The Association between Diabetic Retinopathy and Framingham Risk Score in Koreans with Type II Diabetes

Da Yeong Kim; Su Jeong Song; Jeong Hun Bae; Cheol-Young Park; Eun-Jung Rhee

doi:10.3341/jkos.2016.57.5.779

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

Original Article

J Korean Ophthalmol Soc 2015;57(5):779-785.

Published online: 7 September 2015

DOI: https://doi.org/10.3341/jkos.2016.57.5.779

The Association between Diabetic Retinopathy and Framingham Risk Score in Koreans with Type II Diabetes

Da Yeong Kim, MD¹, Su Jeong Song, MD, PhD¹, Jeong Hun Bae, MD, PhD¹, Cheol-Young Park, MD, PhD², Eun-Jung Rhee, MD, PhD²

¹Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea

²Department of Endocrinology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea

Address reprint requests to Su Jeong Song, MD, PhD Department of Ophthalmology, Kangbuk Samsung Hospital, #29 Saemunan-ro, Jongno-gu, Seoul 03181, Korea Tel: 82-2-2001-2250, Fax: 82-2-2001-2262 E-mail: eye-su@hanmail.net

Received 3 December 20159 March 2016 Accepted 11 April 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/ which perm its unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Cardiovascular complication, Diabetic retinopathy, Framingham Risk Score, Macrovascular complication, Microvascular complication

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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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