EURO PEAN SOCI ETY OF CARDIOLOGY ® Letter to the Editor Macrovascular function indices for the prediction of diabetic retinopathy development in patients with type 2 diabetes Nikolaos Gouliopoulos 1 , Alexios S Antonopoulos 2 , Gerasimos Siasos 2,3 , Marilita M Moschos 1 , Evangelos Oikonomou 2 , Eva Kassi 4 and Dimitris Tousoulis 2 Keywords Arterial stiffness, diabetes mellitus, diabetic retinopathy, endothelial function Diabetic retinopathy is one of the most common causes of vision loss worldwide. 1 Close monitoring of type 2 diabetes (T2D) patients and identification of risk fac- tors for diabetic retinopathy development remains an unmet goal. Endothelial dysfunction and impaired vas- cular mechanics participate in T2D-related mechanisms of vascular disease. 1 We have previously shown a sig- nificant association between diabetic retinopathy, endo- thelial dysfunction and arterial stiffness. 2 In a cohort of 187 consecutive T2D patients we sought to investigate whether biomarkers of vascular function predict diabetic retinopathy development. Patients underwent a full ophthalmological examination and classified according to the Early Treatment Diabetic Retinopathy Study classiEcation. 3 Endothelial function was evaluated by the flow-mediated dilatation (FMD) in the brachial artery, and carotid-femoral pulse wave vel- ocity (PWV) was measured as an index of arterial stiff- ness. FMD/PWV ratio was calculated as a composite risk biomarker of vascular function. Patients without diabetic retinopathy at baseline were re-examined after 30 months for diabetic retinopathy progression. Demographic characteristics, biochemical measure- ments and indices of vascular function of the study population are presented in Table 1. At baseline visit, 50.2% (n ¼ 94) of the population was diagnosed with diabetic retinopathy (either background or prolifera- tive). Diabetic retinopathy patients at baseline were older, had longer duration and earlier onset of diabetes mellitus, and poorer glycaemic control (p < 0.05 for all). Carotid femoral PWV was significantly higher and bra- chial FMD and the composite marker FMD/PWV sig- nificantly lower compared with the no diabetic retinopathy group. At follow-up, 18% of patients free of diabetic retin- opathy at baseline developed diabetic retinopathy, whilst the majority remained free of diabetic retinop- athy progression (82%). Diabetic retinopathy progres- sors had higher baseline HbA1c levels, longer diabetes mellitus duration and an earlier onset of disease (Table 1). Moreover, diabetic retinopathy progressors had increased HbA1c% and body mass index at 1 1st Department of Ophthalmology, Gennimatas General Hospital, National and Kapodistrian University of Athens, School of Medicine, Greece 2 1st Department of Cardiology, Hippokration General Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece 3 Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School and Harvard-MIT Biomedical Engineering Center, Massachusetts Institute of Technology, Boston, USA 4 1st Department of Propaedeutic and Internal Medicine, Division of Diabetes, Laiko University Hospital, National and Kapodistrian University of Athens, School of Medicine, Greece Corresponding author: Gerasimos Siasos, 1st Department of Cardiology, Hippokration General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece. Email: gsiasos@med.uoa.gr European Journal of Preventive Cardiology 0(00) 1–3 ! The European Society of Cardiology 2017 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/2047487317717823 journals.sagepub.com/home/ejpc