Diabetic retinopathy grade as a predictive marker of severity of cardiovascular disease and mortality: DIVERSE Study Group

  • Kiran ShahEmail author
  • Sundaram Natarajan
  • Milind Phadke
  • Onkar C Swami
Original Article


Patients with diabetic retinopathy (DR) are more likely to have subclinical cardiovascular disease. Objective of this study was to assess the prevalence and association of DR grades along with comorbidities in patients with established cardiovascular disease (CVD); association of DR grades beyond ocular morbidity, i.e., long-term outcomes among established CVD; influence of DR grades on prognosis in patients undergoing coronary revascularization. This was a single center, retrospective, data analysis of T2DM patients with established CVD. Goodness of fit was analyzed using Pearson’s chi-square test. DR was observed in 64% (n = 2560) of patients (non-proliferative diabetic retinopathy [NPDR] 37%; proliferative diabetic retinopathy [PDR] 27%). DR and CVD were strongly associated; highest association was observed for congestive heart failure (CHF) (n = 1325), followed by myocardial infarction (MI) (n = 795), unstable angina (UA) (n = 275), and cardiomyopathy (n = 165) (p < 0.00001). Patients with NPDR have greater risk of CHF, MI, UA, and cardiomyopathy vs. PDR [HR 1.32, 1.44, 1.2, and 1.75 respectively]. Five-year all-cause mortality was significantly higher in patients with DR (94.2%; n = 766) vs. that in patients with non-DR (5.78%; n = 47) (p < 0.00001). NPDR patients undergoing CABG (n = 765) had lower 5-year mortality than those underwent PTCA (n = 615) (8.36% vs. 25.85%, p < 0.00001).Three times lower 5-year mortality rate was noted in patients with PDR undergoing CABG vs. that in patients undergoing PTCA (n = 265) (25.3 vs. 72.2%, p < 0.00001). DR was strongly associated with CVD with highest association with CHF, followed by MI, UA, and cardiomyopathy. Cardiovascular events, cerebrovascular events, mortality, and all-cause mortality were higher in patients with DR. Higher risk of mortality was noted in NPDR patients who underwent PTCA than in NPDR patients who underwent CABG.


Diabetic retinopathy Type 2 diabetes mellitus Cardiovascular disease Proliferative diabetic retinopathy Non-proliferative diabetic retinopathy 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was conducted in accordance with the principles of the Declaration of Helsinki, guidelines for good pharmaco-epidemiology practice and local regulatory guidelines. Medical data of the patients who had given their prior consent was collected and analyzed. Being a retrospective, non-interventional study, ethics committee approval was not needed and therefore not obtained.


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Copyright information

© Research Society for Study of Diabetes in India 2018

Authors and Affiliations

  1. 1.Diabetes & Thyroid Care CenterMumbaiIndia
  2. 2.Aditya Jyot Eye Hospital Pvt. Ltd.MumbaiIndia
  3. 3.Pulse Cardiac CenterMumbaiIndia
  4. 4.PuneIndia

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