Diabetic Retinopathy May Predict Heart Failure

Diabetic retinopathy appears to be an independent risk factor for heart failure, new research suggests, which supports the belief that microvascular disease plays a role in the development of heart failure in diabetics.

As reported in the Journal of the American College of Cardiology for April 22, Dr. Tien Y. Wong from the University of Melbourne in Australia and colleagues analyzed data from 1021 adults with type 2 diabetes who were free from renal and heart disease at baseline.

Overall, 125 (12.8%) of the subjects had diabetic retinopathy at baseline. During 9 years of follow-up, 106 patients (10.1%) developed heart failure, the investigators note.

The cumulative incidence of heart failure in subjects with retinopathy was 21.6%, significantly higher than the 8.5% seen in those without retinopathy. After adjusting for several demographic features and for glycemic control, carotid disease, and endothelial dysfunction, the hazard ratio for heart failure associated with diabetic retinopathy was 2.20.
Editorialists Dr. Hector O. Ventura and Dr. Madhavi Reddy, from the Ochsner Clinic Foundation in New Orleans, comment that the current findings could have important implications for clinicians.

"Current guidelines already identify the need for routine screening for retinopathy in the diabetic patient. In addition to appropriate vision care, the detection of retinopathy might now also warrant a fuller cardiac evaluation and closer follow-up to prevent the development of heart failure," they state.

J Am Coll Cardiol 2008;51:1573-1580.

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FACT:
Hyperglycemia increases cardiovascular risk in both type 1 and type 2 diabetes: Available evidence indicates that. The effect of postprandial or post-challenge hyperglycemia on this risk is greater than the effect of fasting hyperglycemia. This was also the conclusion reached in a newly published analysis of the Diabetes Control and Complications Trial (DCCT). This analysis showed that mean blood glucose, compared with HbA1c, was significantly predictive of cardiovascular events during the original study period of the DCCT. More specifically, mean blood glucose was better than HbA1c at predicting the risk of cardiovascular disease. High blood glucose values thus appear to have exerted a detrimental effect on macrovascular complication risk, even during the original duration of the DCCT study, despite this effect not being detected by measurement of HbA1c. Diabetes Care. 2008;31 Suppl 2:S194-201. -Diabetologia. 2008;51:493-501.