Rd e dcv

Pathophysiology/Complications
O R I G I N A L A R T I C L E

Diabetic Retinopathy Is Associated With Mortality and Cardiovascular Disease Incidence
The EURODIAB Prospective Complications Study
MANON V. VAN HECKE, MD1,2 JACQUELINE M. DEKKER, PHD2 COEN D.A. STEHOUWER, MD, PHD2,3 BETTINE C.P. POLAK, MD, PHD1,2 JOHN H. FULLER, FRCP4 ANNE KATRIN SJOLIE, DSCI5 ATHANASIOS KOFINIS, MD6 RAOUL ROTTIERS, MD7 MASSIMO PORTA, MD, PHD8 NISH CHATURVEDI, MRCP9 here is increasing evidence that micro- and macrovascular complications of diabetes share certain pathophysiological mechanisms. This may explain why microangiopathy has been associated with macroangiopathy and with mortality (1–10). For example, microalbuminuria has strongly and independently been associated with the development of cardiovascular disease (CVD) and mortality in type 2 diabetic patients (1–3,10). Further, retinopathy has also been associated with increased cardiovascular and all-cause mortality risk, particularly in type 2 diabetes (4 –9). In type 1 diabetes, however, this association has been explored only in a limited fashion (4,11). Type 1 diabetes, though, offers a better opportunity to study the relationship between retinopathy and cardiovascular events than type 2 diabetes, because of a younger population with less confounding variables associated with the metabolic syndrome. The pathophysiology underlying the association of retinopathy with CVD and mortality is not well understood. Cardiovascular risk factors, such as hypertension, dyslipidemia, and elevated HbA1c level are also known as risk factors for the development of diabetic retinopathy (12,13), and thus, any association may simply reflect shared risk factors. Previous studies (4,7,14), however, reported that conventional cardiovascular risk factors can partly, but not entirely, account for the association between retinopathy and macrovascular disorders. Consequently, it can be hypothesized that, similar to the unknown mechanism by which