Diabetic retinopathy as an independent marker of cardiovascular disease in type 1 diabetes: Results from a nationwide longitudinal matched case–cohort study

Ditte Simmelkær Mabala; Lonny Stokholm; Nis Andersen; Jens Andresen; Toke Bek; Steffen Heegaard; Javad Hajari; Kurt Højlund; Ryo Kawasaki; Caroline Schmidt Laugesen; Sören Möller; Frederik Nørregaard Pedersen; Katja Christina Schielke; Anne Suhr Thykjær; Jakob Grauslund

doi:10.1111/aos.16653

Diabetic retinopathy as an independent marker of cardiovascular disease in type 1 diabetes: Results from a nationwide longitudinal matched case–cohort study

Ditte Simmelkær Mabala, Lonny Stokholm, Nis Andersen, Jens Andresen, Toke Bek, Steffen Heegaard, Javad Hajari, Kurt Højlund, Ryo Kawasaki, Caroline Schmidt Laugesen, Sören Möller, Frederik Nørregaard Pedersen, Katja Christina Schielke, Anne Suhr Thykjær, Jakob Grauslund^*

^*Corresponding author for this work

Department of Clinical Medicine - Department of Ophthalmology

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

Abstract

Purpose: To investigate diabetic retinopathy (DR) as a potential marker of cardiovascular disease (CVD) in adults with type 1 diabetes attending the Danish DR-screening programme and non-diabetes adults. Methods: In this registry-based matched case–cohort study, we identified 16 547 adults with type 1 diabetes, who were registered in the Danish Registry of Diabetic Retinopathy (DiaBase). Each case was age- and sex-matched by five non-diabetes individuals (n = 82 399), and odds ratios (ORs) and hazard ratios (HRs) were estimated for incident and upcoming CVD in multivariable models. Results: Adults with type 1 diabetes (median age 44.5 years, 57.6% male) were more likely to have prevalent CVD (OR 1.29; 95% CI, 1.20–1.38) and to develop CVD within 5 years (HR 1.19; 95% CI, 1.08–1.30) as compared to non-diabetes control. However, adults without DR were less likely to develop CVD (HR 0.84; 95% CI, 0.72–0.97) compared to the reference population. For adults with type 1 diabetes, there was an increasing risk for incident CVD for increasing levels of DR (HR 1.33, 1.95, 1.71 and 2.39 for DR-levels 1–4, respectively). Patients with CVD at the time of the first screening had a higher risk to develop DR during follow-up (HR 1.23; 95% CI, 1.02–1.49). Conclusion: In a nationwide matched case–cohort study adjusted for potential confounders, DR was identified as an independent marker of prevalent and incident CVD in type 1 diabetes with increasing risk demonstrated for higher levels of DR. Likewise, CVD also independently predicted the risk of incident DR.

Original language	English
Journal	Acta Ophthalmologica
Volume	102
Issue	6
Pages (from-to)	635-642
Number of pages	8
ISSN	1755-375X
DOIs	https://doi.org/10.1111/aos.16653
Publication status	Published - Sept 2024

Keywords

cardiovascular disease
diabetic retinopathy
registry-based
screening
type 1 diabetes

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10.1111/aos.16653Licence: CC BY-NC

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Mabala, D. S., Stokholm, L., Andersen, N., Andresen, J., Bek, T., Heegaard, S., Hajari, J., Højlund, K., Kawasaki, R., Laugesen, C. S., Möller, S., Pedersen, F. N., Schielke, K. C., Thykjær, A. S., & Grauslund, J. (2024). Diabetic retinopathy as an independent marker of cardiovascular disease in type 1 diabetes: Results from a nationwide longitudinal matched case–cohort study. Acta Ophthalmologica, 102(6), 635-642. https://doi.org/10.1111/aos.16653

@article{a310922fd9cc42529de33333e6c17382,

title = "Diabetic retinopathy as an independent marker of cardiovascular disease in type 1 diabetes: Results from a nationwide longitudinal matched case–cohort study",

abstract = "Purpose: To investigate diabetic retinopathy (DR) as a potential marker of cardiovascular disease (CVD) in adults with type 1 diabetes attending the Danish DR-screening programme and non-diabetes adults. Methods: In this registry-based matched case–cohort study, we identified 16 547 adults with type 1 diabetes, who were registered in the Danish Registry of Diabetic Retinopathy (DiaBase). Each case was age- and sex-matched by five non-diabetes individuals (n = 82 399), and odds ratios (ORs) and hazard ratios (HRs) were estimated for incident and upcoming CVD in multivariable models. Results: Adults with type 1 diabetes (median age 44.5 years, 57.6% male) were more likely to have prevalent CVD (OR 1.29; 95% CI, 1.20–1.38) and to develop CVD within 5 years (HR 1.19; 95% CI, 1.08–1.30) as compared to non-diabetes control. However, adults without DR were less likely to develop CVD (HR 0.84; 95% CI, 0.72–0.97) compared to the reference population. For adults with type 1 diabetes, there was an increasing risk for incident CVD for increasing levels of DR (HR 1.33, 1.95, 1.71 and 2.39 for DR-levels 1–4, respectively). Patients with CVD at the time of the first screening had a higher risk to develop DR during follow-up (HR 1.23; 95% CI, 1.02–1.49). Conclusion: In a nationwide matched case–cohort study adjusted for potential confounders, DR was identified as an independent marker of prevalent and incident CVD in type 1 diabetes with increasing risk demonstrated for higher levels of DR. Likewise, CVD also independently predicted the risk of incident DR.",

keywords = "cardiovascular disease, diabetic retinopathy, registry-based, screening, type 1 diabetes",

author = "Mabala, {Ditte Simmelk{\ae}r} and Lonny Stokholm and Nis Andersen and Jens Andresen and Toke Bek and Steffen Heegaard and Javad Hajari and Kurt H{\o}jlund and Ryo Kawasaki and Laugesen, {Caroline Schmidt} and S{\"o}ren M{\"o}ller and Pedersen, {Frederik N{\o}rregaard} and Schielke, {Katja Christina} and Thykj{\ae}r, {Anne Suhr} and Jakob Grauslund",

note = "Publisher Copyright: {\textcopyright} 2024 The Authors. Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation.",

year = "2024",

month = sep,

doi = "10.1111/aos.16653",

language = "English",

volume = "102",

pages = "635--642",

journal = "Acta Ophthalmologica",

issn = "1755-375X",

publisher = "John Wiley & Sons Inc.",

number = "6",

}

Mabala, DS, Stokholm, L, Andersen, N, Andresen, J, Bek, T, Heegaard, S, Hajari, J, Højlund, K, Kawasaki, R, Laugesen, CS, Möller, S, Pedersen, FN, Schielke, KC, Thykjær, AS & Grauslund, J 2024, 'Diabetic retinopathy as an independent marker of cardiovascular disease in type 1 diabetes: Results from a nationwide longitudinal matched case–cohort study', Acta Ophthalmologica, vol. 102, no. 6, pp. 635-642. https://doi.org/10.1111/aos.16653

Diabetic retinopathy as an independent marker of cardiovascular disease in type 1 diabetes: Results from a nationwide longitudinal matched case–cohort study. / Mabala, Ditte Simmelkær; Stokholm, Lonny; Andersen, Nis et al.
In: Acta Ophthalmologica, Vol. 102, No. 6, 09.2024, p. 635-642.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

TY - JOUR

T1 - Diabetic retinopathy as an independent marker of cardiovascular disease in type 1 diabetes

T2 - Results from a nationwide longitudinal matched case–cohort study

AU - Mabala, Ditte Simmelkær

AU - Stokholm, Lonny

AU - Andersen, Nis

AU - Andresen, Jens

AU - Bek, Toke

AU - Heegaard, Steffen

AU - Hajari, Javad

AU - Højlund, Kurt

AU - Kawasaki, Ryo

AU - Laugesen, Caroline Schmidt

AU - Möller, Sören

AU - Pedersen, Frederik Nørregaard

AU - Schielke, Katja Christina

AU - Thykjær, Anne Suhr

AU - Grauslund, Jakob

PY - 2024/9

Y1 - 2024/9

N2 - Purpose: To investigate diabetic retinopathy (DR) as a potential marker of cardiovascular disease (CVD) in adults with type 1 diabetes attending the Danish DR-screening programme and non-diabetes adults. Methods: In this registry-based matched case–cohort study, we identified 16 547 adults with type 1 diabetes, who were registered in the Danish Registry of Diabetic Retinopathy (DiaBase). Each case was age- and sex-matched by five non-diabetes individuals (n = 82 399), and odds ratios (ORs) and hazard ratios (HRs) were estimated for incident and upcoming CVD in multivariable models. Results: Adults with type 1 diabetes (median age 44.5 years, 57.6% male) were more likely to have prevalent CVD (OR 1.29; 95% CI, 1.20–1.38) and to develop CVD within 5 years (HR 1.19; 95% CI, 1.08–1.30) as compared to non-diabetes control. However, adults without DR were less likely to develop CVD (HR 0.84; 95% CI, 0.72–0.97) compared to the reference population. For adults with type 1 diabetes, there was an increasing risk for incident CVD for increasing levels of DR (HR 1.33, 1.95, 1.71 and 2.39 for DR-levels 1–4, respectively). Patients with CVD at the time of the first screening had a higher risk to develop DR during follow-up (HR 1.23; 95% CI, 1.02–1.49). Conclusion: In a nationwide matched case–cohort study adjusted for potential confounders, DR was identified as an independent marker of prevalent and incident CVD in type 1 diabetes with increasing risk demonstrated for higher levels of DR. Likewise, CVD also independently predicted the risk of incident DR.

AB - Purpose: To investigate diabetic retinopathy (DR) as a potential marker of cardiovascular disease (CVD) in adults with type 1 diabetes attending the Danish DR-screening programme and non-diabetes adults. Methods: In this registry-based matched case–cohort study, we identified 16 547 adults with type 1 diabetes, who were registered in the Danish Registry of Diabetic Retinopathy (DiaBase). Each case was age- and sex-matched by five non-diabetes individuals (n = 82 399), and odds ratios (ORs) and hazard ratios (HRs) were estimated for incident and upcoming CVD in multivariable models. Results: Adults with type 1 diabetes (median age 44.5 years, 57.6% male) were more likely to have prevalent CVD (OR 1.29; 95% CI, 1.20–1.38) and to develop CVD within 5 years (HR 1.19; 95% CI, 1.08–1.30) as compared to non-diabetes control. However, adults without DR were less likely to develop CVD (HR 0.84; 95% CI, 0.72–0.97) compared to the reference population. For adults with type 1 diabetes, there was an increasing risk for incident CVD for increasing levels of DR (HR 1.33, 1.95, 1.71 and 2.39 for DR-levels 1–4, respectively). Patients with CVD at the time of the first screening had a higher risk to develop DR during follow-up (HR 1.23; 95% CI, 1.02–1.49). Conclusion: In a nationwide matched case–cohort study adjusted for potential confounders, DR was identified as an independent marker of prevalent and incident CVD in type 1 diabetes with increasing risk demonstrated for higher levels of DR. Likewise, CVD also independently predicted the risk of incident DR.

KW - cardiovascular disease

KW - diabetic retinopathy

KW - registry-based

KW - screening

KW - type 1 diabetes

UR - http://www.scopus.com/inward/record.url?scp=85185126717&partnerID=8YFLogxK

U2 - 10.1111/aos.16653

DO - 10.1111/aos.16653

M3 - Journal article

C2 - 38345204

AN - SCOPUS:85185126717

SN - 1755-375X

VL - 102

SP - 635

EP - 642

JO - Acta Ophthalmologica

JF - Acta Ophthalmologica

IS - 6

ER -

Diabetic retinopathy as an independent marker of cardiovascular disease in type 1 diabetes: Results from a nationwide longitudinal matched case–cohort study

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