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Ten-year longitudinal changes in retinal microvascular lesions: the atherosclerosis risk in communities study.

TitleTen-year longitudinal changes in retinal microvascular lesions: the atherosclerosis risk in communities study.
Publication TypeJournal Article
Year of Publication2011
AuthorsLiew G, Campbell S, Klein R, Klein BEK, A Sharrett R, Cotch M F, Wang J J, Wong TY
JournalOphthalmology
Volume118
Issue8
Pagination1612-8
Date Published2011 Aug
ISSN1549-4713
KeywordsAged, Antihypertensive Agents, Atherosclerosis, Blood Pressure, Cardiovascular Diseases, Data Collection, Female, Follow-Up Studies, Humans, Incidence, Male, Middle Aged, Photography, Prospective Studies, Retinal Diseases, Retinal Vessels, Risk Factors, Time Factors
Abstract

OBJECTIVE: There are limited data on the natural history and longitudinal changes of retinal microvascular lesions. We examined 10-year changes in retinal microvascular lesions, focusing on those related to hypertension and shown to predict development of cardiovascular disease.

DESIGN: Prospective cohort.

PARTICIPANTS: We included 1120 middle-aged participants without diabetes of the Atherosclerosis Risk in Communities (ARIC) Study in 1993 to 1995 and again 10 years later in 2003 to 2005.

METHODS: Retinal microvascular lesions were graded from retinal photographs using the same protocol at both examinations, with changes (incidence or disappearance) adjudicated by a side-by-side comparison of photographs. The study sample was stratified by carotid intima media thickness (IMT) and ARIC field center; thus, all analyses were weighted by these factors. Persons with diabetes were excluded because the frequency and pathophysiology of diabetic retinal lesions is different.

MAIN OUTCOME MEASURES: Incidence and disappearance rates of lesions.

RESULTS: The 10-year incidence of focal arteriolar narrowing, arteriovenous (AV) nicking, and retinopathy in persons without diabetes was 3.4% (95% confidence interval [CI], 2.3-4.9), 2.5% (95% CI, 1.6-3.9), and 2.2% (95% CI, 1.3-3.5) respectively. Over the 10-year period, of 32, 219, and 24 eyes with focal arteriolar narrowing, AV nicking and retinopathy at baseline, 50.3% (95% CI, 28.6-71.9), 40.7% (95% CI, 32.7-49.4), and 65.9% (95% CI, 42.4-83.5), respectively, disappeared. Higher baseline plasma fibrinogen and white cell counts were associated with incident focal arteriolar narrowing; antihypertensive medication use was associated with incident AV nicking, and higher diastolic blood pressure, carotid IMT, and white cell counts were associated with incident retinopathy. Higher fasting serum glucose was not significantly associated with incident retinopathy, although this may be related to the small number of lesions (odds ratio, 5.88; 95% CI, 0.74-46.64 per standard deviation difference).

CONCLUSIONS: In this sample of middle-aged adults, new retinal microvascular lesions appeared at a rate between 2% and 4% over 10 years. A high percentage of lesions (≥40%) disappeared over the same period, suggesting considerable remodeling in the retinal microvasculature.

FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any of the materials discussed in this article.

DOI10.1016/j.ophtha.2011.01.003
Alternate JournalOphthalmology
PubMed ID21529953
PubMed Central IDPMC3150229
Grant ListN01HC55020 / HL / NHLBI NIH HHS / United States
N01HC55018 / HL / NHLBI NIH HHS / United States
Z01 EY000426-05 / / Intramural NIH HHS / United States
R01 HL066018-01 / HL / NHLBI NIH HHS / United States
Z99 EY999999 / / Intramural NIH HHS / United States
ZIA EY000426-10 / / Intramural NIH HHS / United States
N01-HC-55022 / HC / NHLBI NIH HHS / United States
N01-HC-55016 / HC / NHLBI NIH HHS / United States
ZIA EY000426-13 / / Intramural NIH HHS / United States
R21-HL077166 / HL / NHLBI NIH HHS / United States
ZIA EY000426-08 / / Intramural NIH HHS / United States
N01HC55022 / HL / NHLBI NIH HHS / United States
N01-HC-55021 / HC / NHLBI NIH HHS / United States
N01HC55015 / HL / NHLBI NIH HHS / United States
Z01 EY000426-04 / / Intramural NIH HHS / United States
ZIA EY000426-11 / / Intramural NIH HHS / United States
N01-HC-55019 / HC / NHLBI NIH HHS / United States
N01-HC-55015 / HC / NHLBI NIH HHS / United States
N01-HC-55020 / HC / NHLBI NIH HHS / United States
N01HC55016 / HL / NHLBI NIH HHS / United States
ZIA EY000426-09 / / Intramural NIH HHS / United States
R21 HL077166-01 / HL / NHLBI NIH HHS / United States
ZIA EY000426-07 / / Intramural NIH HHS / United States
N01HC55019 / HL / NHLBI NIH HHS / United States
ZIA EY000426-12 / / Intramural NIH HHS / United States
R21 HL077166 / HL / NHLBI NIH HHS / United States
ZIA EY000426-06 / / Intramural NIH HHS / United States
Z01 EY000426 / / Intramural NIH HHS / United States
N01-HC-55018 / HC / NHLBI NIH HHS / United States
N01HC55021 / HL / NHLBI NIH HHS / United States