Diabetes Status Modifies the Association Between Carotid Plaque Burden and Retinal Microvascular Parameters

Carotid plaque burden (CPB) is a key indicator of atherosclerosis, yet its relationship with ocular microcirculation in the context of type 2 diabetes mellitus (T2DM) remains poorly understood. This study aimed to examine the association between CPB and ocular vascular parameters, and to evaluate whether this relationship is modified by diabetic status.

This retrospective study included 237 eyes from 123 participants (47 with T2DM, 76 without diabetes). All participants underwent head and neck computed tomography angiography (CTA) to quantify CPB using plaque presence and maximum thickness scores. Retinal vascular calibers (central retinal arteriolar equivalent [CRAE], central retinal venular equivalent [CRVE], and arteriovenous ratio [AVR]) were assessed using fundus photography. Hemodynamic parameters (peak systolic velocity [PSV], end-diastolic velocity [EDV], resistance index [RI], and pulsatility index [PI]) of the ophthalmic artery (OA), central retinal artery (CRA), and posterior ciliary artery (PCA) were measured using color Doppler ultrasound. Linear mixed-effects models (LMM) with patient-level random intercepts were employed to account for inter-eye correlation, with adjustment for age, sex, hypertension, smoking history, ischemic heart disease, stroke history, and hyperlipidemia.

In the diabetic group, plaque thickness score was significantly associated with CRAE (beta = -2.223, P = 0.003), AVR (beta = -0.011, P < 0.001), and PCA RI (beta = 0.005, P = 0.021). Plaque presence score was significantly associated with AVR (beta = -0.022, P = 0.021) and PCA RI (beta = 0.016, P = 0.009). No such associations were observed in the non-diabetic group (all P > 0.05). Interaction analyses revealed that diabetic status significantly modified the relationship between plaque thickness and both CRAE (P for interaction = 0.014) and AVR (P for interaction = 0.002). For plaque presence score, diabetic status significantly modified the association with AVR (P for interaction = 0.013).

Diabetic status significantly modifies the associations between CPB and retinal microvascular parameters (CRAE and AVR). These findings underscore the importance of metabolic status in ocular vascular pathology and suggest that diabetic patients may benefit from intensified ocular monitoring even with modest CPB. Further longitudinal studies are warranted to elucidate the underlying mechanisms.