Presenatation Five

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Presenatation Five

  1. 1. Diabetic Retinopathy and Increased Incidence of Cardiovascular Events in Type 2 Diabetic Patients G. Targher, L. Bertolini, L. Zenari, G. Lippi, I. Pichiri, G. Zoppini, M. Muggeo, G. Arcaro Section of Endocrinology, University of Verona, Verona, Italy Diabetes Unit,“Sacro Cuore” Hospital , Negrar (VR), Italy Targher G et al . Diabet Med 2008; 25: 45-50
  2. 2. INTRODUCTION <ul><li>The current information on the impact of diabetic retinopathy on the incidence of cardiovascular disease (CVD) in people with type 2 diabetes is limited and conflicting, especially with respect to possible sex differences in the association between diabetic retinopathy and CVD. </li></ul>
  3. 3. AIM OF THE STUDY Valpolicella Heart Diabetes Study <ul><li>To assess the predictive power of diabetic retinopathy for incidence of fatal and non-fatal CVD events in a large cohort of type 2 diabetic men and women who were followed for 7 years. </li></ul>
  4. 4. PATIENTS AND METHODS - 1 Valpolicella Heart Diabetes Study <ul><li>BASELINE. We enrolled all of the outpatients who regularly attended our diabetes clinic in the period January to December 2000 ( n = 2103 ; 66.3% of the entire cohort of patients), who were free of diagnosed CVD (myocardial infarction, stroke and coronary/peripheral revascularization procedures). </li></ul><ul><li>PERIODIC EXAMINATIONS. All participants were peridically examined to assess to assess the primary outcome: </li></ul><ul><li>Assessment of glycaemic control (every 4-6 months), diagnostic tests for the surveillance of chronic vascular complications (ECG, arterial Ecodoppler, etc), review of medical records of the hospital (diagnostic tests, clinic visits, etc). </li></ul><ul><li>DIABETIC RETINOPATHY was diagnosed by a single ophtalmologist by fundoscopy after pupillary dilation and classified into three categories: absent, non-proliferative retinopathy and proliferative/laser-treated retinopathy. Presence of proliferative retinopathy was confirmed by fundus fluorescein angiography in all participants. </li></ul><ul><li>FOLLOW-UP DURATION: 7 years (range: 5-89 months) </li></ul>
  5. 5. <ul><li>Primary Outcome (combined) : </li></ul><ul><ul><ul><li>Cardiovascular death </li></ul></ul></ul><ul><ul><ul><li>Non-fatal myocardial infarction </li></ul></ul></ul><ul><ul><ul><li>Non-fatal ischemic stroke </li></ul></ul></ul><ul><ul><ul><li>Coronary revascularization (PTCA and CABG) </li></ul></ul></ul>PATIENTS AND METHODS - 2 Valpolicella Heart Diabetes Study
  6. 6. 406 Cardiovascular Events during 7 years of follow-up Targher G et al . Diabet Med 2008; 25: 45-50
  7. 7. Stages of diabetic retinopathy by sex at baseline % Targher G et al . Diabet Med 2008; 25: 45-50
  8. 8. BASELINE CHARACTERISTICS Targher G et al . Diabet Med 2008; 25: 45-50
  9. 9. Association between Diabetic Retinopathy and incidence of CVD events in Men Model 1: adjusted for age, BMI, waist circumference, smoking, LDL-C, triglycerides, HbA1c, diabetes duration and medications (hypoglycemic, anti-hypertensive, lipid-lowering and anti-platelet drugs) Model 2: additionally adiusted for hypertension (  130/85 mmHg or on treatment) and nephropathy (eGFR  60 ml/min/1.73 m 2 and/or overt proteinuria) Non-proliferative Proliferative/laser-treated Targher G et al . Diabet Med 2008; 25: 45-50
  10. 10. Non-proliferative Proliferative/laser-treated Association between Diabetic Retinopathy and incidence of CVD events in Women Model 1: adjusted for age, BMI, waist circumference, smoking, LDL-C, triglycerides, HbA1c, diabetes duration and medications (hypoglycemic, anti-hypertensive, lipid-lowering and anti-platelet drugs) Model 2: additionally adiusted for hypertension (  130/85 mmHg or on treatment) and nephropathy (eGFR  60 ml/min/1.73 m 2 and/or overt proteinuria) Targher G et al . Diabet Med 2008; 25: 45-50
  11. 11. CONCLUSIONS OF THE STUDY Valpolicella Heart Diabetes Study <ul><li>Diabetic retinopathy, especially in its more advanced stages, is associated with an increased incidence of major CVD events during a 7-year follow-up period, in both type 2 diabetic men and women. </li></ul><ul><li>This association appears to be independent of numerous baseline confounding factors. </li></ul><ul><li>These findings suggest that retinal vessel characteristics may be informative about the risk of CVD in type 2 diabetic individuals, and further emphasize the clinical importance of determining global CVD risk in those with diabetic retinopathy. </li></ul>

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