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Male sex, blood pressure and heart rate are associated with the risk of diabetic retinopathy in normoalbuminuric type 1 diabetic patients

After 48 months of following, UAE, male sex, systolic blood pressure and resting heart rate were risk factors for development or progression of diabetic retinopathy in our normoalbuminuric T1DM. Resting heart rate is an independent predictor of all-cause death and major cardiovascular complications in subjects with and without diabetes. Higher heart rate might promote higher UAE, indicating endothelial dysfunction, which are important factors in the development of retinopathy and nephropathy. Results from EURODIAB study found that diastolic blood pressure is significant risk factor for retinopathy in T1DM even after adjusting for albuminuria while the prospective UKPDS study also found higher relative risk for incidence of retinopathy with higher systolic blood pressure. The data relating gender and risk of microvascular complications in type 1 diabetes are inconsistent. Previous studies suggest that the relative imbalance between testosterone and estradiol plays an important role in the onset of microvascular diseases, rather than the absolute levels of hormones. In multiple regression analyses UAE was strongest variable that predict progression to incipient or progression to proliferative retinopathy confirming previous observations that retinal microvascular abnormalities are associated with renal dysfunction independently of age, diabetes, hypertension and other risk factors. Our results suggest that retinopathy is present and may progress in T1DM even when coexisting renal disease is excluded. This points to the need for close monitoring of normoalbuminuric T1DM aimed at early detecting, preventing or limiting the progression of retinopathy, especially in men with higher UAE, systolic blood pressure and higher resting heart rate.

retinopathy; albuminuria; type 1 diabetes; risk factors

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