Diabetic Retinopathy Including Cardiovascular Disease Complication

Meral Kayıkcioglu^*
*Correspondence: Meral Kayıkcioglu, Department of Cardiology, Ege University, İzmir, Turkey, Email:

Introduction

Type 2 diabetes mellitus is a chronic metabolic disorder characterized by elevated blood glucose levels. It is associated with a range of complications, including cardiovascular disease and diabetic retinopathy. Diabetic retinopathy is a common microvascular complication of T2DM that can lead to vision impairment and blindness. Cardiovascular health plays a pivotal role in the overall well-being of individuals with T2DM. The Life's Simple 8 framework is a tool developed by the American Heart Association to assess and promote cardiovascular health by focusing on seven modifiable health factors and one health behavior. This article explores the associations between cardiovascular health assessed by LS8 and the development of diabetic retinopathy as well as mortality in individuals with T2DM. The LS8 framework is designed to assess and improve cardiovascular health by addressing seven modifiable health factors and one health behavior. Diabetic retinopathy is a microvascular complication of diabetes that affects the blood vessels in the retina, leading to retinal damage and vision impairment. It is a leading cause of blindness in working-age adults. Several risk factors contribute to the development and progression of diabetic retinopathy. Recent research has explored the associations between LS8 components and the development or progression of diabetic retinopathy in individuals with T2DM. Maintaining optimal blood glucose levels, as assessed by the LS8, is associated with a reduced risk of diabetic retinopathy. Tight glycemic control can slow the progression of retinal damage. Healthcare providers should consider the following clinical implications. Tailoring treatment plans to address specific LS8 metrics for each patient can improve overall outcomes, reduce the risk of DR, and lower mortality.

Description

Controlling blood pressure within recommended LS8 ranges is essential for preventing and managing diabetic retinopathy. Hypertension is a significant risk factor for this complication. A favorable cholesterol ratio, as emphasized in the LS8, is linked to a lower risk of diabetic retinopathy. Dyslipidemia can contribute to retinal damage, and cholesterol management is essential. Smoking is a modifiable risk factor included in the LS8 framework. Quitting smoking can significantly reduce the risk of diabetic retinopathy development and progression. Regular physical activity, another component of LS8, can improve overall cardiovascular health and potentially reduce the risk of diabetic retinopathy by enhancing blood flow to the retina. While the LS8 framework encourages a heart-healthy diet and a healthy BMI, research specifically linking these components to diabetic retinopathy is limited. However, the overall impact of these factors on cardiovascular health indirectly influences retinopathy risk. Individuals with T2DM have an increased risk of mortality compared to the general population. Mortality in T2DM can be attributed to several factors, including CVD, kidney disease, infections, and other diabetes-related complications. Cardiovascular health, as assessed by the LS8 framework, is a critical determinant of mortality in T2DM. Research has demonstrated significant associations between LS8 components and mortality in individuals. Maintaining optimal blood glucose levels, as recommended by the LS8, is crucial for reducing mortality in T2DM. Poor glycemic control is associated with an increased risk of death. Controlling blood pressure within LS8-recommended ranges is essential for preventing cardiovascular events and reducing mortality in T2DM. A favorable cholesterol ratio, emphasized in the LS8 framework, is associated with a decreased risk of CVD events and mortality in T2DM [1].

Smoking is a significant risk factor for mortality in T2DM. Quitting smoking, as promoted by the LS8, can substantially reduce the risk of death. Regular physical activity, a key component of LS8, is associated with improved cardiovascular health and reduced mortality in individuals with T2DM. While the direct associations between these LS8 components and mortality are well-established, their impact on mortality in T2DM is mediated primarily through their effects on cardiovascular health and metabolic control. The LS8 framework provides a valuable tool for assessing and promoting cardiovascular health in individuals with T2DM. It underscores the importance of addressing modifiable risk factors to reduce the risk of diabetic retinopathy, CVD events, and mortality. The following clinical implications and future directions are worth considering. Healthcare providers should take a holistic approach to diabetes care, addressing not only glycemic control but also blood pressure, cholesterol levels, and lifestyle factors. Empowering individuals with T2DM with knowledge about the LS8 components and their impact on diabetic retinopathy and mortality can enhance self-management and treatment adherence. Further research is needed to explore the longitudinal impact of LS8 metrics on DR and mortality in diverse populations, potentially leading to refinements in treatment guidelines. Misconceptions about cardiovascular health, such as the belief that heart disease primarily affects men, can further contribute to women's lack of awareness. Collaboration among healthcare providers, including primary care physicians, endocrinologists, ophthalmologists, and dietitians, is essential for comprehensive diabetes care. Regular eye exams to detect diabetic retinopathy and timely interventions are critical to prevent vision loss. Continued research is needed to further elucidate the specific contributions of LS8 components to diabetic retinopathy and mortality in T2DM, especially in large, diverse populations. Cardiovascular health, as assessed by the LS8 framework, plays a pivotal role in the development of diabetic retinopathy and mortality in individuals with T2DM [2].

Optimal management of modifiable risk factors, including blood glucose control, blood pressure management, cholesterol levels, and lifestyle factors, is essential for reducing the risk of diabetic retinopathy, CVD events, and mortality. Healthcare providers and individuals with T2DM should collaborate to prioritize cardiovascular health and implement evidence-based strategies to improve outcomes in diabetes management. Life's Simple 8 is a set of cardiovascular health metrics established by the American Heart Association to evaluate and promote ideal cardiovascular health. This article explores the associations between cardiovascular health assessed by LS8 and the prevalence of DR and mortality in individuals with T2DM. T2DM is a multifaceted condition associated with a wide range of cardiovascular risk factors, including obesity, hypertension, dyslipidemia, and insulin resistance. Individuals with T2DM are at a significantly higher risk of developing CVD, which remains the leading cause of morbidity and mortality in this population. Moreover, T2DM can lead to microvascular complications, such as DR, which is a progressive eye disease affecting the retinal blood vessels. Continual assessment of LS8 metrics and cardiovascular risk factors is essential for guiding treatment adjustments and reducing the risk of DR and mortality. Collaborative care involving primary care providers, endocrinologists, ophthalmologists, and other specialists can optimize the management of T2DM and its complications. DR can result in visual impairment and blindness and is closely linked to systemic vascular dysfunction. Given the intertwined relationship between T2DM, CVD and DR, assessing cardiovascular health in individuals with T2DM using the LS8 framework is valuable for understanding the potential impact on both microvascular and macrovascular complications and overall mortality [3].

LS8 comprises eight key cardiovascular health metrics that can be assessed in clinical practice or population-based studies. Elevated blood pressure is a known risk factor for DR. Poorly controlled hypertension can lead to microvascular changes in the retina, increasing the risk of DR. Dyslipidemia, characterized by elevated LDL-C levels, is associated with DR progression. High cholesterol levels can contribute to retinal vascular changes and oxidative stress. Poor glycemic control is a primary driver of DR development and progression. Hyperglycemia damages the retinal blood vessels and is a central feature of diabetic microvascular complications. A healthy diet and weight management can indirectly influence DR risk by improving glycemic control and reducing the likelihood of obesity-related metabolic dysfunction. Type 2 diabetes mellitus is a chronic metabolic disorder characterized by insulin resistance and impaired glucose regulation. It is a major public health concern globally, with a rising prevalence and a significant burden of complications, including cardiovascular disease and diabetic retinopathy. Smoking is a modifiable risk factor for DR. Smoking damages the microvasculature and exacerbates the adverse effects of diabetes on the retina. Excessive alcohol consumption can disrupt glycemic control and increase the risk of DR, although the relationship may be complex and dose-dependent. Regular physical activity is associated with improved glycemic control and may indirectly reduce the risk of DR through its metabolic benefits. The cumulative effect of favorable LS8 metrics is believed to contribute to a lower risk of DR in individuals with T2DM. Those who adhere to a healthier lifestyle and better manage their cardiovascular risk factors are likely to experience a reduced incidence and severity of DR. Hypertension is a well-established risk factor for cardiovascular events and mortality in T2DM. Effective blood pressure control reduces the risk of CVD-related mortality [4].

Dyslipidemia, particularly elevated LDL-C, is associated with an increased risk of atherosclerosis and CVD-related mortality. Lowering LDL-C levels through medication and lifestyle modifications reduces this risk. Glycemic control is pivotal in preventing diabetes-related complications and reducing mortality. Poorly controlled blood sugar levels increase the risk of CVD and all-cause mortality. A healthy diet and weight management are closely linked to improved cardiovascular health. Maintaining a healthy BMI and adhering to a balanced diet reduce the risk of CVD-related mortality. Smoking is a major modifiable risk factor for premature mortality in T2DM. Quitting smoking is associated with a significant reduction in CVD-related mortality. Moderate alcohol consumption may have cardiovascular benefits, but excessive alcohol intake is associated with increased mortality in T2DM. Regular physical activity promotes cardiovascular fitness and reduces the risk of CVD-related mortality. The LS8 framework has a dual impact on individuals with T2DM by reducing the risk of both DR and mortality. Favorable LS8 metrics contribute to better cardiovascular health by addressing risk factors for CVD, including hypertension, dyslipidemia, hyperglycemia, obesity, and smoking. This leads to a lower risk of CVD-related mortality. Empowering patients with T2DM to understand the importance of LS8 metrics and lifestyle modifications is crucial for promoting adherence to healthier behaviors. By addressing risk factors such as blood pressure, cholesterol, and glycemic control, LS8 metrics also help protect the microvasculature, including the retinal blood vessels, reducing the risk of DR and its complications. Assessing and promoting cardiovascular health through the LS8 framework is a valuable approach in managing individuals with T2DM [5].

Conclusion

Raising awareness among women about the link between pregnancy complications and future cardiovascular risk is critical for several reasons. Awareness empowers women to take proactive steps to manage their cardiovascular health, potentially preventing or delaying the onset of CVD. Informed patients are better advocates for their own health. Women who are aware of the risks can engage in more productive discussions with healthcare providers and seek appropriate care and screenings. Raising awareness can help address disparities in CVD prevention and management, particularly among women from marginalized communities who may have limited access to healthcare information. Educated women can make healthier choices during and after pregnancy, potentially reducing the risk of complications in future generations. Prenatal care should include comprehensive education about the potential long-term health implications of pregnancy complications. Women should be informed about the importance of postpartum followup care and long-term health monitoring. Improved coordination between obstetric care and primary care can ensure that women receive appropriate follow-up and risk assessments after pregnancy. Healthcare providers can offer patient-friendly resources, such as pamphlets, websites, and videos, to educate women about pregnancy complications and cardiovascular health. Peer support programs or patient advocacy groups can provide a platform for women to share their experiences, seek information, and raise awareness within their communities. Healthcare providers should receive training on how to effectively communicate with women about cardiovascular risk associated with pregnancy complications.

Acknowledgement

None.

Conflict of Interest

None.

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