A study has investigated the association of diabetic retinopathy and neuropathy with increased risk of recurrent cardiovascular events in 6068 patients with type 2 diabetes mellitus ( T2DM ) and recent acute coronary syndrome ( ACS ) enrolled in the Evaluation of Lixisenatide in Acute Coronary Syndrome ( ELIXA ).
History of retinopathy and neuropathy as well as duration of type 2 diabetes mellitus were self-reported at screening.
At screening, retinopathy and neuropathy were reported in 10.7% and 17.5% of patients, respectively, while 5.7% reported both.
When adjusted for randomized treatment only, both retinopathy and neuropathy were associated with a primary composite outcome ( cardiovascular death, nonfatal myocardial infarction, stroke, or hospitalization for unstable angina ) ( retinopathy: hazard ratio, HR 1.44, 95% CI 1.19-1.75; neuropathy: HR 1.33, 95% CI 1.12-1.57 ), cardiovascular composite ( cardiovascular death, nonfatal myocardial infarction, stroke, hospitalization for heart failure ) ( retinopathy: HR 1.57, 95% CI 1.31-1.88; neuropathy: HR 1.38, 95% CI 1.19-1.62 ), myocardial infarction ( retinopathy: HR 1.38, 95% CI 1.08-1.76; neuropathy: HR 1.26, 95% CI 1.02-1.54 ), heart failure hospitalization ( retinopathy: HR 2.03, 95% CI 1.48-2.78; neuropathy: HR 1.71, 95% CI 1.30-2.27 ), and all-cause mortality ( retinopathy: HR 1.65, 95% CI 1.28-2.12; neuropathy: HR 1.43, 95% CI 1.14-1.78 ).
When included in the same model, and adjusted for type 2 diabetes mellitus duration, there were no independent associations of either with cardiovascular outcomes, while type 2 diabetes mellitus duration remained strongly associated with all outcomes.
Addition of demographic characteristics and cardiovascular risk factors did not further alter these relationships.
According to study, in patients with type 2 diabetes mellitus and recent ACS, a history of retinopathy and/or neuropathy and longer type 2 diabetes mellitus duration could be considered clinical markers for high risk of recurrent cardiovascular events. ( Xagena )
Seferovic JP et al, J Diabetes Res 2018; 2018: 1631263