Comparison of Coronary Heart Disease and Stroke in Association with Diabetic Retinopathy in Adults with Diabetes Using a National Survey

Objective: Diabetic retinopathy (DR) was reported to have higher prevalence of coronary heart disease (CHD) and stroke compared with people without DR. However, whether DR had similar effects on CHD and stroke in US adults with diabetes was not well known. This study was to compare the association between DR, CHD and stroke in US adults with diabetes using the 2015 Behavioral Risk Factor Surveillance System (BRFSS). Methods: Respondents with diabetes aged over 18 years and undergone a fundus examination over the past 2 years were included in this study. DR, CHD and stroke were self-reported. A weighted hierarchical logistic regression was used to examine the association of DR with CHD and stroke. Results: A total of 21,049 respondents with diabetes aged over 18 years having undergone a fundus examination over the past 2 years were included in the analysis. There were 4690 people reported having CHD, accounting for the weighted prevalence 22.1%. The weighted prevalence of stroke was 9.6%. There was 28.3% of CHD people who had DR which was higher than that in people without CHD. Differences in weighted frequency distributions of gender, age category (over 45 years or not), current smoking, hypercholesterolemia, hypertension and insulin treatment were significantly different between the CHD and without CHD groups (p<0.001). Similar results were found in people with stroke. Logistic analysis showed that DR was related to CHD and stroke (crude OR =1.876, 2.263, respectively, p all <0.001). After adjusting other variables, these associations persisted (Adjusted OR=1.632 (95% CI=1.625-1.639), 1.846 (95% CI=1.836-1.856), respectively, p all<0.001). Conclusion: The BRFSS 2015 data indicated that DR was not only associated with CHD but also associated with stroke in US adults with diabetes, independently of other risk factor. DR might be more strongly associated with stroke than with CHD.