Among patients with diabetes, those with diabetic retinopathy had elevated stroke risk compared with those who did not, according to new data from the ACCORD Eye study presented at the International Stroke Conference.
“As we know, large-artery atherosclerosis and atrial fibrillation are the primary causes of ischemic stroke. However, microvascular disease of the brain is also a cause of stroke and of vascular dementia,” Ka-Ho Wong, MBA, clinical research coordinator and lab manager of the de Havenon Lab at the University of Utah Health Hospitals and Clinics in Salt Lake City, told Healio. “Diabetic retinopathy is a common microvascular complication of diabetes, and we hypothesized that retinopathy would be an important biomarker of stroke risk in diabetic patients, and one that may precede ischemic stroke.”
The researchers analyzed 2,828 patients with diabetes from ACCORD Eye (mean age, 62 years; 62% men; 30.9% with diabetic retinopathy).
During the mean follow-up period of 5.4 years, stroke occurred in 117 patients, according to the researchers.
Among those who had a stroke, 41% had diabetic retinopathy, whereas 30.5% of patients without stroke had diabetic retinopathy (P = .016), Wong and colleagues found.
After adjustment for age, sex, race, total cholesterol, HbA1c, smoking and randomization arm, diabetic retinopathy remained associated with stroke incidence (HR = 1.6; 95% CI, 1.1-2.32).
“Because diabetic retinopathy is more common in patients with uncontrollable diabetes, and diabetic retinopathy increases the risk of having a stroke, it is important for patients to maintain good control of their diabetes,” Wong said in an interview. “Patients with established diabetic retinopathy should pay particular attention to meeting all stroke prevention guidelines established by the American Heart Association.”
The results were consistent regardless of randomization to intensive or standard glucose control (P = .305), intensive or standard lipid control (P = .546) or intensive or standard BP control (P = .422), according to the researchers.
“When comorbid, diabetes, hypertension and dyslipidemia have synergistic deleterious properties that increase the risk of both micro- and macrovascular complications. While the pathology of this association is not clear, the shared vascular risk factors suggest damage to a range of arteries results from uncontrolled hyperglycemia, hypertension and hyperlipidemia,” Wong told Healio. “This research raises the question of whether there is a specific vascular disease pathogenesis in patients with diabetic stroke. Currently, we do not have ongoing follow-up studies, but we are interested in proposing a prospective observational trial in stroke patients with baseline diabetic retinopathy to determine the most common mechanism of stroke in these patients, which would have important implications for prevention efforts.” – by Erik Swain
Wong KH, et al. Abstract 154. Presented at: International Stroke Conference; Feb. 19-21, 2020; Los Angeles.
Disclosure: Wong reports no relevant financial disclosures.