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High pulse wave velocity is associated with the severity of diabetic retinopathy in patients with type 2 diabetes
  1. Sung-Chen Liu1,2,
  2. Shih-Ming Chuang1,3,
  3. Hong-Mou Shih4,5,
  4. Chao-Hung Wang1,
  5. Ming-Chieh Tsai1,
  6. Chun-Chuan Lee1
  1. 1 Division of Endocrinology and Metabolism, Mackay Memorial Hospital, Taipei, Taiwan
  2. 2 Department of Medicine, Mackay Medical College, Sanzhi, Taipei, Taiwan
  3. 3 Mackay Junior College of Medical, Nursing, and Management, Taipei, Taiwan
  4. 4 Division of Nephrology, Mackay Memorial Hospital, Taipei, Taiwan
  5. 5 Graduate Institute of Physiology, National Taiwan University College of Medicine, Taipei, Taiwan
  1. Correspondence to Dr Shih-Ming Chuang, Division of Endocrinology and Metabolism, Mackay Memorial Hospital, Taipei 10449, Taiwan; gopacer{at}


Pulse wave velocity (PWV) is a non-invasive test for assessing arterial stiffness, and brachial-ankle PWV has been used as an index of peripheral arterial stiffness. This study aimed to investigate the association between the PWV value and severity of diabetic retinopathy (DR). 846 patients with type 2 diabetes (T2DM) consecutively underwent brachial-ankle PWV, and the degree of PWV was defined by tertile. The severity of DR was categorized as no diabetic retinopathy (NDR), non-proliferative diabetic retinopathy (NPDR) or proliferative diabetic retinopathy (PDR) based on the Early Treatment Diabetic Retinopathy Study Scale. Multinomial logistic regression analyses were utilized not only to explore the association between the degree of PWV and severity of DR but also to examine the association of a high-tertile PWV with PDR. PWV levels, diabetes duration and blood pressure were all significantly higher in subjects with NPDR or PDR as compared with individuals with NDR. In the univariate analysis, the highest tertile of PWV (>19.6 m/s) was significantly associated with both NPDR (p<0.001) and PDR (p<0.001) as compared with NDR. After adjusting for confounding factors, the highest tertile of PWV remained significantly associated with PDR (p=0.005), but not with NPDR (p=0.107). Furthermore, the highest tertile of PWV was more significantly associated with PDR (OR=6.15, 95%CI 1.38 to 27.38) as compared with the lowest tertile. In our study, an increasing degree of PWV was positively associated with the severity of DR. High PWV was strongly associated with the risk of severe DR, especially PDR.

  • diabetes complications
  • retina
  • vascular stiffness

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  • Contributors SC and MT collected and analyzed data and wrote the paper. MT and SL interpreted the data and revised the manuscript. SC conceived the study. SC, MT and SL analyzed data. SC, CL and CW conducted the study and collected data. SC and CL are the guarantors of this work and, as such, had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethical committee of the Mackay Memorial Hospital (18MMHIS104e).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article. Deidentified participant data from which the figures are composed are available upon reasonable peer request.

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