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Jiang F, Yin S, Zhang X. Mechanism of action and experimental validation of key genes common to diabetic retinopathy and coronary heart disease based on multiple bioinformatics investigations. Front Genet 2025; 16:1548147. [PMID: 40176795 PMCID: PMC11961877 DOI: 10.3389/fgene.2025.1548147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2024] [Accepted: 02/25/2025] [Indexed: 04/04/2025] Open
Abstract
Introduction The relationship between diabetic retinopathy (DR) and coronary artery disease (CHD) has been established as a reliable predictor. However, the underlying mechanisms linking these two conditions remain poorly understood. Identifying common key genes could provide new therapeutic targets for both diseases. Methods Public databases were used to compile training and validation datasets for DR and CHD. Machine learning algorithms and expression validation were employed to identify these key genes. To investigate immune cell differences, single-sample gene set enrichment analysis (ssGSEA) and the Wilcoxon test were applied. Spearman correlation analysis further explored the relationship between key genes and immune cell variations. Additionally, potential therapeutic drugs targeting these key genes were identified and a key gene-drug network was constructed. The role of the key genes in the pathogenesis of DR and CHD was further examined through reverse transcription-quantitative polymerase chain reaction (RT-qPCR). Results Consistent expression trends observed across datasets (GSE221521, GSE113079, GSE189005, GSE42148) led to the identification of HIRIP3 and ZNF416 as key genes. In GSE221521, HIRIP3 was positively correlated with CD56 bright natural killer cells (cor = 0.329, P < 0.001) and type 1T helper cells (cor = 0.327, P < 0.001), while ZNF416 showed significant correlations with CD4 T cell activation (cor = 0.340, P < 0.001) and type 1T helper cells (cor = 0.273, P < 0.05). Moreover, 82 transcription factors (TFs) were predicted, including SP3. Binding free energy calculations for key genes and potential drugs suggested stable binding conformations. RT-qPCR results revealed elevated expression of both HIRIP3 and ZNF416 in the control group compared to the DR with CHD (DRwCHD) group, with only ZNF416 showing significant differences between the groups (p < 0.05). Discussion These findings highlight HIRIP3 and ZNF416 as crucial genes in DR and CHD detection, providing a foundation for identifying novel therapeutic targets for both diseases.
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Affiliation(s)
| | - Shi Yin
- Department of Cardiology, The Affiliated Hospital of Yunnan University, Kunming, China
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Pei X, Yao X, Qi D, Yang Y, Fan S, Li Z. Apolipoprotein and menopausal status are significant influencing factors for diabetic retinopathy in type II diabetes mellitus women. Sci Rep 2025; 15:8868. [PMID: 40087480 PMCID: PMC11909188 DOI: 10.1038/s41598-025-93161-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 03/05/2025] [Indexed: 03/17/2025] Open
Abstract
Diabetic retinopathy (DR) is a common complication of type II diabetes mellitus (T2DM) and a leading cause of blindness in the working population. Apolipoprotein levels have been reported to be associated with the risk of DR. This study aimed to develop a predictive model for DR based on apolipoproteins (apoA and apoB) and menopausal status in Chinese Han women with T2DM and to evaluate the model's effectiveness. Data from 2339 T2DM women were collected between January 2018 and June 2022. Multilevel regression was used to explore the independent effect of apolipoproteins and interaction between apolipoproteins and menopausal status on DR and proliferative diabetic retinopathy (PDR). Receiver operating characteristic (ROC) analysis was performed to compare the fitting degree and predictive efficiency of different models. Results showed that both apoA and apoB were independent influencing factors for DR and PDR and interacted significantly with menopausal status. The interaction between apoA and menopausal status had a protective effect on DR [OR (95% CI) = 0.925 (0.858-0.996), P = 0.040] and PDR [OR (95% CI) = 0.937 (0.895-0.981), P = 0.006]. In contrast, the interaction between apoB and menopausal status was a risk factor for DR [OR (95% CI) = 1.684 (1.141-2.379), P = 0.008)] and PDR [OR (95% CI) = 3.377 (1.148-9.937), P = 0.027]. ROC analysis demonstrated that the interaction model outperformed models without interaction terms (P < 0.01). The area under the curve for the interaction model was 0.879 (95% CI 0.864-0.893) for DR and 0.930 (95% CI 0.915-0.945) for PDR. These findings suggest that the interaction model is highly efficient in predicting DR, particularly PDR, in Chinese Han women with T2DM.
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Affiliation(s)
- Xiaoting Pei
- Henan Key Laboratory of Ophthalmology and Visual Science, Henan Eye Institute, Henan Eye Hospital, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, No. 7, Weiwu Road, Zhengzhou, 450003, Henan, China
| | - Xi Yao
- Henan Key Laboratory of Ophthalmology and Visual Science, Henan Eye Institute, Henan Eye Hospital, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, No. 7, Weiwu Road, Zhengzhou, 450003, Henan, China
| | - Di Qi
- Henan Key Laboratory of Ophthalmology and Visual Science, Henan Eye Institute, Henan Eye Hospital, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, No. 7, Weiwu Road, Zhengzhou, 450003, Henan, China
| | - Yingrui Yang
- Henan Key Laboratory of Ophthalmology and Visual Science, Henan Eye Institute, Henan Eye Hospital, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, No. 7, Weiwu Road, Zhengzhou, 450003, Henan, China
| | - Shuoning Fan
- Henan Key Laboratory of Ophthalmology and Visual Science, Henan Eye Institute, Henan Eye Hospital, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, No. 7, Weiwu Road, Zhengzhou, 450003, Henan, China
| | - Zhijie Li
- Henan Key Laboratory of Ophthalmology and Visual Science, Henan Eye Institute, Henan Eye Hospital, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, No. 7, Weiwu Road, Zhengzhou, 450003, Henan, China.
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Singh A, Bocher O, Zeggini E. Insights into the molecular underpinning of type 2 diabetes complications. Hum Mol Genet 2025; 34:469-480. [PMID: 39807636 PMCID: PMC11891870 DOI: 10.1093/hmg/ddae203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Revised: 12/18/2024] [Accepted: 12/30/2024] [Indexed: 01/16/2025] Open
Abstract
Type 2 diabetes (T2D) complications pose a significant global health challenge. Omics technologies have been employed to investigate these complications and identify the biological pathways involved. In this review, we focus on four major T2D complications: diabetic kidney disease, diabetic retinopathy, diabetic neuropathy, and cardiovascular complications. We discuss advancements in omics research, summarizing findings from genetic, epigenomic, transcriptomic, proteomic, and metabolomic studies across different ancestries and disease-relevant tissues. We stress the importance of integrating multi-omics techniques to elucidate the biological mechanisms underlying T2D complications and advocate for ancestrally diverse studies. Ultimately, these insights will improve risk prediction for T2D complications and inform translation strategies.
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Affiliation(s)
- Archit Singh
- Technical University of Munich (TUM), TUM School of Medicine and Health, Graduate School of Experimental Medicine and Health Sciences, Ismaninger Straße 22, Munich 81675, Germany
- Institute of Translational Genomics, Helmholtz Zentrum München- German Research Center for Environmental Health, Ingolstädter Landstraße 1, Neuherberg 85764, Germany
- Munich School for Data Science (MUDS), Helmholtz Zentrum München- German Research Center for Environmental Health, Ingolstädter Landstraße 1, Neuherberg 85764, Germany
| | - Ozvan Bocher
- Institute of Translational Genomics, Helmholtz Zentrum München- German Research Center for Environmental Health, Ingolstädter Landstraße 1, Neuherberg 85764, Germany
| | - Eleftheria Zeggini
- Institute of Translational Genomics, Helmholtz Zentrum München- German Research Center for Environmental Health, Ingolstädter Landstraße 1, Neuherberg 85764, Germany
- TUM School of Medicine and Health, Technical University of Munich and Klinikum Rechts der Isar, Ismaninger Straße 22, Munich 81675, Germany
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Kha R, Kapucu Y, Indrakumar M, Burlutsky G, Thiagalingam A, Kovoor P, Mitchell P, Liew G. Diabetic retinopathy further increases risk of cardiovascular disease mortality in a high-risk cohort. Sci Rep 2025; 15:4811. [PMID: 39924501 PMCID: PMC11808117 DOI: 10.1038/s41598-025-86559-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2024] [Accepted: 01/13/2025] [Indexed: 02/11/2025] Open
Abstract
Diabetic retinopathy (DR) is the most common microvascular complication of diabetes and is strongly linked with systemic vascular comorbidities. This study investigated if DR predicts risk of cardiovascular disease (CVD) mortality in a high CVD risk cohort. This was a prospective cohort study of 1582 adult participants who presented to a tertiary Australian hospital for evaluation of acute coronary syndrome by coronary angiography. Participants were concurrently examined for DR from mydriatic fundus photographs which were mask-graded according to International Clinical Classification categories of no DR, mild non-proliferative DR, moderate-to-severe NPDR, and proliferative DR. Coronary artery disease was graded from coronary angiograms using the Gensini score. CVD mortality follow-up was assessed 9 years after baseline examination using linkage with the Australian National Death Index. At baseline, 355 (22.4%) participants had any DR. There were 181 (11.4%) fatal CVD events after 9-years follow-up. After controlling for age, sex, BMI, diabetes, total cholesterol, smoking status, hypertension, previous myocardial infarction and stroke, any DR was associated with 1.8-fold higher risk of CVD mortality (Hazard Ratio [HR] 1.84, 95% Confidence Interval [95% CI: 1.30-2.61]). Mild non-proliferative DR (1.85 [1.26-2.72]) and proliferative DR (5.27 [2.32-12.00]) were associated with greater CVD mortality risk. Further adjustment for coronary artery disease using Gensini scores and excluding patients without diabetes had minimal impact on the association. The increased risk of CVD mortality was significant in both men (2.25 [1.60-3.19]) and women (2.38 [1.24-4.58]) with any DR. In individuals with high CVD risk, presence of DR independently predicts increased CVD mortality. This likely reflects additional contribution of microvascular disease to CVD mortality. Individuals with DR may benefit from a comprehensive cardiovascular risk assessment, lifestyle changes, more intensive cardiovascular management and follow-up to minimise risk of death from CVD events.
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Affiliation(s)
- Richard Kha
- Centre for Vision Research, Westmead Institute for Medical Research, Westmead, NSW, 2145, Australia
| | - Yasemin Kapucu
- Centre for Vision Research, Westmead Institute for Medical Research, Westmead, NSW, 2145, Australia
| | - Mayuri Indrakumar
- Centre for Vision Research, Westmead Institute for Medical Research, Westmead, NSW, 2145, Australia
| | - George Burlutsky
- Centre for Vision Research, Westmead Institute for Medical Research, Westmead, NSW, 2145, Australia
| | | | - Pramesh Kovoor
- Department of Cardiology, Westmead Hospital, Westmead, NSW, Australia
| | - Paul Mitchell
- Centre for Vision Research, Westmead Institute for Medical Research, Westmead, NSW, 2145, Australia
| | - Gerald Liew
- Centre for Vision Research, Westmead Institute for Medical Research, Westmead, NSW, 2145, Australia.
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Ting KH, Yang PJ, Huang JY, Lee CY, Su SC, Yang SF. The severity of coronary heart disease and the incidence of later diabetic retinopathy in diabetic population: A retrospective cohort study. PLoS One 2025; 20:e0316112. [PMID: 39823470 PMCID: PMC11741576 DOI: 10.1371/journal.pone.0316112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Accepted: 12/05/2024] [Indexed: 01/19/2025] Open
Abstract
OBJECTIVES The coronary heart disease (CHD) can influence the development of several diseases. The presence of CHD is correlated to a higher incidence of concurrent diabetic retinopathy (DR) in previous study. Herein, we aim to analyze the relationship between the CHD severity and following DR with different severity. METHODS A retrospective cohort study was conducted with the usage of Taiwan National Health Insurance Research Database (NHIRD). The CHD patients with DM were categorized into those with medical treatments and those received percutaneous coronary intervention (PCI) management with a 1:1 ratio. The major outcome was the development of DR, diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR) 6 months after the onset of CHD. RESULTS There was 7317, 316, and 386 episodes of DR, DME and PDR in the mild CHD groups and 8568, 411, and 508 events of DR, DME and PDR in the severe CHD groups, respectively. The severe CHD group showed a significantly higher incidence of DR (aHR: 1.063, 95% CI: 1.038-1.089, P = 0.0324), DME (aHR: 1.412, 95% CI: 1.252-1.594, P = 0.0092) and PDR (aHR: 1.314, 95% CI: 1.172-1.473, P = 0.0113) compared to the mild CHD group. The cumulative incidence of DR was significantly higher in the severe CHD group (P < 0.001). In the subgroup analysis, the association between CHD severity and DR was more prominent in the female population (P = 0.0224). CONCLUSIONS The severe CHD is associated with higher incidence of following DR, DME and PDR, while the incidence of DR in CHD is positively correlated to longer disease period.
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Affiliation(s)
- Ke-Hsin Ting
- Division of Cardiology, Department of Internal Medicine, Changhua Christian Hospital, Yunlin, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Department of Nursing, Hungkuang University, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Po-Jen Yang
- Department of Family and Community Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Jing-Yang Huang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chia-Yi Lee
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Ophthalmology, Nobel Eye Institute, Taipei, Taiwan
| | - Shih-Chi Su
- Whole-Genome Research Core Laboratory of Human Diseases, Chang Gung Memorial Hospital, Keelung, Taiwan
- Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shun-Fa Yang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
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Hattenhauer A, Cabrera K, Locatelli EVT, Donthineni PR, Goldhardt R, Wang J, Galor A. Localization of Microvascular Changes in Systemic Disease Without Retinopathy Using Optical Coherence Tomography Angiography (OCTA). J Clin Med 2025; 14:372. [PMID: 39860380 PMCID: PMC11765723 DOI: 10.3390/jcm14020372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2024] [Revised: 01/05/2025] [Accepted: 01/07/2025] [Indexed: 01/27/2025] Open
Abstract
Background: This study aimed to evaluate the location of retinal fractal dimension (FD) abnormalities in individuals with diabetes mellitus (DM) and hypertension (HTN) without retinopathy. Methods: The annular zone of 6 mm × 6 mm OCTA images centered on the fovea was partitioned into thin annuli and analyzed using fractal analysis to measure FDs. Results: The cohort (n = 114) had an average age of 55.7 years, with 87% self-identifying as male; 29% (n = 33) had HTN, 8% (n = 9) had DM, and 11% (n = 12) had both. Individuals with DM showed significantly lower FDs in the C5 partition of the deep vascular plexus (DVP), located 1.77 mm to 2.14 mm from the foveal center compared to controls without DM (1.57 ± 0.003 vs. 1.58 ± 0.006; p = 0.014). Those with both DM and HTN exhibited significantly lower FDs in the entire superficial vascular plexus (SVP) annulus (1.84 ± 0.01 vs. 1.85 ± 0.007; p = 0.006), as well as the C3 (1.58 ± 0.02 vs. 1.60 ± 0.02; p = 0.008), C4 (1.57 ± 0.002 vs. 1.57 ± 0.01; p = 0.036), C5 (1.56 ± 0.01 vs. 1.57 ± 0.008; p < 0.001), and C6 (1.58 ± 0.01 vs. 1.59 ± 0.008; p < 0.001) partitions of the SVP (1.03 mm to 2.50 mm from the foveal center) and the C4 (1.57 ± 0.008 vs. 1.58 ± 0.008; p = 0.015) and C5 (1.57 ± 0.01 vs. 1.58 ± 0.006; p = 0.012) partitions of the DVP (1.40 mm to 1.77 mm from the foveal center) compared to the controls with neither DM nor HTN. Conclusions: While our study examined FDs in a predominantly male veteran population, our findings align with prior studies that reported lower FDs in DM and HTN cohorts. Our study further localizes these microvascular changes, with the most prominent differences occurring at C5 and C6 of the SVP, representing an area between 1.77 and 2.50 mm from the center of the fovea. These data lay the groundwork for developing screening protocols to identify individuals at risk of developing vasculopathies.
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Affiliation(s)
- Alex Hattenhauer
- Dr. Kiran C Patel College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL 33314, USA;
| | - Kimberly Cabrera
- Surgical Services, Miami Veterans Healthcare System, Miami, FL 33125, USA; (K.C.); (E.V.T.L.); (R.G.)
| | - Elyana V. T. Locatelli
- Surgical Services, Miami Veterans Healthcare System, Miami, FL 33125, USA; (K.C.); (E.V.T.L.); (R.G.)
- Bascom Palmer Eye Institute, University of Miami Health System, Miami, FL 33136, USA (J.W.)
| | - Pragnya Rao Donthineni
- Bascom Palmer Eye Institute, University of Miami Health System, Miami, FL 33136, USA (J.W.)
- Shantilal Shanghvi Cornea Institute, L.V Prasad Eye Institute, Hyderabad 500034, India
| | - Raquel Goldhardt
- Surgical Services, Miami Veterans Healthcare System, Miami, FL 33125, USA; (K.C.); (E.V.T.L.); (R.G.)
- Bascom Palmer Eye Institute, University of Miami Health System, Miami, FL 33136, USA (J.W.)
| | - Jianhua Wang
- Bascom Palmer Eye Institute, University of Miami Health System, Miami, FL 33136, USA (J.W.)
| | - Anat Galor
- Surgical Services, Miami Veterans Healthcare System, Miami, FL 33125, USA; (K.C.); (E.V.T.L.); (R.G.)
- Bascom Palmer Eye Institute, University of Miami Health System, Miami, FL 33136, USA (J.W.)
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Syed MG, Trucco E, Mookiah MRK, Lang CC, McCrimmon RJ, Palmer CNA, Pearson ER, Doney ASF, Mordi IR. Deep-learning prediction of cardiovascular outcomes from routine retinal images in individuals with type 2 diabetes. Cardiovasc Diabetol 2025; 24:3. [PMID: 39748380 PMCID: PMC11697721 DOI: 10.1186/s12933-024-02564-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2024] [Accepted: 12/24/2024] [Indexed: 01/04/2025] Open
Abstract
BACKGROUND Prior studies have demonstrated an association between retinal vascular features and cardiovascular disease (CVD), however most studies have only evaluated a few simple parameters at a time. Our aim was to determine whether a deep-learning artificial intelligence (AI) model could be used to predict CVD outcomes from routinely obtained diabetic retinal screening photographs and to compare its performance to a traditional clinical CVD risk score. METHODS We included 6127 individuals with type 2 diabetes without myocardial infarction or stroke prior to study entry. The cohort was divided into training (70%), validation (10%) and testing (20%) cohorts. Clinical 10-year CVD risk was calculated using the pooled cohort equation (PCE) risk score. A polygenic risk score (PRS) for coronary heart disease was also obtained. Retinal images were analysed using an EfficientNet-B2 network to predict 10-year CVD risk. The primary outcome was time to first major adverse CV event (MACE) including CV death, myocardial infarction or stroke. RESULTS 1241 individuals were included in the test cohort (mean PCE 10-year CVD risk 35%). There was a strong correlation between retinal predicted CVD risk and the PCE risk score (r = 0.66) but not the polygenic risk score (r = 0.05). There were 288 MACE events. Higher retina-predicted risk was significantly associated with increased 10-year risk of MACE (HR 1.05 per 1% increase; 95% CI 1.04-1.06, p < 0.001) and remained so after adjustment for the PCE and polygenic risk score (HR 1.03; 95% CI 1.02-1.04, p < 0.001). The retinal risk score had similar performance to the PCE (both AUC 0.697) and when combined with the PCE and polygenic risk score had significantly improved performance compared to the PCE alone (AUC 0.728). An increase in retinal-predicted risk within 3 years was associated with subsequent increased MACE likelihood. CONCLUSIONS A deep-learning AI model could accurately predict MACE from routine retinal screening photographs with a comparable performance to traditional clinical risk assessment in a diabetic cohort. Combining the AI-derived retinal risk prediction with a coronary heart disease polygenic risk score improved risk prediction. AI retinal assessment might allow a one-stop CVD risk assessment at routine retinal screening.
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Affiliation(s)
- Mohammad Ghouse Syed
- VAMPIRE project, Computing, School of Science and Engineering, University of Dundee, Dundee, USA
| | - Emanuele Trucco
- VAMPIRE project, Computing, School of Science and Engineering, University of Dundee, Dundee, USA
| | - Muthu R K Mookiah
- VAMPIRE project, Computing, School of Science and Engineering, University of Dundee, Dundee, USA
| | - Chim C Lang
- Division of Cardiovascular Research, School of Medicine, University of Dundee, Dundee, DD1 9SY, UK
- Tuanku Muhriz Royal Chair, National University of Malaysia, Bangi, Malaysia
| | - Rory J McCrimmon
- Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, UK
| | - Colin N A Palmer
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - Ewan R Pearson
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - Alex S F Doney
- Division of Cardiovascular Research, School of Medicine, University of Dundee, Dundee, DD1 9SY, UK
| | - Ify R Mordi
- Division of Cardiovascular Research, School of Medicine, University of Dundee, Dundee, DD1 9SY, UK.
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Hernández-Teixidó C, Barrot de la Puente J, Miravet Jiménez S, Fernández-Camins B, Mauricio D, Romero Aroca P, Vlacho B, Franch-Nadal J. Incidence of Diabetic Retinopathy in Individuals with Type 2 Diabetes: A Study Using Real-World Data. J Clin Med 2024; 13:7083. [PMID: 39685542 DOI: 10.3390/jcm13237083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2024] [Revised: 11/18/2024] [Accepted: 11/20/2024] [Indexed: 12/18/2024] Open
Abstract
Background/Objectives: This study aimed to assess the incidence of diabetic retinopathy (DR) in patients with type 2 diabetes (T2DM) treated in primary-care settings in Catalonia, Spain, and identify key risk factors associated with DR development. Methods: A retrospective cohort study was conducted using the SIDIAP (System for Research and Development in Primary Care) database. Patients aged 30-90 with T2DM who underwent retinal screening between 2010 and 2015 were included. Multivariable Cox regression analysis was used to assess the impact of clinical variables, including HbA1c levels, diabetes duration, and comorbidities, on DR incidence. Results: This study included 146,506 patients, with a mean follow-up time of 6.96 years. During this period, 4.7% of the patients developed DR, resulting in an incidence rate of 6.99 per 1000 person-years. Higher HbA1c levels were strongly associated with an increased DR risk, with patients with HbA1c > 10% having more than four times the risk compared to those with HbA1c levels < 7% (hazard ratio: 4.23; 95% CI: 3.90-4.58). Other significant risk factors for DR included greater diabetes duration, male sex, ex-smoker status, macrovascular disease, and chronic kidney disease. In contrast, obesity appeared to be a protective factor against DR, with an HR of 0.93 (95% CI: 0.89-0.98). Conclusions: In our real-world setting, the incidence rate of DR was 6.99 per 1000 person-years. Poor glycemic control, especially HbA1c > 10%, and prolonged diabetes duration were key risk factors. Effective management of these factors is crucial in preventing DR progression. Regular retinal screenings in primary care play a vital role in early detection and reducing the DR burden for T2DM patients.
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Affiliation(s)
- Carlos Hernández-Teixidó
- Primary Health Care Centre Burguillos del Cerro, Servicio Extremeño de Salud, 06370 Badajoz, Spain
- RedGDPS Foundation, 08204 Sabadell, Spain
- Departament of Medicine, Universitat de Barcelona, 08036 Barcelona, Spain
- DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08007 Barcelona, Spain
| | - Joan Barrot de la Puente
- RedGDPS Foundation, 08204 Sabadell, Spain
- DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08007 Barcelona, Spain
- Primary Health Care Center Dr. Jordi Nadal i Fàbregas (Salt), Gerència d'Atenció Primària, Institut Català de la Salut, 17007 Girona, Spain
| | - Sònia Miravet Jiménez
- RedGDPS Foundation, 08204 Sabadell, Spain
- Primary Health Care Center Martorell, Gerència d'Atenció Primària Baix Llobregat, Institut Català de la Salut, 08007 Barcelona, Spain
| | - Berta Fernández-Camins
- RedGDPS Foundation, 08204 Sabadell, Spain
- DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08007 Barcelona, Spain
- Institut de Recerca Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain
| | - Didac Mauricio
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM, ID CB15/00071), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
- Department of Medicine, University of Vic-Central University of Catalonia, 08500 Vic, Spain
| | - Pedro Romero Aroca
- Ophthalmology Service, University Hospital Sant Joan, 43202 Reus, Spain
- Institut de Investigacio Sanitaria Pere Virgili (IISPV), University of Rovira and Virgili, 43002 Tarragona, Spain
| | - Bogdan Vlacho
- DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08007 Barcelona, Spain
- Institut de Recerca Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM, ID CB15/00071), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
| | - Josep Franch-Nadal
- RedGDPS Foundation, 08204 Sabadell, Spain
- Departament of Medicine, Universitat de Barcelona, 08036 Barcelona, Spain
- DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08007 Barcelona, Spain
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM, ID CB15/00071), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
- Primary Health Care Center Raval Sud, Gerència d'Àmbit d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, 08007 Barcelona, Spain
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9
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Lamprou S, Koletsos N, Zografou I, Lazaridis A, Mintziori G, Trakatelli CM, Kotsis V, Gkaliagkousi E, Doumas M, Triantafyllou A. Skin Microvascular Dysfunction in Type 2 Diabetes Mellitus Using Laser Speckle Contrast Analysis and Association with Carotid Intima-Media Thickness. J Clin Med 2024; 13:4957. [PMID: 39201096 PMCID: PMC11355809 DOI: 10.3390/jcm13164957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Revised: 08/06/2024] [Accepted: 08/20/2024] [Indexed: 09/02/2024] Open
Abstract
Background: It is established that diabetes mellitus (DM) is characterized by increased cardiovascular risk associated with subclinical atherosclerosis as well as microvascular alterations. Laser speckle contrast analysis (LASCA) is an innovative, non-invasive method for assessing skin microvascular function. Objectives: We sought to assess skin microvascular function in patients with type 2 DM and matched controls. Methods: Consecutive patients with DM and individuals matched for age, sex and BMI were included in the study. Skin microvascular perfusion was assessed, using LASCA, during baseline, a 5 min occlusion period and a 5 min reperfusion period. Carotid intima-media thickness (cIMT) was measured as a surrogate marker of macrocirculation. Results: In total, 18 patients with DM and 22 in the control group were enrolled. No statistically significant differences were observed in baseline flux, peak flux and percentage decrease during arterial occlusion. During reperfusion, individuals with DM exhibited a smaller peak magnitude compared to controls (147.0 ± 64.7% vs. 189.4 ± 46.0%, respectively; p < 0.05). Moreover, cIMT was higher in patients with DM compared to controls (0.68 ± 0.09 mm vs. 0.60 ± 0.08 mm, respectively, p < 0.01) and was negatively correlated with skin microvascular reactivity in the univariate analysis. In the multivariate analysis, glucose and office systolic blood pressure levels remained significant predictors of microvascular reactivity. Conclusions: Our study shows that patients with type 2 DM exhibit impaired skin microvascular function compared to controls. Furthermore, glucose levels and blood pressure play a key role in microvascular dysfunction. However, additional studies are needed to address the clinical significance of early microvascular changes in DM.
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Affiliation(s)
- Stamatina Lamprou
- Third Department of Internal Medicine, Papageorgiou General Hospital, Aristotle University of Thessaloniki, 56429 Thessaloniki, Greece; (S.L.); (A.L.); (C.M.T.); (V.K.); (E.G.); (A.T.)
| | - Nikolaos Koletsos
- Third Department of Internal Medicine, Papageorgiou General Hospital, Aristotle University of Thessaloniki, 56429 Thessaloniki, Greece; (S.L.); (A.L.); (C.M.T.); (V.K.); (E.G.); (A.T.)
| | - Ioanna Zografou
- Second Propedeutic Department of Internal Medicine, Hippokration General Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece; (I.Z.); (M.D.)
| | - Antonios Lazaridis
- Third Department of Internal Medicine, Papageorgiou General Hospital, Aristotle University of Thessaloniki, 56429 Thessaloniki, Greece; (S.L.); (A.L.); (C.M.T.); (V.K.); (E.G.); (A.T.)
| | - Gesthimani Mintziori
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Papageorgiou General Hospital, Aristotle University of Thessaloniki, 56429 Thessaloniki, Greece;
| | - Christina Maria Trakatelli
- Third Department of Internal Medicine, Papageorgiou General Hospital, Aristotle University of Thessaloniki, 56429 Thessaloniki, Greece; (S.L.); (A.L.); (C.M.T.); (V.K.); (E.G.); (A.T.)
| | - Vasilios Kotsis
- Third Department of Internal Medicine, Papageorgiou General Hospital, Aristotle University of Thessaloniki, 56429 Thessaloniki, Greece; (S.L.); (A.L.); (C.M.T.); (V.K.); (E.G.); (A.T.)
| | - Eugenia Gkaliagkousi
- Third Department of Internal Medicine, Papageorgiou General Hospital, Aristotle University of Thessaloniki, 56429 Thessaloniki, Greece; (S.L.); (A.L.); (C.M.T.); (V.K.); (E.G.); (A.T.)
| | - Michael Doumas
- Second Propedeutic Department of Internal Medicine, Hippokration General Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece; (I.Z.); (M.D.)
| | - Areti Triantafyllou
- Third Department of Internal Medicine, Papageorgiou General Hospital, Aristotle University of Thessaloniki, 56429 Thessaloniki, Greece; (S.L.); (A.L.); (C.M.T.); (V.K.); (E.G.); (A.T.)
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10
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Lingineni VB, Mangudkar S, Gokhale VS, Malik S, Yadav P. Linking Diabetic Retinopathy Severity to Coronary Artery Disease Risk Factors in Type 2 Diabetic Patients. Cureus 2024; 16:e65018. [PMID: 39165443 PMCID: PMC11333929 DOI: 10.7759/cureus.65018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2024] [Indexed: 08/22/2024] Open
Abstract
BACKGROUND Diabetes mellitus (DM) is a common metabolic disorder characterized by hyperglycemia, leading to chronic complications, notably cardiovascular diseases such as coronary artery disease (CAD). Diabetic retinopathy (DR), a leading cause of blindness, may serve as a non-invasive marker for CAD. This study investigates the correlation between DR and CAD to explore its diagnostic potential in diabetic populations. METHODS A cross-sectional study was conducted over one year in a general hospital, involving 100 type 2 DM patients with retinopathy. DR was classified as mild non-proliferative diabetic retinopathy (NPDR), moderate NPDR, severe NPDR, or proliferative retinopathy, based on fundus examinations. Data on age, duration of diabetes, cholesterol levels, glycated hemoglobin (HbA1C), and ECG (electrocardiography) findings were collected. Statistical analysis included frequency analysis, chi-square tests for association between categorical variables, and significance testing with p-values. Data were analyzed using IBM SPSS Statistics for Windows, Version 20.0 (Released 2011; IBM Corp., Armonk, New York, United States). Descriptive statistics were characterized by categorical and continuous variables. The chi-square test determined associations between qualitative variables, with significance set at p<0.05. RESULTS The mean age of patients was 57.13 ± 8.51 years. Age and duration of diabetes were significant predictors of retinopathy severity (p<0.001). Proliferative retinopathy was found exclusively in patients over 70 years. Lower cholesterol levels (<200 mg/dL) were significantly associated with less severe retinopathy (p=0.033), whereas higher cholesterol levels (>200 mg/dL) did not show a statistically significant association with retinopathy severity (p=0.772). Patients with HbA1C levels between 6.5% and 8.5% predominantly had milder forms of retinopathy, as indicated by the significant p-value (<0.001). In contrast, patients with HbA1C levels above 8.5% are more likely to have severe NPDR or proliferative diabetic retinopathy (PDR), but this association was not statistically significant (p=0.582). ECG abnormalities increased with retinopathy severity (p=0.002). Hypertension was significantly linked to cardiac changes in retinopathy patients (p<0.001), while smoking and family history of CAD were not significant factors. This study's cross-sectional design limits causality inference. The single-center sample of 100 patients may not be broadly generalizable. Reliance on self-reported data introduces potential recall bias, and confounding factors such as diet, physical activity, and additional comorbidities were not accounted for. The lack of a control group further limits comparative analysis. Future longitudinal studies with larger, diverse samples are needed. CONCLUSION Retinopathy in DM patients is significantly associated with cardiac changes and other risk factors such as hypertension, dyslipidemia, and poor glycemic control. Aggressive management of these factors is essential. Retinopathy can serve as a predictor of CAD in diabetic patients.
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Affiliation(s)
| | - Sangram Mangudkar
- General Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, IND
| | - Vijayashree S Gokhale
- General Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, IND
| | - Satbir Malik
- General Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, IND
| | - Ponvijaya Yadav
- General Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, IND
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11
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Jeong H, Maatouk CM, Russell MW, Singh RP. Associations between lipid abnormalities and diabetic retinopathy across a large United States national database. Eye (Lond) 2024; 38:1870-1875. [PMID: 38521836 PMCID: PMC11226450 DOI: 10.1038/s41433-024-03022-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 02/21/2024] [Accepted: 03/07/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND/OBJECTIVES While dyslipidaemia has been suggested as a potential risk factor for diabetic retinopathy (DR), previous studies have reported conflicting findings. This study aimed to better characterize the relationship between abnormal serum levels of various lipid markers and the risk of the development and progression of DR. SUBJECTS/METHODS This retrospective cohort study utilized a United States national database of electronic medical records. Adults with a history of type 2 diabetes mellitus without type 1 diabetes mellitus were divided into cohorts based on the presence of abnormal serum levels of various lipid markers. Propensity score matching was performed to match cohorts with abnormal lipid levels to those with normal lipid levels on covariates. The cohorts were then compared to evaluate the hazard ratios (HR) of receiving a new DR diagnosis, pars plana vitrectomy, panretinal photocoagulation, vitreous haemorrhage, proliferative diabetic retinopathy, diabetic macular oedema (DMO), and traction retinal detachment. RESULTS The database contained 1,126,231 eligible patients (mean age: 60.8 [14.2] years; 46.0% female). Among patients without prior DR, low HDL (HR = 0.94, CI = 0.90-0.98), total cholesterol (HR = 0.88, CI = 0.85-0.91), and high triglyceride (HR = 0.91, CI = 0.86-0.97) levels were associated with a decreased risk of receiving a DR diagnosis. Among patients with preexisting DR, high LDL levels was associated with an increased risk of DMO (HR = 1.42, CI = 1.15-1.75), whereas low HDL levels was associated with a marginally decreased risk (HR = 0.92, CI = 0.85-0.99). CONCLUSIONS Elevated levels of markers of dyslipidaemia are inversely associated with the risk of receiving a DR diagnosis, but this relationship is blunted after the onset of DR.
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Affiliation(s)
- Hejin Jeong
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Christopher M Maatouk
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Matthew W Russell
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Rishi P Singh
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA.
- Cleveland Clinic Martin Health, Cleveland Clinic Florida, Stuart, FL, USA.
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12
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Okamura T, Tsukamoto K, Arai H, Fujioka Y, Ishigaki Y, Koba S, Ohmura H, Shoji T, Yokote K, Yoshida H, Yoshida M, Deguchi J, Dobashi K, Fujiyoshi A, Hamaguchi H, Hara M, Harada-Shiba M, Hirata T, Iida M, Ikeda Y, Ishibashi S, Kanda H, Kihara S, Kitagawa K, Kodama S, Koseki M, Maezawa Y, Masuda D, Miida T, Miyamoto Y, Nishimura R, Node K, Noguchi M, Ohishi M, Saito I, Sawada S, Sone H, Takemoto M, Wakatsuki A, Yanai H. Japan Atherosclerosis Society (JAS) Guidelines for Prevention of Atherosclerotic Cardiovascular Diseases 2022. J Atheroscler Thromb 2024; 31:641-853. [PMID: 38123343 DOI: 10.5551/jat.gl2022] [Citation(s) in RCA: 69] [Impact Index Per Article: 69.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Affiliation(s)
- Tomonori Okamura
- Preventive Medicine and Public Health, Keio University School of Medicine
| | | | | | - Yoshio Fujioka
- Faculty of Nutrition, Division of Clinical Nutrition, Kobe Gakuin University
| | - Yasushi Ishigaki
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Iwate Medical University
| | - Shinji Koba
- Division of Cardiology, Department of Medicine, Showa University School of Medicine
| | - Hirotoshi Ohmura
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine
| | - Tetsuo Shoji
- Department of Vascular Medicine, Osaka Metropolitan University Graduate school of Medicine
| | - Koutaro Yokote
- Department of Endocrinology, Hematology and Gerontology, Chiba University Graduate School of Medicine
| | - Hiroshi Yoshida
- Department of Laboratory Medicine, The Jikei University Kashiwa Hospital
| | | | - Juno Deguchi
- Department of Vascular Surgery, Saitama Medical Center, Saitama Medical University
| | - Kazushige Dobashi
- Department of Pediatrics, School of Medicine, University of Yamanashi
| | | | | | - Masumi Hara
- Department of Internal Medicine, Mizonokuchi Hospital, Teikyo University School of Medicine
| | - Mariko Harada-Shiba
- Cardiovascular Center, Osaka Medical and Pharmaceutical University
- Department of Molecular Pathogenesis, National Cerebral and Cardiovascular Center Research Institute
| | - Takumi Hirata
- Institute for Clinical and Translational Science, Nara Medical University
| | - Mami Iida
- Department of Internal Medicine and Cardiology, Gifu Prefectural General Medical Center
| | - Yoshiyuki Ikeda
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University
| | - Shun Ishibashi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Jichi Medical University, School of Medicine
- Current affiliation: Ishibashi Diabetes and Endocrine Clinic
| | - Hideyuki Kanda
- Department of Public Health, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University
| | - Shinji Kihara
- Medical Laboratory Science and Technology, Division of Health Sciences, Osaka University graduate School of medicine
| | - Kazuo Kitagawa
- Department of Neurology, Tokyo Women's Medical University Hospital
| | - Satoru Kodama
- Department of Prevention of Noncommunicable Diseases and Promotion of Health Checkup, Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine
| | - Masahiro Koseki
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Yoshiro Maezawa
- Department of Endocrinology, Hematology and Gerontology, Chiba University Graduate School of Medicine
| | - Daisaku Masuda
- Department of Cardiology, Center for Innovative Medicine and Therapeutics, Dementia Care Center, Doctor's Support Center, Health Care Center, Rinku General Medical Center
| | - Takashi Miida
- Department of Clinical Laboratory Medicine, Juntendo University Graduate School of Medicine
| | | | - Rimei Nishimura
- Department of Diabetes, Metabolism and Endocrinology, The Jikei University School of Medicine
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University
| | - Midori Noguchi
- Division of Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University
| | - Mitsuru Ohishi
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University
| | - Isao Saito
- Department of Public Health and Epidemiology, Faculty of Medicine, Oita University
| | - Shojiro Sawada
- Division of Metabolism and Diabetes, Faculty of Medicine, Tohoku Medical and Pharmaceutical University
| | - Hirohito Sone
- Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine
| | - Minoru Takemoto
- Department of Diabetes, Metabolism and Endocrinology, International University of Health and Welfare
| | | | - Hidekatsu Yanai
- Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine Kohnodai Hospital
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13
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Gurgoglione FL, Pitocco D, Montone RA, Rinaldi R, Bonadonna RC, Magnani G, Calvieri C, Solinas E, Rizzi A, Tartaglione L, Flex A, Viti L, Trani C, Ardissino D, Crea F, Niccoli G. Microvascular Complications Are Associated With Coronary Collateralization in Type 2 Diabetes and Chronic Occlusion. J Clin Endocrinol Metab 2023; 109:237-244. [PMID: 37417706 DOI: 10.1210/clinem/dgad396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 06/15/2023] [Accepted: 07/03/2023] [Indexed: 07/08/2023]
Abstract
CONTEXT Coronary collateral (CC) vessel development appears to be protective with regard to adverse cardiovascular events and survival in patients with coronary chronic total occlusion (CTO). The influence of type 2 diabetes mellitus (T2DM) on CC growth has been controversial. In particular, the role of diabetic microvascular complications (DMC) in determining coronary collateralization has not been elucidated. OBJECTIVE To investigate whether patients with DMC presented differences in CC vessel presence and grading as compared with patients without DMC. METHODS We conducted a single-center observational study, including consecutive T2DM patients, without previous cardiovascular history, undergoing a clinically indicated coronary angiography for chronic coronary syndrome (CCS) and angiographic evidence of at least one CTO. Patients were subdivided into 2 study groups according to the presence/absence of at least one DMC (neuropathy, nephropathy, or retinopathy). The presence and grading of angiographically visible CC development from the patent vessels to the occluded artery were assessed using the Rentrop classification. RESULTS We enrolled 157 patients (mean age 68.6 ± 9.8 years; 120 [76.4%] men). Patients with DMC (75 [47.8%]) had a higher prevalence of CC (69 [92.0%] vs 62 [75.6%], P = .006) and high-grade CC (55 [73.3%] vs 39 [47.6%], P = .001) compared with those without, and we found a positive association between the number of DMC in each patient and the prevalence of high-grade CC. CONCLUSION Among T2DM patients with coronary CTO, the presence of DMC was associated with a high CC development.
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Affiliation(s)
- Filippo Luca Gurgoglione
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Dario Pitocco
- Diabetology Care Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Rocco A Montone
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Riccardo Rinaldi
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Riccardo C Bonadonna
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
- Division of Endocrinology and Metabolic Diseases, University of Parma, 43126 Parma, Italy
| | - Giulia Magnani
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Camilla Calvieri
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, La Sapienza University, 00185 Rome, Italy
| | - Emilia Solinas
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Alessandro Rizzi
- Diabetology Care Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Linda Tartaglione
- Diabetology Care Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Andrea Flex
- Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Luca Viti
- Diabetology Care Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Carlo Trani
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Diego Ardissino
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Filippo Crea
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Giampaolo Niccoli
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
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14
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Wojtasińska A, Kućmierz J, Tokarek J, Dybiec J, Rodzeń A, Młynarska E, Rysz J, Franczyk B. New Insights into Cardiovascular Diseases Treatment Based on Molecular Targets. Int J Mol Sci 2023; 24:16735. [PMID: 38069058 PMCID: PMC10706703 DOI: 10.3390/ijms242316735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 11/07/2023] [Accepted: 11/13/2023] [Indexed: 12/18/2023] Open
Abstract
Cardiovascular diseases (CVDs) which consist of ischemic heart disease, stroke, heart failure, peripheral arterial disease, and several other cardiac and vascular conditions are one of the most common causes of death worldwide and often co-occur with diabetes mellitus and lipid disorders which worsens the prognosis and becomes a therapeutic challenge. Due to the increasing number of patients with CVDs, we need to search for new risk factors and pathophysiological changes to create new strategies for preventing, diagnosing, and treating not only CVDs but also comorbidities like diabetes mellitus and lipid disorders. As increasing amount of patients suffering from CVDs, there are many therapies which focus on new molecular targets like proprotein convertase subtilisin/kexin type 9 (PCSK9), angiopoietin-like protein 3, ATP-citrate lyase, or new technologies such as siRNA in treatment of dyslipidemia or sodium-glucose co-transporter-2 and glucagon-like peptide-1 in treatment of diabetes mellitus. Both SGLT-2 inhibitors and GLP-1 receptor agonists are used in the treatment of diabetes, however, they proved to have a beneficial effect in CVDs as well. Moreover, a significant amount of evidence has shown that exosomes seem to be associated with myocardial ischaemia and that exosome levels correlate with the severity of myocardial injury. In our work, we would like to focus on the above mechanisms. The knowledge of them allows for the appearance of new strategies of treatment among patients with CVDs.
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Affiliation(s)
- Armanda Wojtasińska
- Department of Nephrocardiology, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Lodz, Poland
| | - Joanna Kućmierz
- Department of Nephrocardiology, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Lodz, Poland
| | - Julita Tokarek
- Department of Nephrocardiology, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Lodz, Poland
| | - Jill Dybiec
- Department of Nephrocardiology, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Lodz, Poland
| | - Anna Rodzeń
- Department of Nephrocardiology, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Lodz, Poland
| | - Ewelina Młynarska
- Department of Nephrocardiology, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Lodz, Poland
| | - Jacek Rysz
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Lodz, Poland
| | - Beata Franczyk
- Department of Nephrocardiology, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Lodz, Poland
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15
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Liu C, Yang X, Ji M, Zhang X, Bian X, Chen T, Li Y, Qi X, Wu J, Wang J, Tang Z. Sex-specific association between carotid atherosclerosis and fundus arteriosclerosis in a Chinese population: a retrospective cross-sectional study. Eur J Med Res 2023; 28:518. [PMID: 37968750 PMCID: PMC10648731 DOI: 10.1186/s40001-023-01508-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 11/05/2023] [Indexed: 11/17/2023] Open
Abstract
OBJECTIVES Vascular stiffening is highly predictive of major adverse cardiovascular events. It is not clear whether microangiopathy, such as fundus arteriosclerosis, is related to carotid atherosclerosis. Hence, this study was designed to investigate the relationship between carotid atherosclerosis and fundus arteriosclerosis among individuals of different sexes in the Chinese health-examination population. METHODS This retrospective cross-sectional study involved 20,836 participants, including 13050 males and 7786 females. All participants underwent a detailed health examination, including medical history assessment, physical examination, assessment of lifestyle factors, fundus photography, Doppler ultrasound examination of the neck, and laboratory examinations. Two trained ophthalmologists analysed fundus arteriosclerosis based on fundus photographs, while carotid atherosclerosis was diagnosed using colour Doppler sonography of the neck. Binary logistic regression was used to analyse the relationship between carotid atherosclerosis and fundus arteriosclerosis. RESULTS In participants with fundus arteriosclerosis, the incidence of carotid atherosclerosis was higher than that of participants without fundus arteriosclerosis (52.94% vs. 47.06%). After adjustments for potential confounding factors, fundus arteriosclerosis was significantly associated with the risk of carotid atherosclerosis. The OR with 95% CI for fundus arteriosclerosis was 1.17 (1.02, 1.34) with p = 0.0262, and individuals who did not have fundus arteriosclerosis were used as a reference in the total population. Fundus arteriosclerosis was associated with the incidence of carotid atherosclerosis in males (p = 0.0005) but not in females (p = 0.0746). CONCLUSIONS Fundus arteriosclerosis was closely associated with carotid atherosclerosis in the Chinese population. This association was found in males but not in females.
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Affiliation(s)
- Chunxing Liu
- Department of Laboratory, Hua Dong Sanatorium, Wuxi, 214065, China
| | - Xiaolong Yang
- Department of Ophthalmology, Hua Dong Sanatorium, Wuxi, 214065, China
| | - Mengmeng Ji
- Department of Laboratory, Hua Dong Sanatorium, Wuxi, 214065, China
| | - Xiaowei Zhang
- Department of Nursing, Hua Dong Sanatorium, Wuxi, 214065, China
| | - Xiyun Bian
- Department of Ophthalmology, Hua Dong Sanatorium, Wuxi, 214065, China
| | - Tingli Chen
- Department of Ophthalmology, Hua Dong Sanatorium, Wuxi, 214065, China
| | - Yihan Li
- Department of Otolaryngology, Hua Dong Sanatorium, Wuxi, 214065, China
| | - Xing Qi
- Department of Otolaryngology, Hua Dong Sanatorium, Wuxi, 214065, China
| | - Jianfeng Wu
- Department of Laboratory, Hua Dong Sanatorium, Wuxi, 214065, China
| | - Jing Wang
- Department of Ophthalmology, Hua Dong Sanatorium, Wuxi, 214065, China.
| | - Zaixiang Tang
- Department of Biostatistics, School of Public Health, Suzhou Medical College of Soochow University, Suzhou, 215123, China.
- Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Suzhou Medical College of Soochow University, Suzhou, 215123, China.
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16
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Chu TW, Hsieh TH, Lin TY, Hung SC. Association of diabetic retinopathy with risk of developing cardiovascular diseases in patients undergoing hemodialysis: A population-based cohort study. Nutr Metab Cardiovasc Dis 2023; 33:1565-1573. [PMID: 37246078 DOI: 10.1016/j.numecd.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/18/2023] [Accepted: 05/05/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND AND AIMS While patients undergoing dialysis have substantially increased cardiovascular event rates compared with the general population, predicting individual risk remains difficult. Whether diabetic retinopathy (DR) is associated with cardiovascular diseases in this population is unclear. METHODS AND RESULTS We conducted a nationwide cohort study of 27,686 incident hemodialysis patients with type 2 diabetes who were enrolled in Taiwan's National Health Insurance Research Database between January 1, 2010, and December 31, 2014, and had follow-up data until December 31, 2015. The primary outcome was a composite of macrovascular events, including acute coronary syndrome (ACS), acute ischemic stroke, and peripheral artery disease (PAD). A total of 10,537 (38.1%) patients had DR at baseline. We matched 9164 patients without DR (mean age, 63.7 years; 44.0% women) to 9164 patients with DR (mean age, 63.5 years; 43.8% women) by propensity score. During a median follow-up of 2.4 years, 5204 patients in the matched cohort experienced a primary outcome. The presence of DR was associated with a higher risk of a primary outcome (subdistribution hazard ratio [sHR] 1.07; 95% CI, 1.01-1.13), which reflected a higher risk of acute ischemic stroke (sHR 1.26; 95% CI, 1.14-1.39) and PAD (sHR 1.14; 95% CI, 1.05-1.25) but not ACS (sHR 0.99; 95% CI, 0.92-1.06). CONCLUSIONS The presence of DR signifies an increased risk of acute ischemic stroke and PAD in hemodialysis patients with type 2 diabetes, independent of the known risk factors. These results highlight the need for more comprehensive cardiovascular assessment and management in hemodialysis patients with DR.
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Affiliation(s)
- Ting-Wen Chu
- Department of Ophthalmology, Mackay Memorial Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Tsung-Han Hsieh
- Department of Research, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Ting-Yun Lin
- Division of Nephrology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, School of Medicine, Tzu Chi University, Hualien, Taiwan.
| | - Szu-Chun Hung
- Division of Nephrology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, School of Medicine, Tzu Chi University, Hualien, Taiwan.
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Zafar S, Walder A, Virani S, Biggerstaff K, Orengo-Nania S, Chang J, Channa R. Systemic Adverse Events Among Patients With Diabetes Treated With Intravitreal Anti-Vascular Endothelial Growth Factor Injections. JAMA Ophthalmol 2023; 141:658-666. [PMID: 37261816 PMCID: PMC10236327 DOI: 10.1001/jamaophthalmol.2023.2098] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 04/03/2023] [Indexed: 06/02/2023]
Abstract
Importance Anti-vascular endothelial growth factor (VEGF) agents are currently the mainstay of treatment for diabetic retinopathy (DR). Although effective, data on their systemic safety remains inconclusive, particularly in high-risk patient groups. Objective To explore the systemic safety of intravitreal anti-VEGF agents among patients with diabetes. Design, Setting, and Participants This was a retrospective, longitudinal population-based analysis of the Corporate Data Warehouse, a large-scale database of patients within the US Veteran Health Affairs. All patients 18 years and older with type 2 diabetes who were seen at any Veterans Affairs health care facility in the US between January 1, 2011, and December 31, 2012, were identified. Data were then extracted on incident systemic adverse events among this patient cohort from January 1, 2013, to December 31, 2017. All individuals with diabetes who did and did not receive anti-VEGF injections were included. Patients with a history of prior systemic adverse events and those who received an intravitreal injection between January 1, 2011, and December 31, 2012, were excluded. Data were analyzed from October 2019 to March 2023. Exposure Anti-VEGF injection. Main Outcomes and Measures Proportion of patients with any incident systemic adverse event, acute myocardial infarction, cardiovascular disease, or kidney disease at 1-, 3-, and 5-year follow-up. Results A total of 1 731 782 patients (mean [SD] age, 63.8 [12.3] years; 1 656 589 [95.7%] male) with type 2 diabetes were included. DR was present in 476 013 (27.5%), and 14 022 (0.8%) received anti-VEGF injections. Of the total number of patients with type 2 diabetes, 321 940 (18.6%) developed systemic adverse events between 2013 and 2017. The 5-year cumulative incidence of any systemic adverse event was 37.0% (5187/14 022) in the injection group vs 18.4% (316 753/1 717 760) in the noninjection group (P < .001). Anti-VEGF injections were independently associated with a higher likelihood of developing any systemic adverse event (odds ratio, 1.8; 95% CI, 1.7-1.9) when controlling for age, race, sex, ethnicity, tobacco use, severity of DR, Deyo-Charlson Comorbidity Index score, mean hemoglobin A1c, total number of injections, and statin use. Conclusion and Relevance In this study, intravitreal anti-VEGF injections were independently associated with a higher likelihood of systemic adverse events among patients with diabetes.
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Affiliation(s)
- Sidra Zafar
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Annette Walder
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey, VA Medical Center, Houston, Texas
| | - Salim Virani
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey, VA Medical Center, Houston, Texas
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Kristin Biggerstaff
- Department of Ophthalmology, Baylor College of Medicine, Houston, Texas
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Silvia Orengo-Nania
- Department of Ophthalmology, Baylor College of Medicine, Houston, Texas
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Jonathan Chang
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison
| | - Roomasa Channa
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison
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Jayaraman D, Shivakumar M, Shanthaveerappa P. Ocular findings in patients with chronic kidney disease. TNOA JOURNAL OF OPHTHALMIC SCIENCE AND RESEARCH 2023. [DOI: 10.4103/tjosr.tjosr_39_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023] Open
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19
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Iijima Y, Nakayama M, Miwa T, Yakou F, Tomiyama H, Shikuma J, Ito R, Tanaka A, Manda N, Odawara M. Nephroprotective Effects of Dapagliflozin in Patients with Type 2 Diabetes. Intern Med 2023; 62:681-688. [PMID: 36858619 PMCID: PMC10037009 DOI: 10.2169/internalmedicine.6685-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
Objective This study analyzed changes in the estimated glomerular filtration rate calculated using cystatin C (eGFRcys) and sodium excretion in the urine after administering dapagliflozin as an add-on therapy to conventional treatment for diabetes. Methods This was a single-center, single-group, prospective interventional study. Dapagliflozin was administered to improve the plasma glucose control in 30 subjects with type 2 diabetes mellitus (age 53±8 years old; 66.6% men). Blood and urine tests were performed before and 6 and 12 months after dapagliflozin administration. The daily sodium excretion was estimated with the Kawasaki formula using second-morning urine samples. Results The eGFRcys did not markedly differ before and 6 months after the dapagliflozin administration but was significantly increased after 12 months (p<0.001), and the estimated daily sodium excretion was also significantly increased (p<0.001 at 6 months and p=0.002 at 12 months). The systolic and diastolic blood pressures tended to decrease after administration. The HbA1c level after the administration of dapagliflozin tended to be lower in the T3 group, showing the smallest increase in changes in the estimated daily sodium excretion from baseline to 6 months (28.2-107.5 mEq/day), than in the combined groups of T1 (219.5-110.1 mEq/day) and T2 (101.4-28.9 mEq/day). In contrast, the eGFRcys was significantly higher in the combined groups of T1 and T2 than that in the T3 group at both 6 and 12 months (p=0.031 and p=0.007, respectively). Conclusions Add-on therapy with dapagliflozin increased the urinary sodium excretion and decreased the blood pressure even in the early phase of this therapy. Our results suggest that dapagliflozin add-on therapy may exert nephroprotective effects in subjects with type 2 diabetes mellitus.
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Affiliation(s)
- Yasuhiro Iijima
- Department of Internal Medicine, Todachuo General Hospital, Japan
- Department of Diabetes, Endocrinology and Metabolism, Tokyo Medical University Hospital, Japan
- Department of Shirakawa Community Medicine, Tokyo Medical University, Japan
- Diabetes Center, Manda Memorial Hospital, Japan
| | - Masafumi Nakayama
- Cardiovascular Center, Todachuo General Hospital, Japan
- Cooperative Major in Advanced Biomedical Sciences, Joint Graduate School of Tokyo Women's Medical University and Waseda University, Japan
| | - Takashi Miwa
- Department of Diabetes, Endocrinology and Metabolism, Tokyo Medical University Hospital, Japan
| | - Fumiyoshi Yakou
- Department of Internal Medicine, Todachuo General Hospital, Japan
- Department of Diabetes, Endocrinology and Metabolism, Tokyo Medical University Hospital, Japan
| | | | - Junpei Shikuma
- Department of Diabetes, Endocrinology and Metabolism, Tokyo Medical University Hospital, Japan
| | - Rokuro Ito
- Department of Diabetes, Endocrinology and Metabolism, Tokyo Medical University Hospital, Japan
| | - Akihiko Tanaka
- Department of Internal Medicine, Todachuo General Hospital, Japan
| | - Naoki Manda
- Diabetes Center, Manda Memorial Hospital, Japan
| | - Masato Odawara
- Department of Diabetes, Endocrinology and Metabolism, Tokyo Medical University Hospital, Japan
- Department of Shirakawa Community Medicine, Tokyo Medical University, Japan
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Dai Z, Pang X, Fang J. Editorial: Data mining and network-driven analysis: Drug discovery and mechanism exploration by targeting vascular dysfunction. Front Pharmacol 2022; 13:1099854. [PMID: 36582522 PMCID: PMC9794180 DOI: 10.3389/fphar.2022.1099854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 12/05/2022] [Indexed: 12/15/2022] Open
Affiliation(s)
- Zhao Dai
- Science and Technology Innovation Center, Guangzhou University of Chinese Medicine, Guangzhou, China,Department of Rheumatology, First Affiliated Hospital of Guangzhou University of Chinese Medicine, Beijing, China
| | - Xiaocong Pang
- Department of Pharmacy, Peking University First Hospital, Beijing, China
| | - Jiansong Fang
- Science and Technology Innovation Center, Guangzhou University of Chinese Medicine, Guangzhou, China,*Correspondence: Jiansong Fang,
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21
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Cardiovascular and Mortality Risk with Intravitreal Vascular Endothelial Growth Factor Inhibitors in Patients with Diabetic Retinopathy. Ophthalmol Retina 2022; 6:1145-1153. [PMID: 35777664 DOI: 10.1016/j.oret.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 06/21/2022] [Accepted: 06/22/2022] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To investigate the cardiovascular (CV) safety associated with intravitreal anti-VEGF injections (IAVIs) in patients with diabetic retinopathy (DR). DESIGN Population-based cohort study using Medicare and 2 commercial insurance claims databases in the United States from January 2009 to December 2017. SUBJECTS Patients with DR aged ≥ 18 years in whom treatment with either IVAIs or laser procedure or intravitreal steroid injections was initiated. METHODS We estimated the propensity score (PS) using multivariable logistic regression models, including 85 baseline covariates and PS-matched patients in a 1:1 ratio. We estimated the pooled hazard ratios (HRs) and 95% confidence intervals (CIs). Subgroup analyses based on prior history of CV events were also conducted. MAIN OUTCOME MEASURES A composite CV outcome of myocardial infarction (MI) or stroke, its individual components, and all-cause mortality in 180 and 365 days after treatment initiation. RESULTS We identified 61 508 PS-matched patients in a 1:1 ratio in whom either IVAIs or laser or steroid treatment was initiated. Compared with laser or steroid treatment, IAVIs were not associated with an increased risk of the composite CV outcome (HR, 0.95; 95% CI, 0.83-1.09), MI (HR, 0.93; 95% CI, 0.76-1.13), or stroke (HR, 0.98; 95% CI, 0.80-1.19) or the risk of all-cause mortality (HR, 1.25; 95% CI, 0.97-1.62) at 180 days of follow-up. At 365 days, the risk of the composite CV outcome, stroke, and MI remained similar between the 2 groups, although the risk of all-cause mortality was increased with IAVIs (HR, 1.35; 95% CI, 1.14-1.60). The subgroup analysis showed that the risk of all-cause mortality was increased in patients with a prior history of CV events. CONCLUSIONS Among > 60 000 patients with DR, those who received IAVIs had a risk of CV events similar to those who received laser or steroid treatment. However, the risk of all-cause mortality was higher in patients who received IAVIs for DR.
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22
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Mordi I, Trucco E. The eyes as a window to the heart: looking beyond the horizon. Br J Ophthalmol 2022; 106:1627-1628. [PMID: 36195458 DOI: 10.1136/bjo-2022-322517] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Ify Mordi
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, UK
| | - Emanuele Trucco
- VAMPIRE project, Computing, School of Science and Engineering, University of Dundee, Dundee, UK
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23
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Liang C, Gu C, Wang N. Retinal Vascular Caliber in Coronary Heart Disease and Its Risk Factors. Ophthalmic Res 2022; 66:151-163. [PMID: 36044871 DOI: 10.1159/000526753] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 08/09/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Many clinical and experimental articles have suggested that the retinal vascular diameter can be used as a predictor of coronary heart disease (CHD). However, the results and reliability of the prediction are still controversial. OBJECTIVE A meta-analysis of observational study was conducted to clarify the relationships of retinal vessel caliber with CHD and CHD risk factors. METHOD PubMed and Embase were searched for all observational studies on the relationship of retinal vessel caliber with CHD and CHD risk factors from 2001 to 2021. The meta-analysis has been registered in PROSPERO (registration number is CRD42021267154). RESULT A total of 14 articles were selected for the inclusion in this meta-analysis. In the primary outcome, smaller retinal arteriolar caliber was related to CHD, and the results achieved statistical significance (MD: -5.55, 95% CI: -8.07 to -3.02, p < 0.0001), while there was no significant difference in vein caliber between CHD and healthy people (MD: 1.10, 95% CI: -3.55 to 5.76, p = 0.64 > 0.05). Smaller retinal arteriolar caliber was related to increasing age, male sex, bigger BMI, and hypertension. Bigger retinal arteriolar caliber was related to current smoking. Smaller retinal venule caliber was related to increasing age and hypertension. Bigger retinal venule caliber was related to current smoking, bigger BMI, and diabetes. CONCLUSION Smaller retinal arteriolar caliber was related to CHD, while there was no significant difference in venule caliber between CHD and healthy people. Retinal vascular caliber also independently related to CHD risk factors (e.g., age, gender, smoke, BMI, hypertension, and diabetes).
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Affiliation(s)
| | - Chen Gu
- Jining Puming Eye Hospital, Jining, China
| | - Ning Wang
- Jinan Seventh People's Hospital, Jinan, China
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24
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Barrot J, Real J, Vlacho B, Romero-Aroca P, Simó R, Mauricio D, Mata-Cases M, Castelblanco E, Mundet-Tuduri X, Franch-Nadal J. Diabetic retinopathy as a predictor of cardiovascular morbidity and mortality in subjects with type 2 diabetes. Front Med (Lausanne) 2022; 9:945245. [PMID: 36052329 PMCID: PMC9424917 DOI: 10.3389/fmed.2022.945245] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/26/2022] [Indexed: 12/30/2022] Open
Abstract
This study aimed to evaluate the predictive value of diabetic retinopathy (DR) and its stages with the incidence of major cardiovascular events and all-cause mortality in type 2 diabetes mellitus (T2DM) persons in our large primary healthcare database from Catalonia (Spain). A retrospective cohort study with pseudo-anonymized routinely collected health data from SIDIAP was conducted from 2008 to 2016. We calculated incidence rates of major cardiovascular events [coronary heart disease (CHD), stroke, or both—macrovascular events] and all-cause mortality for subjects with and without DR and for different stages of DR. The proportional hazards regression analysis was done to assess the probability of occurrence between DR and the study events. About 22,402 T2DM subjects with DR were identified in the database and 196,983 subjects without DR. During the follow-up period among the subjects with DR, we observed the highest incidence of all-cause mortally. In the second place were the macrovascular events among the subjects with DR. In the multivariable analysis, fully adjusted for DR, sex, age, body mass index (BMI), tobacco, duration of T2DM, an antiplatelet or antihypertensive drug, and HbA1c, we observed that subjects with any stage of DR had higher risks for all of the study events, except for stroke. We observed the highest probability of all-cause death events (adjusted hazard ratios, AHRs: 1.34, 95% CI: 1.28; 1.41). In conclusion, our results show that DR is related to CHD, macrovascular events, and all-cause mortality among persons with T2DM.
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Affiliation(s)
- Joan Barrot
- Primary Health Care Center Dr. Jordi Nadal i Fàbregas (Salt), Gerència d’Atenció Primària, Institut Català de la Salut, Girona, Spain
- Diabetis des de l’Atenció Primária (DAP)-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGOL), Barcelona, Spain
- Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gorina (IDIAPJGOL), Barcelona, Spain
- Departament of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jordi Real
- Diabetis des de l’Atenció Primária (DAP)-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGOL), Barcelona, Spain
- Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gorina (IDIAPJGOL), Barcelona, Spain
| | - Bogdan Vlacho
- Diabetis des de l’Atenció Primária (DAP)-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGOL), Barcelona, Spain
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- *Correspondence: Bogdan Vlacho,
| | - Pedro Romero-Aroca
- Ophthalmology Service, University Hospital Sant Joan, Institut de Investigacio Sanitaria Pere Virgili (IISPV), University of Rovira and Virgili, Reus, Spain
| | - Rafael Simó
- Diabetes and Metabolism Research Unit, Department of Endocrinology, Vall d’Hebron University Hospital, Vall d’Hebron Research Institute, Barcelona, Spain
- Department of Medicine, Faculty of Medicine, Autonomous University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain
| | - Didac Mauricio
- Diabetis des de l’Atenció Primária (DAP)-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGOL), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Departament of Medicine, University of Vic—Central University of Catalonia, Vic, Spain
| | - Manel Mata-Cases
- Diabetis des de l’Atenció Primária (DAP)-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGOL), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain
- Centre d’Atenció Primària La Mina, Gerència d’Àmbit d’Atenció Primària de Barcelona, Institut Català de la Salut, Barcelona, Spain
| | - Esmeralda Castelblanco
- Diabetis des de l’Atenció Primária (DAP)-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGOL), Barcelona, Spain
- Division of Endocrinology, Metabolism and Lipid Research, John T. Milliken Department of Medicine, School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
| | - Xavier Mundet-Tuduri
- Diabetis des de l’Atenció Primária (DAP)-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGOL), Barcelona, Spain
- Departament of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Xavier Mundet-Tuduri,
| | - Josep Franch-Nadal
- Diabetis des de l’Atenció Primária (DAP)-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGOL), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain
- Primary Health Care Center Raval Sud, Gerència d’Àmbit d’Atenció Primaria, Institut Català de la Salut, Barcelona, Spain
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25
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Yang Y, Zhou Y, Cao Y, Dong Y, Liu C, Zhu W. Impact of diabetic retinopathy on prognosis of patients with heart failure with preserved ejection fraction. Nutr Metab Cardiovasc Dis 2022; 32:1711-1718. [PMID: 35606228 DOI: 10.1016/j.numecd.2022.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 02/07/2022] [Accepted: 04/20/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIMS Diabetic retinopathy (DR) is one of the most common microvascular complications of diabetes mellitus (DM), and could increase the risks of adverse cardiovascular events among DM patients. Since heart failure with preserved ejection fraction (HFpEF) and DM often coexist, our present study aimed to explore the associations of DR with adverse outcomes in HFpEF patients. METHODS AND RESULTS We conducted this study in a large, international population suffering from HFpEF (n = 3442) based on the Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist (TOPCAT) trial. The associations of baseline DR with clinical outcomes were expressed as adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) using the Cox proportional hazard regression models. The crude incidence rates of all the outcomes studied were significantly increased when DM patients with or without DR compared to those without DM (all P < 0.05), whereas there were no differences between DM patients without DR versus those with DR (all P > 0.05). In the multivariate cox regression analysis, DR was not significantly associated with increased risks of the primary composite outcome (HR, 1.178 [95% CI, 0.870-1.596]) and secondary outcomes including all-cause death, cardiovascular death, all-cause hospitalization, hospitalization for HF, myocardial infarction, and stroke (all P > 0.05). CONCLUSIONS Our results of current study suggested that DM but not DR could be regarded as an independent risk factor for the prognosis of HFpEF. CLINICAL TRIAL REGISTRATION URL: https://clinicaltrials.gov. Unique identifier: NCT00094302.
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Affiliation(s)
- Y Yang
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, PR China; NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), Guangzhou, 510080, PR China
| | - Y Zhou
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510060, China
| | - Y Cao
- Department of Cardiology, Guizhou Provincial People's Hospital, Guiyang, 550001, PR China
| | - Y Dong
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, PR China; NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), Guangzhou, 510080, PR China
| | - C Liu
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, PR China; NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), Guangzhou, 510080, PR China.
| | - W Zhu
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, PR China; NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), Guangzhou, 510080, PR China.
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Huang F, Lian J, Ng KS, Shih K, Vardhanabhuti V. Predicting CT-Based Coronary Artery Disease Using Vascular Biomarkers Derived from Fundus Photographs with a Graph Convolutional Neural Network. Diagnostics (Basel) 2022; 12:diagnostics12061390. [PMID: 35741200 PMCID: PMC9221688 DOI: 10.3390/diagnostics12061390] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/26/2022] [Accepted: 06/02/2022] [Indexed: 01/27/2023] Open
Abstract
The study population contains 145 patients who were prospectively recruited for coronary CT angiography (CCTA) and fundoscopy. This study first examined the association between retinal vascular changes and the Coronary Artery Disease Reporting and Data System (CAD-RADS) as assessed on CCTA. Then, we developed a graph neural network (GNN) model for predicting the CAD-RADS as a proxy for coronary artery disease. The CCTA scans were stratified by CAD-RADS scores by expert readers, and the vascular biomarkers were extracted from their fundus images. Association analyses of CAD-RADS scores were performed with patient characteristics, retinal diseases, and quantitative vascular biomarkers. Finally, a GNN model was constructed for the task of predicting the CAD-RADS score compared to traditional machine learning (ML) models. The experimental results showed that a few retinal vascular biomarkers were significantly associated with adverse CAD-RADS scores, which were mainly pertaining to arterial width, arterial angle, venous angle, and fractal dimensions. Additionally, the GNN model achieved a sensitivity, specificity, accuracy and area under the curve of 0.711, 0.697, 0.704 and 0.739, respectively. This performance outperformed the same evaluation metrics obtained from the traditional ML models (p < 0.05). The data suggested that retinal vasculature could be a potential biomarker for atherosclerosis in the coronary artery and that the GNN model could be utilized for accurate prediction.
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Affiliation(s)
- Fan Huang
- Department of Diagnostic Radiology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China; (F.H.); (J.L.); (K.-S.N.)
| | - Jie Lian
- Department of Diagnostic Radiology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China; (F.H.); (J.L.); (K.-S.N.)
| | - Kei-Shing Ng
- Department of Diagnostic Radiology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China; (F.H.); (J.L.); (K.-S.N.)
| | - Kendrick Shih
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China;
| | - Varut Vardhanabhuti
- Department of Diagnostic Radiology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China; (F.H.); (J.L.); (K.-S.N.)
- Correspondence: ; Tel.: +852-2255-3307
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Echouffo-Tcheugui JB, Musani SK, Bertoni AG, Correa A, Fox ER, Mentz RJ. Patients phenotypes and cardiovascular risk in type 2 diabetes: the Jackson Heart Study. Cardiovasc Diabetol 2022; 21:89. [PMID: 35650579 PMCID: PMC9161484 DOI: 10.1186/s12933-022-01501-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 03/28/2022] [Indexed: 11/22/2022] Open
Abstract
Background Cardiovascular prognosis related to type 2 diabetes may not be adequately captured by information on comorbid conditions such as obesity and hypertension. To inform the cardiovascular prognosis among diabetic individuals, we conducted phenotyping using a clustering approach based on clinical data, echocardiographic indices and biomarkers. Methods We performed a cluster analysis on clinical, biochemical and echocardiographic variables from 529 Blacks with diabetes in the Jackson Heart Study. An association between identified clusters and major adverse cardiovascular events (MACE- composite of coronary heart disease, stroke, heart failure and atrial fibrillation) was assessed using Cox proportional hazards modeling. Results Cluster analysis separated individuals with diabetes (68% women, mean age 60 ± 10 years) into three distinct clusters (Clusters 1,2 &3 - with Cluster 3 being a hypertrophic cluster characterized by highest LV mass, levels of brain natriuretic peptide [BNP] and high-sensitivity cardiac troponin-I [hs-cTnI]). After a median 12.1 years, there were 141 cardiovascular events. Compared to Cluster1, Clusters 3 had an increased risk of cardiovascular disease (hazard ratio [HR] 1.60; 95% confidence interval [CI] 1.08, 2.37), while Cluster 2 had a similar risk of outcome (HR 1.11; 95% CI 0.73, 168). Conclusions Among Blacks with diabetes, cluster analysis identified three distinct echocardiographic and biomarkers phenotypes, with cluster 3 (high LV mass, high cardiac biomarkers) associated with worse outcomes, thus highlighting the prognostic value of subclinical myocardial dysfunction. Supplementary Information The online version contains supplementary material available at 10.1186/s12933-022-01501-z.
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Affiliation(s)
- Justin B Echouffo-Tcheugui
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, 5510 Bayview Circle, Baltimore, MD, 21224, USA.
| | - Solomon K Musani
- Department of Medicine, Jackson Heart Study, University of Mississippi Medical Center, Jackson, USA
| | - Alain G Bertoni
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Adolfo Correa
- Department of Medicine, Jackson Heart Study, University of Mississippi Medical Center, Jackson, USA
| | - Ervin R Fox
- Department of Medicine, Division of Cardiology, University of Mississippi Medical Center, Jackson, USA
| | - Robert J Mentz
- Department of Medicine, Division of Cardiology, Duke University School of Medicine, Durham, NC, USA
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Munjral S, Maindarkar M, Ahluwalia P, Puvvula A, Jamthikar A, Jujaray T, Suri N, Paul S, Pathak R, Saba L, Chalakkal RJ, Gupta S, Faa G, Singh IM, Chadha PS, Turk M, Johri AM, Khanna NN, Viskovic K, Mavrogeni S, Laird JR, Pareek G, Miner M, Sobel DW, Balestrieri A, Sfikakis PP, Tsoulfas G, Protogerou A, Misra DP, Agarwal V, Kitas GD, Kolluri R, Teji J, Al-Maini M, Dhanjil SK, Sockalingam M, Saxena A, Sharma A, Rathore V, Fatemi M, Alizad A, Viswanathan V, Krishnan PR, Omerzu T, Naidu S, Nicolaides A, Fouda MM, Suri JS. Cardiovascular Risk Stratification in Diabetic Retinopathy via Atherosclerotic Pathway in COVID-19/Non-COVID-19 Frameworks Using Artificial Intelligence Paradigm: A Narrative Review. Diagnostics (Basel) 2022; 12:1234. [PMID: 35626389 PMCID: PMC9140106 DOI: 10.3390/diagnostics12051234] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/11/2022] [Accepted: 05/11/2022] [Indexed: 11/18/2022] Open
Abstract
Diabetes is one of the main causes of the rising cases of blindness in adults. This microvascular complication of diabetes is termed diabetic retinopathy (DR) and is associated with an expanding risk of cardiovascular events in diabetes patients. DR, in its various forms, is seen to be a powerful indicator of atherosclerosis. Further, the macrovascular complication of diabetes leads to coronary artery disease (CAD). Thus, the timely identification of cardiovascular disease (CVD) complications in DR patients is of utmost importance. Since CAD risk assessment is expensive for low-income countries, it is important to look for surrogate biomarkers for risk stratification of CVD in DR patients. Due to the common genetic makeup between the coronary and carotid arteries, low-cost, high-resolution imaging such as carotid B-mode ultrasound (US) can be used for arterial tissue characterization and risk stratification in DR patients. The advent of artificial intelligence (AI) techniques has facilitated the handling of large cohorts in a big data framework to identify atherosclerotic plaque features in arterial ultrasound. This enables timely CVD risk assessment and risk stratification of patients with DR. Thus, this review focuses on understanding the pathophysiology of DR, retinal and CAD imaging, the role of surrogate markers for CVD, and finally, the CVD risk stratification of DR patients. The review shows a step-by-step cyclic activity of how diabetes and atherosclerotic disease cause DR, leading to the worsening of CVD. We propose a solution to how AI can help in the identification of CVD risk. Lastly, we analyze the role of DR/CVD in the COVID-19 framework.
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Affiliation(s)
- Smiksha Munjral
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA 95661, USA; (S.M.); (M.M.); (A.P.); (A.J.); (T.J.); (I.M.S.); (P.S.C.); (S.K.D.)
| | - Mahesh Maindarkar
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA 95661, USA; (S.M.); (M.M.); (A.P.); (A.J.); (T.J.); (I.M.S.); (P.S.C.); (S.K.D.)
- Department of Biomedical Engineering, North Eastern Hill University, Shillong 793022, India;
| | - Puneet Ahluwalia
- Max Institute of Cancer Care, Max Super Specialty Hospital, New Delhi 110017, India;
| | - Anudeep Puvvula
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA 95661, USA; (S.M.); (M.M.); (A.P.); (A.J.); (T.J.); (I.M.S.); (P.S.C.); (S.K.D.)
- Annu’s Hospitals for Skin and Diabetes, Nellore 524101, India
| | - Ankush Jamthikar
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA 95661, USA; (S.M.); (M.M.); (A.P.); (A.J.); (T.J.); (I.M.S.); (P.S.C.); (S.K.D.)
| | - Tanay Jujaray
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA 95661, USA; (S.M.); (M.M.); (A.P.); (A.J.); (T.J.); (I.M.S.); (P.S.C.); (S.K.D.)
- Department of Molecular, Cell and Developmental Biology, University of California, Santa Cruz, CA 95616, USA
| | - Neha Suri
- Mira Loma High School, Sacramento, CA 95821, USA;
| | - Sudip Paul
- Department of Biomedical Engineering, North Eastern Hill University, Shillong 793022, India;
| | - Rajesh Pathak
- Department of Computer Science Engineering, Rawatpura Sarkar University, Raipur 492015, India;
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria, 40138 Cagliari, Italy; (L.S.); (A.B.)
| | | | - Suneet Gupta
- CSE Department, Bennett University, Greater Noida 201310, India;
| | - Gavino Faa
- Department of Pathology, Azienda Ospedaliero Universitaria, 09124 Cagliari, Italy;
| | - Inder M. Singh
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA 95661, USA; (S.M.); (M.M.); (A.P.); (A.J.); (T.J.); (I.M.S.); (P.S.C.); (S.K.D.)
| | - Paramjit S. Chadha
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA 95661, USA; (S.M.); (M.M.); (A.P.); (A.J.); (T.J.); (I.M.S.); (P.S.C.); (S.K.D.)
| | - Monika Turk
- The Hanse-Wissenschaftskolleg Institute for Advanced Study, 27753 Delmenhorst, Germany;
| | - Amer M. Johri
- Department of Medicine, Division of Cardiology, Queen’s University, Kingston, ON K7L 3N6, Canada;
| | - Narendra N. Khanna
- Department of Cardiology, Indraprastha APOLLO Hospitals, New Delhi 110001, India; (N.N.K.); (A.S.)
| | - Klaudija Viskovic
- Department of Radiology and Ultrasound, University Hospital for Infectious Diseases, 10 000 Zagreb, Croatia;
| | - Sophie Mavrogeni
- Cardiology Clinic, Onassis Cardiac Surgery Centre, 17674 Athens, Greece;
| | - John R. Laird
- Heart and Vascular Institute, Adventist Health St. Helena, St. Helena, CA 94574, USA;
| | - Gyan Pareek
- Minimally Invasive Urology Institute, Brown University, Providence, RI 02912, USA;
| | - Martin Miner
- Men’s Health Centre, Miriam Hospital Providence, Providence, RI 02906, USA;
| | - David W. Sobel
- Rheumatology Unit, National Kapodistrian University of Athens, 15772 Athens, Greece; (D.W.S.); (P.P.S.)
| | - Antonella Balestrieri
- Department of Radiology, Azienda Ospedaliero Universitaria, 40138 Cagliari, Italy; (L.S.); (A.B.)
| | - Petros P. Sfikakis
- Rheumatology Unit, National Kapodistrian University of Athens, 15772 Athens, Greece; (D.W.S.); (P.P.S.)
| | - George Tsoulfas
- Department of Surgery, Aristoteleion University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Athanasios Protogerou
- Cardiovascular Prevention and Research Unit, Department of Pathophysiology, National & Kapodistrian University of Athens, 15772 Athens, Greece;
| | - Durga Prasanna Misra
- Department of Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India; (D.P.M.); (V.A.)
| | - Vikas Agarwal
- Department of Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India; (D.P.M.); (V.A.)
| | - George D. Kitas
- Academic Affairs, Dudley Group NHS Foundation Trust, Dudley DY1 2HQ, UK;
- Arthritis Research UK Epidemiology Unit, Manchester University, Manchester M13 9PL, UK
| | - Raghu Kolluri
- OhioHealth Heart and Vascular, Columbus, OH 43214, USA;
| | - Jagjit Teji
- Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA;
| | - Mustafa Al-Maini
- Allergy, Clinical Immunology and Rheumatology Institute, Toronto, ON L4Z 4C4, Canada;
| | - Surinder K. Dhanjil
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA 95661, USA; (S.M.); (M.M.); (A.P.); (A.J.); (T.J.); (I.M.S.); (P.S.C.); (S.K.D.)
| | | | - Ajit Saxena
- Department of Cardiology, Indraprastha APOLLO Hospitals, New Delhi 110001, India; (N.N.K.); (A.S.)
| | - Aditya Sharma
- Division of Cardiovascular Medicine, University of Virginia, Charlottesville, VA 22904, USA;
| | - Vijay Rathore
- Nephrology Department, Kaiser Permanente, Sacramento, CA 95119, USA;
| | - Mostafa Fatemi
- Department of Physiology & Biomedical Engineering, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA;
| | - Azra Alizad
- Department of Radiology, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA;
| | - Vijay Viswanathan
- MV Hospital for Diabetes and Professor MVD Research Centre, Chennai 600013, India;
| | | | - Tomaz Omerzu
- Department of Neurology, University Medical Centre Maribor, 1262 Maribor, Slovenia;
| | - Subbaram Naidu
- Electrical Engineering Department, University of Minnesota, Duluth, MN 55812, USA;
| | - Andrew Nicolaides
- Vascular Screening and Diagnostic Centre, University of Nicosia Medical School, Nicosia 2408, Cyprus;
| | - Mostafa M. Fouda
- Department of Electrical and Computer Engineering, Idaho State University, Pocatello, ID 83209, USA;
| | - Jasjit S. Suri
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA 95661, USA; (S.M.); (M.M.); (A.P.); (A.J.); (T.J.); (I.M.S.); (P.S.C.); (S.K.D.)
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Markousis-Mavrogenis G, Bacopoulou F, Mavragani C, Voulgari P, Kolovou G, Kitas GD, Chrousos GP, Mavrogeni SI. Coronary microvascular disease: The "Meeting Point" of Cardiology, Rheumatology and Endocrinology. Eur J Clin Invest 2022; 52:e13737. [PMID: 34939183 DOI: 10.1111/eci.13737] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/19/2021] [Accepted: 12/20/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Exertional chest pain/dyspnea or chest pain at rest are the main symptoms of coronary artery disease (CAD), which are traditionally attributed to insufficiency of the epicardial coronary arteries. However, 2/3 of women and 1/3 of men with angina and 10% of patients with acute myocardial infarction have no evidence of epicardial coronary artery stenosis in X-ray coronary angiography. In these cases, coronary microvascular disease (CMD) is the main causative factor. AIMS To present the pathophysiology of CMD in Cardiology, Rheumatology and Endocrinology. MATERIALS-METHODS The pathophysiology of CMD in Cardiology, Rheumatology and Endocrinology was evaluated. It includes impaired microvascular vasodilatation, which leads to inability of the organism to deal with myocardial oxygen needs and, hence, development of ischemic pain. CMD, observed in inflammatory autoimmune rheumatic and endocrine/metabolic disorders, brings together Cardiology, Rheumatology and Endocrinology. Causative factors include persistent systemic inflammation and endocrine/metabolic abnormalities influencing directly the coronary microvasculature. In the past, the evaluation of microcirculation was feasible only with the use of invasive techniques, such as coronary flow reserve assessment. Currently, the application of advanced imaging modalities, such as cardiovascular magnetic resonance (CMR), can evaluate CMD non-invasively and without ionizing radiation. RESULTS CMD may present with a variety of symptoms with 1/3 to 2/3 of them expressed as typical chest pain in effort, more commonly found in women during menopause than in men. Atypical presentation includes chest pain at rest or exertional dyspnea,but post exercise symptoms are not uncommon. The treatment with nitrates is less effective in CMD, because their vasodilator action in coronary micro-circulation is less pronounced than in the epicardial coronary arteries. DISCUSSION Although both classic and new medications have been used in the treatment of CMD, there are still many questions regarding both the pathophysiology and the treatment of this disorder. The potential effects of anti-rheumatic and endocrine medications on the evolution of CMD need further evaluation. CONCLUSION CMD is a multifactorial disease leading to myocardial ischemia/fibrosis alone or in combination with epicardial coronary artery disease. Endothelial dysfunction/vasospasm, systemic inflammation, and/or neuroendocrine activation may act as causative factors and bring Cardiology, Rheumatology and Endocrinology together. Currently, the application of advanced imaging modalities, and specifically CMR, allows reliable assessment of the extent and severity of CMD. These measurements should not be limited to "pure cardiac patients", as it is known that CMD affects the majority of patients with autoimmune rheumatic and endocrine/metabolic disorders.
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Affiliation(s)
| | - Flora Bacopoulou
- University Research Institute of Maternal and Child Health and Precision Medicine, UNESCO Chair on Adolescent Health Care, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece
| | - Clio Mavragani
- Pathophysiology Department, University of Athens, Athens, Greece
| | | | - Genovefa Kolovou
- Onassis Cardiac Surgery Hospital, Athens, Greece.,Epidemiology Department, University of Manchester, Manchester, UK
| | - George D Kitas
- Epidemiology Department, University of Manchester, Manchester, UK
| | - George P Chrousos
- University Research Institute of Maternal and Child Health and Precision Medicine, UNESCO Chair on Adolescent Health Care, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece
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Diabetic kidney disease and risk of incident stroke among adults with type 2 diabetes. BMC Med 2022; 20:127. [PMID: 35346165 PMCID: PMC8962078 DOI: 10.1186/s12916-022-02317-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 11/30/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Data on the relations between kidney function abnormalities and stroke in type 2 diabetes are limited. We evaluated the associations of kidney function abnormalities and chronic kidney disease (CKD) stages with incident stroke in a large sample of adults with type 2 diabetes. METHODS Participants with type 2 diabetes from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study without history of stroke at baseline were included. Urine albumin-to-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR) were assessed at baseline. CKD categories were defined according to the KDIGO (Kidney Disease: Improving Global Outcomes) guidelines. Cox proportional hazards regression models were used to compute hazard ratios (HR) and 95% confidence intervals (CI) for stroke in relation to measures of kidney function and CKD categories. RESULTS A total of 9170 participants (mean age 62.8 [SD: 6.6] years, 38.2% women, 62.9% white) were included. Over a median follow-up of 4.9 years (interquartile range: 4.0-5.7), 156 participants developed a stroke (incidence rate 3.6/1000 person-years [95% CI 3.0-4.2]). After adjusting for relevant confounders, higher UACR and lower eGFR were each associated with increased risk of stroke. Compared to UACR < 30 mg/g, moderate albuminuria and severe albuminuria were associated with increasing hazards for stroke (HR 1.61 [95% CI 1.12-2.32] and 2.29 [95% CI 1.39-3.80], respectively). Compared to eGFR of ≥ 60 mL/min/1.73 m2, decreased eGFR (eGFR < 60 mL/min/1.73 m2) was associated with higher risk of stroke (HR 1.50, 95% CI 0.98-2.29). Compared to no CKD, worsening CKD stage was associated with an increasing risk of stroke (HRs of 1.76 [95% CI 1.10-2.83] for CKD G1, 1.77 [95% CI 1.13-2.75] for CKD G2, and 2.03 [95% CI 1.27-3.24] for CKD G3). CONCLUSIONS In a large sample of adults with type 2 diabetes, increasing albuminuria and worsening stages of early CKD were independently associated with higher risk of incident stroke. TRIAL REGISTRATION ClinicalTrials.gov. Identifier: NCT00000620 .
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Mordi IR, Trucco E, Syed MG, MacGillivray T, Nar A, Huang Y, George G, Hogg S, Radha V, Prathiba V, Anjana RM, Mohan V, Palmer CNA, Pearson ER, Lang CC, Doney ASF. Prediction of Major Adverse Cardiovascular Events From Retinal, Clinical, and Genomic Data in Individuals With Type 2 Diabetes: A Population Cohort Study. Diabetes Care 2022; 45:710-716. [PMID: 35043139 DOI: 10.2337/dc21-1124] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 11/20/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Improved identification of individuals with type 2 diabetes at high cardiovascular (CV) risk could help in selection of newer CV risk-reducing therapies. The aim of this study was to determine whether retinal vascular parameters, derived from retinal screening photographs, alone and in combination with a genome-wide polygenic risk score for coronary heart disease (CHD PRS) would have independent prognostic value over traditional CV risk assessment in patients without prior CV disease. RESEARCH DESIGN AND METHODS Patients in the Genetics of Diabetes Audit and Research Tayside Scotland (GoDARTS) study were linked to retinal photographs, prescriptions, and outcomes. Retinal photographs were analyzed using VAMPIRE (Vascular Assessment and Measurement Platform for Images of the Retina) software, a semiautomated artificial intelligence platform, to compute arterial and venous fractal dimension, tortuosity, and diameter. CHD PRS was derived from previously published data. Multivariable Cox regression was used to evaluate the association between retinal vascular parameters and major adverse CV events (MACE) at 10 years compared with the pooled cohort equations (PCE) risk score. RESULTS Among 5,152 individuals included in the study, a MACE occurred in 1,017 individuals. Reduced arterial fractal dimension and diameter and increased venous tortuosity each independently predicted MACE. A risk score combining these parameters significantly predicted MACE after adjustment for age, sex, PCE, and the CHD PRS (hazard ratio 1.11 per SD increase, 95% CI 1.04-1.18, P = 0.002) with similar accuracy to PCE (area under the curve [AUC] 0.663 vs. 0.658, P = 0.33). A model incorporating retinal parameters and PRS improved MACE prediction compared with PCE (AUC 0.686 vs. 0.658, P < 0.001). CONCLUSIONS Retinal parameters alone and in combination with genome-wide CHD PRS have independent and incremental prognostic value compared with traditional CV risk assessment in type 2 diabetes.
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Affiliation(s)
- Ify R Mordi
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, U.K
| | - Emanuele Trucco
- VAMPIRE Project, Computing, School of Science and Engineering, University of Dundee, Dundee, U.K
| | - Mohammad Ghouse Syed
- VAMPIRE Project, Computing, School of Science and Engineering, University of Dundee, Dundee, U.K
| | - Tom MacGillivray
- VAMPIRE Project, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, U.K
| | - Adi Nar
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, U.K
| | - Yu Huang
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, U.K
| | - Gittu George
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, U.K
| | - Stephen Hogg
- VAMPIRE Project, Computing, School of Science and Engineering, University of Dundee, Dundee, U.K
| | - Venkatesan Radha
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Vijayaraghavan Prathiba
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Ranjit Mohan Anjana
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Colin N A Palmer
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, U.K
| | - Ewan R Pearson
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, U.K
| | - Chim C Lang
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, U.K
| | - Alex S F Doney
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, U.K
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Yalim Z, Alan Yalim S, Eroğul Ö, Doğan M. The role of heart rate variability and heart rate turbulence in diabetic retinopathy. Minerva Endocrinol (Torino) 2022; 47:172-180. [PMID: 35142481 DOI: 10.23736/s2724-6507.20.03346-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
AIMS The aim of this study was to evaluate the cardiac autonomic functions of individuals with asymptomatic diabetic retinopathy (DR) and no obvious heart disease by heart rate turbulence (HRT) and heart rate variability (HRV) analysis. METHODS A total of 72 patients with Type II Diabetes Mellitus: 20 non-retinopathic (NRDM), 26 non-proliferative retinopathic patients (NPDR) and 26 proliferative retinopathic patients (PDR) were enrolled in this cross-sectional study. RESULTS The HRV parameters of Standard deviation of NN intervals (SDNN) (119.8±11.7, 101.1±20.2, 100.6±17.04), Standard deviation of the average NN intervals (SDANN) (108.3±10.8, 91.2±17.5, 93.6±18.4), SDNN Index (49.5±5.1, 40.1±13.4, 38.6±12.7), Root mean square of successive RR interval differences (RMSSD) (28.3±5.1, 22.3±7.5, 26±9.2) and Triangular index (34.4±4.3, 29.7±8.8, 27.3±6.7) were significantly lower in the NPDR and PDR groups than in the NRDM group (for all p<0.05). Also, there was a statistically significant higher Turbulence Onset (-1.80±0.7, -1.1±0.9, -0.43±0.81) and lower Turbulence Slope (8.05±2.59, 5.82±3.39, 4.53±2.07) in HRT parameters in patients in the NPDR and PDR groups than in the NRDM group (respectively, NRDM, NPDM, PDM, for all p<0.001). CONCLUSIONS We found that HRV and HRT parameters had a significant deterioration in retinopathic individuals compared to the group without retinopathy. We think that HRV and HRT analysis can have an important role in the evaluation of these patients.
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Affiliation(s)
- Zafer Yalim
- Department of Cardiology, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey -
| | - Sümeyra Alan Yalim
- Department of İnternal Medicine, Afyonkarahisar State Hospital, Afyonkarahisar, Turkey
| | - Özgür Eroğul
- Department of Ophthalmology, Afyonkarahisar Health Sciences University Hospital, Afyonkarahisar, Turkey
| | - Mustafa Doğan
- Department of Ophthalmology, Afyonkarahisar Health Sciences University Hospital, Afyonkarahisar, Turkey
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Eid M, Mounir A, El Etriby S, Al Taher A, Ezzat MAW. Diabetic Retinopathy as a Predictor of Angiographic Coronary Atherosclerosis Severity in Patients with Type 2 Diabetes Mellitus. Diabetes Metab Syndr Obes 2022; 15:1485-1494. [PMID: 35591908 PMCID: PMC9113458 DOI: 10.2147/dmso.s363406] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 04/30/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Diabetic retinopathy (DR) is one of the most prevalent consequences of diabetes mellitus (DM). Much emphasis has been focused on the link between DR and cardiovascular disorders in patients with type 2 diabetes (T2DM). However, there is little information about the relation between the degree of DR and coronary atherosclerosis severity in Egyptian patients. AIM To assess the correlation between the degree of DR and the coronary atherosclerosis severity in T2DM. PATIENTS AND METHODS This work included 140 diabetic patients with T2DM who underwent diagnostic coronary angiography because of suspected coronary artery disease (CAD). All participants were evaluated by history, fundus assessment, laboratory tests (lipid profile and glycated hemoglobin [HbA1c]), and selective coronary angiography. The severity of coronary artery lesion was detected by Gensini score and vessel score. RESULTS Patients with DR had a significantly higher Gensini score (67.86± 44.56 versus 5.93± 9.02, P < 0.001) and a vessel score (2.29± 0.86 versus 0.50± 0.66, P < 0.001). There was a significant relation between the degree of DR, Gensini score (P < 0.001), and vessel score (P < 0.001), as both scores increased according to the severity of DR. The presence and degree of retinopathy were the only independent factors linked to the severity score in multivariate linear regression analyses (P < 0.001). CONCLUSION The presence and degree of DR are independent predictors of severe coronary atherosclerosis. Therefore, when evaluating whether a patient with T2DM is at high risk for CAD, the DR degree should be taken into consideration.
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Affiliation(s)
- Mohamed Eid
- Department of Internal Medicine, Sohag University Hospital, Sohag University, Sohag, Egypt
| | - Amr Mounir
- Department of Ophthalmology, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt
- Correspondence: Amr Mounir, Email
| | - Shehab El Etriby
- Department of Cardiology, Ain Shams Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ali Al Taher
- Department of Internal Medicine, Sohag University Hospital, Sohag University, Sohag, Egypt
| | - Mohamed A W Ezzat
- Department of Internal Medicine, Sohag University Hospital, Sohag University, Sohag, Egypt
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Diabetic Retinopathy and Skin Tissue Advanced Glycation End Products Are Biomarkers of Cardiovascular Events in Type 2 Diabetic Patients. J Pers Med 2021; 11:jpm11121344. [PMID: 34945815 PMCID: PMC8707336 DOI: 10.3390/jpm11121344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 11/30/2021] [Accepted: 12/05/2021] [Indexed: 12/13/2022] Open
Abstract
Risk of cardiovascular events is not homogeneous in subjects with type 2 diabetes; therefore, its early identification remains a challenge to be met. The aim of this study is to evaluate whether the presence of diabetic retinopathy and accumulation of advanced glycation end-products in subcutaneous tissue can help identify patients at high risk of cardiovascular events. For this purpose, we conducted a prospective study (mean follow-up: 4.35 years) comprising 200 subjects with type 2 diabetes with no history of clinical cardiovascular disease and 60 non-diabetic controls matched by age and sex. The primary outcome was defined as the composite of myocardial infarction, coronary revascularization, stroke, lower limb amputation or cardiovascular death. The Cox proportional hazard multiple regression analysis was used to determine the independent predictors of cardiovascular events. The patients with type 2 diabetes had significantly more cardiovascular events than the non-diabetic subjects. Apart from the classic factors such as age, sex and coronary artery calcium score, we observed that the diabetic retinopathy and advanced glycation end-products in subcutaneous tissue were independent predictors of cardiovascular events. We conclude that the diabetic retinopathy and advanced glycation end-products in subcutaneous tissue could be useful biomarkers for selecting type 2 diabetic patients in whom the screening for cardiovascular disease should be prioritized, thereby creating more personalized and cost-effective medicine.
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Antoniou S, Naka KK, Bechlioulis A, Papadakis M, Tsatsoulis A, Michalis LK, Tigas S. Vascular effects following intensification of glycemic control in poorly controlled patients with long-standing type 2 diabetes mellitus. Hormones (Athens) 2021; 20:783-791. [PMID: 34505233 DOI: 10.1007/s42000-021-00318-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 08/30/2021] [Indexed: 12/31/2022]
Abstract
PURPOSE The aim of the present study was to investigate the effect of intensive antidiabetic therapy on vascular indices in type 2 diabetes mellitus (T2DM) patients. METHODS Poorly controlled T2DM patients (n = 62, mean age 64 years, T2DM duration 14 years, HbA1c ≥ 7.5%) were studied at baseline and following intensive treatment to achieve optimal glycemic control. Brachial artery flow-mediated dilation, carotid-femoral pulse wave velocity, central augmentation index, large and small (C2) artery compliance, carotid intima-media thickness (cIMT), and ankle-brachial index were assessed at baseline and follow-up. RESULTS HbA1c decreased from 8.8% (8.1, 10.1) (median, interquartile range-IQ) to 7.4% (6.9, 7.8), p < 0.001. Triglycerides and high-sensitivity C-reactive protein levels were decreased by ~ 10% and 50%, respectively (p < 0.05). Maximum cIMT and C2 increased at follow-up (0.97 ± 0.25 to 1.03 ± 0.27 mm and 3.3 (2.7, 4.2) to 4.2 (3.2, 5.4) ml/mmHg × 10, respectively, p < 0.05). In subgroup analysis, the observed changes in vascular indices were not affected by diabetes duration, presence of cardiovascular disease, or insulin treatment. CONCLUSION In patients with long-standing T2DM, short-term aggressive glycemic control was associated with an improvement of microvascular function (C2) and deterioration of carotid atherosclerosis (IMT) without any effect on the elastic properties of large arteries.
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Affiliation(s)
- Sofia Antoniou
- Department of Endocrinology, University of Ioannina, 45110, Ioannina, Greece
- 2nd Department of Cardiology and Michaelidion Cardiac Center, University of Ioannina, Ioannina, Greece
| | - Katerina K Naka
- 2nd Department of Cardiology and Michaelidion Cardiac Center, University of Ioannina, Ioannina, Greece
| | - Aris Bechlioulis
- 2nd Department of Cardiology and Michaelidion Cardiac Center, University of Ioannina, Ioannina, Greece
| | - Marios Papadakis
- Department of Surgery II, University Witten-Herdecke, Witten, Germany
| | | | - Lampros K Michalis
- 2nd Department of Cardiology and Michaelidion Cardiac Center, University of Ioannina, Ioannina, Greece
| | - Stelios Tigas
- Department of Endocrinology, University of Ioannina, 45110, Ioannina, Greece.
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Hong J, Surapaneni A, Daya N, Selvin E, Coresh J, Grams ME, Ballew SH. Retinopathy and Risk of Kidney Disease in Persons With Diabetes. Kidney Med 2021; 3:808-815.e1. [PMID: 34693260 PMCID: PMC8515075 DOI: 10.1016/j.xkme.2021.04.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Rationale & Objective Retinopathy and chronic kidney disease (CKD) are typically considered microvascular complications of diabetes, and cardiovascular and cerebrovascular diseases are considered macrovascular complications; however, all may share common pathological mechanisms. This study quantified the association of retinopathy with risk of kidney disease and compared with the association with cardiovascular disease in persons with diabetes. Study Design Retrospective cohort study. Setting & Participants 1,759 participants in the ARIC study who had diabetes at visit 4 and underwent retinal examination at visit 3. Exposure Retinopathy. Outcome Prevalent CKD (estimated glomerular filtration rate [eGFR] < 60 mL/min/1.73 m2), prevalent albuminuria (urinary albumin-creatinine ratio [UACR] > 30 mg/g), incident CKD, incident end-stage kidney disease (ESKD), incident coronary heart disease (CHD), and incident stroke. Analytical Approach The cross-sectional association of retinopathy with prevalent CKD and albuminuria was assessed by logistic regression. The associations between retinopathy, incident CKD, incident ESKD, incident CHD, and incident stroke were examined using Cox proportional hazards models. Seemingly unrelated regression was used to compare the strength of association between retinopathy and outcomes. Results During the median follow-up period of 14.2 years, 723 participants developed CKD, and there were 109 ESKD events, 399 CHD events, and 196 stroke events. Compared with the participants without retinopathy, participants with retinopathy were more likely to have reduced eGFR (OR, 1.56 [95% CI, 1.09-2.23]) and UACR > 30 mg/g (OR, 1.61 [95% CI, 1.24-2.10]). Retinopathy was associated with risk of incident CKD (HR, 1.22 [95% CI, 1.02-1.46]), ESKD (HR, 1.69 [95% CI, 1.11-2.58]), CHD (HR, 1.46 [95% CI, 1.15-1.84]), and stroke (HR, 1.43 [95% CI, 1.03-1.97]). A stronger relationship was found between retinopathy and CHD when compared with retinopathy and CKD (P = 0.03); all other associations were similar. Limitations Retinal examination and kidney measurements were taken at different visits. Conclusions The presence of retinopathy was associated with higher prevalence of kidney disease and higher risk of incident CKD, ESKD, and CHD. These results may suggest that a similar mechanism underlies the development of retinopathy and other adverse outcomes in diabetes.
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Affiliation(s)
- Jingyao Hong
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Aditya Surapaneni
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Natalie Daya
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Elizabeth Selvin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Morgan E Grams
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Shoshana H Ballew
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Gayathri S, Gopi VP, Palanisamy P. Diabetic retinopathy classification based on multipath CNN and machine learning classifiers. Phys Eng Sci Med 2021; 44:639-653. [PMID: 34033015 DOI: 10.1007/s13246-021-01012-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 05/06/2021] [Indexed: 11/28/2022]
Abstract
Eye care professionals generally use fundoscopy to confirm the occurrence of Diabetic Retinopathy (DR) in patients. Early DR detection and accurate DR grading are critical for the care and management of this disease. This work proposes an automated DR grading method in which features can be extracted from the fundus images and categorized based on severity using deep learning and Machine Learning (ML) algorithms. A Multipath Convolutional Neural Network (M-CNN) is used for global and local feature extraction from images. Then, a machine learning classifier is used to categorize the input according to the severity. The proposed model is evaluated across different publicly available databases (IDRiD, Kaggle (for DR detection), and MESSIDOR) and different ML classifiers (Support Vector Machine (SVM), Random Forest, and J48). The metrics selected for model evaluation are the False Positive Rate (FPR), Specificity, Precision, Recall, F1-score, K-score, and Accuracy. The experiments show that the best response is produced by the M-CNN network with the J48 classifier. The classifiers are evaluated across the pre-trained network features and existing DR grading methods. The average accuracy obtained for the proposed work is 99.62% for DR grading. The experiments and evaluation results show that the proposed method works well for accurate DR grading and early disease detection.
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Affiliation(s)
- S Gayathri
- National Institute of Technology, Tiruchirappalli, Tamil Nadu, India
| | - Varun P Gopi
- National Institute of Technology, Tiruchirappalli, Tamil Nadu, India.
| | - P Palanisamy
- National Institute of Technology, Tiruchirappalli, Tamil Nadu, India
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Perilli R, Mariotti SP, Mastropasqua L, Bandello FM, Grigioni M, Tarricone R, Petracca F, Consoli A. Welcoming teleretinography into diabetes integrated care. Eur J Ophthalmol 2021; 32:2382-2387. [PMID: 34425693 DOI: 10.1177/11206721211039346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Integrated Care (IC) is a perfect fit for people with diabetes. Fundus examination (FE) is a disease marker for diabetologists and identifies potentially blinding complications (Diabetic Retinopathy, DR). In our Diabetes Clinic (DC) in Pescara, Italy, FE is possibly provided with telemedicine in same day as other exams, avoiding it to be a standalone clinical one; images taken with a retinal digital camera are graded by a remote ophthalmologist within a shared Electronic Health Record (EHR), immediately readable by other stakeholders; a dedicated care path to the Eye Clinic, University of Chieti-Pescara is provided for urgent cases. Personnel's worktime shortening allows gaining time for ophthalmologists' eye examinations in outpatient settings and other stakeholders' work in the DC. The need for a DR digital screening system is growing worldwide: our experience confirms the ease of implementation, and the advantage of sharing clinical data with all stakeholders when working within an EHR, aiming to optimize an IC effective system.
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Affiliation(s)
- Roberto Perilli
- Territorial Ophthalmology Unit, Local Health Authority, Pescara, Italy
| | - Silvio P Mariotti
- Department of Chronic Diseases and Health Promotion, World Health Organization, Geneva, Switzerland
| | - Leonardo Mastropasqua
- Eye Clinic and National Centre for Excellence in Ophthalmology, University of Chieti-Pescara, Chieti, Italy
| | | | - Mauro Grigioni
- National Centre for Innovative Technologies in Public Health, Istituto Superiore di Sanità, Rome, Italy
| | - Rosanna Tarricone
- Department of Social and Political Sciences, Bocconi University, Milan, Italy.,Centre for Research in Health and Social Care Management (CERGAS), Government, Health and Non Profit Division, SDA Bocconi, Milan, Italy
| | - Francesco Petracca
- Centre for Research in Health and Social Care Management (CERGAS), Government, Health and Non Profit Division, SDA Bocconi, Milan, Italy
| | - Agostino Consoli
- Chair of Endocrinology and Metabolic Diseases, University of Chieti-Pescara, Chieti, Italy
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The Association of Diabetic Retinopathy and Cardiovascular Disease: A 13-Year Nationwide Population-Based Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18158106. [PMID: 34360398 PMCID: PMC8345672 DOI: 10.3390/ijerph18158106] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/18/2021] [Accepted: 07/27/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Previous studies have demonstrated that patients with diabetic retinopathy (DR) have a higher prevalence of risk factors known to be associated with cardiovascular disease (CVD). We hypothesized that patients with more severe DR could have a higher relative risk of CVD. METHODS To test this hypothesis, we used the National Health Insurance Research Database (NHIRD) to evaluate whether associations exist between DR and CVD. The data for this nationwide population-based retrospective cohort study were obtained from the NHIRD in Taiwan from 2001 to 2013. The assessed study outcome used was the incidence and other statistical analyses of CVD in patients with DR during a 13-year follow-up period. RESULTS Our findings obtained from 2001 to 2013 suggest that the incidence rates of CVD are 2.026 times that of diabetes mellitus (DM) without DR (95% C.I. = 1.876-2.187) and 2.75 times that of DM with DR (95% C.I. = 2.487-3.04) compared with the Non-DM group. CONCLUSION The relative risk of CVD in DR was greater than that in the Non-DM group for both men and women. Targeted monitoring of DM, especially the co-existence of diabetic retinopathy, is of utmost importance in the clinical care of the DM population.
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Yap J, Anbalakan K, Tay WT, Ting D, Cheung CY, Sabanayagam C, Cheng CY, Wong TY, Yeo KK. Impact of type 2 diabetes and microvascular complications on mortality and cardiovascular outcomes in a multiethnic Asian population. BMJ Open Diabetes Res Care 2021; 9:e001413. [PMID: 34244217 PMCID: PMC8268896 DOI: 10.1136/bmjdrc-2020-001413] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 06/17/2021] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Diabetes mellitus is a growing public health epidemic in Asia. We examined the impact of type 2 diabetes, glycemic control and microvascular complications on mortality and cardiovascular outcomes in a multiethnic population-based cohort of Asians without prior cardiovascular disease. RESEARCH DESIGN AND METHODS This was a prospective population-based cohort study in Singapore comprising participants from the three major Asian ethnic groups: Chinese, Malays and Indians, with baseline examination in 2004-2011. Participants with type 1 diabetes and those with cardiovascular disease at baseline were excluded. Type 2 diabetes, Hemoglobin A1c (HbA1c) levels and presence of microvascular complications (diabetic retinopathy and nephropathy) were defined at baseline. The primary outcome was all-cause mortality and major adverse cardiovascular events (MACEs), defined as a composite of cardiovascular mortality, myocardial infarction, stroke and revascularization, collected using a national registry. RESULTS A total of 8541 subjects were included, of which 1890 had type 2 diabetes at baseline. Subjects were followed for a median of 6.4 (IQR 4.8-8.8) years. Diabetes was a significant predictor of mortality (adjusted HR 1.74, 95% CI 1.45 to 2.08, p<0.001) and MACE (adjusted HR 1.64, 95% CI 1.39 to 1.93, p<0.001). In those with diabetes, higher HbA1c levels were associated with increased MACE rates (adjusted HR (per 1% increase) 1.18, 95% CI 1.11 to 1.26, p<0.001) but not mortality (p=0.115). Subjects with two microvascular complications had significantly higher mortality and MACE compared with those with only either microvascular complication (adjusted p<0.05) and no microvascular complication (adjusted p<0.05). CONCLUSION Diabetes is a significant predictor of mortality and cardiovascular morbidity in Asian patients without prior cardiovascular disease. Among patients with type 2 diabetes, poorer glycemic control was associated with increased MACE but not mortality rates. Greater burden of microvascular complications identified a subset of patients with poorer outcomes.
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Affiliation(s)
- Jonathan Yap
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | | | - Wan Ting Tay
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Daniel Ting
- Department of Ophthalmology, Singapore Eye Research Institute, Singapore
- Duke-NUS Medical School, Singapore
| | - Carol Yim Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | | | - Ching-Yu Cheng
- Department of Ophthalmology, Singapore Eye Research Institute, Singapore
- Duke-NUS Medical School, Singapore
| | - Tien-Yin Wong
- Department of Ophthalmology, Singapore Eye Research Institute, Singapore
- Duke-NUS Medical School, Singapore
| | - Khung Keong Yeo
- Department of Cardiology, National Heart Centre Singapore, Singapore
- Duke-NUS Medical School, Singapore
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Khazai B, Adabifirouzjaei F, Guo M, Ipp E, Klein R, Klein B, Cotch MF, Wong TY, Swerdloff R, Wang C, Surampudi P, Kaufman J, Park C, Hendel R, Budoff MJ. Relation between Retinopathy and Progression of Coronary Artery Calcium in Individuals with Versus Without Diabetes Mellitus (From the Multi-Ethnic Study of Atherosclerosis). Am J Cardiol 2021; 149:1-8. [PMID: 33892913 PMCID: PMC11305521 DOI: 10.1016/j.amjcard.2021.03.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 02/24/2021] [Accepted: 03/02/2021] [Indexed: 10/21/2022]
Abstract
Retinopathy is a microvascular complication of diabetes mellitus (DM); however, it is also increasingly recognized in persons without DM. The microvascular diseases may play a prominent role in coronary heart disease (CHD) development in individuals with DM. We performed the study to evaluate the relation between non-DM retinopathy and CHD and also the association between baseline retinopathy and incidence and progression of CHD in individuals with and without DM. We included 5709 subjects with and without DM from the Multi-Ethnic Study of Atherosclerosis, who had retinal photos and coronary artery calcium score (CACS) available. We studied the association between baseline retinopathy and incidence and progression of coronary artery calcification (CAC) in subjects with and without DM. In DM group, the presence of retinopathy was significantly associated with an increased rate of CAC (RR 1.3 (95% CI [1.02, 1.66]) after adjusting for age, sex, race, follow-up time, and CHD risk factors. In non-DM group, the presence of retinopathy was not significantly associated with increased risk of CAC, however, the interaction between presence of retinopathy and DM status was not statistically significant. Within the DM group with CAC present at baseline, the presence of retinopathy was significantly associated with greater CAC progression (113 Agatson units (AU) greater, (95% CI [51-174]). In the non-DM group with present CAC at baseline; the presence of retinopathy was associated with 24 (95% CI [-0.69, 48.76]) AU higher CAC progression. All findings were adjusted for CHD risk factors. In conclusion, after adjustment for major CHD risk factors, retinopathy was associated with progression of CAC in both DM and non-DM individuals. However, the association was stronger in those with DM.
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Affiliation(s)
- Bahram Khazai
- Division of Cardiovascular Medicine, University of Miami, Miami, Florida.
| | - Fatemeh Adabifirouzjaei
- Sulpizio Cardiovascular Center, University of California at San Diego, San Diego, California
| | - Mengye Guo
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Eli Ipp
- Section of Diabetes and Metabolism, Harbor-UCLA Medical Center, University of California, Los Angeles, California
| | - Ronald Klein
- Department of Ophthalmology, University of Wisconsin Medical School, Madison, Wisconsin
| | - Barbara Klein
- Department of Ophthalmology, University of Wisconsin Medical School, Madison, Wisconsin
| | - Mary Frances Cotch
- Division of Epidemiology and Clinical Applications, National Eye Institute, Intramural Research Program, National Institutes of Health, Bethesda, Maryland
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
| | - Ronald Swerdloff
- Division of Endocrinology, Department of Medicine, David Geffen School of Medicine at UCLA, Torrance, California
| | - Christina Wang
- Division of Endocrinology, Department of Medicine, David Geffen School of Medicine at UCLA, Torrance, California
| | - Prasanth Surampudi
- Department of Internal Medicine, University of California, Davis, California
| | - Joel Kaufman
- Department of Environmental Health Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Claire Park
- Los Angeles Biomedical Research Institute at Harbor UCLA Medical Center, Torrance, California
| | - Robert Hendel
- Tulane University School of Medicine, Department of Medicine, Division of Cardiology, New Orleans, Louisiana
| | - Matthew J Budoff
- Los Angeles Biomedical Research Institute at Harbor UCLA Medical Center, Torrance, California
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Retinal changes in patients with angina pectoris and anginal equivalents: a study of patients with normal coronary angiography. ACTA ACUST UNITED AC 2021; 59:174-179. [PMID: 33565300 DOI: 10.2478/rjim-2020-0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Indexed: 11/21/2022]
Abstract
Background and aims. Approximately 10-30% of the patients with typical symptoms of angina pectoris have normal angiography showing normal macrovasculature. In these patients, however, the microvascular problems should be monitored. Hence, the main aim of this study is to evaluate retinal changes in normal angiographic patients.Methods. In this descriptive cross-sectional study, 60 normal angiographic patients with typical chest pain or anginal equivalents visiting Modarres Hospital Cardiology Research Center between 2018 and 2019 were enrolled and retinal changes were determined in Labbafinejad Hospital by Optical Coherence Tomography Angiography using Foveal Avascular Zone (FAZ), Superficial Vascular Density (SVD), and Deep Vascular Density (DVD).Results. The results of this study demonstrated that FAZ was normal in all subjects, but SVD and DVD were abnormal in 45% and 8.3%, respectively. Totally, 18.5% and 66.7% showed abnormal SVD among stable angina (SA) and unstable angina (UA) cases, respectively (P < 0.001). There was no statistically significant difference between abnormal DVD in SA and UA cases (P = 0.058). Abnormal SVD was significantly more common among diabetic patients (P < 0.001), while DVD was not related to diabetes presence in the study population (P > 0.05). Moreover, abnormal SVD was more common among patients with chest pain (P = 0.036), while there was no significant difference for DVD (P = 0.371). Interestingly, abnormal ECG was associated with both abnormal DVD and SVD.Conclusions. The results of this study showed that nearly half of the patients with angina pectoris or anginal equivalents who revealed normal angiographic findings may suffer from retinal changes. Thus, retinal assessment is needed in these patients to evaluate microvascular changes.
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Kaze AD, Santhanam P, Erqou S, Bertoni AG, Ahima RS, Echouffo-Tcheugui JB. Microvascular disease and cardiovascular outcomes among individuals with type 2 diabetes. Diabetes Res Clin Pract 2021; 176:108859. [PMID: 33989668 PMCID: PMC8627586 DOI: 10.1016/j.diabres.2021.108859] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 03/13/2021] [Accepted: 05/07/2021] [Indexed: 11/24/2022]
Abstract
AIM To evaluate the associations of microvascular disease (MVD) with incident cardiovascular disease (CVD) in individuals with type 2 diabetes. METHODS A total of 4098 participants with type 2 diabetes and without CVD were assessed for MVD (diabetic kidney disease, retinopathy or neuropathy) in the Look AHEAD (Action for Health in Diabetes) study. Cox models were used to generate hazard ratios (HRs) for: (1) CVD composite (myocardial infarction, stroke, hospitalization for angina and/or death from cardiovascular causes), (2) coronary artery disease (CAD), (3) stroke, and (4) CVD-related deaths. RESULTS Of 4098 participants, 34.7% (n = 1424) had MVD at baseline. Over a median of 9.5 years, 487 developed the CVD composite, 410 CAD events, 100 stroke, and 54 CVD-related deaths. After adjusting for relevant confounders, MVD was associated with increased risks of CVD composite (HR 1.34, 95% CI 1.11-1.61), CAD (HR 1.24, 95% CI 1.01-1.52), stroke (HR 1.55, 95% CI 1.03-2.33), and cardiovascular mortality (HR 1.26, 95% CI 0.72-2.22). HRs for CVD composite by type of MVD were 1.11 (95% CI 0.89-1.38), 1.63 (95% CI 1.22-2.17) and 1.16 (95% CI 0.92-1.46) for diabetic kidney disease, retinopathy, and neuropathy, respectively. CONCLUSIONS Our findings underscore the relevance of MVD in CVD risk assessment in type 2 diabetes.
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Affiliation(s)
- Arnaud D Kaze
- Department of Medicine, Division of Endocrinology, Diabetes & Metabolism, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Prasanna Santhanam
- Department of Medicine, University of Maryland Medical Center, Baltimore, MD, USA
| | - Sebhat Erqou
- Department of Medicine, Providence VA Medical Center and Alpert Medical School of Brown University, Providence, RI, USA
| | - Alain G Bertoni
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Rexford S Ahima
- Department of Medicine, University of Maryland Medical Center, Baltimore, MD, USA
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Dietary glutamic acid and aspartic acid as biomarkers for predicting diabetic retinopathy. Sci Rep 2021; 11:7244. [PMID: 33790305 PMCID: PMC8012375 DOI: 10.1038/s41598-021-83165-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 01/20/2021] [Indexed: 11/25/2022] Open
Abstract
The screening rate of diabetic retinopathy (DR) is low despite the importance of early diagnosis. We investigated the predictive value of dietary glutamic acid and aspartic acid for diagnosis of DR using the Korea National Diabetes Program cohort study. The 2067 patients with type 2 diabetes without DR were included. The baseline intakes of energy, glutamic acid and aspartic acid were assessed using a 3-day food records. The risk of DR incidence based on intake of glutamic acid and aspartic acid was analyzed. The DR group was older, and had higher HbA1c, longer DM duration, lower education level and income than non-DR group (all p < 0.05). The intake of total energy, glutamic acid and aspartic acid were lower in DR group than non-DR group (p = 0.010, p = 0.025 and p = 0.042, respectively). There was no difference in the risk of developing DR according to the intake of glutamic acid and ascorbic acid. But, aspartic acid intake had a negative correlation with PDR. Hence, the intake of glutamic acid and aspartic acid did not affect in DR incidence. However, lower aspartic acid intake affected the PDR incidence.
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Han G, Han J, Han K, Chung TY, Na KS, Lim DH. Relationships among visual acuity, risk of acute myocardial infarction, and stroke: a nationwide cohort study in south korea. Ophthalmic Epidemiol 2021; 29:57-69. [PMID: 33726622 DOI: 10.1080/09286586.2021.1893340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Purpose: Visual impairment (VI) is highly prevalent in the elderly and is associated with functional decline. Previous research demonstrated an association between VI and cardiovascular events, but investigations have yet to be conducted in general population samples. We evaluated the relationship between visual acuity (VA) and development of cardiovascular diseases (CVD) in a nationwide Korean population.Methods: This is a nationwide retrospective cohort study. We used the National Health Information Database of the National Health Insurance Service of Korea to identify subjects who participated in the National Health Insurance Service health screening program in 2012. We monitored 5,941,761 subjects for the development of cardiovascular diseases for a period of 5 years.Results: After adjustments for age, sex, and other covariates, with subjects having a visual acuity better than 20/20 as the reference group, the adjusted hazard ratios (HRs) and 95% confidential intervals (CI) for acute myocardial infarction and stroke were visual acuity between 20/20 and 20/60, 1.073 (95% CI 1.053, 1.094) and 1.151 (95% CI 1.132, 1.171), respectively; for visual acuity between 20/60 and 20/200, 1.236 (95% CI 1.197, 1.277), and 1.336 (95% CI 1.302, 1.371), respectively; and for visual acuity worse than 20/200, 1.325 (95% CI 1.285, 1.366) and 1.383 (95% CI 1.349, 1.418), respectively.Conclusion: Subjects with lower VA had higher risks of acute myocardial infarction and stroke. These results suggest that low VA is an independent risk factor for CVD.
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Affiliation(s)
- Gyule Han
- Department of Ophthalmology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Jisang Han
- Department of Ophthalmology, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Republic of Korea
| | - Kyungdo Han
- Department of Biostatistics, College of Medicine, the Catholic University of Korea, Seoul, Republic of Korea
| | - Tae-Young Chung
- Department of Ophthalmology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Kyung-Sun Na
- Department of Ophthalmology, College of Medicine, Yeouido St. Mary's Hospital, Seoul, Republic of Korea
| | - Dong Hui Lim
- Department of Ophthalmology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea.,Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea
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S. G, Gopi VP, Palanisamy P. A lightweight CNN for Diabetic Retinopathy classification from fundus images. Biomed Signal Process Control 2020; 62:102115. [DOI: 10.1016/j.bspc.2020.102115] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Gayathri S, Gopi VP, Palanisamy P. Automated classification of diabetic retinopathy through reliable feature selection. Phys Eng Sci Med 2020; 43:927-945. [PMID: 32648111 DOI: 10.1007/s13246-020-00890-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 06/23/2020] [Indexed: 02/08/2023]
Abstract
Diabetic retinopathy (DR) is a complication of diabetes mellitus that damages the blood vessels in the retina. DR is considered a serious vision-threatening impediment that most diabetic subjects are at risk of developing. Effective automatic detection of DR is challenging. Feature extraction plays an important role in the effective classification of disease. Here we focus on a feature extraction technique that combines two feature extractors, speeded up robust features and binary robust invariant scalable keypoints, to extract the relevant features from retinal fundus images. The selection of top-ranked features using the MR-MR (maximum relevance-minimum redundancy) feature selection and ranking method enhances the efficiency of classification. The system is evaluated across various classifiers, such as support vector machine, Adaboost, Naive Bayes, Random Forest, and multi-layer perception (MLP) when giving input image features extracted from standard datasets (IDRiD, MESSIDOR, and DIARETDB0). The performances of the classifiers were analyzed by comparing their specificity, precision, recall, false positive rate, and accuracy values. We found that when the proposed feature extraction and selection technique is used together with MLP outperforms all the other classifiers for all datasets in binary and multiclass classification.
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Affiliation(s)
- S Gayathri
- National Institute of Technology, Trichy, Tamilnadu, India
| | - Varun P Gopi
- National Institute of Technology, Trichy, Tamilnadu, India.
| | - P Palanisamy
- National Institute of Technology, Trichy, Tamilnadu, India
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48
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Risk factors for retinopathy in hemodialysis patients with type 2 diabetes mellitus. Sci Rep 2020; 10:14158. [PMID: 32843669 PMCID: PMC7447637 DOI: 10.1038/s41598-020-70998-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 08/04/2020] [Indexed: 11/09/2022] Open
Abstract
There is limited knowledge on the prevalence and risk factors of diabetic retinopathy (DR) in dialysis patients. We have investigated the association between diabetes mellitus and lipid-related biomarkers and retinopathy in hemodialysis patients. We reviewed 1,255 hemodialysis patients with type 2 diabetes mellitus (T2DM) who participated in the German Diabetes and Dialysis Study (4D Study). Associations between categorical clinical, biochemical variables and diabetic retinopathy were examined by logistic regression. On average, patients were 66 ± 8 years of age, 54% were male and the HbA1c was 6.7% ± 1.3%. DR, found in 71% of the patients, was significantly and positively associated with fasting glucose, HbA1c, time on dialysis, age, systolic blood pressure, body mass index and the prevalence of other microvascular diseases (e.g. neuropathy). Unexpectedly, DR was associated with high HDL cholesterol and high apolipoproteins AI and AII. Patients with coronary artery disease were less likely to have DR. DR was not associated with gender, smoking, diastolic blood pressure, VLDL cholesterol, triglycerides, and LDL cholesterol. In summary, the prevalence of DR in patients with type 2 diabetes mellitus requiring hemodialysis is higher than in patients suffering from T2DM, who do not receive hemodialysis. DR was positively related to systolic blood pressure (BP), glucometabolic control, and, paradoxically, HDL cholesterol. This data suggests that glucose and blood pressure control may delay the development of DR in patients with diabetes mellitus on dialysis.
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Simó R, Stehouwer CDA, Avogaro A. Diabetic retinopathy: looking beyond the eyes. Diabetologia 2020; 63:1662-1664. [PMID: 32556614 DOI: 10.1007/s00125-020-05195-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 05/08/2020] [Indexed: 01/30/2023]
Affiliation(s)
- Rafael Simó
- Diabetes and Metabolism Research Unit, Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain.
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Madrid, Spain.
| | - Coen D A Stehouwer
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Angelo Avogaro
- Section of Diabetes and Metabolic Diseases, Department of Medicine, University of Padova, Padova, Italy
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Abstract
Diabetes is one of the fastest growing diseases worldwide, projected to affect 693 million adults by 2045. Devastating macrovascular complications (cardiovascular disease) and microvascular complications (such as diabetic kidney disease, diabetic retinopathy and neuropathy) lead to increased mortality, blindness, kidney failure and an overall decreased quality of life in individuals with diabetes. Clinical risk factors and glycaemic control alone cannot predict the development of vascular complications; numerous genetic studies have demonstrated a clear genetic component to both diabetes and its complications. Early research aimed at identifying genetic determinants of diabetes complications relied on familial linkage analysis suited to strong-effect loci, candidate gene studies prone to false positives, and underpowered genome-wide association studies limited by sample size. The explosion of new genomic datasets, both in terms of biobanks and aggregation of worldwide cohorts, has more than doubled the number of genetic discoveries for both diabetes and diabetes complications. We focus herein on genetic discoveries for diabetes and diabetes complications, empowered primarily through genome-wide association studies, and emphasize the gaps in research for taking genomic discovery to the next level.
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Affiliation(s)
- Joanne B Cole
- Programs in Metabolism and Medical & Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Diabetes Unit and Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Division of Endocrinology and Center for Basic and Translational Obesity Research, Boston Children's Hospital, Boston, MA, USA
| | - Jose C Florez
- Programs in Metabolism and Medical & Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA.
- Diabetes Unit and Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA.
- Department of Medicine, Harvard Medical School, Boston, MA, USA.
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