Eye and kidney damage in diabetes tied to heart problems

By Lisa Rapaport

(Reuters Health) - Diabetes complications like eye, kidney and nerve damage can all increase the odds of hospitalizations and death from heart problems, a recent study suggests.

Compared to diabetic patients without any of these complications, diabetics with all three had almost twice the risk of cardiovascular events like heart attacks and strokes, the study found.

Diabetes damages eyes, kidneys and nerves through its effects on the microvasculature.

"It is the damage to small vessels that places individuals at greater risk of blindness, amputations and kidney failure," said lead study author Dr. Jack Brownrigg, a surgeon at St. George's Vascular Institute in London.

The new findings suggest that patients who have microvascular damage may need aggressive treatment with statin medications to lower cholesterol and reduce their risk of cardiovascular events, Brownrigg added.

"Microvascular disease in more than one tissue - for example eye complications and kidney damage - should prompt consideration of more intensive management of cholesterol to achieve lower targets," Brownrigg said.

For the current study, Brownrigg and colleagues followed more than 49,000 individuals with type 2 diabetes receiving care at more than 600 medical practices in the U.K.

Half the patients were tracked for at least 5.5 years.

During the study, roughly 2,800 individuals, or almost 6 percent, experienced a cardiovascular event such as a heart attack or stroke, researchers report in The Lancet Diabetes and Endocrinology, May 20.

Peripheral neuropathy was associated with a 40 percent higher risk of cardiovascular events. Diabetics with retinopathy had 39 percent higher odds of a cardiovascular event during the study period. And with kidney damage, the risk for cardiovascular events was increased by 35 percent.

One limitation of the study is that researchers lacked data on the severity of some diabetes complications that might make patients more susceptible to heart attacks or strokes, the authors note.

Even so, the findings still point to the need for doctors to consider statin treatment for any patient with microvascular damage not already taking these drugs, Naveed Sattar and David Preiss of the University of Glasgow in the U.K. note in an accompanying editorial.

This is especially true for patients under 40 who may not be covered by current prescribing guidelines for statins, and for patients with multiple types of tissue damage such as complications in the eyes and kidneys, Sattar and Preiss wrote.

These patients also need to aggressively manage their blood pressure to keep it in a healthy range, Sattar said by email.

"Once folks have some evidence of microvascular disease, we should strongly ensure targets for cholesterol and blood pressure are met to lessen patients' cardiovascular disease risk," Sattar said.

Even when patients are prescribed statins and blood pressure medicines, they may not take the drugs consistently or the doses may be too low to bring cholesterol and blood pressure into a healthy range, Sattar added.

If they have kidney damage or multiple complications from diabetes, patients might need to achieve even lower targets for cholesterol or blood pressure than individuals without renal complications.

"Often, patients can be undertreated," Sattar said.

SOURCE: http://bit.ly/1VliPvm and http://bit.ly/20REknl

Lancet Diabetes Endocrinol 2016.