member of Red de Investigación en “Enfermedades Metabólicas y Cáncer” (RED2018-102799-T), Ministerio de Economía y Competitividad (MINECO), Madrid, Spain. Institut de Recerca del Hospital de la Santa Creu i Sant Pau and Biomedical Research Institute’s Dr. Pifarré Foundation from Lleida (IRBLleida) were accredited by the Generalitat de Catalunya as Centre de Recerca de Catalunya (CERCA).Frontiers2022info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://doi.org/10.3389/fcvm.2022.945421http://hdl.handle.net/10459.1/84486reponame:Repositori Obert UdL instname:Universitat de Lleida (UdL)InglésReproducció del document publicat a: https://doi.org/10.3389/fcvm.2022.945421Frontiers in Cardiovascular Medicine, 2022, vol. 9cc-by (c) authors, 2022info:eu-repo/semantics/openAccesshttp://creativecommons.org/licenses/by/4.0/oai:repositori.udl.cat:10459.1/844862026-06-24T12:42:17Z
dc.title.none.fl_str_mv Diabetic retinopathy predicts cardiovascular disease independently of subclinical atherosclerosis in individuals with type 2 diabetes: A prospective cohort study
title Diabetic retinopathy predicts cardiovascular disease independently of subclinical atherosclerosis in individuals with type 2 diabetes: A prospective cohort study
spellingShingle Diabetic retinopathy predicts cardiovascular disease independently of subclinical atherosclerosis in individuals with type 2 diabetes: A prospective cohort study
Castelblanco Echavarría, Esmeralda
Cardiovascular disease
Diabetic retinopathy
Major adverse cardiovascular events
Subclinical atherosclerosis
Type 2 diabetes
title_short Diabetic retinopathy predicts cardiovascular disease independently of subclinical atherosclerosis in individuals with type 2 diabetes: A prospective cohort study
title_full Diabetic retinopathy predicts cardiovascular disease independently of subclinical atherosclerosis in individuals with type 2 diabetes: A prospective cohort study
title_fullStr Diabetic retinopathy predicts cardiovascular disease independently of subclinical atherosclerosis in individuals with type 2 diabetes: A prospective cohort study
title_full_unstemmed Diabetic retinopathy predicts cardiovascular disease independently of subclinical atherosclerosis in individuals with type 2 diabetes: A prospective cohort study
title_sort Diabetic retinopathy predicts cardiovascular disease independently of subclinical atherosclerosis in individuals with type 2 diabetes: A prospective cohort study
dc.creator.none.fl_str_mv Castelblanco Echavarría, Esmeralda
Granado Casas, Minerva
Hernández García, Marta
Pinyol, Montserrat
Correig, Eudald
Julve, Josep
Rojo López, Marina Idalia
Alonso, Núria
Avogaro, Angelo
Ortega, Emilio
Mauricio Puente, Dídac
author Castelblanco Echavarría, Esmeralda
author_facet Castelblanco Echavarría, Esmeralda
Granado Casas, Minerva
Hernández García, Marta
Pinyol, Montserrat
Correig, Eudald
Julve, Josep
Rojo López, Marina Idalia
Alonso, Núria
Avogaro, Angelo
Ortega, Emilio
Mauricio Puente, Dídac
author_role author
author2 Granado Casas, Minerva
Hernández García, Marta
Pinyol, Montserrat
Correig, Eudald
Julve, Josep
Rojo López, Marina Idalia
Alonso, Núria
Avogaro, Angelo
Ortega, Emilio
Mauricio Puente, Dídac
author2_role author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Cardiovascular disease
Diabetic retinopathy
Major adverse cardiovascular events
Subclinical atherosclerosis
Type 2 diabetes
topic Cardiovascular disease
Diabetic retinopathy
Major adverse cardiovascular events
Subclinical atherosclerosis
Type 2 diabetes
description Background: Diabetic retinopathy (DR) and preclinical atherosclerosis are associated with higher cardiovascular risk. However, no studies have investigated the predictive role of DR and preclinical atherosclerosis jointly on cardiovascular events in subjects with type 2 diabetes (T2D). We aimed to assess the contribution of DR and subclinical atherosclerosis on the risk of adverse cardiovascular events in subjects with T2D without previous cardiovascular disease (CVD). Methods: We included two prospective cohorts of subjects with T2D from the same geographical area. Assessment of subclinical atherosclerosis was performed by carotid ultrasound. An ophthalmologist classified DR according to standard criteria. Cardiovascular outcomes considered for analysis were the following: ischemic heart disease, stroke, heart failure, peripheral artery disease, revascularization procedures, and cardiovascular mortality. Bivariable and multivariable predictive models were performed. Results: From a total of 374 subjects with T2D 44 developed cardiovascular events during the 7.1 years of follow-up. Diabetes duration, total cholesterol, and glycated hemoglobin (HbA1c) at baseline were higher in subjects who developed cardiovascular outcomes (p < 0.001, p = 0.026, and p = 0.040, respectively). Compared with subjects without events, those developing cardiovascular events had higher prevalence of retinopathy (65.9% vs. 38.8%, p = 0.001; respectively) and more than mild retinopathy (43.2% vs. 31.8%, p = 0.002; respectively). Furthermore, all-cause mortality was higher in subjects with MACE than those without events (13.6% vs. 3.3%, p = 0.009; respectively). The multivariable analyses showed that HbA1c and the presence of DR at baseline were predictive of cardiovascular outcomes (p = 0.045 and p = 0.023, respectively). However, the burden of subclinical atherosclerosis was not (p = 0.783 and p = 0.071, respectively). Conclusion: DR is a strong predictor of cardiovascular events in T2D individuals at primary CVD prevention, even after accounting for the presence of preclinical carotid atherosclerosis. These results may help to individualize CVD prevention strategies in T2D.
publishDate 2022
dc.date.none.fl_str_mv 2022
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://doi.org/10.3389/fcvm.2022.945421
http://hdl.handle.net/10459.1/84486
url https://doi.org/10.3389/fcvm.2022.945421
http://hdl.handle.net/10459.1/84486
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Reproducció del document publicat a: https://doi.org/10.3389/fcvm.2022.945421
Frontiers in Cardiovascular Medicine, 2022, vol. 9
dc.rights.none.fl_str_mv cc-by (c) authors, 2022
info:eu-repo/semantics/openAccess
http://creativecommons.org/licenses/by/4.0/
rights_invalid_str_mv cc-by (c) authors, 2022
http://creativecommons.org/licenses/by/4.0/
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv Frontiers
publisher.none.fl_str_mv Frontiers
dc.source.none.fl_str_mv reponame:Repositori Obert UdL
instname:Universitat de Lleida (UdL)
instname_str Universitat de Lleida (UdL)
reponame_str Repositori Obert UdL
collection Repositori Obert UdL
repository.name.fl_str_mv
repository.mail.fl_str_mv
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