title: Impact of Diabetic Retinopathy on Vulnerability of Atherosclerotic Coronary Plaque and Incidence of Acute Coronary Syndrome.
abstract: Although an association has been reported between the microvascular complications of diabetic patients and their poor prognosis after cardiovascular events related to advanced atherosclerosis, it is not clear whether there is a relation between diabetic retinopathy (DR) and the severity of plaque vulnerability. Fifty-seven diabetic patients with coronary artery disease, classified as non-DR (n = 42) or DR (n = 15), underwent angioscopic observation of at least 1 entire coronary artery. The number of yellow plaques (NYP) through the observed coronary artery was counted and their color grades, defined as 1 (light yellow), 2 (yellow), or 3 (intense yellow), were evaluated. The NYP per vessel and the maximum yellow grade were determined. The association between the presence of DR and incidences of acute coronary syndrome (ACS) was analyzed during the follow-up period (mean 7.1 ± 3.3 years; range, 0.83 to 11.75 years). Mean NYP per vessel and maximum yellow grade were significantly greater in DR than in non-DR patients (2.08 ± 1.01 vs 1.26 ± 0.77, p = 0.002, and 2.40 ± 0.74 vs 1.90 ± 0.82, p = 0.044, respectively). The cumulative incidences of ACS were higher in the DR group (p = 0.004), and the age-adjusted hazard ratio for ACS was 6.943 (95% CI 1.267 to 38.054; p = 0.026) for DR compared with non-DR patients. Our findings indicate that coronary atherosclerosis and plaque vulnerability are more severe in patients with DR. DR as a microvascular complication may be directly linked with macrovascular plaque vulnerability and fatal cardiovascular events such as ACS.
authors.affiliation: Cardiovascular Center, Nippon Medical School Chiba-Hokusoh Hospital, Chiba, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Kurihara
authors.affiliation: Cardiovascular Center, Nippon Medical School Chiba-Hokusoh Hospital, Chiba, Japan. Electronic address: takanom@nms.ac.jp.
authors.forename: Masamichi
authors.initials: M
authors.lastname: Takano
authors.affiliation: Division of Cardiology, Nippon Medical School, Tokyo, Japan.
authors.forename: Kyoichi
authors.initials: K
authors.lastname: Mizuno
authors.affiliation: Cardiovascular Center, Nippon Medical School Chiba-Hokusoh Hospital, Chiba, Japan.
authors.forename: Yusaku
authors.initials: Y
authors.lastname: Shibata
authors.affiliation: Cardiovascular Center, Nippon Medical School Chiba-Hokusoh Hospital, Chiba, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Matsushita
authors.affiliation: Cardiovascular Center, Nippon Medical School Chiba-Hokusoh Hospital, Chiba, Japan.
authors.forename: Hidenori
authors.initials: H
authors.lastname: Komiyama
authors.affiliation: Cardiovascular Center, Nippon Medical School Chiba-Hokusoh Hospital, Chiba, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Yamamoto
authors.affiliation: Cardiovascular Center, Nippon Medical School Chiba-Hokusoh Hospital, Chiba, Japan.
authors.forename: Katsuhito
authors.initials: K
authors.lastname: Kato
authors.affiliation: Cardiovascular Center, Nippon Medical School Chiba-Hokusoh Hospital, Chiba, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Munakata
authors.affiliation: Cardiovascular Center, Nippon Medical School Chiba-Hokusoh Hospital, Chiba, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Murakami
authors.affiliation: Cardiovascular Center, Nippon Medical School Chiba-Hokusoh Hospital, Chiba, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Okamatsu
authors.affiliation: Cardiovascular Center, Nippon Medical School Chiba-Hokusoh Hospital, Chiba, Japan.
authors.forename: Noritake
authors.initials: N
authors.lastname: Hata
authors.affiliation: Cardiovascular Center, Nippon Medical School Chiba-Hokusoh Hospital, Chiba, Japan.
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Seino
authors.affiliation: Division of Cardiology, Nippon Medical School, Tokyo, Japan.
authors.forename: Wataru
authors.initials: W
authors.lastname: Shimizu
mesh_terms: D054058:Acute Coronary Syndrome / Q000453:epidemiology*; D000368:Aged; D017546:Angioscopy; D015331:Cohort Studies; D015897:Comorbidity; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000453:epidemiology*; D003920:Diabetes Mellitus / Q000453:epidemiology*; D003930:Diabetic Retinopathy / Q000000981:diagnostic imaging / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging / Q000453:epidemiology*; D011379:Prognosis; D016016:Proportional Hazards Models; D012171:Retinal Vessels / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D012720:Severity of Illness Index