Diabetic retinopathy, its progression, and incident cardiovascular events in the ACCORD trial.
Diabetic retinopathy, its progression, and incident cardiovascular events in the ACCORD trial.
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协议试验中的糖尿病性视网膜病，其进展和入射心血管事件。
DOI：
10.2337/dc12-1311
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发表时间：
2013-05
期刊：
影响因子：
16.2
通讯作者：
ACCORD Study Group
中科院分区：
文献类型：
--
作者：
Gerstein HC;Ambrosius WT;Danis R;Ismail-Beigi F;Cushman W;Calles J;Banerji M;Schubart U;Chew EY;ACCORD Study Group
糖尿病视网膜病变的存在及其严重程度与未来的心血管（CV）事件显著相关。其进展是否也与事件CV结果有关尚未评估。在控制糖尿病心血管风险行动（ACCORD）试验的参与者中分析了视网膜病变、其4年进展和CV结局（CV死亡或非致死性心肌梗死或卒中）之间的关系，这些参与者也参加了ACCORD眼科研究。视网膜病变分为无、轻度、中度或重度，恶化分为<2步、2-3步或>3步变化（包括激光治疗或玻璃体切除术）。平均年龄61岁的参与者（n = 3，433）有基线视网膜照片（7个立体视野）。与无视网膜病变相比，CV结局的校正HR（95% CI）从轻度视网膜病变的1.49（1.12-1.97）上升至重度视网膜病变的2.35（1.47-3.76）。对2，856例患者的子集进行了4年时糖尿病视网膜病变进展的评价。对于视网膜病变严重程度的每种变化，主要结局的风险增加38%（1.38 [1.10-1.74]）。对A1 C、收缩压和血脂的基线和随访水平单独或一起进行额外校正，结果显示恶化与CV结局之间的关系不显著。视网膜病变的严重程度及其进展是CV事件结局的决定因素。视网膜可以提供代谢和血流动力学因素对未来CV结局影响的解剖学指标。
Both the presence of diabetic retinopathy and its severity are significantly associated with future cardiovascular (CV) events. Whether its progression is also linked to incident CV outcomes hasn’t been assessed. The relationship between retinopathy, its 4-year progression, and CV outcomes (CV death or nonfatal myocardial infarction or stroke) was analyzed in participants in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial who also participated in the ACCORD Eye Study. Retinopathy was classified as either none, mild, moderate, or severe, and worsening was classified as a <2-step, 2–3-step, or >3-step change (that included incident laser therapy or vitrectomy). Participants (n = 3,433) of mean age 61 years had baseline retinal photographs (seven stereoscopic fields). Compared with no retinopathy, the adjusted HRs (95% CI) for the CV outcome rose from 1.49 (1.12–1.97) for mild retinopathy to 2.35 (1.47–3.76) for severe retinopathy. A subset of 2,856 was evaluated for progression of diabetic retinopathy at 4 years. The hazard of the primary outcome increased by 38% (1.38 [1.10–1.74]) for every category of change in retinopathy severity. Additional adjustment for the baseline and follow-up levels of A1C, systolic blood pressure, and lipids either individually or together rendered the relationships between worsening and CV outcomes nonsignificant. Both the severity of retinopathy and its progression are determinants of incident CV outcomes. The retina may provide an anatomical index of the effect of metabolic and hemodynamic factors on future CV outcomes.
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DOI：
10.1056/nejmoa1001288
发表时间：
2010-07-15
期刊：
The New England journal of medicine
影响因子：
--
作者：
ACCORD Study Group;ACCORD Eye Study Group;Chew EY;Ambrosius WT;Davis MD;Danis RP;Gangaputra S;Greven CM;Hubbard L;Esser BA;Lovato JF;Perdue LH;Goff DC Jr;Cushman WC;Ginsberg HN;Elam MB;Genuth S;Gerstein HC;Schubart U;Fine LJ
通讯作者：
Fine LJ
影响因子：
16.2
作者：
Miettinen, H;Haffner, SM;Laakso, M
通讯作者：
Laakso, M
影响因子：
158.5
作者：
Holman, Rury R.;Paul, Sanjoy K.;Neil, H. Andrew W.
通讯作者：
Neil, H. Andrew W.
影响因子：
158.5
作者：
Gerstein, Hertzel C.;Miller, Michael E.;Friedewald, William T.
通讯作者：
Friedewald, William T.
影响因子：
2.8
作者：
McGeechan, Kevin;Liew, Gerald;Wong, Tien Y.
通讯作者：
Wong, Tien Y.