Association of Diabetic Macular Edema and Proliferative Diabetic Retinopathy With Cardiovascular Disease: A Systematic Review and Meta-analysis.
Association of Diabetic Macular Edema and Proliferative Diabetic Retinopathy With Cardiovascular Disease: A Systematic Review and Meta-analysis.
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DOI：
10.1001/jamaophthalmol.2017.0988
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发表时间：
2017-06-01
影响因子：
8.1
通讯作者：
Wong TY
中科院分区：
文献类型：
--
作者：
Xie J;Ikram MK;Cotch MF;Klein B;Varma R;Shaw JE;Klein R;Mitchell P;Lamoureux EL;Wong TY
以前关于糖尿病视网膜病变（DR）和心血管疾病（CVD）之间关系的研究主要集中在DR的早期阶段。了解2型糖尿病和DR严重阶段（糖尿病黄斑水肿[DME]和增殖性糖尿病视网膜病变[PDR]）的患者是否具有更高的CVD风险，将使医生能够更有效地为患者提供咨询。研究2型糖尿病患者DR的严重阶段（DME和PDR）与发生CVD的相关性。从一开始就对MEDLINE、EMBASE、Current Contents和科克伦图书馆中评价DR和CVD关系的英文出版物进行了综述（1950年1月1日）至2014年12月31日，使用检索词糖尿病视网膜病变或黄斑水肿和中风或脑血管疾病或冠状动脉疾病或心力衰竭或心肌梗死或心绞痛或急性冠状动脉综合征或冠心病或心肌病。在筛选合格性的656项研究中，从8项前瞻性基于人群的研究中纳入了7604名个体，这些研究的数据包括基于糖尿病的DR分级、随访访视和明确的CVD事件终点。两名独立审查员对4个数据库进行了系统检索，并开发了一个汇总数据库。通过使用个体参与者数据，然后进行标准的逆方差荟萃分析（2步分析），估计DME、PDR和威胁视力的DR患者与无这些疾病的患者的发病率比（IRR）。审查和分析于2009年1月1日至2017年1月1日进行。心血管事件，包括冠心病、中风或心血管原因死亡。在7604例2型糖尿病患者中，DME的患病率为4.6%，PDR的患病率为7.4%。平均随访5.9年（范围：3.2-10.1年）后，报告了1203例CVD事件，包括916例冠心病病例。与未患DME或PDR的患者相比，DME或PDR患者更容易发生CVD（IRR，1.39; 95% CI，1.16-1.67）和致死性CVD（IRR，2.33; 95% CI，1.49-3.67）。2型糖尿病和DME或PDR患者发生CVD的风险增加，这表明这些人应该更密切地随访以预防CVD。
Previous studies on the relationship between diabetic retinopathy (DR) and cardiovascular disease (CVD) focused on the early stages of DR. Understanding whether patients with type 2 diabetes and severe stages of DR (diabetic macular edema [DME] and proliferative diabetic retinopathy [PDR]) have a higher risk of CVD will allow physicians to more effectively counsel patients. To examine the association of severe stages of DR (DME and PDR) with incident CVD in patients with type 2 diabetes. English-language publications were reviewed for articles evaluating the relationship of DR and CVD in MEDLINE, EMBASE, Current Contents, and the Cochrane Library from inception (January 1, 1950) to December 31, 2014, using the search terms diabetic retinopathy OR macular edema AND stroke OR cerebrovascular disease OR coronary artery disease OR heart failure OR myocardial infarction OR angina pectoris OR acute coronary syndrome OR coronary artery disease OR cardiomyopathy. Among 656 studies screened for eligibility, 7604 individuals were included from 8 prospective population-based studies with data on photographic-based DR grading, follow-up visits, and well-defined incident CVD end point. Two independent reviewers conducted a systematic search of the 4 databases, and a single pooled database was developed. Incidence rate ratios (IRRs) were estimated for patients with DME, PDR, and vision-threatening DR, compared with persons without these conditions, by using individual participant data followed by a standard inverse-variance meta-analysis (2-step analysis). The review and analyses were performed from January 1, 2009, to January 1, 2017. Incident CVD, including coronary heart disease, stroke, or death from cardiovascular causes. Among 7604 patients with type 2 diabetes, the prevalence of DME was 4.6% and PDR, 7.4%. After a mean follow-up of 5.9 years (range, 3.2–10.1 years), 1203 incident CVD events, including 916 coronary heart disease cases, were reported. Persons with DME or PDR were more likely to have incident CVD (IRR, 1.39; 95% CI, 1.16–1.67) and fatal CVD (IRR, 2.33; 95% CI, 1.49–3.67) compared with those without DME or PDR. Patients with type 2 diabetes and DME or PDR have an increased risk of incident CVD, which suggests that these persons should be followed up more closely to prevent CVD.
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影响因子：
5.1
作者：
Dunstan, DW;Zimmet, PZ;McCarty, DJ
通讯作者：
McCarty, DJ
影响因子：
37.8
作者：
Bild, DE;Detrano, R;Saad, MF
通讯作者：
Saad, MF
影响因子：
16.2
作者：
KLEIN, R;KLEIN, BEK;MOSS, SE
通讯作者：
MOSS, SE
影响因子：
16.2
作者：
Faglia, E;Favales, F;Morabito, A
通讯作者：
Morabito, A
影响因子：
--
作者：
KLEIN, R;KLEIN, BEK;CRUICKSHANKS, KJ
通讯作者：
CRUICKSHANKS, KJ