What is the clinical evidence from this study?

Study design: Observational. Population: Diabetes mellitus and diabetic retinopathy (n=44). Intervention: Diabetic retinopathy vs. Diabetes without retinopathy and healthy controls. Primary outcome: Coronary flow reserve (p=<0.01).

What question did this study set out to answer?

To assess differences in coronary flow reserve between diabetic patients with and without diabetic retinopathy compared to control subjects.

August 1, 2026Journal of the American College of Cardiology

Retinopathy Identifies Marked Restriction of Coronary Flow Reserve in Patients With Diabetes Mellitus

Q: What are the key findings of this study?

Diabetic retinopathy was associated with a marked restriction in coronary flow reserve compared to diabetic patients without retinopathy (1.9 vs 2.8) and controls (3.3, p<0.01).

Q: What question did this study set out to answer?

To assess differences in coronary flow reserve between diabetic patients with and without diabetic retinopathy compared to control subjects.

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Key result

Diabetic retinopathy is linked to ~32% lower coronary flow reserve versus diabetes without retinopathy.

P<0.01
n=44

Why the study?

Does the presence of diabetic retinopathy identify restricted coronary flow reserve in patients with diabetes mellitus?

Key Points

To assess differences in coronary flow reserve between diabetic patients with and without diabetic retinopathy compared to control subjects.
Enrolled 29 patients with diabetes mellitus (18 with nonproliferative retinopathy [8 background, 10 preproliferative] and 11 without retinopathy) and 15 control patients with chest pain and angiographically normal coronary arteries.
Administered 3 mg isosorbide dinitrate, then measured phasic flow velocities in the proximal left anterior descending coronary artery at rest and during adenosine-induced hyperemia (0.14 mg/kg/min) using a Doppler guide wire.
Calculated coronary blood flow and determined coronary flow reserve as the ratio of hyperemic to baseline flow.
Coronary flow reserve was significantly lower in diabetic patients with (1.9 ± 0.4) and without retinopathy (2.8 ± 0.3) than in controls (3.3 ± 0.4, p < 0.01 for both), with a significantly greater reduction in patients with retinopathy (p < 0.01).
Coronary blood flow was lower during hyperemia (107 ± 23 and 116 ± 18 vs. 136 ± 17 ml/min, p < 0.05) and higher at baseline (58 ± 16 and 45 ± 12 vs. 37 ± 10 ml/min, p < 0.05) in diabetic patients with and without retinopathy versus controls.
Among patients with retinopathy, those with preproliferative disease exhibited significantly lower maximal hyperemic flow (102 ± 11 vs. 114 ± 16 ml/min, p < 0.05) and lower flow reserve (1.6 ± 0.2 vs. 2.3 ± 0.2, p < 0.01) than those with background retinopathy.

Study Design

Type

Observational (n=44)

Structured PICO

Does the presence of diabetic retinopathy identify restricted coronary flow reserve in patients with diabetes mellitus?

Population

44 patients, including 29 with diabetes mellitus (18 with and 11 without diabetic retinopathy) and 15 control patients with chest pain and normal coronary arteries.

Exposure

Diabetes mellitus with diabetic retinopathy

Comparator

Diabetes mellitus without retinopathy, and non-diabetic controls

Outcome

Coronary flow reserve (hyperemic/baseline flow ratio) measured using a 15-MHz Doppler guide wiresurrogate

Main Result

Absolute Event Rate: 1.9% vs 3.3%

p-value: p=<0.01

Discussion

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Implication

Diabetic retinopathy is associated with a marked restriction of coronary flow reserve in patients with diabetes mellitus, suggesting a link between ocular and coronary microvascular disease.

Cite This Study

Akasaka et al. (1997) conducted an observational in Diabetes mellitus and diabetic retinopathy (n=44). Diabetic retinopathy vs. Diabetes without retinopathy and healthy controls was evaluated on Coronary flow reserve (p=<0.01). Diabetic retinopathy was associated with a marked restriction in coronary flow reserve compared to diabetic patients without retinopathy (1.9 vs 2.8) and controls (3.3, p<0.01).

synapsesocial.com/papers/6a6e0e614ab9c8d284ae1a87 https://doi.org/10.1016/s0735-1097(97)00242-8

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Implication

Diabetic retinopathy is associated with a marked restriction of coronary flow reserve in patients with diabetes mellitus, suggesting a link between ocular and coronary microvascular disease.

Retinopathy Identifies Marked Restriction of Coronary Flow Reserve in Patients With Diabetes Mellitus

Key Points

Study Design

Structured PICO

Main Result

Discussion

Implication

Cite This Study

Retinopathy Identifies Marked Restriction of Coronary Flow Reserve in Patients With Diabetes Mellitus

Key Points

Study Design

Structured PICO

Main Result

Discussion

Implication

Cite This Study

Also Consider

Also Consider