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...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: Populationbased, 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.展开更多
Purpose: There are few data on the effect of serum lipids on microvascular disease. This study assessed the relationships between serum lipid levels and microvascular disease, as seen in the retina, among participants...Purpose: There are few data on the effect of serum lipids on microvascular disease. This study assessed the relationships between serum lipid levels and microvascular disease, as seen in the retina, among participants who attended a population-based study in Australia (n=3654, aged 49 + years). Methods: Diameters of retinal arterioles and venules were measured from digitised photographs of each participant to obtain an estimate of generalised arteriolar narrowing. Focal arteriolar narrowing, arteriovenous nicking, and retinopathy lesions (microaneurysms, haemorrhages, hard/soft exudates) were graded using a standard protocol. Fasting blood tests were performed in 89% of subjects. Adjusted means were calculated using general linear models. Logistic regression models were used to determine the odds ratios for retinal microvascular signs. Results: After controlling for age, sex, body mass index, smoking, and mean arterial blood pressure, elevated high-density lipoprotein cholesterol was associated with narrower retinal arterioles (Ptrend=0.002) and venules (Ptrend=0.03) and with increased odds of generalised arteriolar narrowing (odds ratio 1.6, 95% confidence interval 1.1- 2.2 for the highest vs the lowest quintile of high-density lipoprotein cholesterol). Serum triglyceride had a U-shaped relationship with venular diameter (Ptrend=0.003). We found no consistent pattern of association between serum total cholesterol or low-density lipoprotein cholesterol and any retinal microvascular signs. Conclusions: These findings suggest that microvascular disease in the retina may result from processes distinct from dyslipidaemia.展开更多
文摘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: Populationbased, 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.
文摘Purpose: There are few data on the effect of serum lipids on microvascular disease. This study assessed the relationships between serum lipid levels and microvascular disease, as seen in the retina, among participants who attended a population-based study in Australia (n=3654, aged 49 + years). Methods: Diameters of retinal arterioles and venules were measured from digitised photographs of each participant to obtain an estimate of generalised arteriolar narrowing. Focal arteriolar narrowing, arteriovenous nicking, and retinopathy lesions (microaneurysms, haemorrhages, hard/soft exudates) were graded using a standard protocol. Fasting blood tests were performed in 89% of subjects. Adjusted means were calculated using general linear models. Logistic regression models were used to determine the odds ratios for retinal microvascular signs. Results: After controlling for age, sex, body mass index, smoking, and mean arterial blood pressure, elevated high-density lipoprotein cholesterol was associated with narrower retinal arterioles (Ptrend=0.002) and venules (Ptrend=0.03) and with increased odds of generalised arteriolar narrowing (odds ratio 1.6, 95% confidence interval 1.1- 2.2 for the highest vs the lowest quintile of high-density lipoprotein cholesterol). Serum triglyceride had a U-shaped relationship with venular diameter (Ptrend=0.003). We found no consistent pattern of association between serum total cholesterol or low-density lipoprotein cholesterol and any retinal microvascular signs. Conclusions: These findings suggest that microvascular disease in the retina may result from processes distinct from dyslipidaemia.
