与视网膜静脉阻塞及小动脉栓子有关的心血管危险因素:社区研究及心血管健康研究中的动脉粥样硬化危险性

Objective: To examine the associations of retinal vein occlusion and arteriola r emboli with cardiovascular disease. Design: Population-based cross-sectional study. Participants: Pooled from the Atherosclerosis Risk in Communities Study (n=12 642; mean age, 60 years) and the Cardiovascular Health Study (n=2824; mean age, 79 years). Methods: Retinal vein occlusion and arteriolar emboli were iden tified from a single nonmydriatic retinal photograph using a standardized protoc ol. Photographs were also graded for arteriovenous nicking and focal arteriolar narrowing. All participants had a comprehensive systemic evaluation, including s tandardized carotid ultrasonography. Main Outcome Measures: Retinal vein occlusi on and arteriolar emboli. Results: Prevalences of retinal vein occlusion and art eriolar emboli were 0.3%(n=39 cases) and 0.2%(n=34 cases), respectively. After adjusting for age, retinal vein occlusion was associated with hypertension (odd s ratio [OR], 2.96; 95%confidence interval [CI], 1.43-6.14), systolic bloo d pr essure (BP) (OR, 4.12; 95%CI, 1.40-12.16; highest quartile vs. lowest), diasto lic BP (OR, 2.64; 95%CI, 1.07-6.46; highest quartile vs. lowest), carotid arte ry plaque (OR, 5.62; 95%CI, 2.60-12.16), body mass index (OR, 3.88; 95%CI, 1. 23-12.18; highest quartile vs. lowest), plasma fibrinogen (OR, 3.29; 95%CI, 1. 08-10.02; highest quartile vs. lowest), arteriovenous nicking (OR, 4.09; 95%CI , 2.00-8.36), and focal arteriolar narrowing (OR, 5.17; 95%CI, 2.59-10.29). A fter adjusting for age, retinal arteriolar emboli were associated with hypertens ion (OR, 3.14; 95%CI, 1.44-6.84), systolic BP (OR, 3.46; 95%CI, 1.13-10.65; highest quartile vs. lowest), prevalent coronary heart disease (OR, 2.33; 95%CI , 1.01-5.42), carotid artery plaque (OR, 4.62; 95%CI, 1.85-11.57), plasma lip oprotein (a) (OR, 3.69; 95%CI, 1.20-11.41; highest quartile vs. lowest), plasm a fibrinogen (OR, 3.09; 95%CI, 0.98-9.76; highest quartile vs. lowest), and cu rrent cigarette smoking (OR, 3.08; 95%CI, 1.47-6.47). Approximately a quarter of participants with retinal vein occlusion and arteriolar emboli had evidence o f carotid artery plaque as defined from ultrasound. Conclusions: Retinal vein oc clusion and retinal arteriolar emboli are associated with carotid artery disease , hypertension, and other cardiovascular risk factors.

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.

视网膜血管直径与高血压风险的前瞻性队列研究

Objective: To examine the relation between diameters of the re tinal arterioles and 10 year incidence of hypertension.Design: Population based prospective coho rt study. Setting: Beaver Dam eye study. Participants: 2451 normotensive people aged 43 to 84 years. Main outcome measures: Diameters of retinal arterioles and venules measured from digitised photographs of the retina taken at baseline. Mea surements summarised as the arteriole: venule ratio, with a lower ratio indicati ng smaller arteriolar diameters. Incident hypertension, defined as systolic bloo d pressure ≥140 mm Hg, diastolic blood pressure ≥90 mm Hg, or use of antihyper tensive drugs during follow up. Results: 721 participants developed hypertension over a 10 year period. Those with lower arteriole: venule ratios had a higher c umulative incidence of hypertension (incidences of 17.4%, 24.1%, 31.0%, and 4 5.1%, respectively, for decreasing quarters of distribution of arteriole:venule ratio). After adjustment for age and sex, participants with arteriole:venule ra tios in the lowest quarter had a threefold higher risk of hypertension (odds rat io 2.95, 95%confidence interval 2.77 to 3.88) than those with ratios in the hig hest quarter. This association remained significant after further adjustment for baseline systolic and diastolic blood pressure and other risk factors (1.82, 1. 39 to 2.40, for lowest versus highest ratio quarters). Conclusions: Narrowed ret inal arterioles are associated with long term risk of hypertension, suggesting t hat structural alterations of the microvasculature may be linked to the developm ent of hypertension.

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.

药物治疗和视网膜血管直径

Purpose: To study the influence of different medications on retinal vessel diameters. Design: Cross- sectional study. Methods: Retinal photographs in the Beaver Dam Eye Study (n=4926, aged43 to 84 years) were digitized, and the diameters of retinal vessels were measured. Participants’ current medications were recorded at the examination. Results: There were few significant associations between medication use and retinal vessel diameters. After adjusting for age, blood pressure, and other factors, participants who were using topical beta- blocker eyedrops had narrower retinal arteriolar (P=.05) and venular (P=.006) diameters than nonusers. Systemic beta- blocker was not associated with retinal vessel diameter size. Conclusion: We found few associations between current medication use and retinal vessel diameter. Retinal vessels were narrowed in those taking antiglaucoma medications, most strikingly in those prescribed topical beta- blockers, although such a relationship could not be established among those using systemic beta- blockers.

视网膜动脉直径和高血压发生危险相关性的前瞻性队列研究

Obsjective: To examine the relation between diameters of the retinal arterioles and 10 year incidence of hypertension. Design: Population based prospective cohort study. Setting: Beaver Dam eye study. Participants: 2451 normotensive people aged 43 to 84 years. Main outcome measures: Diameters of retinal arterioles and venules measured from digitised photographs of the retina taken at baseline. Measurements summarised as the arteriole: venule ratio, with a lower ratio indicating smaller arteriolar diameters. Incident hypertension, defined as systolic blood pressure≥ 140 mm Hg, diastolic blood pressure≥ 90 mm Hg, or use of antihypertensive drugs during follow up. Results: 721 participants developed hypertension over a 10 year period. Those with lower arteriole: venule ratios had a higher cumulative incidence of hypertension (incidences of 17.4% , 24.1% , 31.0% , and 45.1% , respectively, for decreasing quarters of distribution of arteriole:venule ratio). After adjustment for age and sex, participants with arteriole:venule ratios in the lowest quarter had a threefold higher risk of hypertension (odds ratio 2.95, 95% confidence interval 2.77 to 3.88) than those with ratios in the highest quarter. This association remained significant after further adjustment for baseline systolic and diastolic blood pressure and other risk factors (1.82, 1.39 to 2.40, for lowest versus highest ratio quarters). Conclusions: Narrowed retinal arterioles are associated with long term risk of hypertension, suggesting that structural alterations of the microvasculature may be linked to the development of hypertension.

雌激素替代疗法与视网膜血管管径

Objective: It is unclear if estrogen replacement therapy (ERT)-has an effect on the retinal circulation. In the current study, we examine the association of ERT, female reproductive factors, and retinal vascular caliber. Design: Populati on-based crosssectional study. Participants: Women participants aged 43 to 84 y ears living in Beaver Dam, Wisconsin. Methods: Retinal photographs of participan ts taken at the baseline examination were digitized, and the diameters of arteri oles and venules were measured using awell-established technique. Estrogen repl acement therapy and female reproductive factors were ascertained by interview. M ain Outcome Measures: Retinal arteriolar and venular diameters. Results: Of the 2469 women participants with data for analysis, 10.5%were current users of ERT and 7.4%were past users. After adjusting for age, blood pressure (BP), body mas s index, smoking, and other factors, women who were current users of ERT had nar rower retinal arteriolar and venular diameters than those who were past users or never used, with mean arteriolar diameters of 167.6 μm for current users, 170. 8 μm for past users, and 170.9 μm for those who never used (P=0.009) and mean venular diameters of 239.9 μm for current users, 244.0 μm for past users, and 243.9 μm for those who never used (P=0.02). There was a signifi-cant trend of increasing narrowing for both arterioles (P trend, 0.01) and venules (P trend, 0 .007) with increasing duration of ERT. Associations were somewhat stronger in yo unger women and women without a history of hypertension and cigarette smoking. F emale reproductive factors (e.g., age of menarche and pregnancy) were not associ ated with retinal vessel diameters. Conclusions: Estrogen replacement therapy is associated with narrower retinal vessel diameters, independent of BP and other vascular factors.