title: Diabetic retinopathy and risk of heart failure.
abstract: OBJECTIVE
  The purpose of this study was to examine the association of diabetic retinopathy with incident heart failure (HF).
  
  
  BACKGROUND
  Microvascular disease might play a more prominent role in the pathogenesis of diabetic cardiomyopathy, a major cause of HF in diabetes. Whether diabetic retinopathy, a microvascular complication of diabetes, predicts HF is unclear.
  
  
  METHODS
  A population-based study included 1,021 middle-aged type 2 diabetic persons with normal renal function and free of clinical coronary heart disease or HF at baseline. Diabetic retinopathy signs were graded from retinal photographs. Incident HF events were prospectively identified from hospital stay and death records.
  
  
  RESULTS
  There were 125 (12.8%) participants with diabetic retinopathy. After 9-year follow-up, 106 (10.1%) participants developed incident HF events. Persons with retinopathy were more likely to develop HF (cumulative incidence of 21.6%) than those without retinopathy (cumulative incidence of 8.5%). After controlling for age, gender, race, smoking, diabetes duration, insulin use, blood pressure, lipid profile, and other risk factors, participants with retinopathy had more than 2.5-fold higher risk of developing HF than those without retinopathy (hazard ratio [HR] 2.71; 95% confidence interval [CI] 1.46 to 5.05). This association remained significant after further adjustments for glycemic control, carotid atherosclerosis, and serum markers of endothelial dysfunction (HR 2.20, 95% CI 1.08 to 4.47).
  
  
  CONCLUSIONS
  The presence of diabetic retinopathy signifies an excess risk of HF, independent of known risk factors. This further supports a contribution of microvascular disease to the development of HF in people with diabetes.
authors.affiliation: Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia.
authors.forename: Ning
authors.initials: N
authors.lastname: Cheung
authors.forename: Jie J
authors.initials: JJ
authors.lastname: Wang
authors.forename: Sophie L
authors.initials: SL
authors.lastname: Rogers
authors.forename: Frederick
authors.initials: F
authors.lastname: Brancati
authors.forename: Ronald
authors.initials: R
authors.lastname: Klein
authors.forename: A Richey
authors.initials: AR
authors.lastname: Sharrett
authors.forename: Tien Y
authors.initials: TY
authors.lastname: Wong
mesh_terms: D009202:Cardiomyopathies / Q000150:complications; D016001:Confidence Intervals; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000503:physiopathology*; D003930:Diabetic Retinopathy / Q000150:complications*; D004727:Endothelium / Q000503:physiopathology; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006304:Health Status; D006305:Health Status Indicators; D006333:Heart Failure / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D006442:Glycated Hemoglobin