Diabetic retinopathy as an independent marker of cardiovascular disease in type 1 diabetes: Results from a nationwide longitudinal matched case-cohort study

Ditte Simmelkær Mabala, Lonny Stokholm, Nis Andersen, Jens Andresen, Toke Bek, Steffen Heegaard, Javad Hajari, Kurt Højlund, Ryo Kawasaki, Caroline Schmidt Laugesen, Sören Möller, Frederik Nørregaard Pedersen, Katja Christina Schielke, Anne Suhr Thykjaer, Jakob Grauslund*

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

PURPOSE: To investigate diabetic retinopathy (DR) as a potential marker of cardiovascular disease (CVD) in adults with type 1 diabetes attending the Danish DR-screening programme and non-diabetes adults.

METHODS: In this registry-based matched case-cohort study, we identified 16 547 adults with type 1 diabetes, who were registered in the Danish Registry of Diabetic Retinopathy (DiaBase). Each case was age- and sex-matched by five non-diabetes individuals (n = 82 399), and odds ratios (ORs) and hazard ratios (HRs) were estimated for incident and upcoming CVD in multivariable models.

RESULTS: Adults with type 1 diabetes (median age 44.5 years, 57.6% male) were more likely to have prevalent CVD (OR 1.29; 95% CI, 1.20-1.38) and to develop CVD within 5 years (HR 1.19; 95% CI, 1.08-1.30) as compared to non-diabetes control. However, adults without DR were less likely to develop CVD (HR 0.84; 95% CI, 0.72-0.97) compared to the reference population. For adults with type 1 diabetes, there was an increasing risk for incident CVD for increasing levels of DR (HR 1.33, 1.95, 1.71 and 2.39 for DR-levels 1-4, respectively). Patients with CVD at the time of the first screening had a higher risk to develop DR during follow-up (HR 1.23; 95% CI, 1.02-1.49).

CONCLUSION: In a nationwide matched case-cohort study adjusted for potential confounders, DR was identified as an independent marker of prevalent and incident CVD in type 1 diabetes with increasing risk demonstrated for higher levels of DR. Likewise, CVD also independently predicted the risk of incident DR.

Original languageEnglish
JournalActa Ophthamologica
ISSN1755-375X
DOIs
Publication statusE-pub ahead of print - 12 Feb 2024

Bibliographical note

© 2024 The Authors. Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation.

Keywords

  • cardiovascular disease
  • diabetic retinopathy
  • registry-based
  • screening
  • type 1 diabetes

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