The presence and severity of diabetic retinopathy may predict future cardiovascular (CV) events such as heart attack or stroke. The relationship between diabetic retinopathy, its 4-year progression, and CV outcomes including 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. The diabetic retinopathy was classified as either none, mild, moderate, or severe and whether it was worsening was also graded. The hazard of CV death or nonfatal myocardial infarction or stroke increased by 38% for every category of change in retinopathy severity and steps of progression further raised the hazard. Thus the researchers believe that both the severity of retinopathy and its progression are determinants of predisposition to 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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