DIABETIC RETINOPATHY AS A PREDICTOR OF SEVERITY OF CORONARY ARTERY DISEASE

Main Article Content

Muhammad Saad Jibran
Zohaib Ullah Zahid
Syed Abid Habib
Shawana .

Abstract

ABSTRACT

OBJECTIVES: To determine the association between diabetic retinopathy (DR) and severity of coronary artery disease (CAD) and evaluate the relation of stage of DR with severity of CAD.

METHODS: This cross-sectional study was conducted in Cardiology Unit, Lady Reading Hospital, Peshawar from January-June, 2017. Patients with diabetes mellitus for >5years who underwent coronary angiography (CA) were included. All patients underwent fundoscopy and categorized into: No-DR, pre-proliferative-DR and proliferative-DR. CA was performed to assess the severity of CAD and patients were categorized into: none, mild, moderate and severe CAD on the basis of number of vessels involved or left main stem (LMS) disease. The correlation between DR and CAD was determined by chi-square test and prevalence odd ratios (POR) were calculated by using logistic regression model.

RESULTS: A total of 166 patients with mean age of 55.5±8.8years were included in the study, of which 79 were males, 35 had no-DR, 110 had pre-proliferative-DR and 21 had proliferative-DR while 63 patients had mild CAD, 50 had moderate CAD and 18 had severe CAD. By using Chi square test, association between DR and severity of CAD was calculated to be 86.68 (p-0.000). After adjustments for various risk factors, PORs for severity of CAD with increasing stage of DR were found to be significantly increased from 0.27 times for no-DR to 4.27 times for pre-proliferative-DR and 6.33 times for proliferative-DR.

CONCLUSION: DR is not only strongly associated with CAD but higher stage of retinopathy predicts a more severe CAD increasing the odds of CAD by 2.27 times.

KEYWORDS: Coronary Artery Disease (MeSH); Diabetic Retinopathy (MeSH); Diabetes Mellitus (MeSH).

Article Details

How to Cite
Jibran, Muhammad Saad, et al. “DIABETIC RETINOPATHY AS A PREDICTOR OF SEVERITY OF CORONARY ARTERY DISEASE”. KHYBER MEDICAL UNIVERSITY JOURNAL, vol. 10, no. 4, Dec. 2018, pp. 188-91, doi:10.35845/kmuj.2018.18199.
Section
Original Articles
Author Biographies

Muhammad Saad Jibran, Department of Cardiology, Medical Teaching Institute Lady Reading Hospital, Peshawar, Pakistan

POST GRADUATE MEDICAL RESIDENT, CARDIOLOGY UNIT, LADY READING HOSPITAL PESHAWAR

Syed Abid Habib, Department of Cardiology, Medical Teaching Institute Lady Reading Hospital, Peshawar, Pakistan

POST GRADUATE MEDICAL RESIDENT, CARDIOLOGY UNIT, LADY READING HOSPITAL PESHAWAR

References

REFERENCES

Resl M, Clodi M. [Diabetes and cardiovascular complications]. Wien Med Wochenschr 2010 Jan 1;160(1-2):3-7. DOI: 10.1007/s10354-010-0744-y.

Fioretto P, Dodson PM, Ziegler D, Rosenson RS. Residual microvascular risk in diabetes: unmet needs and future directions. Nat Rev Endocrinol 2010 Jan;6(1):19-25. DOI: 10.1038/nrendo.2009.213.

Weckbach S, Findeisen HM, Schoenberg SO, Kramer H, Stark R, Clevert DA et al. Systemic cardiovascular complications in patients with long-standing diabetes mellitus: comprehensive assessment with whole-body magnetic resonance imaging/magnetic resonance angiography. Invest Radiol 2009 Apr;44(4):242-50. DOI: 10.1097/RLI.0b013e31819a60d3.

Hernández C, Candell-Riera J, Ciudin A, Francisco G, Aguadé-Bruix S, Simó R. Prevalence and risk factors accounting for true silent myocardial ischemia: a pilot case-control study comparing type 2 diabetic with non-diabetic control subjects. Cardiovasc Diabetol 2011 Jan 21;10:9. DOI: 10.1186/1475-2840-10-9.

Gu K, Cowie CC, Harris MI. Diabetes and decline in heart disease mortality in US adults. J Am Med Assoc 1999 Apr 14;281(14):1291-7.

Kannel WB, McGee DL. Diabetes and cardiovascular disease: the Framingham study. J Am Med Assoc 1979 May 11;241(19):2035-8.

Miettinen H, Haffner SM, Lehto S, Rönnemaa T, Pyörälà K, Laakso M. Retinopathy predicts coronary heart disease events in NIDDM patients. Diabetes Care 1996 Dec;19(12):1445-8.

Faglia E, Favales F, Calia P, Paleari F, Segalini G, Gamba PL et al. Cardiac events in 735 type 2 diabetic patients who underwent screening for unknown asymptomatic coronary heart disease: 5-year follow-up report from the Milan Study on Atherosclerosis and Diabetes (MiSAD). Diabetes Care 2002 Nov;25(11):2032-6.

Soedamah-Muthu SS, Chaturvedi N, Witte DR, Stevens LK, Porta M, Fuller JH; EURODIAB Prospective Complications Study Group. Relationship between risk factors and mortality in type 1 diabetic patients in Europe: the EURODIAB Prospective Complications Study (PCS). Diabetes Care 2008 Jul;31(7):1360-6. DOI: 10.2337/dc08-0107.

Targher G, Bertolini L, Tessari R, Zenari L, Arcaro G. Retinopathy predicts future cardiovascular events among type 2 diabetic patients: The Valpolicella Heart Diabetes Study. Diabetes Care 2006 May;29(5):1178.

Turner RC, Millns H, Neil HA, Stratton IM, Manley SE, Matthews DR et al. Risk factors for coronary artery disease in non-insulin dependent diabetes mellitus: United Kingdom Prospective Diabetes Study (UKPDS: 23). Br Med J 1998 Mar 14;316(7134):823-8.

Klein R, Klein BE, Moss SE, Cruickshanks KJ. Association of ocular disease and mortality in a diabetic population. Arch Ophthalmol 1999 Nov;117(11):1487-95.

Campeau L. Grading of angina pectoris. Circulation. 1976;54:522-3

American Academy of Ophthalmology. International clinical diabetic retinopathy disease severity scale. (Cited on: November 18, 2018). Available from URL: http://www.icoph.org/downloads/Diabetic-Retinopathy-Scale.pdf

Gupta R, Birnbaum Y, Uretsky BF. The renal patient with coronary artery disease: current concepts and dilemmas. J Am Coll Cardiol 2004 Oct 6;44(7):1343-53. DOI: 10.1016/j.jacc.2004.06.058

Schrier RW. Role of diminished renal function in cardiovascular mortality: marker or pathogenetic factor? J Am Coll Cardiol 2006 Jan 3;47(1):1-8. DOI: 10.1016/j.jacc.2005.07.067

Remuzzi G, Schieppati A, Ruggenenti P. Clinical practice. Nephropathy in patients with type 2 diabetes. New Eng J Med 2002 Apr 11;346(15):1145-51. DOI: 10.1056/NEJMcp011773

Ritz E, Orth SR. Nephropathy in patients with type 2 diabetes mellitus. New Eng J Med 1999 Oct 7;341(15):1127-33. DOI: 10.1056/NEJM199910073411506

Jawa A, Kcomt J, Fonseca VA. Diabetic nephropathy and retinopathy. Med Clin North Am 2004 Jul;88(4):1001-36, xi. DOI: 10.1016/j.mcna.2004.04.012

Ohno T, Takamoto S, Motomura N. Diabetic retinopathy and coronary artery disease from the cardiac surgeon’s perspective. Ann Thorac Surg 2008 Feb;85(2):681-9. DOI: 10.1016/j.athoracsur.2007.07.066.

Antonetti DA, Barber AJ, Bronson SK, Freeman WM, Gardner TW, Jefferson LS et al. Diabetic retinopathy: seeing beyond glucose-induced microvascular disease. Diabetes 2006 Sep;55(9):2401-11. DOI: 10.2337/db05-1635

El Demerdash F, Refaie W, Allakany R, Tantawy S, Dawood E. Diabetic retinopathy: A predictor of coronary artery disease. Egyptian Heart J 2012;64(2):63-8. DOI: 10.1016/j.ehj.2011.08.006

Ohno T, Kinoshita O, Fujita H, Kato S, Hirose A, Sigeeda T et al. Detecting occult coronary artery disease followed by early coronary artery bypass surgery in patients with diabetic retinopathy: report from a diabetic retinocoronary clinic. J Thorac Cardiovasc Surg 2010 Jan 1;139(1):92-7. DOI: 10.1016/j.jtcvs.2009.04.005.

Gimeno-Orna JA, Faure-Nogueras E, Castro-Alonso FJ, Boned-Juliani B. Ability of retinopathy to predict cardiovascular disease in patients with type 2 diabetes mellitus. Am J Cardiol 2009 May 15;103(10):1364-7. DOI: 10.1016/j.amjcard.2009.01.345