SGLT2 inhibitor short-term efficacy and SYNTAX score association in coronary heart disease retinopathy: a propensity score matching study

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Background Type 2 diabetes (T2DM) and hypertension (HTN) are key risk factors for retinopathy and often coexist with coronary heart disease (CHD). While AI-based retinal imaging predicts CHD risk, links between CHD lesion complexity and retinopathy, and potential benefits of Sodium-Glucose Cotransporter-2 (SGLT2) inhibitors on retinopathy in CHD patients with T2DM, lack sufficient evidence. Methods This case-control study (Jan 2024-Mar 2025) enrolled 642 subjects from Beijing Tongren Hospital (affiliated with Capital Medical University). Retinal imaging data were analyzed. Propensity score matching (PSM) created baseline and optimized datasets. Univariate/multivariate logistic regression assessed if CHD increases retinopathy risk in patients with T2DM, HTN, or both. Pearson correlation evaluated associations between CHD lesion complexity (SYNTAX score) and retinal parameters. Stratified analysis assessed SGLT2 inhibitor effects on retinopathy in hypertensive-diabetic subgroups with/without CHD. The analysis of SGLT2 inhibitor efficacy was based on a retrospective cohort study of drug utilization rather than a prospective randomized intervention. Results Within the hypertensive-diabetic cohort, CHD patients ( n = 97 SGLT2i treated vs. n = 69 controls) showed SGLT2 inhibitors reduced MRV(Venular)C risk ( P < 0.001, OR = 0.584) but increased AVR1.5-2.0PD risk ( P = 0.003). Post-PSM, CHD + T2DM + HTN patients had decreased MRAC vs. T2DM + HTN patients ( P < 0.001, OR = 0.776). SYNTAX score positively correlated with retinal vein diameter and negatively with AVR (both P < 0.05). Conclusion CHD elevates retinopathy risk in patients with T2DM, HTN, or both. Coronary lesion complexity correlates with retinal microvascular changes. SGLT2 inhibitors demonstrate a potential protective effect against some aspects of retinopathy development.

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