Association between aspirin intake and diabetic retinopathy attenuated by CVD, CKD history

Roshini Claire Anthony
11 May 2017
Association between aspirin intake and diabetic retinopathy attenuated by CVD, CKD history

Current intake of aspirin is associated with a higher risk of diabetic retinopathy, particularly vision-threatening diabetic retinopathy (VTDR) in individuals with diabetes, according to findings from the SEED* study. However, the association was no longer significant after controlling for history of cardiovascular disease (CVD) or chronic kidney disease (CKD).

Subjects were 2,061 individuals aged ≥40 years with diabetes who were enrolled in the population-based, cross-sectional SEED study. Seven hundred and eleven patients (34.5 percent) had diabetic retinopathy (mean age 61.9 years, 50.35 percent male), of which 177 (8.6 percent) had VTDR. [PloS One 2017;12:e0175966]

After adjusting for confounders, current intake of aspirin was associated with incidence of diabetic retinopathy (odds ratio [OR], 1.35, 95 percent confidence interval [CI], 1.03–1.75; p=0.028) and VTDR (OR, 1.89, 95 percent CI, 1.24–2.84; p=0.003).

The association between aspirin intake and VTDR remained after adjusting for diabetes duration (OR, 1.69, 95 percent CI, 1.09–2.61; p=0.019); however, the association between aspirin intake and diabetic retinopathy was no longer significant (OR, 1.31, 95 percent CI, 0.99–1.74; p=0.063).

Upon adjusting for history of CVD (angina, heart attack, stroke) and CKD ([estimated glomerular filtration rate, eGFR] <60 mL/min/1.73m2), aspirin intake was no longer significant with incidence of diabetic retinopathy (OR, 1.23, 95 percent CI, 0.90–1.67; p=0.187) or VTDR (OR, 1.40, 95 percent CI, 0.86–2.25; p=0.168).  

“Aspirin use ... might be an indicator of diabetic complications [CVD, CKD] that were co-present with more severe [diabetic retinopathy] type,” said the researchers.

Evidence from previous studies examining the association between aspirin use and diabetic retinopathy has been conflicting with some studies demonstrating a higher risk for diabetic retinopathy with aspirin use and others showing a potential protective effect of aspirin. [PLoS One 2013;8:e76417; Diabetes 1989;38:491-498]

According to the researchers, the differing results in the studies could stem from variations in study population or design. They called for longitudinal studies into investigating the association between aspirin and diabetic retinopathy and the role played by CVD or CKD history.

They also acknowledged limitations of the current study including the lack of information on aspirin dosage and duration of use and the design of the study which did not allow for establishment of causality.

 

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