视网膜病与充血性心力衰竭危险度的关系

Context: Congestive heart failure(CHF)affects a substantial proportion of adults including those without preexisting coronary heart disease. The pathogenesis of CHF is uncertain, but microvascular disease has been hypothesized as a possible factor. Objective: To determine the relationship of retinopathy, a marker of systemic microvascular disease, to risk of CHF. Design, Setting, and Participants: Population-based, prospective 7-year cohort study in 4 US communities using the Atherosclerosis Risk in Communities Study database. Participants(n=11612, aged 49 to 73 years)had retinal photographs taken between 1993 and 1995. The photographs were graded according to a standardized protocol for the presence of retinopathy(eg, microaneurysms, retinal hemorrhages, soft exudates), arteriovenous nicking, focal arteriolar narrowing, and generalized arteriolar narrowing. Main Outcome Measures: Association between retinopathy and incident CHF, identified from hospitalization and death records. Results: The 7-year cumulative incidence of CHF was 5.4%(492 events). Participants with retinopathy had a higher incidence of CHF compared with those without retinopathy(15.1 %vs 4.8%, P< .001). After controlling for age, sex, race, preexisting coronary heart disease, mean arterial blood pressure, diabetes, glucose level, cholesterol level, smoking, body mass index, and study site, the presence of retinopathy was associated with a 2-fold higher risk of CHF(relative risk, 1.96; 95%confidence interval, 1.51-2.54). Among participants without preexisting coronary heart disease, diabetes, or hypertension, retinopathy was associated with a 3-fold higher risk of CHF(relative risk, 2.98; 95%confidence interval, 1.50-5.92). Conclusions: Retinopathy is an independent predictor of CHF, even in persons without preexisting coronary heart disease, diabetes, or hypertension. This suggests that microvascular disease may play an important role in the development of heart failure in the general population. Some asymptomatic persons with retinopathy on an ophthalmologic examination may benefit from further assessment of CHF risk.

视网膜病变与充血性心力衰竭风险研究

Context: Congestive heart failure (CHF) affects a substantial proportion of ad ults including those without preexisting coronary heart disease. The pathogenesi s of CHF is uncertain, but microvascular disease has been hypothesized as a poss ible factor. Objective: To determine the relationship of retinopathy, a marker o f systemic microvascular disease, to risk of CHF. Design, Setting, and Participa nts: Populationbased, prospective 7-year cohort study in 4 US communities usi ng the Atherosclerosis Risk in Communities Study database. Participants (n=1 161 2, aged 49 to 73 years) had retinal photographs taken between 1993 and 1995. The photographs were graded according to a standardized protocol for the presence o f retinopathy (eg, microaneurysms, retinal hemorrhages, soft exudates), arteriov enous nicking, focal arteriolar narrowing, and generalized arteriolar narrowing. Main Outcome Measures: Association between retinopathy and incident CHF, identi fied from hospitalization and death records. Results: The 7-year cumulative inc idence of CHF was 5.4%(492 events). Participants with retinopathy had a higher incidence of CHF compared with those without retinopathy (15.1 %vs 4.8%, P< .0 01). After controlling for age, sex, race, preexisting coronary heart disease, m ean arterial blood pressure, diabetes, glucose level, cholesterol level, smoking , body mass index, and study site, the presence of retinopathy was associated wi th a 2-fold higher risk of CHF (relative risk, 1.96; 95%confidence interval, 1 .51-2.54). Among participants without preexisting coronary heart disease, diabe tes, or hypertension, retinopathy was associated with a 3-fold higher risk of C HF (relative risk, 2.98; 95%confidence interval, 1.50-5.92). Conclusions: Reti nopathy is an independent predictor of CHF, even in persons without preexisting coronary heart disease, diabetes, or hypertension. This suggests that microvascu lar disease may play an important role in the development of heart failure in th e general population. Some asymptomatic persons with retinopathy on an ophthalmo logic examination may benefit from further assessment of CHF risk.