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Prospective study of inflammatory biomarkers and risk of diabetic retinopathy in the diabetes control and complications trial.
JAMA Ophthalmol. 2013 Apr; 131(4):514-21.JO

Abstract

IMPORTANCE

This study demonstrates that increasing quintiles of baseline high-sensitivity C-reactive protein (hsCRP) level may be associated with higher risk of incident clinically significant macular edema, the leading cause of vision loss in working-aged individuals in North America.

OBJECTIVE

To determine whether baseline levels of hsCRP and intercellular adhesion molecule 1 (ICAM-1) predict development and progression of diabetic retinopathy (DR), clinically significant macular edema (CSME), retinal hard exudates, and proliferative DR in the Diabetes Control and Complications Trial (DCCT) cohort.

DESIGN

The DCCT was a large multicenter randomized controlled clinical trial.

SETTING

Twenty-nine medical centers in the United States and Canada.

PARTICIPANTS

The DCCT population consisted of 1441 subjects with type 1 diabetes mellitus aged 13 to 39 years at study entry.

INTERVENTION

We measured levels of hsCRP, ICAM-1, vascular cell adhesion molecule 1, and tumor necrosis factor α receptor 1 in stored baseline blood samples.

MAIN OUTCOME MEASURES

We assessed the association of levels of hsCRP, ICAM-1, vascular cell adhesion molecule 1, and tumor necrosis factor α receptor 1 with incident DR end points ascertained from grading of standardized 7-field stereoscopic retinal color photographs taken at baseline and every 6 months during follow-up.

RESULTS

After adjustment for randomized treatment assignment and other factors, we observed a statistically significant association between hsCRP and risk of CSME, with a relative risk (RR) for the top vs bottom quintile of 1.83 (95% CI, 0.94-3.55; P for trend = .01). Similarly, for the development of retinal hard exudates, the RR for the top vs bottom quintile of hsCRP level was 1.78 (95% CI, 0.98-3.25; P for trend = .004), whereas for ICAM-1 level, the RR comparing the top vs bottom quintiles was 1.50 (95% CI, 0.84-2.68; P for trend = .05). There were no statistically significant associations between baseline VCAM-1 or tumor necrosis factor α receptor 1 levels and risk of any of the DR end points.

CONCLUSIONS AND RELEVANCE

After adjusting for known risk factors, increasing quintiles of baseline hsCRP level may be associated with higher risk of incident CSME and macular hard exudate in the DCCT cohort. Circulating levels of ICAM-1 may also be associated with the development of retinal hard exudates.

Authors+Show Affiliations

Department of Ophthalmology and Vision Sciences, University of Toronto, St Michael’s Hospital, Toronto, Canada. rajeev.muni@utoronto.caNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23392399

Citation

Muni, Rajeev H., et al. "Prospective Study of Inflammatory Biomarkers and Risk of Diabetic Retinopathy in the Diabetes Control and Complications Trial." JAMA Ophthalmology, vol. 131, no. 4, 2013, pp. 514-21.
Muni RH, Kohly RP, Lee EQ, et al. Prospective study of inflammatory biomarkers and risk of diabetic retinopathy in the diabetes control and complications trial. JAMA Ophthalmol. 2013;131(4):514-21.
Muni, R. H., Kohly, R. P., Lee, E. Q., Manson, J. E., Semba, R. D., & Schaumberg, D. A. (2013). Prospective study of inflammatory biomarkers and risk of diabetic retinopathy in the diabetes control and complications trial. JAMA Ophthalmology, 131(4), 514-21. https://doi.org/10.1001/jamaophthalmol.2013.2299
Muni RH, et al. Prospective Study of Inflammatory Biomarkers and Risk of Diabetic Retinopathy in the Diabetes Control and Complications Trial. JAMA Ophthalmol. 2013;131(4):514-21. PubMed PMID: 23392399.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prospective study of inflammatory biomarkers and risk of diabetic retinopathy in the diabetes control and complications trial. AU - Muni,Rajeev H, AU - Kohly,Radha P, AU - Lee,Eudocia Q, AU - Manson,JoAnn E, AU - Semba,Richard D, AU - Schaumberg,Debra A, PY - 2013/2/9/entrez PY - 2013/2/9/pubmed PY - 2013/6/6/medline SP - 514 EP - 21 JF - JAMA ophthalmology JO - JAMA Ophthalmol VL - 131 IS - 4 N2 - IMPORTANCE: This study demonstrates that increasing quintiles of baseline high-sensitivity C-reactive protein (hsCRP) level may be associated with higher risk of incident clinically significant macular edema, the leading cause of vision loss in working-aged individuals in North America. OBJECTIVE: To determine whether baseline levels of hsCRP and intercellular adhesion molecule 1 (ICAM-1) predict development and progression of diabetic retinopathy (DR), clinically significant macular edema (CSME), retinal hard exudates, and proliferative DR in the Diabetes Control and Complications Trial (DCCT) cohort. DESIGN: The DCCT was a large multicenter randomized controlled clinical trial. SETTING: Twenty-nine medical centers in the United States and Canada. PARTICIPANTS: The DCCT population consisted of 1441 subjects with type 1 diabetes mellitus aged 13 to 39 years at study entry. INTERVENTION: We measured levels of hsCRP, ICAM-1, vascular cell adhesion molecule 1, and tumor necrosis factor α receptor 1 in stored baseline blood samples. MAIN OUTCOME MEASURES: We assessed the association of levels of hsCRP, ICAM-1, vascular cell adhesion molecule 1, and tumor necrosis factor α receptor 1 with incident DR end points ascertained from grading of standardized 7-field stereoscopic retinal color photographs taken at baseline and every 6 months during follow-up. RESULTS: After adjustment for randomized treatment assignment and other factors, we observed a statistically significant association between hsCRP and risk of CSME, with a relative risk (RR) for the top vs bottom quintile of 1.83 (95% CI, 0.94-3.55; P for trend = .01). Similarly, for the development of retinal hard exudates, the RR for the top vs bottom quintile of hsCRP level was 1.78 (95% CI, 0.98-3.25; P for trend = .004), whereas for ICAM-1 level, the RR comparing the top vs bottom quintiles was 1.50 (95% CI, 0.84-2.68; P for trend = .05). There were no statistically significant associations between baseline VCAM-1 or tumor necrosis factor α receptor 1 levels and risk of any of the DR end points. CONCLUSIONS AND RELEVANCE: After adjusting for known risk factors, increasing quintiles of baseline hsCRP level may be associated with higher risk of incident CSME and macular hard exudate in the DCCT cohort. Circulating levels of ICAM-1 may also be associated with the development of retinal hard exudates. SN - 2168-6173 UR - https://www.unboundmedicine.com/medline/citation/23392399/Prospective_study_of_inflammatory_biomarkers_and_risk_of_diabetic_retinopathy_in_the_diabetes_control_and_complications_trial_ L2 - https://jamanetwork.com/journals/jamaophthalmology/fullarticle/10.1001/jamaophthalmol.2013.2299 DB - PRIME DP - Unbound Medicine ER -