Data_Sheet_2_Association of Diabetic Retinopathy With Stroke: A Systematic Review and Meta-Analysis.xlsx

Background: The population-based studies conducted thus far do not provide conclusive evidence of the link between diabetic retinopathy (DR) and stroke. The aim of the present systematic review was to determine whether DR is specifically associated with stroke.Methods: MEDLINE, Embase, and Web of Science were systematically searched from their inception to July 31, 2020. All cohort studies that reported associations between the presence of DR and incident stroke were included. The pooled hazard ratios (HRs), pooled risk ratios (RRs), and 95% confidence intervals (CIs) were calculated.Results: The meta-analysis included 19 cohort studies involving 81,452 diabetic patients. The pooled effect size of any DR related to stroke was 1.25 for HR (95% CI: 1.12–1.39; P < 0.0001) and 1.96 for RR (95% CI: 1.60–2.39; P < 0.0001). Subgroup analysis for the type of diabetes yielded pooled HR of 1.29 (95% CI: 1.10–1.50; P = 0.001) in patients with type 2 diabetes mellitus (T2DM). The pooled RR was 2.29 (95% CI: 1.77–2.96; P < 0.0001) in patients with T2DM. Two studies addressed the DR-related stroke among type 1 diabetes mellitus (T1DM) patients. One study found a significant association between DR and stroke (OR: 1.6; 95% CI: 1.1–2.3; P < 0.01), while the other did not identify an association between these two conditions (RR: 1.40; 95% CI: 0.62–2.18; P = 0.178).Conclusions: The presence of DR is associated with an increased risk of stroke in diabetic patients. This correlation is robust in T2DM patients but uncertain in T1DM patients. Our findings indicate that DR is an important biomarker for the prediction of stroke. To further validate the role of DR in stroke-risk stratification, additional research is required on the association between the stage of DR and stroke risk, and more studies including T1DM patients are necessary.

背景：迄今为止进行的基于人群的研究尚未提供关于糖尿病视网膜病变（DR）与中风之间联系的确定性证据。本系统性综述的目的是确定DR是否与中风存在特定关联。方法：对MEDLINE、Embase和Web of Science数据库从创立至2020年7月31日进行了系统检索。纳入了所有报告DR存在与中风发病率相关联的队列研究。计算了汇总的危度比（HRs）、汇总的风险比（RRs）和95%置信区间（CIs）。结果：系统综述纳入了19项队列研究，涉及81,452名糖尿病患者。与中风相关的任何DR的汇总效应量为HR的1.25（95%置信区间：1.12–1.39；P < 0.0001）和RR的1.96（95%置信区间：1.60–2.39；P < 0.0001）。按糖尿病类型进行的亚组分析显示，在2型糖尿病（T2DM）患者中，汇总HR为1.29（95%置信区间：1.10–1.50；P = 0.001）。在T2DM患者中，汇总RR为2.29（95%置信区间：1.77–2.96；P < 0.0001）。两项研究针对1型糖尿病（T1DM）患者的DR相关中风进行了探讨。一项研究发现DR与中风之间存在显著关联（OR：1.6；95%置信区间：1.1–2.3；P < 0.01），而另一项研究并未发现这两种疾病之间的关联（RR：1.40；95%置信区间：0.62–2.18；P = 0.178）。结论：DR的存在与糖尿病患者中风风险的增加相关。这种相关性在T2DM患者中稳健，但在T1DM患者中尚不明确。我们的研究结果指出，DR是预测中风的重要生物标志物。为进一步验证DR在中风风险分层中的作用，需要进一步研究DR阶段与中风风险之间的关系，并且需要更多包括T1DM患者的研究。