Targher G et al. (2008) Diabetic retinopathy is associated with an increased incidence of cardiovascular events in type 2 diabetic patients. Diabet Med 25: 45–50

Previous studies suggested that diabetes-associated retinopathy increases the risk of cardiovascular disease (CVD) events, but cohorts were generally small and the findings were conflicting, particularly for possible sex-specific effects. Targher and colleagues examined the association between retinopathy and incident CVD events in a large population of men and women with type 2 diabetes and without a diagnosis of CVD at baseline.

The authors included 2,103 outpatients (1,302 men, 801 women) with type 2 diabetes enrolled in a prospective, observational study during 2000. Patients were grouped according to their retinopathy status at baseline (no retinopathy, n = 1,116; nonproliferative retinopathy, n = 798; proliferative or laser-treated retinopathy, n = 189). CVD events included cardiovascular death and nonfatal ischemic stroke or coronary heart disease.

During ∼7 years of follow-up, 406 patients experienced CVD events. After adjustment (for age, BMI, waist circumference, smoking status, lipid level, glycated hemoglobin level, diabetes duration and medication use), the risk of incident CVD events was significantly greater in patients with nonproliferative (hazard ratio [male versus female] 1.61 versus 1.67) and proliferative or laser-treated retinopathy (hazard ratio [male versus female] 3.75 versus 3.81) than in patients with no retinopathy (each comparison P <0.001). After further adjustment for hypertension and advanced nephropathy, the risk of incident CVD events remained significantly increased only in patients with proliferative retinopathy.

The authors conclude that retinopathy, particularly at advanced stages, is an independent risk factor for incident CVD events in both men and women with type 2 diabetes.