This Article Full Text Full Text (PDF) All Versions of this Article: 38/2/398    most recent 01.STR.0000254547.91276.50v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Cheung, N. Articles by Wong, T. Y. Search for Related Content PubMed PubMed Citation Articles by Cheung, N. Articles by Wong, T. Y. Pubmed/NCBI databases Medline Plus Health Information Diabetic Eye Problems Stroke Related Collections Type 2 diabetes Acute Stroke Syndromes Risk Factors for Stroke

(Stroke. 2007;38:398.)
© 2007 American Heart Association, Inc.

Research Reports

Is Diabetic Retinopathy an Independent Risk Factor For Ischemic Stroke?

Ning Cheung, MBBS; Sophie Rogers, Mepi; David J. Couper, PhD; Ronald Klein, MD, MPH; A. Richey Sharrett, MD, DrPH Tien Y. Wong, MD, PhD

From Centre for Eye Research Australia (N.C., S.R., T.Y.W.), University of Melbourne, Australia; Department of Biostatistics (D.J.C.), University of North Carolina, Chapel Hill, NC; Department of Ophthalmology (R.K.), University of Wisconsin, Madison, Wis; Department of Epidemiology (A.R.S.), Johns Hopkins University, Baltimore, Md; Singapore Eye Research Institute (T.Y.W.), National University of Singapore.

Correspondence to Tien Wong, MD, PhD, University of Melbourne, 32 Gisborne Street, Victoria 3002, Australia. E-mail twong{at}unimelb.edu.au

Background and Purpose— The relationship between diabetic retinopathy and ischemic stroke is uncertain and examined in this study.

Methods— A population-based, prospective cohort study of 1617 middle-aged persons with diabetes. Diabetic retinopathy signs were ascertained from retinal photographs, and incident ischemic stroke events were prospectively identified and validated.

Results— Over an average follow-up of 7.8 years, there were 75 ischemic stroke events. After adjustment for age, gender, race, center, 6-year mean arterial blood pressure, anti-hypertensive treatment use, fasting glucose, insulin treatment, duration of diabetes, high-density lipoprotein and low-density lipoprotein cholesterol levels and cigarette smoking status, diabetic retinopathy was associated with an increased risk of ischemic stroke (hazard rate ratio, 2.34; 95% CI, 1.13 to 4.86).

Conclusions— Diabetic retinopathy predicts incident ischemic stroke in people with diabetes, independent of other risk factors.

Key Words: diabetic retinopathy • ischemic stroke

This article has been cited by other articles:

				N. Cheung, J. J. Wang, S. L. Rogers, F. Brancati, R. Klein, A. R. Sharrett, T. Y. Wong, and for the ARIC (Atherosclerosis Risk In Communities) Diabetic retinopathy and risk of heart failure. J. Am. Coll. Cardiol., April 22, 2008; 51(16): 1573 - 1578. [Abstract] [Full Text] [PDF]

				D. A. De Silva, T. Y. Wong, H.-M. Chang, B.-F. Ng, G. Tikellis, S. M. Saw, F.-P. Woon, C. P.L.H. Chen, and M.-C. Wong Is Routine Retinal Examination Useful in Patients With Acute Ischemic Stroke? Stroke, April 1, 2008; 39(4): 1352 - 1354. [Abstract] [Full Text] [PDF]

				M. L. Baker, P. J. Hand, J. J. Wang, and T. Y. Wong Retinal Signs and Stroke: Revisiting the Link Between the Eye and Brain Stroke, April 1, 2008; 39(4): 1371 - 1379. [Abstract] [Full Text] [PDF]

				N. Cheung, A. R. Sharrett, R. Klein, M. H. Criqui, F.M. A. Islam, K. J. Macura, M. F. Cotch, B. E.K. Klein, and T. Y. Wong Aortic Distensibility and Retinal Arteriolar Narrowing: The Multi-Ethnic Study of Atherosclerosis Hypertension, October 1, 2007; 50(4): 617 - 622. [Abstract] [Full Text] [PDF]

				N. Cheung, J. J. Wang, R. Klein, D. J. Couper, A. R. Sharrett, and T. Y. Wong Diabetic Retinopathy and the Risk of Coronary Heart Disease: The Atherosclerosis Risk in Communities Study Diabetes Care, July 1, 2007; 30(7): 1742 - 1746. [Abstract] [Full Text] [PDF]