Diabetic Retinopathy Severity Linked to Increased Heart Failure Risk in Patients with Diabetes and CKD: Study
Taiwan: A new study published in Scientific Reports has shed light on the relationship between diabetic retinopathy (DR) severity and heart failure (HF) risk in individuals with both diabetes and chronic kidney disease (CKD). Conducted by Dr. Ping-Hsun Wu and colleagues from Kaohsiung Medical University Hospital in Taiwan, the research highlights how worsening retinal microvascular damage may signal increased vulnerability to cardiovascular complications, including HF.
The observational cohort study involved 1,503 adults diagnosed with both diabetes and CKD. Participants underwent detailed retinal imaging (fundus photography), and DR severity was categorized into three groups, ranging from mild or no apparent retinopathy to proliferative diabetic retinopathy (PDR). The researchers then assessed whether the extent of DR correlated with concurrent HF and predicted future hospitalizations due to HF over five years.
The study revealed the following findings:
- Statistical analysis showed a strong association between advanced diabetic retinopathy and an increased likelihood of heart failure.
- Patients with severe DR had more than twice the odds of having concurrent heart failure compared to those with mild or no DR (adjusted odds ratio: 2.09).
- Among individuals without heart failure at baseline, those with moderate-to-severe DR had a notably higher risk of being hospitalized for heart failure during follow-up.
- The hazard ratio for heart failure hospitalization was 1.37 in patients with severe non-proliferative DR.
- The hazard ratio increased to 1.86 in those with proliferative DR compared to individuals with less severe forms of DR.
These findings suggest that the severity of diabetic retinopathy could serve as a valuable clinical indicator of cardiovascular risk, particularly in a population already burdened with diabetes and CKD. The results reinforce the interconnected nature of microvascular and macrovascular complications in diabetes and highlight the importance of holistic monitoring.
However, the authors caution that the observational nature of the study does not allow for conclusions about causality. Certain confounding factors, such as duration of diabetes, statin adherence, and the type of heart failure—preserved versus reduced ejection fraction—were not captured in detail. These limitations highlight the need for future prospective studies incorporating broader datasets and more refined cardiovascular assessments.
According to the authors, the study also raises the possibility that DR may act as a visual marker of underlying cardiovascular strain. Retinal imaging, a relatively non-invasive and accessible diagnostic tool, could be integrated into routine risk assessments to help identify patients at heightened risk of HF progression.
The authors concluded, "Among adults with diabetes and CKD, DR severity appears to be independently associated with both existing heart failure and future risk of HF-related hospitalization. Incorporating DR assessments into cardiovascular screening protocols may enhance risk stratification and aid in the timely implementation of preventive strategies for this high-risk population."
Reference:
Huang, Y., Shen, F., Liu, P., Su, W., Huang, T., Lin, M., Kuo, M., Chiu, Y., Hwang, S., Lin, Y., & Wu, P. (2025). Dissecting the relationship between heart failure and diabetic retinopathy severity in patients with diabetes and chronic kidney disease: An observational cohort study. Scientific Reports, 15(1), 1-11. https://doi.org/10.1038/s41598-025-04523-1
