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Association of Diabetic Macular Edema and Proliferative Diabetic Retinopathy With Cardiovascular Disease: A Systematic Review and Meta-analysis.

Publication ,  Journal Article
Xie, J; Ikram, MK; Cotch, MF; Klein, B; Varma, R; Shaw, JE; Klein, R; Mitchell, P; Lamoureux, EL; Wong, TY
Published in: JAMA Ophthalmol
June 1, 2017

IMPORTANCE: Previous studies on the relationship between diabetic retinopathy (DR) and cardiovascular disease (CVD) focused on the early stages of DR. Understanding whether patients with type 2 diabetes and severe stages of DR (diabetic macular edema [DME] and proliferative diabetic retinopathy [PDR]) have a higher risk of CVD will allow physicians to more effectively counsel patients. OBJECTIVE: To examine the association of severe stages of DR (DME and PDR) with incident CVD in patients with type 2 diabetes. DATA SOURCES: English-language publications were reviewed for articles evaluating the relationship of DR and CVD in MEDLINE, EMBASE, Current Contents, and the Cochrane Library from inception (January 1, 1950) to December 31, 2014, using the search terms diabetic retinopathy OR macular edema AND stroke OR cerebrovascular disease OR coronary artery disease OR heart failure OR myocardial infarction OR angina pectoris OR acute coronary syndrome OR coronary artery disease OR cardiomyopathy. STUDY SELECTION: Among 656 studies screened for eligibility, 7604 individuals were included from 8 prospective population-based studies with data on photographic-based DR grading, follow-up visits, and well-defined incident CVD end point. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers conducted a systematic search of the 4 databases, and a single pooled database was developed. Incidence rate ratios (IRRs) were estimated for patients with DME, PDR, and vision-threatening DR, compared with persons without these conditions, by using individual participant data followed by a standard inverse-variance meta-analysis (2-step analysis). The review and analyses were performed from January 1, 2009, to January 1, 2017. MAIN OUTCOME AND MEASURES: Incident CVD, including coronary heart disease, stroke, or death from cardiovascular causes. RESULTS: Among 7604 patients with type 2 diabetes, the prevalence of DME was 4.6% and PDR, 7.4%. After a mean follow-up of 5.9 years (range, 3.2-10.1 years), 1203 incident CVD events, including 916 coronary heart disease cases, were reported. Persons with DME or PDR were more likely to have incident CVD (IRR, 1.39; 95% CI, 1.16-1.67) and fatal CVD (IRR, 2.33; 95% CI, 1.49-3.67) compared with those without DME or PDR. CONCLUSIONS AND RELEVANCE: Patients with type 2 diabetes and DME or PDR have an increased risk of incident CVD, which suggests that these persons should be followed up more closely to prevent CVD.

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Published In

JAMA Ophthalmol

DOI

EISSN

2168-6173

Publication Date

June 1, 2017

Volume

135

Issue

6

Start / End Page

586 / 593

Location

United States

Related Subject Headings

  • Risk Factors
  • Macular Edema
  • Incidence
  • Humans
  • Global Health
  • Diabetic Retinopathy
  • Cardiovascular Diseases
  • 3212 Ophthalmology and optometry
 

Citation

APA
Chicago
ICMJE
MLA
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Xie, J., Ikram, M. K., Cotch, M. F., Klein, B., Varma, R., Shaw, J. E., … Wong, T. Y. (2017). Association of Diabetic Macular Edema and Proliferative Diabetic Retinopathy With Cardiovascular Disease: A Systematic Review and Meta-analysis. JAMA Ophthalmol, 135(6), 586–593. https://doi.org/10.1001/jamaophthalmol.2017.0988
Xie, Jing, M Kamran Ikram, Mary Frances Cotch, Barbara Klein, Rohit Varma, Jonathan E. Shaw, Ronald Klein, Paul Mitchell, Ecosse L. Lamoureux, and Tien Yin Wong. “Association of Diabetic Macular Edema and Proliferative Diabetic Retinopathy With Cardiovascular Disease: A Systematic Review and Meta-analysis.JAMA Ophthalmol 135, no. 6 (June 1, 2017): 586–93. https://doi.org/10.1001/jamaophthalmol.2017.0988.
Xie J, Ikram MK, Cotch MF, Klein B, Varma R, Shaw JE, et al. Association of Diabetic Macular Edema and Proliferative Diabetic Retinopathy With Cardiovascular Disease: A Systematic Review and Meta-analysis. JAMA Ophthalmol. 2017 Jun 1;135(6):586–93.
Xie, Jing, et al. “Association of Diabetic Macular Edema and Proliferative Diabetic Retinopathy With Cardiovascular Disease: A Systematic Review and Meta-analysis.JAMA Ophthalmol, vol. 135, no. 6, June 2017, pp. 586–93. Pubmed, doi:10.1001/jamaophthalmol.2017.0988.
Xie J, Ikram MK, Cotch MF, Klein B, Varma R, Shaw JE, Klein R, Mitchell P, Lamoureux EL, Wong TY. Association of Diabetic Macular Edema and Proliferative Diabetic Retinopathy With Cardiovascular Disease: A Systematic Review and Meta-analysis. JAMA Ophthalmol. 2017 Jun 1;135(6):586–593.

Published In

JAMA Ophthalmol

DOI

EISSN

2168-6173

Publication Date

June 1, 2017

Volume

135

Issue

6

Start / End Page

586 / 593

Location

United States

Related Subject Headings

  • Risk Factors
  • Macular Edema
  • Incidence
  • Humans
  • Global Health
  • Diabetic Retinopathy
  • Cardiovascular Diseases
  • 3212 Ophthalmology and optometry