The risk of stroke related to diabetic retinopathy may not be modifiable.


LOS ANGELES – Evidence continues to accumulate that diabetic retinopathy predicts a high risk of stroke.
In a new study with nearly 3,000 people, people with diabetic retinopathy were 60% more likely than others with diabetes to develop an incident stroke over time. The researchers also found that addressing glucose, lipid and blood pressure levels did not mitigate this risk in this secondary analysis of the ACCORD eye study.

Ka-Ho Wong, BS, MBA

"We are not surprised by the finding that diabetic retinopathy increases the risk of stroke, since diabetic retinopathy is a common microvascular disease that is an established risk factor for cardiovascular disease," lead author Ka told Medscape Medical News -Ho Wong, BS, MBA. .

However, "we were surprised that none of the trial interventions mitigated this risk, particularly the intensive reduction in blood pressure, because hypertension is the most important cause of microvascular disease," he said. Wong is a clinical research coordinator and laboratory manager of the Havenon lab in the hospitals and health clinics at the University of Utah in Salt Lake City.
The study findings were published on February 12 before the formal presentation at the International Stroke Conference (ISC) 2020 next week in Los Angeles.
Common predictor of vascular disease
Diabetic retinopathy is the most common complication of diabetes mellitus, which affects up to 50% of people living with type 1 and type 2 diabetes. In addition, previous research suggests that complications of macrovascular diabetes, including stroke, They could share a common or synergistic path.

This damage to the small vessels in the eye has also been linked to an increased risk of adverse cardiac events, including heart failure, as Medscape Medical News reported.
For more information, Wong and his colleagues analyzed 2828 participants in the Eye Study Action to control cardiovascular risk in diabetes (ACCORD). They compared the risk of stroke among 874 people with diabetic retinopathy with other diabetics in 1954 without this complication. The average age was 62 years and 62% were men.
Diabetic neuropathy at the start of the study was diagnosed using the severity scale of the diabetic retinopathy study of early treatment using stereoscopic background photographs of seven fields.

A total of 117 participants experienced a stroke during a mean follow-up of 5.4 years.

The researchers found that diabetic retinopathy was more common among patients who had a stroke (41%) versus 31% of those without stroke (P = 0.016).

The link between diabetic retinopathy and stroke was maintained in an analysis adjusted for multiple factors, including baseline age, sex, race, total cholesterol, A1c, smoking and more. The risk remained high, with a risk ratio of 1.60 (95% confidence interval, 1.10 – 2.32; P = .015).

Regarding the potential to modify this risk, the association was not affected among the participants randomly assigned to the ACCORD glucose intervention (P = .305), the lipid intervention (P = .546) or the blood pressure intervention (P = .422).

The study was a secondary analysis, so information about the type of stroke and location was not available.

The panorama
"Diabetic retinopathy is associated with an increased risk of stroke, suggesting that the microvascular pathology inherent in diabetic retinopathy has greater cardiovascular implications," the researchers say.

Despite these findings, the researchers suggest that patients with diabetic retinopathy receive aggressive medical treatment to try to reduce their risk of stroke.

"It is important that all people with diabetes maintain good blood glucose control, and people with established diabetic retinopathy should pay special attention to complying with all stroke prevention guidelines established by the American Stroke Association," he said. Wong

"Patients with established diabetic retinopathy should pay special attention to compliance with all stroke prevention guidelines established by the (American Heart Association)," he added.

Wong and his colleagues would like to broaden these findings. Pending the grant application and financial support, they propose a prospective observation trial in patients with stroke with baseline diabetic retinopathy. One objective would be to identify the most common mechanisms that lead to stroke in this population, "which would have important implications for prevention efforts," he said.

Consistent findings
"The results of the study showing that having diabetic retinopathy is also associated with an increase in stroke is really not surprising. There have been other studies, population-based studies, conducted in the past, that have found a similar relationship. "Larry B. Goldstein, MD, said in a video comment about the findings.

"The results are actually quite consistent with several other studies that have evaluated the same relationship," added Goldstein, who is president of the Department of Neurology and co-director of the Kentucky Institute of Neuroscience, University of Kentucky HealthCare, in Lexington.

Wong and Goldstein have not disclosed relevant financial relationships. The National Institute of Neurological Disorders and Stroke of the NIH funded the study.

International Stroke Conference (ISC) 2020: Oral Presentation 154. Presented on February 21, 2020.

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. (tagsToTranslate) macrovascular complications of diabetes (t) diabetes mellitus (t) stroke (t) stroke (t) cva (stroke)


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