title: Prevalence and Cardiovascular Associations of Diabetic Retinopathy and Maculopathy: Results from the Gutenberg Health Study.
abstract: OBJECTIVE
  Diabetic retinopathy (DR) is the leading cause of blindness in people of working age. The purpose of this paper is to report the prevalence and cardiovascular associations of diabetic retinopathy and maculopathy (DMac) in Germany.
  
  
  METHODS
  The Gutenberg Health Study (GHS) is a population-based study with 15,010 participants aged between 35 at 74 years from the city of Mainz and the district of Mainz-Bingen. We determined the weighted prevalence of DR and DMac by assessing fundus photographs of persons with diabetes from the GHS data base. Diabetes was defined as HbA1c ≥ 6.5%, known diagnosis diabetes mellitus or known diabetes medication. Furthermore, we analysed the association between DR and cardiovascular risk factors and diseases.
  
  
  RESULTS
  Overall, 7.5% (1,124/15,010) of the GHS cohort had diabetes. Of these, 27.7% were unaware of their disease and thus were newly diagnosed by their participation in the GHS. The prevalence of DR and DMac was 21.7% and 2.3%, respectively among patients with diabetes. Vision-threatening disease was present in 5% of the diabetic cohort. In the multivariable analysis DR (all types) was associated with age (Odds Ratio [95% confidence interval]: 0.97 [0.955-0.992]; p = 0.006) arterial hypertension (1.90 [1.190-3.044]; p = 0.0072) and vision-threatening DR with obesity (3.29 [1.504-7.206]; p = 0.0029). DR (all stages) and vision-threatening DR were associated with duration of diabetes (1.09 [1.068-1.114]; p<0.0001 and 1.18 [1.137-1.222]; p<0.0001, respectively).
  
  
  CONCLUSIONS
  Our calculations suggest that approximately 142 000 persons aged between 35 and 74 years have vision threatening diabetic retinal disease in Germany [corrected].Prevalence of DR was lower in the GHS compared to East-Asian studies. Associations were found with age, arterial hypertension, obesity, and duration of diabetes mellitus.
authors.affiliation: Department of Ophthalmology, University Medical Center, Mainz, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Raum
authors.affiliation: Department of Ophthalmology, University Medical Center, Mainz, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Lamparter
authors.affiliation: Department of Ophthalmology, University Medical Center, Mainz, Germany; Center for thrombosis & haemostasis (CTH), University Medical Center, Mainz, Germany.
authors.forename: Katharina A
authors.initials: KA
authors.lastname: Ponto
authors.affiliation: NIHR Biomedical Research Center at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom.
authors.forename: Tunde
authors.initials: T
authors.lastname: Peto
authors.affiliation: Department of Ophthalmology, University Medical Center, Mainz, Germany.
authors.forename: René
authors.initials: R
authors.lastname: Hoehn
authors.affiliation: Biomedical statistics, University Medical Center, Mainz, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Schulz
authors.affiliation: Biomedical statistics, University Medical Center, Mainz, Germany.
authors.forename: Astrid
authors.initials: A
authors.lastname: Schneider
authors.affiliation: Center for thrombosis & haemostasis (CTH), University Medical Center, Mainz, Germany; Department of Medicine II, University Medical Center, Mainz, Germany; German Center for Heart and Circulations System Research (DZHK), University Medical Center, Mainz, Germany.
authors.forename: Philipp S
authors.initials: PS
authors.lastname: Wild
authors.affiliation: Department of Ophthalmology, University Medical Center, Mainz, Germany.
authors.forename: Norbert
authors.initials: N
authors.lastname: Pfeiffer
authors.affiliation: Department of Ophthalmology, University Medical Center, Mainz, Germany; Dardenne Eye Hospital, Bonn, Germany.
authors.forename: Alireza
authors.initials: A
authors.lastname: Mirshahi
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000150:complications*; D015331:Cohort Studies; D015897:Comorbidity; D003930:Diabetic Retinopathy / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012164:Retinal Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*; D012307:Risk Factors