Published Online
on December 28, 2006

A more recent version of this article appeared on February 1, 2007

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Submitted on June 30, 2006
Revised on August 18, 2006
Accepted on September 20, 2006

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; and 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.

^* To whom correspondence should be addressed. 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

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