<b>Objective. </b>We evaluated the
association between diabetic retinopathy stages and lower-extremity arterial disease (LEAD), its
prognostic value, and the influence of potential contributors in this
relationship in a prospective cohort of patients with type 2 diabetes.
<p><b>Research
design and methods</b><b>. </b>Diabetic retinopathy was staged at baseline as absent,
non-proliferative or proliferative. Cox regression model was fitted to compute
HR (95% CI) for major LEAD (lower-limb amputation
or revascularization) during follow-up by baseline retinopathy stages.
Retinopathy-LEAD association was assessed in subgroups by age, gender, diabetes
duration, HbA1c, systolic blood pressure, diabetic kidney disease, smoking, and
macrovascular disease at baseline. The performance of retinopathy to stratify LEAD
risk was assessed using c-statistic, integrated discrimination improvement (IDI) and net reclassification
improvement (NRI).<b></b></p>
<p><b>Results. </b>Among 1320 participants without a baseline history of LEAD, 94 (7.1%)
patients developed a major LEAD during a
7.1-year median follow-up (incidence rate 9.6,
95%CI [7.8–11.7] per 1000 person-years). The LEAD incidence rate increased by worsening
retinopathy: absent 5.5 (3.9–7.8),
non-proliferative 14.6 (11.1–19.3), proliferative 20.1 (11.1–36.3) per 1000
person-years. Compared with
absent retinopathy, non-proliferative (multi-adjusted HR 2.31, 95%CI [1.43–3.81],
p=0.0006) and proliferative retinopathy (3.14 [1.40–6.15], p=0.007) remained
associated with major LEAD. No heterogeneity was observed across subgroups.
Retinopathy enhanced c-statistic (+0.023 [0.003–0.044], p=0.02), IDI (0.209 [0.130 – 0.321], p<0.001) and NRI (0.562
[0.382–
0.799], p<0.001) for LEAD risk, beyond traditional risk factors.</p>
<p><b>Conclusions. </b>An independent dose-response relationship was observed
between diabetic retinopathy
stages and major LEAD. Retinopathy yielded incremental prognostic information for LEAD risk stratification,
suggesting its usefulness as LEAD predictor.<b></b></p>
High Prevalence of Lower Extremity Peripheral Artery Disease in Type 2 Diabetes Patients with Proliferative Diabetic Retinopathy