Retinal vessel calibre shown to be independently associated with microvascular and macrovascular disease in type 2 diabetes
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The aim of this population-based prospective study was to describe the relationship of retinal arteriolar and venular calibres to the long-term incidence of microvascular and macrovascular complications in the retina as well as in other end-organ targets in subjects with type 2 diabetes. 1370 subjects diagnosed to have diabetes at ≥30 years of age participated in the baseline assessment from 1980 to 1982, 987 in the 4-year follow-up and 533 in the 10-year follow-up. Computer-assisted grading was used to determine the average calibre of retinal arterioles (central retinal arteriolar equivalent [CRAE]) and retinal venules (central retinal venular equivalent [CRVE]) at all examinations. Main outcome parameters included incidence and progression of diabetic retinopathy; incidence of proliferative diabetic retinopathy and macular oedema; incidence of nephropathy, neuropathy, and lower extremity amputation; and ischaemic heart disease, stroke, and overall mortality. After adjusting for other factors, smaller CRAE was associated with the 14-year cumulative incidence of lower extremity amputation (P=0.02), 22-year all-cause mortality (P=0.03), and 22-year stroke mortality (P=0.03) but not with the other endpoints. Larger CRVE was associated with the 14-year incidence of diabetic nephropathy (P<0.001) and the 22-year stroke mortality (P=0.003), but not with the other end-points. Measuring retinal vessel caliber may help refine risk assessment of long-term non-retinal vascular complications.
Abstract
