Diabetic retinopathy and cardiovascular disease in type II diabetics. The Framingham Heart Study and the Framingham Eye Study
Related Experiment Videos
R Hiller1, R D Sperduto, M J Podgor
1Biometry and Epidemiology Program, National Eye Institute, Bethesda, MD 20892.
Insights
Diabetic retinopathy, a small vessel complication, is linked to cardiovascular events in younger individuals with Type II diabetes. This suggests a potential generalized microangiopathy in diabetes pathogenesis.
Area of Science:
- Cardiology
- Ophthalmology
- Endocrinology
Background:
- Diabetic retinopathy is a microvascular complication of diabetes.
- Cardiovascular events are typically associated with macrovascular disease.
- The relationship between microvascular and macrovascular complications in diabetes is not fully understood.
Purpose of the Study:
- To investigate the association between diabetic retinopathy and cardiovascular events.
- To explore age-related differences in this association.
Main Methods:
- Utilized data from the Framingham Heart Study and Framingham Eye Study.
- Analyzed 206 individuals with Type II diabetes.
- Employed logistic regression to account for covariates.
Main Results:
- Significant association found between diabetic retinopathy and cardiovascular disease, particularly in younger age groups (52-64 years).
- Odds ratios varied significantly across age groups, indicating an age-dependent relationship.
- Associations remained consistent after adjusting for sex, diabetes duration, age at diagnosis, and insulin treatment.
Conclusions:
- Diabetic retinopathy is associated with cardiovascular events in younger Type II diabetics, challenging the strict microvascular vs. macrovascular disease distinction.
- This association may indicate a generalized microangiopathy contributing to cardiovascular disease in diabetes.
- Further research into the role of microangiopathy in diabetic cardiovascular disease is warranted.
Abstract:
Data from the Framingham Heart Study and the Framingham Eye Study were used to examine the association between diabetic retinopathy and the occurrence of cardiovascular events (coronary heart disease, intermittent claudication, congestive heart failure, and stroke). Among the 206 persons with Type II diabetes in the Framingham Eye Study, the odds ratios for diabetic retinopathy and cardiovascular disease were 14.3 (95% confidence interval (CI) = 2.7-101.9), 2.0 (95% CI = 0.5-8.1), and 0.3 (95% CI = 0.05-1.3) for ages 52-64, 65-74, and 75-85 years, respectively. The test for homogeneity indicated highly significant differences for the odds ratios across age groups. The associations were similar when sex, duration of diabetes, age at diagnosis of diabetes, and history of insulin treatment were accounted for by logistic regression. Our data suggest an association in younger diabetics between diabetic retinopathy, a small vessel complication of diabetes, and a group of cardiovascular events commonly thought to result from large vessel disease. The finding may merely indicate that diabetics with large vessel disease are also more likely to have small vessel disease. However, it is also consistent with the hypothesis, suggested by histologic data, that a more generalized microangiopathy affecting not only the eye but also organs such as the heart may play a role in the pathogenesis of cardiovascular disease in diabetics.