Diabetic retinopathy enhances coronary artery calcium-based cardiovascular risk stratification in patients with type 2 diabetes: insights from the ACCoDiab study
Authors' conclusion
The combination of diabetic retinopathy and CAC score significantly enhances cardiovascular risk stratification in T2DM patients, beyond traditional risk factors, highlighting that both microvascular and macrovascular factors should be considered in comprehensive cardiovascular risk assessment.
Study context
- Population
- Patients with T2D and no history of CV events (175 females, 249 males; mean age 61 years), ACCoDiab study
- Participants
- 424 patients
- Exposure
- Coronary artery calcium (CAC) score plus diabetic retinopathy (DR) vs CAC score alone for CV risk prediction
- Outcome
- First CV event: nonfatal MI, ischemic stroke, hospitalization for HF, peripheral artery disease revascularization, CV death
- Follow-up
- Seven years
Methodological detailsprimary prevention cohort
- Primary prevention cohort
Main finding
As reported in the abstract
Predictive power for CV events (AUC)
CAC + DR
75
AUC · CI 0.69–0.82
CAC
68
AUC · CI 0.61–0.75
P = 0.01
Observational data: associations, not effects.
Further findings
DR prevalence by incident CV events
- DR prevalence, patients with events vs without
- 58% vs. 25%
- P
- P < 0.001
Independent association with CV events
- Both CAC score and DR were independently associated with CV events
Predictive power after adjusting for traditional risk factors
- AUC, CAC-based model with DR, adjusted for traditional risk factors
- 79 [0.73-0.86]
- AUC, CAC-based model without DR, adjusted for traditional risk factors
- 73 [0.66-0.81]
- P
- P = 0.04
Reclassification
- DR reclassified a significant proportion of patients into higher-risk categories, particularly those with low and moderate CAC scores
DR severity
- DR severity provided incremental prognostic information but no significant additional stratification beyond binary presence of DR
Original publication
Diabetic retinopathy enhances coronary artery calcium-based cardiovascular risk stratification in patients with type 2 diabetes: insights from the ACCoDiab study. Cardiovasc Diabetol. Published 27 July 2026. doi:10.
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