CLINICAL SCIENCE

The relation of atherosclerotic cardiovascular disease to retinopathy in people with diabetes in the Cardiovascular Health Study

Ronald Klein¹, Emily K Marino², Lewis H Kuller⁷, Joseph F Polak³, Russell P Tracy⁴, John S Gottdiener⁵, Gregory L Burke⁶, Larry D Hubbard¹ and Robin Boineau⁸

¹ Department of Ophthalmology and Visual Sciences, University of Wisconsin Medical School, Madison, WI 53705-2397, USA
² CHS Coordinating Center, Department of Biostatistics, University of Washington, Seattle, WA, USA
³ Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
⁴ University of Vermont, Laboratory for Clinical Biochemistry Research, Colchester Research Facility, Colchester, VT, USA
⁵ St Francis Hospital, Roslyn, NY, USA
⁶ Department of Public Health Sciences, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA
⁷ Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
⁸ National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA

Correspondence to:
Correspondence to:
Ronald Klein, Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, 610 North Walnut Street, 460 WARF, Madison, WI 53705-2397, USA;
kleinr{at}epi.ophth.wisc.edu

Aims: To describe the association of retinopathy with atherosclerosis and atherosclerotic risk factors in people with diabetes.

Methods: 296 of the 558 people classified as having diabetes by the American Diabetes Association criteria, from a population based cohort of adults (ranging in age from 69 to 102 years) living in four United States communities (Allegheny County, Pennsylvania; Forsyth County, North Carolina; Sacramento County, California; and Washington County, Maryland) were studied from 1997 to 1998. Lesions typical of diabetic retinopathy were determined by grading a 45° colour fundus photograph of one eye of each participant, using a modification of the Airlie House classification system.

Results: Retinopathy was present in 20% of the diabetic cohort, with the lowest prevalence (16%), in those 80 years of age or older. Retinopathy was detected in 20.3% of the 296 people with diabetes; 2.7% of the 296 had signs of proliferative retinopathy and 2.1% had signs of macular oedema. The prevalence of diabetic retinopathy was higher in black people (35.4%) than white (16.0%). Controlling for age, sex, and blood glucose, retinopathy was more frequent in black people than white (odds ratio (OR) 2.26, 95% confidence interval (CI) 1.01, 5.05), in those with longer duration of diabetes (OR (per 5 years of diabetes) 1.42, 95% CI 1.18, 1.70), in those with subclinical cardiovascular disease (OR 1.49, 95% CI 0.51, 4.31), or coronary heart disease or stroke (OR 3.23, 95% CI 1.09, 9.56) than those without those diseases, in those with higher plasma low density lipoprotein (LDL) cholesterol (OR (per 10 mg/dl of LDL cholesterol) 1.12, 95% CI 1.02, 1.23), and in those with gross proteinuria (OR 4.76, 95% CI 1.53, 14.86).

Conclusion: Data from this population based study suggest a higher prevalence of retinopathy in black people than white people with diabetes and the association of cardiovascular disease, elevated plasma LDL cholesterol, and gross proteinuria with diabetic retinopathy. However, any conclusions or explanations regarding associations described here must be made with caution because only about one half of those with diabetes mellitus were evaluated.

Keywords: diabetes; diabetic retinopathy; atherosclerosis; dyslipidaemia

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