Recent publications on Residual Risk

The R3i has previously discussed the proposal that the presence of microvascular complications is predictive of cardiovascular events (1). This report adds to this argument, showing that coronary atherosclerosis and plaque vulnerability are more severe in individuals with diabetic retinopathy.
 
This study evaluated the extent and severity of coronary atherosclerosis in 57 diabetes patients with coronary artery disease, either with (n=15) or without (n=42) diabetic retinopathy. The extent of coronary atherosclerosis (yellow plaques) in at least one coronary artery was quantitated, and the severity assessed by colour rating (1 = light yellow; 2 = yellow, or 3 = intense yellow). Over a mean follow-up of 7.1 ± 3.3 years, patients with diabetic retinopathy not only had more coronary atherosclerosis (mean yellow plaques per vessel 2.08 ± 1.01 vs.1.26 ± 0.77, p = 0.002), but also more severe coronary atherosclerosis (mean rating 2.40 ± 0.74 vs. 1.90 ± 0.82, p = 0.044) compared with those without. In addition, the incidence of acute coronary syndromes (ACS) was significantly higher in those with diabetic retinopathy (p = 0.004), with nearly 7-fold higher risk of ACS (adjusted hazard ratio 6.943, 95% confidence interval, 1.267–38.054; p = 0.026). The finding that coronary atherosclerosis is more prevalent and more severe in patients with diabetic retinopathy suggests a link between diabetes-related microvascular complications and macrovascular plaque vulnerability.
 
1. Rosenson RS, Fioretto P, Dodson PM. Does microvascular disease predict macrovascular events in type 2 diabetes? Atherosclerosis 2011;218:13-8.