The retina as a window into detecting subclinical cardiovascular disease in type 2 diabetes.
Authors
Affiliations (9)
Affiliations (9)
- Department of Cardiovascular Sciences, National Institute for Health Research Leicester Biomedical Research Centre and British Heart Foundation Centre of Research Excellence, University of Leicester, Leicester, UK.
- Department of Imaging Services, University Hospitals of Leicester NHS Trust, Leicester, UK.
- Department of Renal Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK.
- Leicester Diabetes Centre, University of Leicester and the NIHR Leicester Biomedical Research Centre, Leicester, UK.
- Cardiovascular Translational Laboratory, St Paul's Hospital, University of British Columbia Centre for Heart Lung Innovation, Vancouver, BC, Canada.
- School of Computing and Mathematical Sciences, University of Leicester, Leicester, UK.
- The University of Leicester Ulverscroft Eye Unit, Leicester Royal Infirmary, Leicester, UK.
- Department of Cardiovascular Sciences, National Institute for Health Research Leicester Biomedical Research Centre and British Heart Foundation Centre of Research Excellence, University of Leicester, Leicester, UK. [email protected].
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK. [email protected].
Abstract
Individuals with Type 2 Diabetes (T2D) are at high risk of subclinical cardiovascular disease (CVD), potentially detectable through retinal alterations. In this single-centre, prospective cohort study, 255 asymptomatic adults with T2D and no prior history of CVD underwent echocardiography, non-contrast coronary computed tomography and cardiovascular magnetic resonance. Retinal photographs were evaluated for diabetic retinopathy grade and microvascular geometric characteristics using deep learning (DL) tools. Associations with cardiac imaging markers of subclinical CVD were explored. Of the participants (aged 64 ± 7 years, 62% males); 200 (78%) had no diabetic retinopathy and 55 (22%) had mild background retinopathy. Groups were well-matched for age, sex, ethnicity, CV risk factors, urine microalbuminuria, and serum natriuretic peptide and high-sensitivity troponin levels. Presence of retinopathy was associated with a greater burden of coronary atherosclerosis (coronary artery calcium score ≥ 100; OR 2.63; 95% CI 1.29–5.36; <i>P</i> = 0.008), more concentric left ventricular remodelling (OR 3.11; 95% CI 1.50–6.45; <i>P</i> = 0.002), and worse global longitudinal strain (OR 2.32; 95% CI 1.18–4.59; <i>P</i> = 0.015), independent of key co-variables. Early diabetic retinopathy is associated with a high burden of coronary atherosclerosis and markers of early heart failure. Routine diabetic eye screening may serve as an effective alternative to currently advocated screening tests for detecting subclinical CVD in T2D, presenting opportunities for earlier detection and intervention. The online version contains supplementary material available at 10.1038/s41598-025-13468-4.