Author + information
- Received October 1, 2007
- Revision received November 16, 2007
- Accepted November 21, 2007
- Published online April 22, 2008.
- Ning Cheung, MBBS⁎,
- Jie J. Wang, PhD⁎,†,
- Sophie L. Rogers, Mepi⁎,
- Frederick Brancati, MD, MPH‡,
- Ronald Klein, MD, MPH§,
- A. Richey Sharrett, MD, DrPH‡,
- Tien Y. Wong, MD, PhD⁎∥,⁎ (, )
- ARIC (Atherosclerosis Risk In Communities) Study Investigators
- ↵⁎Reprint requests and correspondence:
Dr. Tien Y. Wong, Centre for Eye Research Australia, University of Melbourne, 32 Gisborne Street, Victoria 3002, Australia.
Objectives The purpose of this study was to examine the association of diabetic retinopathy with incident heart failure (HF).
Background Microvascular disease might play a more prominent role in the pathogenesis of diabetic cardiomyopathy, a major cause of HF in diabetes. Whether diabetic retinopathy, a microvascular complication of diabetes, predicts HF is unclear.
Methods A population-based study included 1,021 middle-aged type 2 diabetic persons with normal renal function and free of clinical coronary heart disease or HF at baseline. Diabetic retinopathy signs were graded from retinal photographs. Incident HF events were prospectively identified from hospital stay and death records.
Results There were 125 (12.8%) participants with diabetic retinopathy. After 9-year follow-up, 106 (10.1%) participants developed incident HF events. Persons with retinopathy were more likely to develop HF (cumulative incidence of 21.6%) than those without retinopathy (cumulative incidence of 8.5%). After controlling for age, gender, race, smoking, diabetes duration, insulin use, blood pressure, lipid profile, and other risk factors, participants with retinopathy had more than 2.5-fold higher risk of developing HF than those without retinopathy (hazard ratio [HR] 2.71; 95% confidence interval [CI] 1.46 to 5.05). This association remained significant after further adjustments for glycemic control, carotid atherosclerosis, and serum markers of endothelial dysfunction (HR 2.20, 95% CI 1.08 to 4.47).
Conclusions The presence of diabetic retinopathy signifies an excess risk of HF, independent of known risk factors. This further supports a contribution of microvascular disease to the development of HF in people with diabetes.
This study was supported by contracts N01-HC-35125, N01-HC-35126, N01-HC-55015, N01-HC-55016, N01-HC-55018, N01-HC-55019, N01-HC-55020, N01-HC-55021, and N01-HC-55022 from the National Heart, Lung, and Blood Institute, Bethesda, Maryland. Additional support was provided by the National Heart Foundation, Australia (to Dr. Wong).
- Received October 1, 2007.
- Revision received November 16, 2007.
- Accepted November 21, 2007.
- American College of Cardiology Foundation