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Subclinical atherosclerosis associates with diabetic retinopathy incidence: a prospective study

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Abstract

Background

The prospective correlation between subclinical atherosclerosis and diabetic retinopathy (DR) incidence in Chinese patients with type 2 diabetes mellitus (T2DM) remains elusive.

Methods

Prospective data were obtained from 2781 patients with diabetes, among whom 1,964 and 2,180 T2DM patients without any and referable DR at baseline, respectively, were included in the analysis. Multivariate analyses were performed using the Cox proportional hazards model.

Results

Over a median follow-up of 22.2 months (interquartile range 12.7–27.7), 282 (14.36%) and 125 (5.73%) patients developed any and referable DR, respectively. After adjustment for confounders, each standard deviation (SD) increase in brachial-ankle pulse wave velocity (ba-PWV) was associated with 31% (95% confidence interval 1.15–1.50) and 38% (1.14–1.66) higher risks of incident any and referable DR, respectively. Compared with the lowest ba-PWV quartile, the highest ba-PWV quartile had 135% (1.48–3.72) and 293% (1.83–8.44) higher risks of developing any and referable DR, respectively. Per SD increase of pulse pressure (PP) was associated with 22% (1.09–1.38) and 22% (1.02–1.46) higher risks of incident any and referable DR, respectively. The restricted cubic spline models further indicated a significant linear association of baseline subclinical atherosclerosis with referable DR, and a nonlinear association with any DR. In addition, adding the ba-PWV to the prognostic model for DR incidence improved the C-statistic value, the integrated discrimination improvement value, and the net reclassification improvement value (all P < 0.05).

Conclusions

Baseline subclinical atherosclerosis was significantly associated with an increased risk of DR incidence, and elevated ba-PWV independently predicted incident DR in T2DM patients.

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Availability of data and materials

The datasets used and/or analyzed during the current study are not publicly available due to the individual privacy of the patients included in this study, but are available from the corresponding author on reasonable request.

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Acknowledgements

We wish to thank all participants for their collaboration in the MMC and Dr. Liping Xuan of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, who provides us with good suggestions for data analysis.

Funding

This work was supported by the National Key Research and Development Program of China (grant numbers 2016YFC0901200 to Y.Z., 2018YFC1311800 to W.W., 2018YFC1314800 to W.G.), the SHMHDF (grant number DMRFP_II_01 to Y.Z.), and the Program for Shanghai Outstanding Medical Academic Leader (grant number 2019LJ07 to Y.Z.).

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Author notes

  1. Qianhua Fang, Minqi Xiang, Juan Shi and Yingxia Zhou these authors have contributed equally to this work and share the first authorship.

Authors and Affiliations

  1. Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

    Qianhua Fang, Minqi Xiang, Juan Shi, Yingxia Zhou, Ying Peng, Shujie Wang, Cong Liu, Jie Hong, Weiqiong Gu, Weiqing Wang & Yifei Zhang

  2. Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

    Qianhua Fang, Minqi Xiang, Juan Shi, Yingxia Zhou, Ying Peng, Shujie Wang, Cong Liu, Jie Hong, Weiqiong Gu, Weiqing Wang & Yifei Zhang

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  1. Qianhua Fang
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Contributions

WW and YZ conceived the study, QF, YP, JS, YZ, SW, CL, JH, and WG collected the clinical data. QF, MX, JS, and YZ designed the study, performed data analysis, and wrote the manuscript. WW and YZ verified the underlying data and revised the manuscript. All authors reviewed the study and approved the final version.

Corresponding authors

Correspondence to Weiqing Wang or Yifei Zhang.

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Conflict of interest

The authors declare that they have no conflict of interests.

Ethics approval

The study protocol was approved by the Ethics Committee of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine. Our study was performed abiding by the principles of the Declaration of Helsinki.

Informed consent

All participants provided written informed consent prior to their inclusion in the study.

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This article belongs to the topical collection Eye Complications of Diabetes, managed by Giuseppe Querques

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Fang, Q., Xiang, M., Shi, J. et al. Subclinical atherosclerosis associates with diabetic retinopathy incidence: a prospective study. Acta Diabetol 59, 1041–1052 (2022). https://doi.org/10.1007/s00592-022-01897-w

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  • DOI: https://doi.org/10.1007/s00592-022-01897-w

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