title: Adverse association between diabetic retinopathy and cardiac structure and function.
abstract: BACKGROUND
  Recent work has demonstrated a link between retinopathy, a marker of microvascular disease, and the development of heart failure, a finding particularly relevant in individuals with diabetes. Our objective was to assess the relationship between retinopathy and cardiac structure and function in a cohort of individuals with type 2 diabetes mellitus.
  
  
  METHODS
  Stereoscopic fundus photography of 7 standard fields was obtained in 531 Mexican American adults with type 2 diabetes mellitus recruited as sibships from Starr County, Texas. Retinopathy was centrally scored and classified as no retinopathy, early nonproliferative diabetic retinopathy, moderate to severe nonproliferative diabetic retinopathy, or proliferative diabetic retinopathy. Echocardiography was used to assess cardiac structure and function. Multilevel mixed models were used to assess associations of clinical and echocardiographic variables with retinopathy while accounting for correlations among siblings.
  
  
  RESULTS
  More severe diabetic retinopathy was associated with the presence of hypertension, previous cardiovascular disease, longer duration of diabetes, elevated glycosylated hemoglobin, and greater albuminuria. With worsening severity of diabetic retinopathy, left ventricular (LV) mass and left atrial dimension increased, and LV ejection fraction and LV fractional shortening decreased, independent of potential confounding variables.
  
  
  CONCLUSIONS
  More severe diabetic retinopathy was associated with worse cardiac structure and function by echocardiography independent of potential confounding variables. These data suggest a possible microvascular contribution to the development of diabetes-associated cardiac enlargement and dysfunction. Alternatively, common pathways may be leading to both disorders.
authors.affiliation: Winters Center for Heart Failure Research and Section of Cardiology, Baylor College of Medicine, Houston, TX 77030, USA. daguilar@bcm.edu
authors.forename: David
authors.initials: D
authors.lastname: Aguilar
authors.forename: D Michael
authors.initials: DM
authors.lastname: Hallman
authors.forename: Linda B
authors.initials: LB
authors.lastname: Piller
authors.forename: Barbara E K
authors.initials: BE
authors.lastname: Klein
authors.forename: Ronald
authors.initials: R
authors.lastname: Klein
authors.forename: Richard B
authors.initials: RB
authors.lastname: Devereux
authors.forename: Donna K
authors.initials: DK
authors.lastname: Arnett
authors.forename: Victor H
authors.initials: VH
authors.lastname: Gonzalez
authors.forename: Craig L
authors.initials: CL
authors.lastname: Hanis
mesh_terms: D000368:Aged; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000453:epidemiology* / Q000503:physiopathology; D003925:Diabetic Angiopathies / Q000453:epidemiology* / Q000503:physiopathology; D003930:Diabetic Retinopathy / Q000145:classification / Q000453:epidemiology* / Q000503:physiopathology; D015150:Echocardiography, Doppler; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging; D006333:Heart Failure / Q000453:epidemiology*; D006346:Heart Septum / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D018487:Ventricular Dysfunction, Left / Q000453:epidemiology