The association of atherosclerosis, vascular risk factors, and retinopathy in adults with diabetes
- 1 July 2002
- journal article
- Published by Elsevier BV in Ophthalmology
- Vol. 109 (7), 1225-1234
- https://doi.org/10.1016/s0161-6420(02)01074-6
Abstract
The aim of this report is to describe the prevalence of retinopathy and its associations with atherosclerosis and vascular risk factors in people with diabetes. Cross-sectional study. Persons with diabetes, having gradable fundus photographs, from a biracial population-based cohort of adults (ages 51–72 years), and living in four United States communities (Forsyth County, North Carolina; the city of Jackson, Mississippi; suburbs of Minneapolis, Minnesota; and Washington County, Maryland) were studied from 1993 to 1995. Lesions typical of diabetic retinopathy were detected by grading a 45° color fundus photograph of one eye of each participant, using a modification of the Airlie House classification system. Severity of diabetic retinopathy (none, minimal nonproliferative, moderate nonproliferative, severe nonproliferative, and proliferative) and macular edema. Retinopathy was detected in 328/1600 (20.5%) of those with diabetes; 114/1724 (6.6%) had hard exudate, 28/1600 (1.8%) had proliferative diabetic retinopathy, and 27/1662 (1.6%) had macular edema. The prevalence of diabetic retinopathy was higher in blacks (27.7%) compared with whites (16.7%). Controlling for duration of diabetes, serum glucose, systolic blood pressure, and type of diabetes medications taken, severity of retinopathy was associated with carotid artery intima-media wall thickness (odds ratio [OR]/0.1-mm thickness 1.09; 95% confidence interval [CI], 1.01, 1.17; P = 0.01), serum albumin (OR/0.1 g/dl 0.94; 95% CI, 0.88, 0.99; P = 0.02), but not race (OR blacks versus whites,1.24; 95% CI, 0.88, 1.75; P = 0.21). Severity of diabetic retinopathy was not associated with coronary artery disease or stroke history or any of the plasma lipids studied. Controlling for age, gender, duration of diabetes, serum glucose, and type of diabetes medications taken, the presence of retinal hard exudates was associated with plasma low-density lipoprotein cholesterol (OR/10 mg/dl 1.18; 95% CI, 1.09, 1.29; P < 0.001), and plasma Lp(a) (OR/10 mg/dl 1.02; 95% CI, 1.00, 1.05; P = 0.04) but not race or blood pressure. These data suggest that plasma lipids are associated with the presence of hard exudate and that carotid artery intima-media wall thickness is associated with retinopathy, but other manifestations of atherosclerosis and most of its risk factors are not associated with severity of diabetic retinopathy.Keywords
This publication has 52 references indexed in Scilit:
- The Wisconsin epidemiologic study of diabetic retinopathy: XVIIOphthalmology, 1998
- Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33)The Lancet, 1998
- Differences between respondents and nonrespondents in a multicenter community-based study vary by gender and ethnicityJournal of Clinical Epidemiology, 1996
- The effect of nonresponse on prevalence estimates for a referent population: Insights from a population-based cohort studyAnnals of Epidemiology, 1996
- Arterial Wall Thickness Is Associated With Prevalent Cardiovascular Disease in Middle-Aged AdultsStroke, 1995
- B-mode-detected carotid artery plaque in a general population. Atherosclerosis Risk in Communities (ARIC) Study Investigators.Stroke, 1994
- Relation of carotid artery wall thickness to diabetes mellitus, fasting glucose and insulin, body size, and physical activity. Atherosclerosis Risk in Communities (ARIC) Study Investigators.Stroke, 1994
- Glycosylated hemoglobin predicts the incidence and progression of diabetic retinopathyPublished by American Medical Association (AMA) ,1988
- Chi-Square Tests with One Degree of Freedom; Extensions of the Mantel- Haenszel ProcedureJournal of the American Statistical Association, 1963
- DIABETIC ANGIOPATHY: A SPECIFIC VASCULAR DISEASEThe Lancet, 1954