J Korean Med Sci.  2016 Aug;31(8):1292-1299. 10.3346/jkms.2016.31.8.1292.

The Degree of Diabetic Retinopathy in Patients with Type 2 Diabetes Correlates with the Presence and Severity of Coronary Heart Disease

• Um T
• Lee DH
• Kang JW
• Kim EY
• Yoon YH

• KMID: 2373759
• DOI: http://doi.org/10.3346/jkms.2016.31.8.1292

Abstract

Both diabetic retinopathy (DR) and coronary heart disease (CHD) are clinically significant in diabetic patients. We investigated the correlation between the severity of DR and the presence and severity of CHD among type 2 diabetic patients. A total of 175 patients who were examined at the DR clinic and underwent dual-source computed tomography (DSCT) angiography within 6 months were included. The degree of DR was graded as no DR, nonproliferative DR (NPDR), and proliferative DR (PDR). The severity of CHD and the numbers of significant stenotic coronary artery on DSCT angiography according to DR grade were assessed. The mean Agatston Calcium Score (ACS) in patients with PDR was significantly higher than other groups (P < 0.001). The overall odds of an ACS increase were about 4.7-fold higher in PDR group than in no DR group (P < 0.001). In PDR group, in comparison with in no DR, the odds of having 1 or 2 arterial involvement were 3-fold higher (P = 0.044), and those of having 3 were 17-fold higher (P = 0.011). The c-index, one of the predictability values in regression analysis model, was not significantly increased when PDR was added to classical CHD risk factors (0.671 to 0.706, P = 0.111). Conclusively, patients with PDR develop a greater likelihood of not only having CHD, but being more severe nature. PDR has no additional effect to classical CHD risk factors for predicting CHD.

Keyword

Coronary Heart Disease; Diabetic Retinopathy; Type 2 Diabetes

MeSH Terms

Aged
Angiography
Coronary Artery Disease/complications/*pathology
Coronary Vessels/diagnostic imaging
Diabetes Mellitus, Type 2/*complications
Diabetic Retinopathy/complications/*diagnosis/diagnostic imaging
Female
Glomerular Filtration Rate
Humans
Linear Models
Male
Middle Aged
Odds Ratio
Risk Factors
Severity of Illness Index
Tomography, X-Ray Computed

Figure

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  Fig. 1 Fundus photographs and coronary CT images of representative cases in each diabetic retinopathy category. (A) A patient with no DR (top) and no sign of coronary artery stenosis. The total ACS was zero in this case. (B) A patient with NPDR (top) and significant stenosis in the mLAD artery (yellow arrow) and dLCX artery (green arrow). Calcified plaques are evident in the LAD artery (red arrow) and the total ACS of this case was 159.2. (C) A patient with PDR (top) showing significant stenosis in the dRCA (yellow arrow), LAD artery (red arrow) and pLCX artery (green arrow) with heavy calcified plaques. The total ACS in this patient was 374.6. DR, diabetic retinopathy; NPDR, non-proliferative DR; PDR, proliferative DR; ACS, Agatston calcium score; mLAD, mid left anterior descending; dLCX, distal left circumflex; dRCA, distal right coronary artery.

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  Fig. 2 Correlation between the number of significant stenotic coronary arteries and the ACS. ACS, Agatston calcium score.

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  Fig. 3 The proportional odds ratio for increasing ACS between PDR, NPDR and no DR group, respectively. ACS, Agatston calcium score; DR, diabetic retinopathy; NPDR, non-proliferative DR; PDR, proliferative DR.

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  Fig. 4 Odds ratios for significantly stenotic coronary artery numbers among different DR states. DR: diabetic retinopathy.

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