Diabetic retinopathy, its progression, and incident cardiovascular events in the ACCORD trial

Hertzel C. Gerstein, Walter T. Ambrosius, Ronald Danis, Faramarz Ismail-Beigi, William Cushman, Jorge Calles, Maryann Banerji, Ulrich Schubart, Emily Y. Chew

Research output: Contribution to journalArticle

40 Citations (Scopus)

Abstract

OBJECTIVE-Both the presence of diabetic retinopathy and its severity are significantly associated with future cardiovascular (CV) events. Whether its progression is also linked to incident CV outcomes hasn't been assessed. RESEARCH DESIGN AND METHODS-The relationship between retinopathy, its 4-year progression, and CV outcomes (CV death or nonfatal myocardial infarction or stroke) was analyzed in participants in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial who also participated in the ACCORD Eye Study. Retinopathy was classified as either none, mild, moderate, or severe, and worsening was classified as a <2-step, 2-3-step, or >3-step change (that included incident laser therapy or vitrectomy). RESULTS-Participants (n = 3,433) of mean age 61 years had baseline retinal photographs (seven stereoscopic fields). Comparedwith no retinopathy, the adjustedHRs (95%CI) for the CV outcome rose from 1.49 (1.12-1.97) for mild retinopathy to 2.35 (1.47-3.76) for severe retinopathy. A subset of 2,856 was evaluated for progression of diabetic retinopathy at 4 years. The hazard of the primary outcome increased by 38%(1.38 [1.10-1.74]) for every category of change in retinopathy severity. Additional adjustment for the baseline and follow-up levels of A1C, systolic blood pressure, and lipids either individually or together rendered the relationships between worsening and CV outcomes nonsignificant. CONCLUSIONS-Both the severity of retinopathy and its progression are determinants of incident CV outcomes. The retina may provide an anatomical index of the effect of metabolic and hemodynamic factors on future CV outcomes.

Original languageEnglish (US)
Pages (from-to)1266-1271
Number of pages6
JournalDiabetes care
Volume36
Issue number5
DOIs
StatePublished - May 1 2013

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Diabetic Retinopathy
Blood Pressure
Vitrectomy
Laser Therapy
Retina
Research Design
Hemodynamics
Stroke
Myocardial Infarction
Lipids

All Science Journal Classification (ASJC) codes

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing

Cite this

Gerstein, H. C., Ambrosius, W. T., Danis, R., Ismail-Beigi, F., Cushman, W., Calles, J., ... Chew, E. Y. (2013). Diabetic retinopathy, its progression, and incident cardiovascular events in the ACCORD trial. Diabetes care, 36(5), 1266-1271. https://doi.org/10.2337/dc12-1311

Diabetic retinopathy, its progression, and incident cardiovascular events in the ACCORD trial. / Gerstein, Hertzel C.; Ambrosius, Walter T.; Danis, Ronald; Ismail-Beigi, Faramarz; Cushman, William; Calles, Jorge; Banerji, Maryann; Schubart, Ulrich; Chew, Emily Y.

In: Diabetes care, Vol. 36, No. 5, 01.05.2013, p. 1266-1271.

Research output: Contribution to journalArticle

Gerstein, HC, Ambrosius, WT, Danis, R, Ismail-Beigi, F, Cushman, W, Calles, J, Banerji, M, Schubart, U & Chew, EY 2013, 'Diabetic retinopathy, its progression, and incident cardiovascular events in the ACCORD trial', Diabetes care, vol. 36, no. 5, pp. 1266-1271. https://doi.org/10.2337/dc12-1311
Gerstein HC, Ambrosius WT, Danis R, Ismail-Beigi F, Cushman W, Calles J et al. Diabetic retinopathy, its progression, and incident cardiovascular events in the ACCORD trial. Diabetes care. 2013 May 1;36(5):1266-1271. https://doi.org/10.2337/dc12-1311
Gerstein, Hertzel C. ; Ambrosius, Walter T. ; Danis, Ronald ; Ismail-Beigi, Faramarz ; Cushman, William ; Calles, Jorge ; Banerji, Maryann ; Schubart, Ulrich ; Chew, Emily Y. / Diabetic retinopathy, its progression, and incident cardiovascular events in the ACCORD trial. In: Diabetes care. 2013 ; Vol. 36, No. 5. pp. 1266-1271.
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AU - Cushman, William

AU - Calles, Jorge

AU - Banerji, Maryann

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AU - Chew, Emily Y.

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