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Retinal Artery Occlusion as an Early Indicator of Macrovascular Complications in Diabetes

Published:September 25, 2022DOI:https://doi.org/10.1016/j.amjmed.2022.09.012

      Abstract

      Background

      A characteristic of the retinal circulation is that arterial occlusion is embolic or secondary to vasculitis but rarely or never due to in situ atherosclerosis. Therefore, retinal artery occlusion suggests the presence of cardiac or large-vessel disease outside the eye. This cohort study examined the general risk of macrovascular disease in individuals with diabetes, with or without retinal artery occlusion.

      Methods

      We retrieved data on 992 subjects with incident retinal artery occlusion and preexisting diabetes, registered in Denmark between January 1, 2000, and December 31, 2018. Each retinal artery occlusion subject was matched for age, sex, and diabetes duration, with 5 control subjects with diabetes but without retinal artery occlusion. We performed survival analyses to compare the risk of extraocular macrovascular disease between the 2 groups in a 5-year follow-up.

      Results

      After 1 year, the incidence of macrovascular disease in subjects with retinal artery occlusion was approximately 21 per 100 person-years (95% confidence interval [CI]: 18.11-24.29), compared to 6.25 per 100 patient-years (95% CI: 5.57-7.00) in those without retinal artery occlusion. After 5 years, the cumulative incidences of macrovascular disease were 51.2% (95% CI: 47.9-54.7%) and 29.4% (95% CI: 28.0-30.8%) in patients with diabetes with or without retinal artery occlusion, respectively. Hazard rate ratios were 3.36 (95% CI: 2.79-4.05) after 1 year and 2.27 (95% CI: 2.04-2.53) after 5 years.

      Conclusion

      Among individuals with diabetes, those diagnosed with retinal artery occlusion had a higher general risk of macrovascular complications for at least 5 years after the occlusion event compared with those without retinal artery occlusion.

      Keywords

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      References

        • Varma DD
        • Cugati S
        • Lee AW
        • et al.
        A review of central retinal artery occlusion: clinical presentation and management.
        Eye. 2013; 27: 688-697
        • Hayreh SS
        Acute retinal arterial occlusive disorders.
        Prog Retin Eye Res. 2011; 30: 359-394https://doi.org/10.1016/j.preteyeres.2011.05.001
        • Park SJ
        • Choi N-K
        • Seo KH
        • Park KH
        • Woo SJ
        Nationwide incidence of clinically diagnosed central retinal artery occlusion in Korea, 2008 to 2011.
        Ophthalmology. 2014; 121: 1933-1938
        • Hayreh SS
        • Podhajsky PA
        • Zimmerman MB
        Retinal artery occlusion. Associated systemic and ophthalmic abnormalities.
        Ophthalmology. 2009; 116: 1928-1936
        • Hong JH
        • Sohn SI
        • Kwak J
        • et al.
        Retinal artery occlusion and associated recurrent vascular risk with underlying etiologies.
        PLoS One. 2017; 12e0177663https://doi.org/10.1371/journal.pone.0177663
        • Klein R
        • Klein BE
        • Jensen SC
        • Moss SE
        • Meuer SM
        Retinal emboli and stroke: the Beaver Dam Eye Study.
        Arch Ophthalmol (Chicago, Ill 1960). 1999; 117: 1063-1068https://doi.org/10.1001/archopht.117.8.1063
        • Risimić D
        • Nikolić D
        • Simeunović D
        • Jakšić V
        • Cekić S
        • Milenković S
        Correlation of atherogenic risk factors with retinal artery occlusion in adults.
        Med Glas (Zenica). 2014; 11: 110-114
        • Goldacre MJ
        • Wotton CJ
        • Keenan TDL
        Risk of selected eye diseases in people admitted to hospital for hypertension or diabetes mellitus: record linkage studies.
        Br J Ophthalmol. 2012; 96: 872-876
        • Leavitt JA
        • Larson TA
        • Hodge DO
        • Gullerud RE
        The incidence of central retinal artery occlusion in Olmsted County, Minnesota.
        Am J Ophthalmol. 2011; 152 (e2): 820-823
        • Woo SCY
        • Lip GYH
        • Lip PL
        Associations of retinal artery occlusion and retinal vein occlusion to mortality, stroke, and myocardial infarction: a systematic review.
        Eye (Lond). 2016; 30: 1031-1038
        • Haymore JG
        • Mejico LJ
        Retinal vascular occlusion syndromes.
        Int Ophthalmol Clin. 2009; 49: 63-79
        • Cade WT
        Diabetes-related microvascular and macrovascular diseases in the physical therapy setting.
        Phys Ther. 2008; 88: 1322-1335
        • Brannick B
        • Wynn A
        • Dagogo-Jack S
        Prediabetes as a toxic environment for the initiation of microvascular and macrovascular complications.
        Exp Biol Med (Maywood). 2016; 241: 1323-1331
        • American Diabetes Association Professional Practice Committee
        Classification and diagnosis of diabetes mellitus: standards of medical care in diabetes-2022.
        Diabetes Care. 2022; 45: S17-S38
        • Chang YS
        • Ho CH
        • Chu CC
        • et al.
        Risk of retinal artery occlusion in patients with diabetes mellitus: a retrospective large-scale cohort study.
        PLoS One. 2018; 13e0201627https://doi.org/10.1371/journal.pone.0201627
        • Pedersen CB
        The Danish Civil Registration System.
        Scand J Public Health. 2011; 39: 22-25
        • Lynge E
        • Sandegaard JL
        • Rebolj M
        The Danish National Patient Register.
        Scand J Public Health. 2011; 39: 30-33
        • Kildemoes HW
        • Sørensen HT
        • Hallas J
        The Danish National Prescription Registry.
        Scand J Public Health. 2011; 39: 38-41
        • Okkonen M
        • Havulinna AS
        • Ukkola O
        • et al.
        Risk factors for major adverse cardiovascular events after the first acute coronary syndrome.
        Ann Med. 2021; 53: 817-823
        • Sposato LA
        • Lam M
        • Allen B
        • Shariff SZ
        • Saposnik G
        First-ever ischemic stroke and incident major adverse cardiovascular events in 93,627 older women and men.
        Stroke. 2020; 51: 387-394
        • Tsai IT
        • Wang CP
        • Lu YC
        • et al.
        The burden of major adverse cardiac events in patients with coronary artery disease.
        BMC Cardiovasc Disord. 2017; 17: 1
        • Bhatt DL
        • Peterson ED
        • Harrington RA
        • et al.
        Prior polyvascular disease: risk factor for adverse ischaemic outcomes in acute coronary syndromes.
        Eur Heart J. 2009; 30: 1195-1202
        • Berger A
        • Simpson A
        • Bhagnani T
        • et al.
        Incidence and cost of major adverse cardiovascular events and major adverse limb events in patients with chronic coronary artery disease or peripheral artery disease.
        Am J Cardiol. 2019; 123: 1893-1899
        • Einarson TR
        • Acs A
        • Ludwig C
        • Panton UH
        Prevalence of cardiovascular disease in type 2 diabetes: a systematic literature review of scientific evidence from across the world in 2007-2017.
        Cardiovasc Diabetol. 2018; 17: 83
        • Leon BM
        • Maddox TM
        Diabetes and cardiovascular disease: Epidemiology, biological mechanisms, treatment recommendations and future research.
        World J Diabetes. 2015; 6: 1246-1258
        • McCarter RJ
        • Hempe JM
        • Gomez R
        • Chalew SA
        Biological variation in HbA1c predicts risk of retinopathy and nephropathy in type 1 diabetes.
        Diabetes Care. 2004; 27: 1259-1264
        • Savage S
        • Estacio RO
        • Jeffers B
        • Schrier RW
        Urinary albumin excretion as a predictor of diabetic retinopathy, neuropathy, and cardiovascular disease in NIDDM.
        Diabetes Care. 1996; 19: 1243-1248
        • Lind M
        • Odén A
        • Fahlén M
        • Eliasson B
        The true value of HbA1c as a predictor of diabetic complications: simulations of HbA1c variables.
        PLoS One. 2009; 4: e4412
        • Wolde HF
        • Atsedeweyen A
        • Jember A
        • et al.
        Predictors of vascular complications among type 2 diabetes mellitus patients at University of Gondar Referral Hospital: a retrospective follow-up study.
        BMC Endocr Disord. 2018; 18: 52
        • Pearce I
        • Simó R
        • Lövestam-Adrian M
        • Wong DT
        • Evans M
        Association between diabetic eye disease and other complications of diabetes: Implications for care. A systematic review.
        Diabetes Obes Metab. 2019; 21: 467-478
        • El-Asrar AM
        • Al-Rubeaan KA
        • SA Al-Amro
        • Moharram OA
        • Kangave D
        Retinopathy as a predictor of other diabetic complications.
        Int Ophthalmol. 2001; 24: 1-11
        • Simó R
        • Bañeras J
        • Hernández C
        • et al.
        Diabetic retinopathy as an independent predictor of subclinical cardiovascular disease: baseline results of the PRECISED study.
        BMJ Open Diabetes Res Care. 2019; 7e000845
        • Xu X-H
        • Sun B
        • Zhong S
        • Wei D-D
        • Hong Z
        • Dong A-Q
        Diabetic retinopathy predicts cardiovascular mortality in diabetes: a meta-analysis.
        BMC Cardiovasc Disord. 2020; 20: 478
        • He F
        • Xia X
        • Wu XF
        • Yu XQ
        • Huang FX
        Diabetic retinopathy in predicting diabetic nephropathy in patients with type 2 diabetes and renal disease: a meta-analysis.
        Diabetologia. 2013; 56: 457-466
        • Rudkin AK
        • Lee AW
        • Aldrich E
        • Miller NR
        • Chen CS
        Clinical characteristics and outcome of current standard management of central retinal artery occlusion.
        Clin Experiment Ophthalmol. 2010; 38: 496-501
        • Sacco RL
        • Kasner SE
        • Broderick JP
        • et al.
        An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association.
        Stroke. 2013; 44: 2064-2089
        • Huang L
        • Wang Y
        • Zhang R
        Intravenous thrombolysis in patients with central retinal artery occlusion: a systematic review and meta-analysis.
        J Neurol. 2022; 269: 1825-1833
        • Douglas DJ
        • Schuler JJ
        • Buchbinder D
        • Dillon BC
        • Flanigan DP
        The association of central retinal artery occlusion and extracranial carotid artery disease.
        Ann Surg. 1988; 208: 85-90
        • Mac Grory B
        • Schrag M
        • Biousse V
        • et al.
        Management of central retinal artery occlusion: a scientific statement from the American Heart Association.
        Stroke. 2021; 52: e282-e294
        • Sundbøll J
        • Adelborg K
        • Munch T
        • et al.
        Positive predictive value of cardiovascular diagnoses in the Danish National Patient Registry: a validation study.
        BMJ Open. 2016; 6e012832