title: The degree of retinopathy is equally predictive for renal and macrovascular outcomes in the ACCORD Trial.
abstract: OBJECTIVE
  Diabetic retinopathy (DR) is associated with a higher risk of renal and cardiovascular events. We sought to compare the risk for renal versus cardiovascular (CV) outcomes, stratified by retinopathy severity.
  
  
  METHODS
  ACCORD was a randomized trial of people with type 2 diabetes, at high-risk for CV disease. A subgroup (n=3,369 from 71 clinics) had stereoscopic fundus photographs graded centrally. Participants were stratified at baseline to moderate/severe DR or no/mild DR and were monitored for renal and CV outcomes at follow-up visits over 4 years. The composite renal outcome was composed of serum creatinine doubling, macroalbuminuria, or end-stage renal disease. The composite CV outcome was the ACCORD trial primary outcome. Competing risk techniques were used to estimate the relative risk (RR) of renal versus CV composite outcomes within each DR stratum.
  
  
  RESULTS
  The hazards ratio for doubling of serum creatinine and incident CV event in the moderate/severe DR versus no/mild DR strata were: 2.31 (95% CI: 1.25-4.26) and 1.98 (95% CI: 1.49-2.62), respectively. The RR of the two composite outcomes was highly similar in the no/mild DR stratum (adjusted RR at 4 years for CV versus renal events=0.96, 95% CI: 0.72-1.28) and the moderate/severe DR stratum (adjusted RR=0.92, 95% CI: 0.64-1.31).
  
  
  CONCLUSIONS
  Thus, in people with type 2 diabetes at high risk for cardiovascular disease, incident CV versus renal events was similar, irrespective of the severity of the DR. Further evaluation of the specificity of DR for microvascular versus macrovascular events in other populations is warranted.
authors.affiliation: Division of Nephrology and Hypertension, University of North Carolina School of Medicine, Chapel Hill, NC. Electronic address: amy_mottl@med.unc.edu.
authors.forename: Amy K
authors.initials: AK
authors.lastname: Mottl
authors.affiliation: Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Pajewski
authors.affiliation: Tulane University School of Medicine, New Orleans, LA.
authors.forename: Vivian
authors.initials: V
authors.lastname: Fonseca
authors.affiliation: Case Western Reserve University and Cleveland VA Medical Center, Cleveland, OH.
authors.forename: Faramarz
authors.initials: F
authors.lastname: Ismail-Beigi
authors.affiliation: National Eye Institute, National Institutes of Health, Bethesda, MD.
authors.forename: Emily
authors.initials: E
authors.lastname: Chew
authors.affiliation: Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC.
authors.forename: Walter T
authors.initials: WT
authors.lastname: Ambrosius
authors.affiliation: Department of Ophthalmology, Wake Forest School of Medicine, Winston-Salem, NC.
authors.forename: Craig
authors.initials: C
authors.lastname: Greven
authors.affiliation: North Bronx Healthcare Network and Albert Einstein College of Medicine, Bronx, NY.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Schubart
authors.affiliation: Division of Endocrinology, University of North Carolina School of Medicine, Chapel Hill, NC.
authors.forename: John
authors.initials: J
authors.lastname: Buse
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D003925:Diabetic Angiopathies / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D003928:Diabetic Nephropathies / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D003930:Diabetic Retinopathy / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000473:pathology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D012720:Severity of Illness Index
keywords: Albuminuria; Macrovascular; Microvascular; Nephropathy; Retinopathy