Can Ophthalmoscope Predict Silent Coronary Artery Disease in Patients with Type 2 Diabetes Mellitus?

Naglaa Abdul-Maboud Soliman¹, Wafaa Mostafa Abd-El Gawad^2*

¹Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
²Geriatrics and Gerontology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.

DOI: 10.4236/aar.2014.35046                

Abstract

Background & Aim: Diabetic retinopathy (DR) and Coronary Artery Disease (CAD) share similar pathophysiological background of vascular damage. So we aimed to study the relationship between DR and silent CAD in patients with type 2 diabetes mellitus (T2DM). Subject & Methods: A cross sectional study was performed on 40 patients with T2DM from diabetic outpatient clinic in Ain Shams University Hospitals, Cairo, Egypt from June 2012 to December 2012. All patients were subjected to data collection, laboratory analysis and imaging studies. Patients with known CAD, abnormal resting or stress ECG, abnormal ejection fraction or segmental wall motion abnormalities, smoking history, hypertension, or abnormal lipid profile were excluded. Results: Mean age is 62.35 ± 1.38 years, 75% (n = 30) were females, 75% (n = 30) had DR, and 77.50% (n = 31) had positive Tc⁹⁹ scan. There is a significant positive association between Tc⁹⁹ scan and DR (p value = 0.029) as 86.7% of patients with DR had positive Tc⁹⁹ scan. Resting and stress perfusion TC⁹⁹ scan were significantly worse (91.77% vs 100%; 86.48% vs 96.27%, p value = 0.008, 0.005 respectively) and microalbuminuria were significantly higher (207 ± 29.65 vs 36 ± 10.66 mg/dl, p value =< 0.001) in patients with DR. By binary logistic regression, DR was an independent predictor for CAD (OR was 16.377, 95% CI was 1.017 - 263.586, p value = 0.049) after adjustment of SBP and albuminuria. Conclusion: DR is an independent predictor of asymptomatic CAD even with normal stress ECG and echocardiography. Routine screening for CAD using Tc⁹⁹ scan is recommended in patients with DR even if asymptomatic. More multi-centric prospective studies are needed to elucidate the effect of the degree of DR on CAD risk.

Keywords

Type 2 Diabetes Mellitus, Coronary Artery Disease, Diabetic Retinopathy, Tc⁹⁹ Scan

Conflicts of Interest

The authors declare no conflicts of interest.

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