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May 27, 2007
Diabetic retinopathy linked to ischemic stroke risk
Eyeworld May 2007
The Wisconsin Epidemiological Study of Diabetic Retinopathy found proliferative retinopathy was associated with incident stroke and stroke mortality in participants with Type 2 diabetes, Dr. Wong noted in the analysis. However, that study did not find an association of mild and moderate retinopathy with incident stroke, he added. Another study, the United Kingdom Prospective Diabetes Study, concluded retinopathy was not a significant risk factor for stroke, Dr. Wong noted.“Unlike ischemic strokes in nondiabetic individuals, the contribution of large vessel disease to diabetic ischemic stroke may be less important. Autopsy studies indicate that diabetic strokes are commonly related to cerebral microvascular disease,” the researchers said in the analysis. A separate study from the University of Kuopio in Finland found proliferative retinopathy was significantly associated with death, increasing the risks of all-cause, cardiovascular and coronary heart disease mortality by 3.05-, 3.32- and 2.54-fold, respectively. The risks for death were also elevated in women with background retinopathy as well, according to Markku Laakso, M.D., who reported the findings in Diabetes Care.Investigators followed 824 Finnish patients (425 men and 399 women) for 18 years; none had cardiovascular disease at baseline.
The associations the Finnish group found “were independent of current smoking, hypertension, total cholesterol, HDL cholesterol, glycemic control of diabetes, duration of diabetes, and proteinuria. This suggests the presence of common background pathways for diabetic microvascular and macrovascular disease other than those included in the conventional risk assessment of cardiovascular disease.”
What ophthalmologists can do
“Retinal specialists and ophthalmologists in general should be aware that patients with diabetes who have signs of retinopathy, even mild retinopathy, are at higher risk of ischemic stroke,” Dr. Wong said.
He also recommended ophthalmologists refer patients with retinopathy to their primary physician “for a careful stroke risk assessment and for the patients’ physicians to start risk reduction therapy in people with retinopathy.”
Posted by mehdi khanlari at May 27, 2007 11:40 PM