CARDIOVASCULAR AUTONOMIC NEUROPATHY AND PROLIFERATIVE DIABETIC-RETINOPATHY

PURPOSE: To determine prospectively whether cardiovascular autonomic n europathy is a risk factor for proliferative diabetic retinopathy. MET HODS: A five year follow-up study of 88 diabetic persons was performed at a center providing primary and specialized care for diabetes. Part icipants were white, insulin dependent patients with diabetes of 15 to 21 years' duration. The primary end point was the presence of prolife rative diabetic retinopathy, seen either on fundus photography or opht halmologic examination. Cardiovascular autonomic neuropathy was measur ed at baseline by using a standard protocol. RESULTS: Fourteen patient s developed proliferative diabetic retinopathy during follow-up. One m easure of cardiovascular autonomic neuropathy, the 30:15 ratio, the he art rate variation at the 30th beat compared with that at the 15th bea t, was lower among patients with proliferative diabetic retinopathy (P =.0049) The risk of proliferative diabetic retinopathy in patients wi th an abnormal cardiovascular autonomic neuropathy index was 2.59, alt hough the estimate was not statistically significant because of the sm all number of patients who developed proliferative diabetic retinopath y. CONCLUSIONS: This study provides prospective evidence that cardiova scular autonomic neuropathy is associated with proliferative diabetic retinopathy. In addition to ocular determinants of proliferative diabe tic retinopathy, systemic risk factors also should be considered when examining patients with diabetes mellitus.