Prospective Association between Diabetic Retinopathy and Cardiovascular Disease—A Systematic Review and Meta-analysis of Cohort Studies

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• 作者：Vivian Yawei Guo ; PhD^* ; ^&dagger ; ; Bing Cao ; PhD^&Dagger ; ; Xinyin Wu ; PhD^§ ; ; Jack Jock Wai Lee ; PhD^* ; Benny Chung-ying Zee ; PhD^* ; ^‖ ; ^{bzee@cuhk.edu.hk" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Cardiovascular disease ; diabetes ; diabetic retinopathy ; meta-analysis ; systematic review
• 刊名：Journal of Stroke and Cerebrovascular Diseases
• 出版年：2016
• 出版时间：July 2016
• 年：2016
• 卷：25
• 期：7
• 页码：1688-1695
• 全文大小：888 K

文摘

Diabetic retinopathy (DR) is linked to increased risk of cardiovascular (CV) disease. However, the effect size of the association was not consistent. In this study, we performed a systematic review and meta-analysis of available cohort studies to determine the association between DR and CV disease, and to investigate the factors that influence the association.

Methods

Terms related to DR and CV disease were searched from MEDLINE and EMBASE database. High-quality articles (Newcastle–Ottawa scales above 6) conducted in cohort studies reporting the association between DR and CV disease were identified. Study-specific estimates were pooled using random effects with inverse variance meta-analysis. Subgroup analysis was performed according to diabetes types. Heterogeneity of included studies was assessed using the I² test. The cause of the heterogeneity was examined using metaregression analyses.

Results

A total of 13 studies representing 17,611 patients without CV disease at baseline were included. At follow-up, there were 1457 CV disease-related incidences. Overall, DR was associated with increased risk of CV disease (relative risk [RR]: 2.42, 95% confidence interval [CI]: 1.77-3.31) in diabetes. Specifically, the RR was 3.59 (95% CI: 1.79-7.20) for type 1 diabetes and 1.81 (95% CI: 1.47-2.23) for type 2 diabetes. Significant heterogeneity was found in studies with type 1 diabetes. Metaregression analysis showed that baseline systolic blood pressure was a key factor leading to the heterogeneity.

Conclusion

In conclusion, DR is significantly associated with CV disease incidence and CV disease-related mortality in diabetes. Patients with DR may need more intensive management to control future CV disease attacks.