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Vascular and Cardiac Target Organ Damage in Type 2 Diabetics With and Without Diabetic Retinopathy

Francisco Leon-Garrigosa, Jessica M Schrieber, J. Javier Servat, Luis Garcia-Ortiz, Jose Ignacio Recio-Rodriguez, Ma Carmen Patino-Alonso, Cristina Agudo-Conde, Emiliano Rodriguez Sanchez, Manuel Angel Gomez-Marcos.

Abstract
Objective: In this study, we sought to assess the differences in cardiac and vascular end-organ damage in type 2 diabetics, with and without diabetic retinopathy.
Methods: A cross-sectional study of 131 diabetic patients (44 with diabetic retinopathy and 87 without diabetic retinopathy). Retinography was performed with a Topcon TRC NW 200 non-mydriatic retinal camera. Using the Early Treatment of Diabetic Retinopathy Study Severity Scale, two independent observers graded the retinopathy. Pulse-wave velocity, ambulatory arterial stiffness indices, ambulatory arterial stiffness indices to blood pressure variability ratio, carotid intima–media thickness, and ankle/brachial index were used as markers of vascular damage. Left ventricular hypertrophy was evaluated by the Cornell voltage–duration product and Lewis Index.
Results: A total of 33.60% of the subjects had diabetic retinopathy. The patients with diabetic retinopathy were more likely to be women (p=0.031), be insulin users (p=0.001), have a longer duration of disease (p=0.033), and have poorer blood glucose control (HbA1c 6.98 in patients with diabetic retinopathy versus 6.40 in patients without diabetic retinopathy) (p=0.012). Patients with diabetic retinopathy did not statistically differ from diabetics without retinopathy with regards to cardiac or vascular target organ damage. However, patients with diabetic retinopathy showed a trend (defined as a p-value ranging from 0.051 to 0.15) toward a higher resting heart rate, higher ratio of night/day SBP, higher ratio of night/day DBP, higher resting ambulatory systolic blood pressure measure (mmHg), higher resting ambulatory diastolic blood pressure measure (mmHg), higher ASSI-BPVR, and higher Lewis Index.
Conclusions: Although the sample size limited the conclusions that could be drawn between diabetic retinopathy and levels of vascular and cardiac target organ damage, trends were observed in a number of indices for these conditions and measures thereof.

Key words: Diabetic retinopathy, diabetes mellitus, arterial stiffness, subclinical organ damage


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