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Diabetic retinopathy associated with heart failure risk, study results show

Wednesday, May 21 2008 | Comments

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What's This? Diabetic retinopathy is associated with an increased risk of heart failure (HF) among patients with type 2 diabetes, suggesting microvascular disease contributes to the development of HF in these patients, according to an analysis of data from a population-based study.

Researchers assessed retinal photographs from patients with diabetes (aged 45-64 years) for signs of diabetic retinopathy. No subject had coronary heart disease, HF, or impaired renal function at baseline. All individuals were participating in the larger Atherosclerosis Risk in Communities (ARIC) study.

Diabetic retinopathy was found in 125 patients at baseline (12.8%). Hospital and death records showed that 106 patients (10.1%) experienced an HF event during 8.9 years of follow-up. The cumulative incidence of HF was 21.6% among patients with retinopathy compared with 8.5% among those without retinopathy.

In an analysis adjusted for demographic and cardiovascular risk characteristics, the risk of heart failure was significantly greater among patients with retinopathy (HR, 2.71; 95% CI, 1.46-5.05). The risk remained significantly greater after further adjustment for glycemic measurements, carotid atherosclerosis, and markers of endothelial dysfunction (HR, 2.20; 95% CI, 1.08-4.47).

Additional analyses showed that the association was significant in both men (HR, 3.67; 95% CI, 1.22-11.01) and women (HR, 2.98; 95% CI, 1.34-6.64) and in both black patients (HR, 7.88; 95% CI, 2.40-25.92) and white patients (HR, 2.39; 95% CI, 1.04-5.51). These analyses also showed that the association between retinopathy and HF was somewhat stronger for patients without hypertension (HR, 5.59; 95% CI, 1.86-16.82) than for those with hypertension (HR, 2.22; 95% CI, 1.08-4.54).

Dr. Tien Y. Wong, one of the investigators, told VerusMed, "The assessment of retinopathy signs presents clinicians a unique opportunity to directly visualize and assess the actual morphology of diabetic microvascular damage."

"Our study shows that people with diabetic retinopathy have excess risks of heart failure, extending the evidence seen in previous studies that retinopathy is a marker of widespread systemic vascular damage, and is a harbinger for subclinical and clinical cardiovascular disease," added Wong, a professor and chairman of the department of ophthalmology at the University of Melbourne in Australia.

"Another implication from this study is that the findings show the risk factors for retinopathy and heart failure are similar--that is, hyperglycemia, hypertension, and hyperlipidemia. This emphasizes the need to control these risk factors to prevent both complications," he said. (Cheung N, et al. J Am Coll Cardiol 2008;51:1573–1578.)

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