Aims: Chronic kidney disease (CKD) is a well-established cardiovascular risk factor for type 2 diabetes (T2D); however, the role of diabetic retinopathy (DR) remains unclear. This study evaluated the individual and combined effects of DR and CKD on cardiovascular disease (CVD) in T2D.
Methods: We analyzed individuals with T2D and no prior CVD from the Korean NHIS cohort (n = 2,064,406) and the UK Biobank (n = 21,350). The primary outcome was a composite of cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke.
Results: In the Korean cohort, adjusted hazard ratios (aHRs) for the primary outcome were elevated in those with PDR (aHR 1.37), CKD (aHR 1.36), and even more so when both were present (aHR 2.21), compared to individuals without DR or CKD. Similar results were observed in the UK Biobank. The effect of PDR on CVD was strongest in younger individuals, with aHRs of 3.28 (<40 years), 1.77 (40-64 years), and 1.29 (≥65 years) (Reference: No DR in each age group).
Conclusions: PDR and CKD, both independently and in combination, increase cardiovascular risk in individuals with T2D, particularly among younger age groups. These findings support incorporating PDR into cardiovascular risk assessment and management.
Keywords: Cardiovascular disease; Chronic kidney disease; Diabetic retinopathy; Mortality; Type 2 diabetes.
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