Three noninvasive methods in the evaluation of subclinical cardiovascular disease in patients with diabetic retinopathy: endothelial dysfunction, serum E-selectin level and monocyte to HDL ratio

ABSTRACTAim: Cardiovascular risk has increased in diabetic retinopathy (DR). Brachial artery flow mediated dilation (FMD) is a non-invasive method used to evaluate endothelial dysfunction. Measurement of adhesion molecules such as E-selectin is the indirect method of predicting endothelial dysfunction. Monocyte/ HDL ratio (MHR) is a novel marker found to be related with cardiovascular diseases. In this study, in DR patients without an apparent cardiovascular disease, we aimed to investigate the relation between endothelial dysfunction indicators such as MHR, FMD, E-selectin and subclinical atherosclerosis.Material and Method: In this study, 96 diabetic patients without apparent cardiac symptoms and 32 healthy control patients that matched for gender, age and body mass index (BMI) were included. The patients were separated into four groups as; nonproliferative diabetic retinopathy (NPDR, n=31), proliferative diabetic retinopathy (PDR, n=32), diabetic patients without a retinopathy (n=33) and control group (n=33). Anthropometric, biochemical values and FMD were measured. Correlation and regression analysis were done for the relation between MHR and FMD.Results: MHR was significantly high in PDR group (p<.001). E-selectin and FMD which are indicators for endothelial dysfunction were significantly different between groups (p< .001). E-selectin measures were highest in PDR group, lower in NPDR group, however it was significantly higher than DM and control groups (p= .026). Inversely proportional to E-selectin, FMD was significantly higher in control and significantly lower in PDR group (p< .001). Univariate logistic regression method was used to determine factors that had an influence on FMD. Glucose, HbA1C, CRP and MHR had a negative effect. Conclusion: In patients with DR, MHR levels might be used as a novel non-invasive marker to determine early atherosclerotic risk.