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
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The American Journal of MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- A review of central retinal artery occlusion: clinical presentation and management.Eye. 2013; 27: 688-697
- Acute retinal arterial occlusive disorders.Prog Retin Eye Res. 2011; 30: 359-394https://doi.org/10.1016/j.preteyeres.2011.05.001
- Nationwide incidence of clinically diagnosed central retinal artery occlusion in Korea, 2008 to 2011.Ophthalmology. 2014; 121: 1933-1938
- Retinal artery occlusion. Associated systemic and ophthalmic abnormalities.Ophthalmology. 2009; 116: 1928-1936
- Retinal artery occlusion and associated recurrent vascular risk with underlying etiologies.PLoS One. 2017; 12e0177663https://doi.org/10.1371/journal.pone.0177663
- 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
- Correlation of atherogenic risk factors with retinal artery occlusion in adults.Med Glas (Zenica). 2014; 11: 110-114
- 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
- The incidence of central retinal artery occlusion in Olmsted County, Minnesota.Am J Ophthalmol. 2011; 152 (e2): 820-823
- Associations of retinal artery occlusion and retinal vein occlusion to mortality, stroke, and myocardial infarction: a systematic review.Eye (Lond). 2016; 30: 1031-1038
- Retinal vascular occlusion syndromes.Int Ophthalmol Clin. 2009; 49: 63-79
- Diabetes-related microvascular and macrovascular diseases in the physical therapy setting.Phys Ther. 2008; 88: 1322-1335
- Prediabetes as a toxic environment for the initiation of microvascular and macrovascular complications.Exp Biol Med (Maywood). 2016; 241: 1323-1331
- Classification and diagnosis of diabetes mellitus: standards of medical care in diabetes-2022.Diabetes Care. 2022; 45: S17-S38
- 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
- The Danish Civil Registration System.Scand J Public Health. 2011; 39: 22-25
- The Danish National Patient Register.Scand J Public Health. 2011; 39: 30-33
- The Danish National Prescription Registry.Scand J Public Health. 2011; 39: 38-41
- Risk factors for major adverse cardiovascular events after the first acute coronary syndrome.Ann Med. 2021; 53: 817-823
- First-ever ischemic stroke and incident major adverse cardiovascular events in 93,627 older women and men.Stroke. 2020; 51: 387-394
- The burden of major adverse cardiac events in patients with coronary artery disease.BMC Cardiovasc Disord. 2017; 17: 1
- Prior polyvascular disease: risk factor for adverse ischaemic outcomes in acute coronary syndromes.Eur Heart J. 2009; 30: 1195-1202
- 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
- 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
- Diabetes and cardiovascular disease: Epidemiology, biological mechanisms, treatment recommendations and future research.World J Diabetes. 2015; 6: 1246-1258
- Biological variation in HbA1c predicts risk of retinopathy and nephropathy in type 1 diabetes.Diabetes Care. 2004; 27: 1259-1264
- Urinary albumin excretion as a predictor of diabetic retinopathy, neuropathy, and cardiovascular disease in NIDDM.Diabetes Care. 1996; 19: 1243-1248
- The true value of HbA1c as a predictor of diabetic complications: simulations of HbA1c variables.PLoS One. 2009; 4: e4412
- 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
- Association between diabetic eye disease and other complications of diabetes: Implications for care. A systematic review.Diabetes Obes Metab. 2019; 21: 467-478
- Retinopathy as a predictor of other diabetic complications.Int Ophthalmol. 2001; 24: 1-11
- Diabetic retinopathy as an independent predictor of subclinical cardiovascular disease: baseline results of the PRECISED study.BMJ Open Diabetes Res Care. 2019; 7e000845
- Diabetic retinopathy predicts cardiovascular mortality in diabetes: a meta-analysis.BMC Cardiovasc Disord. 2020; 20: 478
- Diabetic retinopathy in predicting diabetic nephropathy in patients with type 2 diabetes and renal disease: a meta-analysis.Diabetologia. 2013; 56: 457-466
- Clinical characteristics and outcome of current standard management of central retinal artery occlusion.Clin Experiment Ophthalmol. 2010; 38: 496-501
- 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
- Intravenous thrombolysis in patients with central retinal artery occlusion: a systematic review and meta-analysis.J Neurol. 2022; 269: 1825-1833
- The association of central retinal artery occlusion and extracranial carotid artery disease.Ann Surg. 1988; 208: 85-90
- Management of central retinal artery occlusion: a scientific statement from the American Heart Association.Stroke. 2021; 52: e282-e294
- Positive predictive value of cardiovascular diagnoses in the Danish National Patient Registry: a validation study.BMJ Open. 2016; 6e012832
Article Info
Publication History
Published online: September 25, 2022
Publication stage
In Press Journal Pre-ProofFootnotes
Funding: This study was partly funded by an unrestricted grant from the Obel Family Foundation and Lions Club Bannerslund . The sponsor did not influence the design or execution of the study.
Conflicts of Interest: MO reports none. HV has served as an advisory board member for Bayer and Novartis. TBL has been an investigator for Janssen Scientific Affairs, LLC, Bayer AG, and Boehringer Ingelheim and has also received speaker honoraria from Bayer, Bristol-Myers Squibb, Pfizer, and Merck Sharp & Dome. ML is a principal investigator on trials at the Rigshospitalet sponsored by Novartis, Allergan, Alcon, Novo Nordisk, Eli Lilly, Spark Therapeutics, Nightstar, Sanofi and Roche and has been compensated for speaking and consulting for several of these entities. FLS has received consultancy fees from Bayer.
Authorship: All authors had access to the data and a role in writing this manuscript.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
