Assessing the risk of heart failure in patients with diabetic retinopathy with type 2 diabetes mellitus
DOI:
https://doi.org/10.18203/2349-3933.ijam20253348Keywords:
Type 2 diabetes mellitus, Diabetic retinopathy, Heart failure, HFrEF, Cardiovascular risk, Microvascular complicationsAbstract
Background: Type 2 diabetes mellitus (T2DM) is associated with both microvascular and macrovascular complications, notably diabetic retinopathy (DR) and heart failure (HF), respectively. While DR is a well-established marker of retinal microangiopathy, emerging evidence suggests it may also reflect systemic vascular pathology. However, data on this association in the Indian population remains limited.
Methods: A hospital-based cross-sectional observational study was conducted at GSVMMC, Kanpur, between August 2023 and February 2025. Ninety-two adults with T2DM were enrolled and assessed for DR using fundoscopic examination and graded from 0 to 3. Heart failure was diagnosed and classified via echocardiography into HFpEF, HFmrEF, and HFrEF. Biochemical markers, including HbA1c and NT-proBNP, were evaluated. Statistical analysis included Chi-square tests and ANOVA using statistical package for the social sciences (SPSS) v20.
Results: Among the 92 patients, 73 (79.34%) had some form of heart failure, and 74 (80.43%) had DR. A significant association was found between DR and HF (p=0.001). The prevalence of HFrEF increased with DR severity from 10% in grade 0 to 35% in grade 3 DR (p=0.045). Additionally, poor glycemic control and higher body mass index (BMI) were common in patients with more severe DR and HF.
Conclusion: DR is significantly associated with both the presence and severity of HF in T2DM patients. Retinal examination may serve as a practical, non-invasive tool for early cardiovascular risk stratification. These findings support integrated screening strategies in diabetic care.
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References
Cheung N, Wang JJ, Klein R, Couper DJ, Sharrett AR, Wong TY. Diabetic retinopathy and the risk of coronary heart disease: the Atherosclerosis Risk in Communities Study. Diabetes Care. 2010;33(1):41-6.
Wong TY, Cheung CMG, Larsen M, Sharma S, Simó R. Diabetic retinopathy. Nat Rev Dis Primers. 2016;2:16012. DOI: https://doi.org/10.1038/nrdp.2016.12
Giacco F, Brownlee M. Oxidative stress and diabetic complications. Circ Res. 2010;107(9):1058-70. DOI: https://doi.org/10.1161/CIRCRESAHA.110.223545
Zhu X, Zhang J, Sun H, Jiang C, Dong Y. Diabetic retinopathy and risk of heart failure: a systematic review and meta-analysis. Cardiovasc Diabetol. 2020;19(1):147.
Brownrigg JR, Hughes CO, Burleigh D, Karthikesalingam A, Patterson BO, Holt PJ, et al. Microvascular disease and risk of cardiovascular events among individuals with type 2 diabetes: a population-level cohort study. Lancet Diabetes Endocrinol. 2016;4(7):588-97. DOI: https://doi.org/10.1016/S2213-8587(16)30057-2
Yau JW, Rogers SL, Kawasaki R, Lamoureux EL, Kowalski JW, Bek T, et al. Global prevalence and major risk factors of diabetic retinopathy. Diabetes Care. 2012;35(3):556-64. DOI: https://doi.org/10.2337/dc11-1909
Wilkinson CP, Ferris FL 3rd, Klein RE, Lee PP, Agardh CD, Davis M, Dills D, et al. Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales. Ophthalmol. 2003;110(9):1677-82. DOI: https://doi.org/10.1016/S0161-6420(03)00475-5
Paulus WJ, Tschöpe C. A novel paradigm for heart failure with preserved ejection fraction: comorbidities drive myocardial dysfunction and remodeling through coronary microvascular endothelial inflammation. J Am Coll Cardiol. 2013;62(4):263-71. DOI: https://doi.org/10.1016/j.jacc.2013.02.092
Ting DSW, Cheung GCM, Wong TY. Diabetic retinopathy: global prevalence, major risk factors, screening practices and public health challenges: a review. Clin Exp Ophthalmol. 2016;44(4):260-77. DOI: https://doi.org/10.1111/ceo.12696
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