Diabetic retinopathy is associated with an increased incidence of cardiovascular events in Type 2 diabetic patients

Microvascular disease and cardiovascular outcomes among individuals with type 2 diabetes

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.

Role of ellagic acid for the prevention and treatment of liver diseases

Globally, one of the alarming problems is the prevalence and burden of liver diseases, which accounts for 2 million cases per year. Chronic liver aetiologies such as hepatitis infections, alcoholic or non-alcoholic liver disease, environmental agents, and drug-induced toxicity are invariably responsible for liver fibrosis progression to finally hepatocellular carcinoma. Current treatment options are unable to overwhelm and cure liver diseases. Emerging findings suggest researchers' interest in using evidence-based complementary medicine such as ellagic acid with extensive pharmacological properties. They include antioxidant, anti-inflammatory, anti-hyperlipidaemic, anti-viral, anti-angiogenic, and anticancer activity. The molecular functions elicited by ellagic acid include scavenging of free radicals, regulation of lipid metabolism, the prohibition of fibrogenesis response-mediating proteins, inhibits hepatic stellate cells and myofibroblasts, restrains hepatic viral replication, facilitates suppression of growth factors, regulates transcription factors, proinflammatory cytokines, augments the liver immune response, fosters apoptosis and inhibits cell proliferation in tumorigenic cells. This review will most notably focus on preclinical and clinical information based on currently available evidence to warrant ellagic acid's prospective role in preventing liver diseases.

Risk of cardiovascular diseases is increased even with mild diabetic retinopathy: the Japan Diabetes Complications Study

OBJECTIVE

Diabetic retinopathy (DR) is linked to cardiovascular risk in diabetic patients. This study examined whether mild-stage DR is associated with risk of coronary heart disease (CHD) and stroke in type 2 diabetic patients of the Japan Diabetes Complications Study (JDCS).

DESIGN

Prospective cohort study.

PARTICIPANTS

In the JDCS, there were 2033 Japanese persons with type 2 diabetes free of cardiovascular diseases at baseline.

METHODS

Diabetic retinopathy was ascertained from clinical and photographic grading (70%) following the international clinical diabetic retinopathy and diabetic macular edema disease severity scales. Incident CHD and stroke were followed up prospectively annually up to 8 years.

MAIN OUTCOME MEASURES

Eight-year incidence of CHD and stroke compared between persons with or without DR.

RESULTS

After adjusting for traditional cardiovascular risk factors, persons with mild to moderate nonproliferative DR had a higher risk of CHD (hazard ratio [HR], 1.69; 95% confidence interval [CI], 1.17-2.97) and stroke (HR, 2.69; 95% CI, 1.03-4.86). Presence of retinal hemorrhages or microaneurysms was associated with risk of CHD (HR, 1.63; 95% CI, 1.04-2.56) but was not associated with stroke (P = 0.06). Presence of cotton-wool spots was associated with risk of incident stroke (HR, 2.39; 95% CI, 1.35-4.24) but was not associated with CHD (P = 0.66). When information about DR was added in the prediction models for CHD and stroke based on traditional cardiovascular risk factors, the area under the receiver operating curve improved from 0.682 to 0.692 and 0.640 to 0.677, and 9% and 13% of persons were reclassified correctly for CHD and stroke, respectively.

CONCLUSIONS

Type 2 diabetic patients with even a mild stage of DR, such as dot hemorrhages, are already at higher risk of CHD and stroke independent of traditional risk factors.