Top

International Ophthalmology

Published in:

01-12-2024 | Diabetic Retinopathy | Original Paper

The association in diabetic retinopathy and stroke finding from NHANES evidence

Authors: Jing Tang, Ping Huang

Published in: International Ophthalmology | Issue 1/2024

Abstract

Purpose

Diabetic retinopathy and stroke are both vascular pathologies, and this study intends to investigate the relationship between diabetic retinopathy and stroke.

Methods

The NHANES database was used to find the relationship between diabetic retinopathy and stroke with 1948 individuals aged 40 years or older. The sensitivity of the data was verified by multiple interpolation, further analysis was done by subgroup analyses, and possible links were investigated with mediation studies.

Results

Diabetes retinopathy was found to be closely associated with stroke, with the PDR group having a higher stroke incidence than the NPDR group. After controlling for covariates, there were still substantial differences in the risk of stroke among patients with NPDR and PDR. Overall, subgroup analysis revealed DR group showed an important distinction, compared to the non-DR (OR = 1.76, 95% CI 1.15–2.64). The results of the mediation research indicated that the connection between DR and stroke was mediated by the frailty index and hypertension.

Conclusion

This study demonstrated a statistically significant correlation between DR and stroke, which persisted even after DR staging and was more prevalent in PDR patients than in NPDR patients. Stroke prevention may benefit from DR health management.

Available only for authorised users

Yau JW, Rogers SL, Kawasaki R, Lamoureux EL, Kowalski JW, Bek T, Chen SJ, Dekker JM, Fletcher A, Grauslund J, Haffner S, Hamman RF, Ikram MK, Kayama T, Klein BE, Klein R, Krishnaiah S, Mayurasakorn K, O’Hare JP, Orchard TJ, Porta M, Rema M, Roy MS, Sharma T, Shaw J, Taylor H, Tielsch JM, Varma R, Wang JJ, Wang N, West S, Xu L, Yasuda M, Zhang X, Mitchell P, Wong TY (2012) Global prevalence and major risk factors of diabetic retinopathy. Diabetes Care 35:556–564. https://doi.org/10.2337/dc11-1909CrossRefPubMedPubMedCentral

Taurone S, Ralli M, Nebbioso M, Greco A, Artico M, Attanasio G, Gharbiya M, Plateroti AM, Zamai L, Micera A (2020) The role of inflammation in diabetic retinopathy: a review. Eur Rev Med Pharmacol Sci 24:10319–10329. https://doi.org/10.26355/eurrev_202010_23379

Rajsic S, Gothe H, Borba HH, Sroczynski G, Vujicic J, Toell T, Siebert U (2019) Economic burden of stroke: a systematic review on post-stroke care. Eur J Health Econ 20:107–134. https://doi.org/10.1007/s10198-018-0984-0CrossRefPubMed

Bakraa R, Aldhaheri R, Barashid M, Benafeef S, Alzahrani M, Bajaba R, Alshehri S, Alshibani M (2021) Stroke risk factor awareness among populations in Saudi Arabia. IJGM 14:4177–4182. https://doi.org/10.2147/IJGM.S325568CrossRef

Win ASS, Thein MK, Tun KS, Myint TW (2021) Measurement properties of all versions of the Stroke Specific Quality of Life Scale (SS-QOL) 2.0: a systematic review protocol. JBI Evid Syn 19:412–418. https://doi.org/10.11124/JBIES-20-00254

Feng Z, Tong WK, Zhang X, Tang Z (2023) Prevalence of depression and association with all-cause and cardiovascular mortality among individuals with type 2 diabetes: a cohort study based on NHANES 2005–2018 data. BMC Psychiatry 23:490. https://doi.org/10.1186/s12888-023-04999-zCrossRefPubMedPubMedCentral

Ambrosy AP, Hernandez AF, Armstrong PW, Butler J, Dunning A, Ezekowitz JA, Felker GM, Greene SJ, Kaul P, McMurray JJ, Metra M, O’Connor CM, Reed SD, Schulte PJ, Starling RC, Tang WH, Voors AA, Mentz RJ (2016) The clinical course of health status and association with outcomes in patients hospitalized for heart failure – insights from ASCEND-HF. Eur J Heart Fail 18:306–313. https://doi.org/10.1002/ejhf.420CrossRefPubMed

He MS, Chang FL, Lin HZ, Wu JL, Hsieh TC, Lee YC (2018) The association between diabetes and age-related macular degeneration among the elderly in Taiwan. Diabetes Care 41:2202–2211. https://doi.org/10.2337/dc18-0707CrossRefPubMed

Searle SD, Mitnitski A, Gahbauer EA, Gill TM, Rockwood K (2008) A standard procedure for creating a frailty index. BMC Geriatr 8:24. https://doi.org/10.1186/1471-2318-8-24CrossRefPubMedPubMedCentral

10.

Hakeem FF, Bernabé E, Sabbah W (2021) Association between oral health and frailty among American older adults. J Am Med Dir Assoc 22:559-563.e2. https://doi.org/10.1016/j.jamda.2020.07.023CrossRefPubMed

11.

Zhu XR, Zhang YP, Bai L, Zhang XL, Zhou JB, Yang JK (2017) Prediction of risk of diabetic retinopathy for all-cause mortality, stroke and heart failure: evidence from epidemiological observational studies. Medicine 96:e5894. https://doi.org/10.1097/MD.0000000000005894CrossRefPubMedPubMedCentral

12.

Hu K, Jiang M, Zhou Q, Zeng W, Lan X, Gao Q, Mei F, Zhao L, Chen F, Wu A, Tao G, Mou C, Ma B (2021) Association of diabetic retinopathy with stroke: a systematic review and meta-analysis. Front Neurol 12:626996. https://doi.org/10.3389/fneur.2021.626996CrossRefPubMedPubMedCentral

13.

Wong KH, Hu K, Peterson C, Sheibani N, Tsivgoulis G, Majersik JJ, de Havenon AH (2020) Diabetic retinopathy and risk of stroke: a secondary analysis of the ACCORD Eye Study. Stroke 51:3733–3736. https://doi.org/10.1161/STROKEAHA.120.030350CrossRefPubMedPubMedCentral

14.

Das UN (2016) Diabetic macular edema, retinopathy and age-related macular degeneration as inflammatory conditions. Arch Med Sci 12:1142–1157. https://doi.org/10.5114/aoms.2016.61918CrossRefPubMedPubMedCentral

15.

Yongpeng Z, Yaxing W, Jinqiong Z, Qian W, Yanni Y, Xuan Y, Jingyan Y, Wenjia Z, Ping W, Chang S, Ming Y, Yanan L, Jinyuan W, Shouling W, Shuohua C, Haiwei W, Lijian F, Qianqian W, Jingyuan Z, Zihan N, Yuning C, Ying X, Jonas JB, Wenbin W (2022) The association between diabetic retinopathy and the prevalence of age-related macular degeneration—The Kailuan Eye Study. Front Public Health 10:922289. https://doi.org/10.3389/fpubh.2022.922289CrossRefPubMedPubMedCentral

16.

Lee WA, Cheng CL, Lee CH, Kao Yang YH, Lin SJ, Hsieh CY (2017) Risks of newly onset hemorrhagic stroke in patients with neovascular age-related macular degeneration. Pharmacoepidemiol Drug Saf 26:1277–1285. https://doi.org/10.1002/pds.4299CrossRefPubMed

17.

Khan KN, Mahroo OA, Khan RS, Mohamed MD, McKibbin M, Bird A, Michaelides M, Tufail A, Moore AT (2016) Differentiating drusen: Drusen and drusen-like appearances associated with ageing, age-related macular degeneration, inherited eye disease and other pathological processes. Prog Retin Eye Res 53:70–106. https://doi.org/10.1016/j.preteyeres.2016.04.008CrossRefPubMed

18.

Tan TE, Nguyen Q, Chua J, Schmetterer L, Tan GSW, Wong CW, Tsai A, Cheung GCM, Wong TY, Ting DSW (2019) Global assessment of retinal arteriolar, venular and capillary microcirculations using fundus photographs and optical coherence tomography angiography in diabetic retinopathy. Sci Rep 9:11751. https://doi.org/10.1038/s41598-019-47770-9CrossRefPubMedPubMedCentral

19.

Choi JM, Kim SM, Bae YH, Ma DJ (2021) A study of the association between retinal vessel geometry and optical coherence tomography angiography metrics in diabetic retinopathy. Invest Ophthalmol Vis Sci 62:14. https://doi.org/10.1167/iovs.62.13.14CrossRefPubMedPubMedCentral

20.

Al-Khazraji BK, Appleton CT, Beier F, Birmingham TB, Osteoarthritis SJK (2018) Osteoarthritis, cerebrovascular dysfunction and the common denominator of inflammation: a narrative review. Osteoarthritis Cartilage 26:462–470. https://doi.org/10.1016/j.joca.2018.01.011CrossRefPubMed

21.

Klug NR, Chechneva OV, Hung BY, O’Donnell ME (2021) High glucose-induced effects on Na+-K+-2Cl− cotransport and Na+/H+ exchange of blood-brain barrier endothelial cells: involvement of SGK1, PKCβII, and SPAK/OSR1. Am J Physiol Cell Physiol 320:C619–C634. https://doi.org/10.1152/ajpcell.00177.2019CrossRefPubMedPubMedCentral

22.

Chen X, Liu L, Liu M, Huang X, Meng Y, She H, Zhao L, Zhang J, Zhang Y, Gu X, Qin X, Zhang Y, Li J, Xu X, Wang B, Hou FF, Tang G, Liao R, Huo Y, Li J, Yang L (2021) Hypertensive retinopathy and the risk of stroke among hypertensive adults in China. Invest Ophthalmol Vis Sci 62:28. https://doi.org/10.1167/iovs.62.9.28CrossRefPubMedPubMedCentral

23.

Nippert AR, Newman EA (2020) Regulation of blood flow in diabetic retinopathy. Vis Neurosci 37:E004. https://doi.org/10.1017/S0952523820000036CrossRefPubMed

24.

Mishra A, Newman EA (2012) Aminoguanidine reverses the loss of functional hyperemia in a rat model of diabetic retinopathy. Front Neuroenergetics 3:10. https://doi.org/10.3389/fnene.2011.00010CrossRefPubMedPubMedCentral

25.

Zuloaga KL, Krasnow SM, Zhu X, Zhang W, Jouihan SA, Shangraw RE, Alkayed NJ, Marks DL (2014) Mechanism of protection by soluble epoxide hydrolase inhibition in type 2 diabetic stroke. PLoS ONE 9:e97529. https://doi.org/10.1371/journal.pone.0097529CrossRefPubMedPubMedCentral

26.

Anita NZ, Swardfager W (2022) Soluble epoxide hydrolase and diabetes complications. Int J Mol Sci 23:6232. https://doi.org/10.3390/ijms23116232CrossRefPubMedPubMedCentral

27.

Blodgett J, Theou O, Kirkland S, Andreou P, Rockwood K (2015) The association between sedentary behaviour, moderate-vigorous physical activity and frailty in NHANES cohorts. Maturitas 80:187–191. https://doi.org/10.1016/j.maturitas.2014.11.010CrossRefPubMed

28.

Simó-Servat O, Hernández C, Simó R (2019) Diabetic retinopathy in the context of patients with diabetes. Ophthalmic Res 62:211–217. https://doi.org/10.1159/000499541CrossRefPubMed

Title: The association in diabetic retinopathy and stroke finding from NHANES evidence
Authors: Jing Tang
Ping Huang
Publication date: 01-12-2024
Publisher: Springer Netherlands
Keywords: Diabetic Retinopathy
Diabetic Retinopathy
Stroke
Published in: International Ophthalmology / Issue 1/2024
Print ISSN: 0165-5701
Electronic ISSN: 1573-2630
DOI: https://doi.org/10.1007/s10792-024-03098-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The association in diabetic retinopathy and stroke finding from NHANES evidence

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2024

A meta-analysis of the efficacy of two-wall orbital decompression operations for thyroid-associated ophthalmopathy

Asymmetric proptosis in thyroid eye disease

Corneal endothelial changes seven years after phacoemulsification cataract surgery

Aqueous humor protein markers in myopia: a review

Exploring the impact of optical corrections on visual functions in myopia control–a scoping review

Comparison of three techniques for simultaneous intraocular lens implantation in subluxated cataract surgery: Transconjunctival intrascleral, Z-suture knotless transscleral, and Cionni capsular tension ring assisted