Diabetic retinopathy as an independent predictor of subclinical cardiovascular disease : Baseline results of the PRECISED study
Simó Canonge, Rafael (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Bañeras, Jordi (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Hernández, Cristina (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Rodríguez-Palomares, José (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Valente, Filipa (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Gutiérrez García-Moreno, Laura (Hospital Universitari Vall d'Hebron. Institut de Recerca)
González-Alujas, Teresa (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Ferreira-Gonzalez, Ignacio (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Aguadé-Bruix, Santiago (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Montaner, Joan (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Seron, Daniel (Red de Investigación Renal)
Genescà Ferrer, Joan (Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas)
Boixadera Espax, Anna (Hospital Universitari Vall d'Hebron. Institut de Recerca)
García Arumí, José (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Planas, Alejandra (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Simó-Servat, Olga (Hospital Universitari Vall d'Hebron. Institut de Recerca)
García-Dorado, David (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Universitat Autònoma de Barcelona

Date:	2019
Abstract:	Objective Detection of subclinical cardiovascular disease (CVD) has significant impact on the management of type 2 diabetes. We examined whether the assessment of diabetic retinopathy (DR) is useful for identifying patients at a higher risk of having silent CVD. Research design and methods Prospective case-control study comprising 200 type 2 diabetic subjects without history of clinical CVD and 60 age-matched non-diabetic subjects. The presence of subclinical CVD was examined using two parameters: (1) calcium coronary score (CACs); (2) composite of CACs >400 UA, carotid plaque ≥3 mm, carotid intima-media thickness ratio >1, or the presence of ECG changes suggestive of previous asymptomatic myocardial infarction. In addition, coronary angio-CT was performed. DR was assessed by slit-lamp biomicroscopy and retinography. Results Type 2 diabetic subjects presented higher CACs than non-diabetic control subjects (p<0. 01). Age, male gender, and the presence of DR were independently related to CACs >400 (area under the receiver operating characteristic curve (AUROC) 0. 76). In addition, an inverse relationship was observed between the degree of DR and CACs <10 AU. The variables independently associated with the composite measurement of subclinical CVD were age, diabetes duration, the glomerular filtration rate, microalbuminuria, and the presence of DR (AUROC 0. 71). In addition, a relationship (p<0. 01) was observed between the presence and degree of DR and coronary stenosis. Conclusions The presence and degree of DR is independently associated with subclinical CVD in type 2 diabetic patients. Our results lead us to propose a rationalized screening for coronary artery disease in type 2 diabetes based on prioritizing patients with DR, particularly those with moderate-severe degree.
Grants:	Instituto de Salud Carlos III PIE 2013/27 Instituto de Salud Carlos III RD16/0019/0021
Note:	Funding This work was supported by an Integrative Excellence Project by the Spanish Institute of Health, Instituto de Salud Carlos III, grant PIE 2013/27, CIBER CV, CIBERDEM, and the European Regional Development Fund (ERDF-FEDER). The Neurovascular Research Laboratory is part of the Spanish Stroke Research Network INVICTUS+ (RD16/0019/0021).
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Published in:	BMJ open diabetes research and care, Vol. 7 Núm. 1 (29 2019) , p. e000845, ISSN 2052-4897

DOI: 10.1136/bmjdrc-2019-000845
PMID: 31908800

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