Research Highlights:

  • Damage to small blood vessels of the eye may be a marker for heightened risk of stroke in people with diabetes.
  • Damage to small blood vessels in the eye may also indicate injury to other blood vessels that can result in stroke or vascular dementia.

Embargoed until 4 a.m. CT/5 a.m. ET Wednesday, Feb. 12, 2020

DALLAS, Feb. 12, 2020 — Damaged small blood vessels in the eye may be a marker for increased  stroke risk among people with diabetes, according to preliminary research to be presented at the American Stroke Association’s International Stroke Conference 2020 – Feb. 19-21 in Los Angeles, a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.

Diabetic retinopathy, damage to small blood vessels of the eye, is a common complication of diabetes and can lead to blindness. It has also previously been linked with an increased risk of heart attack and heart attack deaths.

“A build-up of plaque in large arteries feeding the brain and the common heart arrhythmia atrial fibrillation, are the primary causes of ischemic (clot-caused) strokes. And, damage to small blood vessels also cause stroke and vascular dementia, so we thought that diabetic retinopathy might be an important biomarker of stroke risk for patients with diabetes,” said Ka-Ho Wong, B.S., M.B.A., lead author of the study and clinical research coordinator and lab manager of the de Havenon Lab at the University of Utah Health Hospitals and Clinics in Salt Lake City, Utah.

Researchers followed 874 people with diabetes who developed diabetic retinopathy and 1,954 who did not. All of the patients (average age of 62; 62% male) are participating in ACCORD (Action to Control Cardiovascular Risk in Diabetes), a large trial to test whether intensive efforts to control blood sugar, reduce cholesterol and lower blood pressure can reduce the risk of heart disease in people with diabetes.

During a five-year follow-up, researchers found:

  • Overall, 117 patients had a stroke;

  • Diabetic retinopathy was more common in patients with stroke (41%) than those without (30%);

  • After adjusting for multiple stroke risk factors, those with diabetic retinopathy had a 60% higher risk of stroke than people with diabetes who did not have diabetic retinopathy; and

  • The heightened risk was found in all treatment groups.

“We were surprised that none of the ACCORD interventions (glucose, lipid and blood pressure control) decreased diabetic retinopathy and stroke risk, especially intense blood-pressure reduction, since a lot of microvascular diseases are caused by high blood pressure. This finding is in line with results from ACCORD, which showed no reduction in heart attacks,” Wong said.

Despite the these findings, the researchers suggest that patients with diabetic retinopathy receive aggressive medical management to reduce stroke risk.

“It’s important for everyone with diabetes to maintain good blood glucose control, and those with established diabetic retinopathy should pay particular attention to meeting all the stroke prevention guidelines that are established by the American Stroke Association,” Wong said.

To reduce stroke risk, the American Stroke Association recommends a healthy lifestyle, which includes low salt intake; getting regular physical activity; maintaining a healthy weight; avoiding tobacco; managing stress; limiting alcohol intake to no more than one drink per day for women and two drinks per day for men; and taking medication as prescribed for high blood pressure, diabetes, high cholesterol and atrial fibrillation.

The study did not have information on the type (bleeding or blockage) or location of the strokes that occurred.

Co-authors are Cecilia Peterson B.S.; Rock Theodore, B.S.; Kinga Aitken, M.D, M.P.H.; Michael Dela Cruz, B.A.; Jennifer Majersik, M.D., Ms.C.I.; and Adam de Havenon, M.D. Author disclosures are available in the abstract.

The National Institute of Neurological Disorders and Stroke at the National Institutes of Health funded the study.

Additional Resources:

Statements and conclusions of study authors that are presented at American Stroke Association scientific meetings are solely those of the study authors and do not necessarily reflect Association policy or position. The Association makes no representation or warranty as to their accuracy or reliability. The Association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations are available at https://www.heart.org/en/about-us/aha-financial-information.

The American Stroke Association’s International Stroke Conference (ISC) is the world’s premier meeting dedicated to the science of stroke and brain health. ISC 2020 will be held February 19-21 at the Los Angeles Convention Center in California. The 2 ½-day conference features more than 1,600 compelling scientific presentations in 21 categories that emphasize basic, clinical and translational science for health care professionals and researchers. These science and other clinical presentations will provide attendees with a better understanding of stroke and brain health to help improve prevention, treatment and outcomes for the more than 800,000 Americans who have a stroke each year. Stroke is the fifth leading cause of death and a leading cause of serious, long-term disability in the U.S. Worldwide, cerebrovascular accidents (stroke) are the second leading cause of death and the third leading cause of disability, according to the World Health Organization. Engage in the International Stroke Conference on social media via #ISC20.

About the American Stroke Association

The American Stroke Association is a relentless force for a world with fewer strokes and longer, healthier lives. We team with millions of volunteers and donors to ensure equitable health and stroke care in all communities. We work to prevent, treat and beat stroke by funding innovative research, fighting for the public’s health, and providing lifesaving resources. The Dallas-based association was created in 1998 as a division of the American Heart Association. To learn more or to get involved, call 1-888-4STROKE or visit strokeassociation.org. Follow us on Facebook and Twitter.

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