Retinal vessel caliber and microvascular and macrovascular disease in type 2 diabetes: XXI: the Wisconsin Epidemiologic Study of Diabetic Retinopathy.
OBJECTIVE
To describe the relationship of retinal arteriolar and venular calibers to the long-term incidence of microvascular and macrovascular complications in people with type 2 diabetes.


METHODS
Population-based prospective study.


METHODS
One thousand three hundred seventy persons diagnosed to have diabetes at > or =30 years of age in south central Wisconsin participated in the baseline examination from 1980 to 1982, 987 in the 4-year follow-up, and 533 in the 10-year follow-up.


METHODS
Computer-assisted grading was used to determine the average caliber of retinal arterioles (central retinal arteriolar equivalent [CRAE]) and retinal venules (central retinal venular equivalent [CRVE]) at all examinations.


METHODS
Incidence and progression of diabetic retinopathy; incidence of proliferative diabetic retinopathy and macular edema; incidence of nephropathy, neuropathy, and lower extremity amputation; and ischemic heart disease, stroke, and overall mortality.


RESULTS
While adjusting for other factors, smaller CRAE was associated with the 14-year cumulative incidence of lower extremity amputation (odds ratio [OR], first vs. second to fourth quartiles, 2.20; 95% confidence interval [CI], 1.14-4.24; P = 0.02), 22-year all-cause mortality (hazard ratio [HR], 1.18; 95% CI, 1.02-1.38; P = 0.03), and 22-year stroke mortality (HR, 1.47; 95% CI, 1.04-2.07; P = 0.03) but not with the other end points. Larger CRVE was associated with the 14-year incidence of diabetic nephropathy (OR, fourth vs. first to third quartiles, 2.08; 95% CI, 1.47-2.94; P<0.001) and 22-year stroke mortality (HR, 1.71; 95% CI, 1.20-2.44; P = 0.003) but with none of the other end points.


CONCLUSIONS
Retinal vessel caliber is independently associated with risk of incident nephropathy, lower extremity amputation, and stroke mortality in persons with type 2 diabetes. Measurement of retinal vessel caliber from photographs may provide additional information for the prediction of these events.
Klein
Ronald
R
Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin 53726-2336, USA. Kleinr@epi.ophth.wisc.edu
Klein
Barbara E K
BE
Moss
Scot E
SE
Wong
Tien Y
TY
D000671:Amputation, Surgical / Q000706:statistics & numerical data; D001160:Arterioles / Q000473:pathology; D002423:Cause of Death; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000453:epidemiology*; D003928:Diabetic Nephropathies / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D003929:Diabetic Neuropathies / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D003930:Diabetic Retinopathy / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D018450:Disease Progression; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008269:Macular Edema / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000401:mortality; D011446:Prospective Studies; D012161:Retinal Artery / Q000473:pathology*; D012169:Retinal Vein / Q000473:pathology*; D012307:Risk Factors; D020521:Stroke / Q000401:mortality; D014699:Venules / Q000473:pathology; D014922:Wisconsin / Q000453:epidemiology