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Subclinical CVD Inflammatory Markers 

Diabetic Retinopathy. Subclinical CVD Inflammatory Markers . Barbara Eden Kobrin Klein, MD, MPH Professor University of Wisconsin Madison Department of Ophthalmology and Visual Sciences for the MESA Eye Group. Diabetic Retinopathy.

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Subclinical CVD Inflammatory Markers 

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  1. Diabetic Retinopathy Subclinical CVDInflammatory Markers  Barbara Eden Kobrin Klein, MD, MPH Professor University of Wisconsin Madison Department of Ophthalmology and Visual Sciences for the MESA Eye Group

  2. Diabetic Retinopathy • Diabetic retinopathy (DR) is a leading cause of blindness among adults under the age of 65 years in the United States • More than 60% of patients with type 2 DM develop DR • 5-20% develop proliferative DR, after 20 years of disease

  3. Diabetic Retinopathy and Subclinical CVD • DR related to clinical CVD • DR was related to an increased CVD and mortality in WESDR • Other studies found a positive association between DR and coronary calcification, carotid artery IMT and ABI

  4. Methods • Fundus photographs • Camera: 45 degree 6.3 MP digital non-mydriatic camera (Canon, Lake Success, NY) • Two photographic fields each eye: the first centered on the optic disc and the second centered on the fovea • Standard software for image acquisition and archiving (Digital Healthcare Inc. Eye QSL, England) • Retinopathy graded at University of Wisconsin, Madison according to protocol by trained graders with QC monitoring • Fasting blood glucose

  5. Results • 921 of 6176 MESA ppt. at 2nd exam had DM • diabetes defined (FBG ≥7.0 mmol/L (≥126 mg/dl)) or used hypoglycemic medication • gradable photographs

  6. Risk factors for Any Retinopathy

  7. Vision-Threatening Retinopathy • No significant associations

  8. Stratified Analyses • Data suggest that OR may differ by subgroups

  9. Comment • These data give slim evidence of a cross-sectional relationship of the presence of diabetic retinopathy and LV/MV • Temporal relationship of these characteristics is unknown • At this time a likely interpretation is that sub-clinical CVD and retinopathy are the result of diabetes but they may not be causally related to each other

  10. Inflammatory Markers and Diabetic Retinopathy: Pathology • Loss of retinal pericytes and endothelial cells characterize pathologic changes of diabetic retinopathy • DR characterized by increased vascular permeability and increasing vascular occlusion

  11. Background • Hoorn Study and Eurodiab found markers of systemic inflammation associated with DR • Factor VIII (pro-coagulant activity) associated with DR • Other hemostatic factors associated with DR in some studies

  12. Comment • Some markers of inflammatory activity, endothelial dysfunction and homeostatic factors are associated with DR after controlling for relevant risk factors • However, these data are cross-sectional so temporal relationship is unknown • Relatively low prevalence of retinopathy especially in some of the racial/ethnic groups may reflect bias in recruiting that may influence the relationships we investigated

  13. Risk factors for Any Retinopathy

  14. Association of DR with SD increase in Agatston score

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