Association of retinal abnormalities and adverse cardiac events in patients with coronary artery disease and type 2 diabetes

BACKGROUND: The aim of this study was to evaluate the association of retinal abnormalities and cardiac mortality in patients with coronary artery disease (CAD) and type 2 diabetes (DM). METHODS: The ARTEMIS study is a prospective cohort study of 1,946 patients (68% male; mean age 66.9 ± 8.6 years) diagnosed with CAD. Type 2 DM was diagnosed in 834 patients (43%), and 525 (27%) of them had retinal images available. RESULTS: During mean follow-up of 8.7 ± 2.2 years, 54 cardiac deaths occurred. From all analyzed retinal abnormalities, diabetic retinopathy (DR) was associated with cardiac death (p = 0.005). DR was independently associated with increased risk of cardiac death (DR 16.2% vs. non-DR 8.4%; hazard ratio [HR] 2.0, 95% CI: 1.0-4.0, p = 0.04) when adjusted with confounding factors. DR was associated with sudden cardiac death (SCD) (DR 8.5% vs. non-DR 3.8%; HR 2.9, 95% CI: 1.1-7.7, p = 0.03) but not with non-sudden cardiac death (DR 7.7% vs. non-DR 4.6%; HR 1.5, 95% CI: 0.6-3.9, p = 0.5). Interestingly, increased hs-TnT, measured in stable phase of CAD, was also associated with DR (p < 0.001). CONCLUSIONS: DR seems to be associated with cardiac death, and more specifically, with SCD in patients with CAD and type 2 DM. DR might be a novel marker of microvascular cardiac disease resulting in ongoing myocardial injury and SCD.