title: Relations between Cardiac and Visual Phenotypes in Diabetes: A Multivariate Approach.
abstract: Cardiovascular disease and diabetes represent a major public health concern. The former is the most frequent cause of death and disability in patients with type 2 diabetes, where left ventricular dysfunction is highly prevalent. Moreover, diabetic retinopathy is becoming a dominant cause of visual impairment and blindness. The complex relation between cardiovascular disease and diabetic retinopathy as a function of ageing, obesity and hypertension remains to be clarified. Here, we investigated such relations in patients with diabetes type 2, in subjects with neither overt heart disease nor advanced proliferative diabetic retinopathy. We studied 47 patients and 50 controls, aged between 45 and 65 years, equally distributed according to gender. From the 36 measures regarding visual structure and function, and the 11 measures concerning left ventricle function, we performed data reduction to obtain eight new derived variables, seven of which related to the eye, adjusted for age, gender, body mass index and high blood pressure using both discriminant analysis (DA) and logistic regression (LR). We found moderate to strong correlation between left ventricle function and the eye constructs: minimum correlation was found for psychophysical motion thresholds (DA: 0.734; LR: 0.666), while the maximum correlation was achieved with structural volume density in the neural retina (DA: 0.786; LR: 0.788). Controlling the effect of pairwise correlated visual constructs, the parameters that were most correlated to left ventricle function were volume density in retina and thickness of the retinal nerve fiber layers (adjusted multiple R2 is 0.819 and 0.730 for DA and LR), with additional contribution of psychophysical loss in achromatic contrast discrimination. We conclude that visual structural and functional changes in type 2 diabetes are related to heart dysfunction, when the effects of clinical, demographic and associated risk factors are taken into account, revealing a genuine relation between cardiac and retinal diabetic phenotypes.
authors.affiliation: Laboratory of Biostatistics and Medical Informatics, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.|Institute for Biomedical Imaging and Life Sciences, University of Coimbra, Coimbra, Portugal.
authors.forename: Bárbara
authors.initials: B
authors.lastname: Oliveiros
authors.affiliation: Institute of Nuclear Sciences Applied to Health, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
authors.forename: Mafalda
authors.initials: M
authors.lastname: Sanches
authors.affiliation: Institute of Nuclear Sciences Applied to Health, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
authors.forename: Bruno
authors.initials: B
authors.lastname: Quendera
authors.affiliation: Medical Imaging Department, University Centre Hospitals of Coimbra, Coimbra, Portugal.
authors.forename: Bruno
authors.initials: B
authors.lastname: Graça
authors.affiliation: Endocrinology, Diabetes and Metabolism Department, University Centre Hospitals of Coimbra, Coimbra, Portugal.
authors.forename: Daniela
authors.initials: D
authors.lastname: Guelho
authors.affiliation: Endocrinology, Diabetes and Metabolism Department, University Centre Hospitals of Coimbra, Coimbra, Portugal.
authors.forename: Leonor
authors.initials: L
authors.lastname: Gomes
authors.affiliation: Endocrinology, Diabetes and Metabolism Department, University Centre Hospitals of Coimbra, Coimbra, Portugal.
authors.forename: Francisco
authors.initials: F
authors.lastname: Carrilho
authors.affiliation: Medical Imaging Department, University Centre Hospitals of Coimbra, Coimbra, Portugal.
authors.forename: Filipe
authors.initials: F
authors.lastname: Caseiro-Alves
authors.affiliation: Laboratory of Biostatistics and Medical Informatics, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.|Institute of Nuclear Sciences Applied to Health, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.|Institute for Biomedical Imaging and Life Sciences, University of Coimbra, Coimbra, Portugal.
authors.forename: Miguel
authors.identifier: http://orcid.org/0000-0003-4364-6373
authors.initials: M
authors.lastname: Castelo-Branco
mesh_terms: D000368:Aged; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000473:pathology; D016022:Case-Control Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000503:physiopathology*; D003930:Diabetic Retinopathy / Q000209:etiology* / Q000473:pathology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D010865:Pilot Projects; D011446:Prospective Studies