Journal List > J Korean Ophthalmol Soc > v.57(5) > 1010587

Kim, Song, Bae, Park, and Rhee: The Association between Diabetic Retinopathy and Framingham Risk Score in Koreans with Type II Diabetes

Abstract

Purpose

In this study, we compared the risk of cardiovascular complications between diabetic retinopathy (DR) groups based on the Framingham Risk Score.

Methods

Subjects 40 years of age or older were enrolled in the present study from September 2008 to September 2009. Five scales were used to evaluate the severity of DR for the most severely affected eye in each patient: no DR, mild nonproliferative DR (NPDR), moderate NPDR, severe NPDR and proliferative DR (PDR). The first group included no DR patients and the second group included mild NPDR patients. The third group included moderate NPDR, severe NPDR and PDR patients. The Framingham Risk Score was analyzed among the groups to determine whether a difference in score existed.

Results

DR was found in 126 subjects. The first group included 403 subjects, the second group 22 subjects and the third group 104 subjects. The average Framingham Risk Score that appeared with increasing severity of DR was 10.89 ± 7.98 in the first group, 12.25 ± 10.84 in the second group and 13.25 ± 10.66 in the third group. The average difference between the first and third groups was statistically significant (p = 0.014).

Conclusions

In our study, the Framingham Risk Score increased significantly with more severe DR (p = 0.042). Our results are useful when considering the easily accessible identification of DR and that cardiovascular disease is one of the main causes of death worldwide. However, confirming the exact causal relationship based on our results is difficult because the study design was cross-sectional and additional studies are necessary.

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Table 1.
Patient characteristics (n = 529)
Characteristics Values
Age (years) 55.21 ± 6.28
Male (%) 55.4
Smoking (%) 22.3
Diabetes duration (years) 6.58 ± 6.10
HbAlc (%) 7.50 ± 1.46
Fasting blood glucose concentration (mg/dL) 154.88 ± 42.53
2-hour post-prandial glucose (mg/dL) 201.18 ± 67.15
Triglycerides (mg/dL) 164.54 ± 111.17
HDL-cholesterol (mg/dL) 48.92 ± 15.46
LDL-cholesterol (mg/dL) 111.69 ± 34.21
Total cholesterol (mg/dL) 191.04 ± 42.94
Insulin (mIU/mL) 9.20 ± 4.40
C peptide (ng/mL) 2.62 ± 1.35
Body mass index (kg/m2) 24.70 ± 3.22
Systolic blood pressure (mm Hg) 124.36 ± 14.44
Diastolic blood pressure (mm Hg) 76.43 ± 9.18

Values are presented as mean ± SD or n (%).

HDL = high-density lipoprotein; LDL = low-density lipoprotein.

Table 2.
Framingham Risk Score comparison between groups
Characteristics Group 1 (n = 403) Group 2 (n = 22) Group 3 (n = 104) p-value
Age (years) 54.97 ± 6.32 56.36 ± 5.95 55.90 ± 6.16 0.270
Male (%) 216 (53.6) 12 (54.5) 65 (62.5) 0.265
Smoking (%) 93 (23.1) 6 (27.3) 19 (18.3) 0.489
HDL-cholesterol (mg/dL) 48.60 ± 12.92 51.05 ± 10.14 49.70 ± 23.49 0.654
Total cholesterol (mg/dL) 191.79 ± 43.68 191.13 ± 57.71 188.09 ± 36.28 0.736
Mean arterial pressure (mm Hg) 91.92 ± 9.80 93.46 ± 11.87 94.07 ± 11.91 0.227
Antihypertensive treatment (%) 243 (60.3) 18 (81.8) 54 (51.9) 0.028
Framingham Risk Score (%) 10.89 ± 7.98 12.25 ± 10.84 13.25 ± 10.66 0.043
   Group 1-Group 2       0.473
   Group 2-Group 3       0.625
   Group 1-Group 3 0.014

Values are presented as mean ± SD or n (%).

HDL = high-density lipoprotein.

Mean arterial pressure = diastolic blood pressure + (systolic blood pressure - diastolic blood pressure)/3;

One-way analysis of variance (ANOVA); JChi-square test.

Table 3.
Adjusted coefficients and 95% confidence intervals of Framingham Risk Score (%)
Variables Coefficients 95 % Confidence interval p-value
Retinopathy severity
 Group 1-Group 2 1.799 (-1.844, 5.442) 0.333
 Group 2-Group 3 0.448 (-3.458, 4.355) 0.822
 Group 1-Group 3 2.247 (0.418, 4.075) 0.016
 Triglycerides (mg/dL) 0.008 (0.004, 0.012) <0.001

Adjusted for serum triglycerides.

Generalized linear models.

Table 4.
Adjusted mean (SEM) of Framingham Risk Score (%)
Values Group 1 Group 2 Group 3 p-value
Adjusted mean (SEM) 10.89 (0.42) 12.69 (1.81) 13.14 (0.83) 0.042

Adjusted for serum triglycerides.

SEM = standard errors of mean.

Generalized linear models.

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