1
|
Chew EY, Burns SA, Abraham AG, Bakhoum MF, Beckman JA, Chui TYP, Finger RP, Frangi AF, Gottesman RF, Grant MB, Hanssen H, Lee CS, Meyer ML, Rizzoni D, Rudnicka AR, Schuman JS, Seidelmann SB, Tang WHW, Adhikari BB, Danthi N, Hong Y, Reid D, Shen GL, Oh YS. Standardization and clinical applications of retinal imaging biomarkers for cardiovascular disease: a Roadmap from an NHLBI workshop. Nat Rev Cardiol 2024:10.1038/s41569-024-01060-8. [PMID: 39039178 DOI: 10.1038/s41569-024-01060-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/21/2024] [Indexed: 07/24/2024]
Abstract
The accessibility of the retina with the use of non-invasive and relatively low-cost ophthalmic imaging techniques and analytics provides a unique opportunity to improve the detection, diagnosis and monitoring of systemic diseases. The National Heart, Lung, and Blood Institute conducted a workshop in October 2022 to examine this concept. On the basis of the discussions at that workshop, this Roadmap describes current knowledge gaps and new research opportunities to evaluate the relationships between the eye (in particular, retinal biomarkers) and the risk of cardiovascular diseases, including coronary artery disease, heart failure, stroke, hypertension and vascular dementia. Identified gaps include the need to simplify and standardize the capture of high-quality images of the eye by non-ophthalmic health workers and to conduct longitudinal studies using multidisciplinary networks of diverse at-risk populations with improved implementation and methods to protect participant and dataset privacy. Other gaps include improving the measurement of structural and functional retinal biomarkers, determining the relationship between microvascular and macrovascular risk factors, improving multimodal imaging 'pipelines', and integrating advanced imaging with 'omics', lifestyle factors, primary care data and radiological reports, by using artificial intelligence technology to improve the identification of individual-level risk. Future research on retinal microvascular disease and retinal biomarkers might additionally provide insights into the temporal development of microvascular disease across other systemic vascular beds.
Collapse
Affiliation(s)
- Emily Y Chew
- Division of Epidemiology and Clinical Applications, National Eye Institute, NIH, Bethesda, MD, USA.
| | - Stephen A Burns
- School of Optometry, Indiana University, Bloomington, IN, USA
| | - Alison G Abraham
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - Mathieu F Bakhoum
- Departments of Ophthalmology and Visual Science and Pathology, School of Medicine, Yale University, New Haven, CT, USA
| | - Joshua A Beckman
- Division of Vascular Medicine, University of Southwestern Medical Center, Dallas, TX, USA
| | - Toco Y P Chui
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA
| | - Robert P Finger
- Department of Ophthalmology, Mannheim Medical Faculty, University of Heidelberg, Mannheim, Germany
| | - Alejandro F Frangi
- Division of Informatics, Imaging and Data Science (School of Health Sciences), Department of Computer Science (School of Engineering), University of Manchester, Manchester, UK
- Alan Turing Institute, London, UK
| | - Rebecca F Gottesman
- Stroke Branch, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD, USA
| | - Maria B Grant
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama Heersink School of Medicine, Birmingham, AL, USA
| | - Henner Hanssen
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Cecilia S Lee
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
| | - Michelle L Meyer
- Department of Emergency Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Damiano Rizzoni
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Alicja R Rudnicka
- Population Health Research Institute, St. George's University of London, London, UK
| | - Joel S Schuman
- Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Sara B Seidelmann
- Department of Clinical Medicine, Columbia College of Physicians and Surgeons, Greenwich, CT, USA
| | - W H Wilson Tang
- Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Bishow B Adhikari
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD, USA
| | - Narasimhan Danthi
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD, USA
| | - Yuling Hong
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD, USA
| | - Diane Reid
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD, USA
| | - Grace L Shen
- Retinal Diseases Program, Division of Extramural Science Programs, National Eye Institute, NIH, Bethesda, MD, USA
| | - Young S Oh
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD, USA
| |
Collapse
|
2
|
Freiberg J, Welikala R, Rovelt J, Barman SA, Owen CG, Rudnicka AR, Kolko M. Longitudinal associations of retinal vessel morphology with intraocular pressure and blood pressure at follow-up visit-Findings from a Danish eye and vision cohort, Project FOREVER. Acta Ophthalmol 2024. [PMID: 38953839 DOI: 10.1111/aos.16737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 06/22/2024] [Indexed: 07/04/2024]
Abstract
PURPOSE To characterise the retinal vasculometry of a Danish eye and vision cohort and examine associations with systolic blood pressure (BP), diastolic BP, mean arterial BP, and intraocular pressure (IOP). DESIGN Longitudinal study. METHODS The retinal vasculature of fundus images from the FOREVER (Finding Ophthalmic Risks and Evaluating the Value of Eye exams and their predictive Reliability) cohort was analysed using a fully automated image analysis program. Longitudinal associations of retinal vessel morphology at follow-up visit with IOP (baseline and follow-up) and BP (follow-up) were examined using multilevel linear regression models adjusting for age, sex and retinal vasculometry at baseline as fixed effects and person as random effect. Width measurements were additionally adjusted for the spherical equivalent. RESULTS A total of 2089 subjects (62% female) with a mean age of 61 (standard deviation 8) years and a mean follow-up period of 4.1 years (SD 0.6 years) were included. The mean arteriolar diameter was approximately 20% thinner than the mean venular diameter, and venules were about 21%-23% less tortuous than arterioles. BP at follow-up was associated with decreased arteriolar diameter from baseline to follow-up. After adjusting for baseline IOP, IOP at follow-up was associated with increased arteriolar tortuosity above baseline (0.59%, 95% CI 0.08-1.10, p-value 0.024). CONCLUSION In a Danish eye and vision cohort, variations in BP and alterations in IOP over time were associated with changes in the width and tortuosity of retinal vessels. Our findings contribute novel insights into retinal vascular alterations over time.
Collapse
Affiliation(s)
- Josefine Freiberg
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Roshan Welikala
- School of Computer Science and Mathematics, Kingston University, Surrey, UK
| | - Jens Rovelt
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Sarah A Barman
- School of Computer Science and Mathematics, Kingston University, Surrey, UK
| | - Christopher G Owen
- Population Health Research Institute, St. George's, University of London, London, UK
| | - Alicja R Rudnicka
- Population Health Research Institute, St. George's, University of London, London, UK
| | - Miriam Kolko
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
- Department of Ophthalmology, Copenhagen University Hospital, Rigshospitalet, Glostrup, Copenhagen, Denmark
| |
Collapse
|
3
|
Iorga RE, Costin D, Munteanu-Dănulescu RS, Rezuș E, Moraru AD. Non-Invasive Retinal Vessel Analysis as a Predictor for Cardiovascular Disease. J Pers Med 2024; 14:501. [PMID: 38793083 PMCID: PMC11122007 DOI: 10.3390/jpm14050501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 05/06/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024] Open
Abstract
Cardiovascular disease (CVD) is the most frequent cause of death worldwide. The alterations in the microcirculation may predict the cardiovascular mortality. The retinal vasculature can be used as a model to study vascular alterations associated with cardiovascular disease. In order to quantify microvascular changes in a non-invasive way, fundus images can be taken and analysed. The central retinal arteriolar (CRAE), the venular (CRVE) diameter and the arteriolar-to-venular diameter ratio (AVR) can be used as biomarkers to predict the cardiovascular mortality. A narrower CRAE, wider CRVE and a lower AVR have been associated with increased cardiovascular events. Dynamic retinal vessel analysis (DRVA) allows the quantification of retinal changes using digital image sequences in response to visual stimulation with flicker light. This article is not just a review of the current literature, it also aims to discuss the methodological benefits and to identify research gaps. It highlights the potential use of microvascular biomarkers for screening and treatment monitoring of cardiovascular disease. Artificial intelligence (AI), such as Quantitative Analysis of Retinal vessel Topology and size (QUARTZ), and SIVA-deep learning system (SIVA-DLS), seems efficient in extracting information from fundus photographs and has the advantage of increasing diagnosis accuracy and improving patient care by complementing the role of physicians. Retinal vascular imaging using AI may help identify the cardiovascular risk, and is an important tool in primary cardiovascular disease prevention. Further research should explore the potential clinical application of retinal microvascular biomarkers, in order to assess systemic vascular health status, and to predict cardiovascular events.
Collapse
Affiliation(s)
- Raluca Eugenia Iorga
- Department of Surgery II, Discipline of Ophthalmology, “Grigore T. Popa” University of Medicine and Pharmacy, Strada Universitatii No. 16, 700115 Iași, Romania; (R.E.I.); (A.D.M.)
| | - Damiana Costin
- Doctoral School, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | | | - Elena Rezuș
- Department of Internal Medicine II, Discipline of Reumathology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania;
| | - Andreea Dana Moraru
- Department of Surgery II, Discipline of Ophthalmology, “Grigore T. Popa” University of Medicine and Pharmacy, Strada Universitatii No. 16, 700115 Iași, Romania; (R.E.I.); (A.D.M.)
| |
Collapse
|
4
|
Xue CC, Li C, Hu JF, Wei CC, Wang H, Ahemaitijiang K, Zhang Q, Chen DN, Zhang C, Li F, Zhang J, Jonas JB, Wang YX. Retinal vessel caliber and tortuosity and prediction of 5-year incidence of hypertension. J Hypertens 2023; 41:830-837. [PMID: 36883461 DOI: 10.1097/hjh.0000000000003406] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
PURPOSE With arterial hypertension as a global risk factor for cerebrovascular and cardiovascular diseases, we examined whether retinal blood vessel caliber and tortuosity assessed by a vessel-constraint network model can predict the incidence of hypertension. METHODS The community-based prospective study included 9230 individuals who were followed for 5 years. Ocular fundus photographs taken at baseline were analyzed by a vessel-constraint network model. RESULTS Within the 5-year follow-up, 1279 (18.8%) and 474 (7.0%) participants out of 6813 individuals free of hypertension at baseline developed hypertension and severe hypertension, respectively. In multivariable analysis, a higher incidence of hypertension was related to a narrower retinal arteriolar diameter ( P < 0.001), wider venular diameter ( P = 0.005), and a smaller arteriole-to-venule diameter ratio ( P < 0.001) at baseline. Individuals with the 5% narrowest arteriole or the 5% widest venule diameter had a 17.1-fold [95% confidence interval (CI):7.9, 37.2] or 2.3-fold (95% CI: 1.4, 3.7) increased risk for developing hypertension, as compared with those with the 5% widest arteriole or the 5% narrowest venule. The area under the receiver operator characteristic curve for predicting the 5-year incidence of hypertension and severe hypertension was 0.791 (95% CI: 0.778, 0.804) and 0.839 (95% CI: 0.821, 0.856), respectively. Although the venular tortuosity was positively associated with the presence of hypertension at baseline ( P = 0.01), neither arteriolar tortuosity nor venular tortuosity was associated with incident hypertension (both P ≥ 0.10). CONCLUSION AND RELEVANCE Narrower retinal arterioles and wider venules indicate an increased risk for incident hypertension within 5 years, while tortuous retinal venules are associated with the presence rather than the incidence of hypertension. The automatic assessment of retinal vessel features performed well in identifying individuals at risk of developing hypertension.
Collapse
Affiliation(s)
- Can C Xue
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory
- Department of Ophthalmology, Peking University Third Hospital
| | - Cai Li
- School of Biological Science and Medical Engineering, Beihang University, Beijing
- Hefei Innovation Research Institute, Beihang University, Hefei
| | - Jing F Hu
- School of Biological Science and Medical Engineering, Beihang University, Beijing
- Hefei Innovation Research Institute, Beihang University, Hefei
| | - Chuan C Wei
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory
| | - Hua Wang
- School of Biological Science and Medical Engineering, Beihang University, Beijing
- Hefei Innovation Research Institute, Beihang University, Hefei
| | - Kailimujiang Ahemaitijiang
- School of Biological Science and Medical Engineering, Beihang University, Beijing
- Hefei Innovation Research Institute, Beihang University, Hefei
| | - Qi Zhang
- Eye Center, the 2nd Affiliated Hospital, Medical College of Zhejiang University, Hangzhou
| | - Dong N Chen
- Department of Physical Examination, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Chun Zhang
- Department of Ophthalmology, Peking University Third Hospital
| | - Fan Li
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory
| | - Jicong Zhang
- School of Biological Science and Medical Engineering, Beihang University, Beijing
- Hefei Innovation Research Institute, Beihang University, Hefei
| | - Jost B Jonas
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory
- Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Mannheim
- Privatpraxis Prof Jonas und Dr Panda-Jonas, Heidelberg, Germany
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
| | - Ya X Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory
| |
Collapse
|
5
|
Streese L, Pichler FA, Hauser C, Hanssen H. Microvascular wall-to-lumen ratio in patients with arterial hypertension: A randomized controlled exercise trial. Microvasc Res 2023; 148:104526. [PMID: 36914089 DOI: 10.1016/j.mvr.2023.104526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/07/2023] [Accepted: 03/07/2023] [Indexed: 03/15/2023]
Abstract
BACKGROUND AND AIMS High blood pressure is one of the main cardiovascular disease risk factors that contribute to vascular remodeling and dysfunction. We aimed to investigate I) group differences of the retinal microstructure between patients with hypertension and healthy individuals and II) the effects of a high-intensity interval training (HIIT) on hypertension-induced microvascular remodeling in patients with hypertension in a randomized controlled trial. METHODS Arteriolar and venular retinal vessel microstructure including retinal vessel wall (RVW), lumen diameter and wall-to-lumen ratio (WLR) of 41 hypertensive patients, treated with anti-hypertensive medication, and 19 normotensive healthy controls were screened based on high-resolution fundoscopies. Patients with hypertension were randomized to a control group receiving standard physical activity recommendations and an intervention group receiving a supervised and walking-based HIIT for eight weeks. Measurements were repeated after the intervention period. RESULTS Hypertensive patients showed thicker arteriolar RVW (28.0 ± 7.7mu vs. 21.4 ± 4.4mu, p = 0.003) and higher arteriolar WLR (58.5 ± 14.8 % vs. 42.5 ± 8.2 %, p < 0.001) compared to normotensive controls. The intervention group showed reductions in arteriolar RVW (β -3.1 (95 % CI, -4.38, -1.78) p < 0.001) and arteriolar WLR (-5.3 (-10.14, -0.39) p = 0.035) compared to the control group. The intervention effects were independent of age, sex, change in blood pressure and change in cardiorespiratory fitness. CONCLUSIONS HIIT in patients with hypertension improves retinal vessel microvascular remodeling after eight weeks of training. In patients with hypertension, screening retinal vessel microstructure by fundoscopy and monitoring efficacy of short-term exercise treatment are sensitive diagnostic approaches to quantify microvascular health in these patients.
Collapse
Affiliation(s)
- Lukas Streese
- Department of Sport, Exercise and Health, Medical Faculty, University of Basel, Basel, Switzerland; Faculty of Health Care, Niederrhein University of Applied Sciences, Krefeld, Germany.
| | - Franziska Anna Pichler
- Department of Sport, Exercise and Health, Medical Faculty, University of Basel, Basel, Switzerland
| | - Christoph Hauser
- Department of Sport, Exercise and Health, Medical Faculty, University of Basel, Basel, Switzerland
| | - Henner Hanssen
- Department of Sport, Exercise and Health, Medical Faculty, University of Basel, Basel, Switzerland
| |
Collapse
|
6
|
Hanssen H, Streese L, Vilser W. Retinal vessel diameters and function in cardiovascular risk and disease. Prog Retin Eye Res 2022; 91:101095. [PMID: 35760749 DOI: 10.1016/j.preteyeres.2022.101095] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 06/03/2022] [Accepted: 06/13/2022] [Indexed: 12/13/2022]
Abstract
In the last two decades evidence has gradually accumulated suggesting that the eye may be a unique window for cardiovascular risk stratification based on the assessment of subclinical damage of retinal microvascular structure and function. This can be facilitated by non-invasive analysis of static retinal vessel diameters and dynamic recording of flicker light-induced and endothelial function-related dilation of both retinal arterioles and venules. Recent new findings have made retinal microvascular biomarkers strong candidates for clinical implementation as reliable risk predictors. Beyond a review of the current evidence and state of research, the article aims to discuss the methodological benefits and pitfalls and to identify research gaps and future directions. Above all, the potential use for screening and treatment monitoring of cardiovascular disease risk are highlighted. The article provides fundamental comprehension of retinal vessel imaging by explaining anatomical and physiological essentials of the retinal microcirculation leading to a detailed description of the methodological approach. This allows for better understanding of the underlying retinal microvascular pathology associated with the prevalence and development of cardiovascular disease. A body of new evidence is presented on the clinical validity and predictive value of retinal vessel diameters and function for incidence cardiovascular disease and outcome. Findings in children indicate the potential for utility in childhood cardiovascular disease prevention, and the efficacy of exercise interventions highlight the treatment sensitivity of retinal microvascular biomarkers. Finally, coming from the availability of normative data, solutions for diagnostic challenges are discussed and conceptual steps towards clinical implementation are put into perspective.
Collapse
Affiliation(s)
- Henner Hanssen
- Department of Sport, Exercise and Health, Preventive Sports Medicine and Systems Physiology, Medical Faculty, University of Basel, Switzerland.
| | - Lukas Streese
- Department of Sport, Exercise and Health, Preventive Sports Medicine and Systems Physiology, Medical Faculty, University of Basel, Switzerland
| | - Walthard Vilser
- Institute of Biomedical Engineering and Informatics, Ilmenau University of Technology, Ilmenau, Germany; Neonatology and Pediatric Intensive Care Unit, Department of Pediatrics, Jena University Hospital, Jena, Germany
| |
Collapse
|
7
|
Cheung CY, Biousse V, Keane PA, Schiffrin EL, Wong TY. Hypertensive eye disease. Nat Rev Dis Primers 2022; 8:14. [PMID: 35273180 DOI: 10.1038/s41572-022-00342-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/18/2022] [Indexed: 02/07/2023]
Abstract
Hypertensive eye disease includes a spectrum of pathological changes, the most well known being hypertensive retinopathy. Other commonly involved parts of the eye in hypertension include the choroid and optic nerve, sometimes referred to as hypertensive choroidopathy and hypertensive optic neuropathy. Together, hypertensive eye disease develops in response to acute and/or chronic elevation of blood pressure. Major advances in research over the past three decades have greatly enhanced our understanding of the epidemiology, systemic associations and clinical implications of hypertensive eye disease, particularly hypertensive retinopathy. Traditionally diagnosed via a clinical funduscopic examination, but increasingly documented on digital retinal fundus photographs, hypertensive retinopathy has long been considered a marker of systemic target organ damage (for example, kidney disease) elsewhere in the body. Epidemiological studies indicate that hypertensive retinopathy signs are commonly seen in the general adult population, are associated with subclinical measures of vascular disease and predict risk of incident clinical cardiovascular events. New technologies, including development of non-invasive optical coherence tomography angiography, artificial intelligence and mobile ocular imaging instruments, have allowed further assessment and understanding of the ocular manifestations of hypertension and increase the potential that ocular imaging could be used for hypertension management and cardiovascular risk stratification.
Collapse
Affiliation(s)
- Carol Y Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Valérie Biousse
- Departments of Ophthalmology and Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Pearse A Keane
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK.,Institute of Ophthalmology, University College London, London, UK
| | - Ernesto L Schiffrin
- Hypertension and Vascular Research Unit, Lady Davis Institute for Medical Research, and Department of Medicine, Sir Mortimer B. Davis Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Tien Y Wong
- Singapore Eye Research Institute, Singapore National Eye Center, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore. .,Tsinghua Medicine, Tsinghua University, Beijing, China.
| |
Collapse
|
8
|
Higher prevalence of diabetic retinopathy among female Chinese diabetic patients with metabolic syndrome. Jpn J Ophthalmol 2021; 66:102-109. [PMID: 34655347 DOI: 10.1007/s10384-021-00877-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 06/28/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To investigate the association between metabolic syndrome (MetS) and diabetic retinopathy (DR), as well as the association between MetS and retinal vessel caliber, among Chinese patients with type 2 diabetes mellitus in north-eastern China. STUDY DESIGN Cross-sectional study. PATIENTS AND METHODS The patients were recruited from a community-based study, the Fushun Diabetic Retinopathy Cohort Study (FS-DIRECT). The presence of DR was determined using a modified version of the Early Treatment Diabetic Retinopathy Study (ETDRS) scale. The central retinal arteriolar equivalent (CRAE) and the central retinal venular equivalent (CRVE) were identified by use of Integrative Vessel Analysis software. The presence of MetS was defined according to the Joint Interim Statement proposed in 2009. RESULTS The prevalence of DR was significantly higher among female patients with MetS than among those without it (47.2% vs 30.9%, P = 0.002), and it increased as the number of MetS components increased (P = 0.003). Furthermore, the presence of MetS (odds ratio 2.43, 95% CI 1.39-4.26) as well as higher numbers of MetS components were significantly associated with DR in female patients, after adjustment for potential risk factors. Patients with MetS (multivariate β coefficient, 95% CI - 6.9, - 10.0, to - 3.8) or a higher number of Mets components tended to have significantly smaller CRAE. CONCLUSION In this study cohort, female patients with MetS had a higher prevalence of DR. Patients tended to have thinner central retinal arterioles as the number of MetS components increased.
Collapse
|
9
|
Invernizzi A, Schiuma M, Parrulli S, Torre A, Zicarelli F, Colombo V, Marini S, Villella E, Bertoni A, Antinori S, Rizzardini G, Galli M, Meroni L, Giacomelli A, Staurenghi G. Retinal vessels modifications in acute and post-COVID-19. Sci Rep 2021; 11:19373. [PMID: 34588541 PMCID: PMC8481283 DOI: 10.1038/s41598-021-98873-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 08/31/2021] [Indexed: 12/23/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is an infectious disease caused by SARS-CoV-2 primarily affecting the respiratory system which can damage vessels walls virtually in any body district. Changes affecting retinal vessels are a good marker for systemic vascular alterations. This study investigated retinal vessels during the acute phase of COVID-19 and after patients recovery. Fifty-nine eyes from 32 COVID-19 patients and 80 eyes from 53 unexposed subjects were included. Mean arteries diameter (MAD) and mean veins diameter (MVD) were assessed through semi-automatic analysis on fundus color photos at baseline and 6 months later in patients and subjects unexposed to the virus. At baseline MAD and MVD were significantly higher in COVID-19 patients compared to unexposed subjects (p < 0.0001). Both MAD and MVD significantly decreased in COVID-19 patients at follow-up (from 97.5 ± 10.9 to 92.2 ± 11.4 µm, p < 0.0001 and from 133.1 ± 19.3 to 124.6 ± 16.1 µm, p < 0.0001, respectively). Despite this reduction vessels diameter remained significantly higher in severe COVID-19 patients compared to unexposed subjects. Transient retinal vessels dilation could serve a biomarker for systemic inflammation while long-lasting alterations seen in severe COVID-19 likely reflect irreversible structural damage to the vessels walls and should be further investigated for their possible effects on tissues perfusion and function.
Collapse
Affiliation(s)
- Alessandro Invernizzi
- Eye Clinic, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, University of Milan, Via G.B. Grassi 74, 20157, Milan, Italy.
- Department of Biomedical and Clinical Sciences "L. Sacco", Luigi Sacco Hospital, University of Milan, Milan, Italy.
- The Discipline of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, Save Sight Institute, Sydney Eye Hospital, The University of Sydney, 8 Macquarie Street, Sydney, NSW, 2001, Australia.
| | - Marco Schiuma
- Department of Biomedical and Clinical Sciences "L. Sacco", Luigi Sacco Hospital, University of Milan, Milan, Italy
- Department of Infectious Diseases, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Salvatore Parrulli
- Eye Clinic, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, University of Milan, Via G.B. Grassi 74, 20157, Milan, Italy
| | - Alessandro Torre
- Department of Infectious Diseases, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Federico Zicarelli
- Eye Clinic, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, University of Milan, Via G.B. Grassi 74, 20157, Milan, Italy
| | - Valeria Colombo
- Department of Infectious Diseases, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Sara Marini
- Eye Clinic, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, University of Milan, Via G.B. Grassi 74, 20157, Milan, Italy
| | - Elena Villella
- Eye Clinic, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, University of Milan, Via G.B. Grassi 74, 20157, Milan, Italy
| | - Alice Bertoni
- Eye Clinic, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, University of Milan, Via G.B. Grassi 74, 20157, Milan, Italy
| | - Spinello Antinori
- Department of Biomedical and Clinical Sciences "L. Sacco", Luigi Sacco Hospital, University of Milan, Milan, Italy
- Department of Infectious Diseases, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Giuliano Rizzardini
- Department of Infectious Diseases, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Massimo Galli
- Department of Biomedical and Clinical Sciences "L. Sacco", Luigi Sacco Hospital, University of Milan, Milan, Italy
- Department of Infectious Diseases, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Luca Meroni
- Department of Infectious Diseases, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Andrea Giacomelli
- Department of Infectious Diseases, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Giovanni Staurenghi
- Eye Clinic, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, University of Milan, Via G.B. Grassi 74, 20157, Milan, Italy
- Department of Biomedical and Clinical Sciences "L. Sacco", Luigi Sacco Hospital, University of Milan, Milan, Italy
| |
Collapse
|
10
|
Diabetic Retinopathy and Hearing Loss: Results from the Fifth Korean National Health and Nutrition Survey. J Clin Med 2021; 10:jcm10112398. [PMID: 34071684 PMCID: PMC8199348 DOI: 10.3390/jcm10112398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/23/2021] [Accepted: 05/26/2021] [Indexed: 11/17/2022] Open
Abstract
We investigated the association between the severity of diabetic retinopathy (DR) and hearing loss based on vascular etiology. We used data from the Korean National Health and Nutrition Survey 2010–2012. Adults aged >40 years with diabetes were enrolled. Demographic, socioeconomic, general medical, noise exposure and biochemical data were used. Participants were classified into three groups: diabetes without DR, non-proliferative DR (NPDR), and proliferative DR (PDR); participants were also divided into two groups (middle age (40 ≤ age < 65 years) vs. old age (age ≥ 65 years)). The association between hearing loss and DR was determined using logistic regression analysis. A total of 1045 participants (n = 411, middle-aged group; n = 634, old-age group) were enrolled. Overall, the prevalence of hearing loss was 58.1%, 61.4%, and 85.0% in the no DR, NPDR, and PDR groups, respectively. After adjusting for confounding factors, the logistic regression model showed that there was no significant association between the prevalence of DR and hearing loss in the overall sample. However, the presence of PDR (OR 7.74, 95% CI 2.08–28.82) was significantly associated with hearing loss in the middle-aged group. Middle-aged people with diabetes may have an association between DR severity and hearing loss. The potential role of microvascular diseases in the development of hearing loss, especially in middle-aged patients, could be considered.
Collapse
|
11
|
Köchli S, Endes K, Grenacher J, Streese L, Lona G, Hauser C, Deiseroth A, Zahner L, Hanssen H. Socioeconomic Status and Parental Lifestyle Are Associated With Vascular Phenotype in Children. Front Public Health 2021; 9:610268. [PMID: 33842418 PMCID: PMC8032988 DOI: 10.3389/fpubh.2021.610268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 03/03/2021] [Indexed: 01/08/2023] Open
Abstract
Background/Aims: Socioeconomic barriers and lifestyle conditions affect development of cardiovascular disease in adults, but little is known about the association of parental lifestyle and education with childhood health. We aimed to investigate the association of socioeconomic status (SES), migration background, parental physical activity (PA) and smoking status with micro-and macrovascular health in children. Methods: In 2016/2017, 833 school children (aged 7.2 ± 0.4 years) in Basel (Switzerland) were screened for retinal arteriolar-to-venular ratio (AVR), pulse wave velocity (PWV), SES, migration background and parental PA as well as smoking status. Results: High parental PA levels were associated with a favorable higher AVR (p = 0.020) and lower PWV (p = 0.035), but not independent of parental smoking status. Children with parents who smoked had a higher PWV [4.39 (4.35-4.42) m/s] compared to children with non-smoking parents [4.32 (4.29-4.34) m/s, p = 0.001]. Children of parents with a low household income had a higher PWV [4.36 (4.32-4.41) m/s] compared to children of parents with a high household income [4.30 (4.26-4.34) m/s, p = 0.033]. Low parental educational level was associated with a lower AVR [0.86 (0.85-0.88)] compared to children with highly educated parents [AVR:0.88 (0.87-0.88), p = 0.007; PWV: 4.33 (4.30-4.35) m/s, p = 0.041]. Children with a European background showed a higher AVR [0.88 (0.87-0.88)] compared to non-European children [AVR: (0.86 (0.85-0.87), p = 0.034]. Conclusion: Parental PA is associated with better macro- and microvascular childhood health. However, the positive association is lost when parental smoking is considered in the analysis. Socioeconomic factors seem to associate with subclinical vascular alterations in children. Primary prevention programs should focus on including parental lifestyle interventions and educational programs to reduce the burden of lifestyle-associated barriers in order to improve cardiovascular health during lifespan. Clinical Trial Registration: ClinicalTrials.gov Exercise and Arterial Modulation in Youth, https://clinicaltrials.gov/ct2/show/NCT02853747, NCT02853747.
Collapse
Affiliation(s)
- Sabrina Köchli
- Department of Sport, Exercise and Health, Medical Faculty, University of Basel, Basel, Switzerland
| | - Katharina Endes
- Department of Sport, Exercise and Health, Medical Faculty, University of Basel, Basel, Switzerland
| | - Julia Grenacher
- Department of Sport, Exercise and Health, Medical Faculty, University of Basel, Basel, Switzerland
| | - Lukas Streese
- Department of Sport, Exercise and Health, Medical Faculty, University of Basel, Basel, Switzerland
| | - Giulia Lona
- Department of Sport, Exercise and Health, Medical Faculty, University of Basel, Basel, Switzerland
| | - Christoph Hauser
- Department of Sport, Exercise and Health, Medical Faculty, University of Basel, Basel, Switzerland
| | - Arne Deiseroth
- Department of Sport, Exercise and Health, Medical Faculty, University of Basel, Basel, Switzerland
| | - Lukas Zahner
- Department of Sport, Exercise and Health, Medical Faculty, University of Basel, Basel, Switzerland
| | - Henner Hanssen
- Department of Sport, Exercise and Health, Medical Faculty, University of Basel, Basel, Switzerland
| |
Collapse
|
12
|
Huang H, Cao Y, Li J, Liu C, Owusu-Agyeman M, Chen B, Li L, Du F, Hu X, Liu Y, Ye M, Dong B, Xue R, Dong Y, Yao F. Association between retinal arterial narrowing and left ventricular diastolic dysfunction in masked hypertensives. J Clin Hypertens (Greenwich) 2020; 22:1050-1058. [PMID: 32430984 DOI: 10.1111/jch.13863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 03/10/2020] [Accepted: 03/18/2020] [Indexed: 11/29/2022]
Abstract
Morphological change in retinal vessel diameters has been reported to be associated with negative cardiovascular outcomes, but its association with left ventricular diastolic dysfunction (LVDD) is not clear. This study aimed to examine the association between echocardiographic markers of LVDD and retinal vascular diameters, in untreated masked hypertension (MH). In this observational study, 105 MH patients without other cardiovascular risks were included (mean age 48.4 ± 5.7, female 72.4%). All individuals underwent extensive clinical and laboratory investigations, including echocardiography, ambulatory blood pressure monitoring, and retinal vascular diameters measured by optical coherence tomography. In the group, LVDD was diagnosed in 36 participants evaluated by left ventricular volume index, E/A and E/e' ratio. Compared to non-LVDD, LVDD subjects displayed narrower retinal arteriolar diameter (139.1 ± 33.8 vs 165.1 ± 29.1; adjusted P = .007) and wider retinal venular diameter (237.9 ± 42.2 vs 214.9 ± 44.8; adjusted P = .045). Significant and independent associations were demonstrated for retinal arteriolar narrowing and E/A ratio (adjusted β = 0.744, P = .031) and for retinal arteriolar diameter and E/e' ratio (adjusted β = -0.158, P = .001) after controlling for age, gender, body mass index, ambulatory systolic blood pressure, low-density lipoprotein cholesterol, and retinal venular diameter. In untreated MH subjects, retinal arteriolar diameter, a marker of microvascular damage, was independently associated with echocardiographic markers of diastolic dysfunction. These findings might underscore the hypothesis that microvascular disease could contribute to cardiac remodeling.
Collapse
Affiliation(s)
- Huiling Huang
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.,Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou, China
| | - Yalin Cao
- Department of Cardiology, Guizhou Provincial People's Hospital, Guiyang, China
| | - Jiayong Li
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.,Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou, China
| | - Chen Liu
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.,Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou, China
| | - Marvin Owusu-Agyeman
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.,Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou, China
| | - Baolin Chen
- Department of Cardiology, Guizhou Provincial People's Hospital, Guiyang, China
| | - Ling Li
- Department of Cardiology, Guizhou Provincial People's Hospital, Guiyang, China
| | - Fawang Du
- Department of Cardiology, Guizhou Provincial People's Hospital, Guiyang, China
| | - Xingwei Hu
- Department of Cardiology, Guizhou Provincial People's Hospital, Guiyang, China
| | - Yanqiu Liu
- Department of Cardiac ultrasound, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Min Ye
- Department of Cardiac ultrasound, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Bin Dong
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.,Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou, China
| | - Ruicong Xue
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.,Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou, China
| | - Yugang Dong
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.,Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou, China
| | - Fengjuan Yao
- Department of Cardiac ultrasound, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| |
Collapse
|
13
|
Qi Z, Zhao ZY, Xu JT, Zhu LP, Zhang Y, Bao YM, Zhang ZF. Radial Pulse Wave Signals Combined with Ba-PWV for the Risk Prediction of Hypertension and the Monitoring of Its Accompanying Metabolic Risk Factors. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2020; 2020:3926851. [PMID: 32419802 PMCID: PMC7210560 DOI: 10.1155/2020/3926851] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 03/13/2020] [Accepted: 04/15/2020] [Indexed: 12/21/2022]
Abstract
Our aim was to study whether radial pulse wave signals can improve the risk prediction of incident hypertension and are associated with its concomitant metabolic risk factors beyond the traditional cardiovascular risk factor Ba-PWV. By enrolling 523 Chinese subjects in this study, linear and stepwise regression analysis was performed to assess the association of radial artery pulse wave signals and Ba-PWV with blood pressure and its related metabolic risk factors such as fasting plasma glucose (FPG), total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and uric acid (UA). The area under the receiver-operating characteristic curve (AUC), net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were calculated by risk assessment plot to compare the discriminative ability among models with and without radial artery pulse wave signals. After adjusting related confounding factors, radial artery pulse wave variable h 3/h 1 was selected as the sensitive influential factor for blood pressure. Moreover, a new model with h 3/h 1 had a higher AUC than the reference model without it (0.86 vs 0.84; P=0.030). And the NRI and IDI for the new model was 50.0% (P=0.017) and 3.16% (P=0.044), respectively. In addition to Ba-PWV, we found that the decrease of t 4, t 5, and h 5 might be associated with higher FPG, TC, LDL-C, and UA and lower HDL-C. This research might provide a valuable additional tool for remote wearable monitoring of radial artery pulse wave signals in hypertension risk evaluation and management.
Collapse
Affiliation(s)
- Zhen Qi
- Shanghai Geriatric Institute of Chinese Medicine, Shanghai University of Traditional Chinese Medicine, 365 South Xiangyang Road, Shanghai 200031, China
| | - Zhi-Yue Zhao
- Basic Medical College, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Shanghai 201203, China
| | - Jia-Tuo Xu
- Basic Medical College, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Shanghai 201203, China
| | - Li-Ping Zhu
- Physical Examination Center, The First People's Hospital of Taicang Affiliated to Suzhou University, 58 South Changsheng Road, Taicang 215400, China
| | - Yu Zhang
- Department of Cerebral Surgery, The First People's Hospital of Taicang Affiliated to Suzhou University, 58 South Changsheng Road, Taicang 215400, China
| | - Yi-Min Bao
- Basic Medical College, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Shanghai 201203, China
| | - Zhi-Feng Zhang
- Basic Medical College, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Shanghai 201203, China
| |
Collapse
|
14
|
Madhloum N, Luyten LJ, Provost EB, De Boever P, Dockx Y, Sleurs H, Plusquin M, Roodt JO, Vrijens K, Nawrot TS. Establishing reference values for macro- and microvascular measurements in 4-to-5 year-old children of the ENVIRONAGE prospective birth cohort. Sci Rep 2020; 10:5107. [PMID: 32198402 PMCID: PMC7083909 DOI: 10.1038/s41598-020-61987-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 12/30/2019] [Indexed: 01/01/2023] Open
Abstract
Cardiovascular risk factors are usually better tolerated, and can therefore be perceived as less harmful, at a young age. However, over time the effects of these adverse factors may persist or accumulate and lead to excess morbidity and mortality from cardiovascular diseases later in life. Until now, reference values for the basic cardiovascular health characteristics of 4-to-6 year-old children are lacking. Within a follow-up study of the ENVIRONAGE (ENVIRonmental influence ON early AGE) birth cohort we assessed various cardiovascular measurements in 288 children aged 4–5 years. For the macrovasculature, we measured their blood pressure and examined the intima-media thickness of the carotid artery (CIMT), the arterial elasticity (including the pulse-wave velocity (PWV), carotid distensibility (DC) and compliance (CC) coefficients), the carotid β stiffness index (SIβ) and Young’s Elastic Modulus (YEM). Retinal microvascular traits included the Central Retinal Arteriolar Equivalent (CRAE) and Central Retinal Venular Equivalent (CRVE). Age of the study population averaged (±SD) 4.2 (±0.4 years. Mean systolic and diastolic blood pressure were 97.9 (±8.1) mmHg and 54.7(±7.6) mmHg, respectively. CIMT for the total population averaged 487.1 (±68.1) µm. The average stiffness values for DC, CC, SIβ, and PWV were 78.7 (±34.2) 10−³/kPa, 1.61 (±0.59) mm2/kPa and 4.4 (±2.4), and 3.7 m/s (±0.9) respectively. The mean determined for YEM was 163.2 kPa (±79.9). Concerning the microvasculature, the average CRAE was 180.9 (±14.2) µm and the corresponding value for CRVE was 251.0 (±19.7) µm. In contrast to the macrovasculature, a significant gender-related difference existed for the microvasculature: in boys, both the CRAE (178.8 µm vs 182.6 µm; p = 0.03) and CRVE (247.9 µm vs 254.0 µm; p = 0.01) were narrower than in girls. We have provided reference values for young children to understand changes in the early cardiovascular health trajectory. Establishing these reference values of cardiovascular phenotypes at this young age is necessary to develop targeted health promotion strategies as well as for better understanding of the life course changes of both small and large blood vessels.
Collapse
Affiliation(s)
- Narjes Madhloum
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium
| | - Leen J Luyten
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium.,Unité de Recherche en Biologie Cellulaire (URBC) - Namur Research Institute for Life Sciences (Narilis), Namur University, Namur, Belgium
| | - Eline B Provost
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium.,Health Unit, Flemish Institute for Technological Research (VITO), Mol, Belgium
| | - Patrick De Boever
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium.,Health Unit, Flemish Institute for Technological Research (VITO), Mol, Belgium
| | - Yinthe Dockx
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium
| | - Hanne Sleurs
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium
| | - Michelle Plusquin
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium
| | - Jos Op't Roodt
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium.,Department of Internal Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Karen Vrijens
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium
| | - Tim S Nawrot
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium. .,Department of Public Health & Primary Care, Occupational and Environmental Medicine, Leuven University, Leuven, Belgium.
| |
Collapse
|
15
|
Dai G, He W, Xu L, Pazo EE, Lin T, Liu S, Zhang C. Exploring the effect of hypertension on retinal microvasculature using deep learning on East Asian population. PLoS One 2020; 15:e0230111. [PMID: 32134976 PMCID: PMC7058325 DOI: 10.1371/journal.pone.0230111] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 02/23/2020] [Indexed: 11/18/2022] Open
Abstract
Hypertension is the leading risk factor of cardiovascular disease and has profound effects on both the structure and function of the microvasculature. Abnormalities of the retinal vasculature may reflect the degree of microvascular damage due to hypertension, and these changes can be detected with fundus photographs. This study aimed to use deep learning technique that can detect subclinical features appearing below the threshold of a human observer to explore the effect of hypertension on morphological features of retinal microvasculature. We collected 2012 retinal photographs which included 1007 from patients with a diagnosis of hypertension and 1005 from normotensive control. By method of vessel segmentation, we removed interference information other than retinal vasculature and contained only morphological information about blood vessels. Using these segmented images, we trained a small convolutional neural networks (CNN) classification model and used a deep learning technique called Gradient-weighted Class Activation Mapping (Grad-CAM) to generate heat maps for the class “hypertension”. Our model achieved an accuracy of 60.94%, a specificity of 51.54%, a precision of 59.27%, and a recall of 70.48%. The AUC was 0.6506. In the heat maps for the class “hypertension”, red patchy areas were mainly distributed on or around arterial/venous bifurcations. This indicated that the model has identified these regions as being the most important for predicting hypertension. Our study suggested that the effect of hypertension on retinal microvascular morphology mainly occurred at branching of vessels. The change of the branching pattern of retinal vessels was probably the most significant in response to elevated blood pressure.
Collapse
Affiliation(s)
- Guangzheng Dai
- The Second Clinical College, Dalian Medical University, Dalian, Liaoning, China
- Clinical Research Center, He Eye Specialists Hospitals, Shenyang, Liaoning, China
| | - Wei He
- The Second Clinical College, Dalian Medical University, Dalian, Liaoning, China
- Clinical Research Center, He Eye Specialists Hospitals, Shenyang, Liaoning, China
- Clinical College, He University, Shenyang, Liaoning, China
- * E-mail:
| | - Ling Xu
- Clinical Research Center, He Eye Specialists Hospitals, Shenyang, Liaoning, China
- Clinical College, He University, Shenyang, Liaoning, China
| | - Eric E. Pazo
- Clinical Research Center, He Eye Specialists Hospitals, Shenyang, Liaoning, China
- Clinical College, He University, Shenyang, Liaoning, China
| | - Tiezhu Lin
- Clinical Research Center, He Eye Specialists Hospitals, Shenyang, Liaoning, China
- Clinical College, He University, Shenyang, Liaoning, China
| | - Shasha Liu
- Clinical Research Center, He Eye Specialists Hospitals, Shenyang, Liaoning, China
| | - Chenguang Zhang
- The Second Clinical College, Dalian Medical University, Dalian, Liaoning, China
- Clinical Research Center, He Eye Specialists Hospitals, Shenyang, Liaoning, China
| |
Collapse
|
16
|
Kario K, Kanegae H, Oikawa T, Suzuki K. Hypertension Is Predicted by Both Large and Small Artery Disease. Hypertension 2019; 73:75-83. [PMID: 30571549 DOI: 10.1161/hypertensionaha.118.11800] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Both small and large artery disease might precede the development of hypertension. However, no prospective trial has yet determined the role of small and large artery disease on the rate of new-onset hypertension in a normotensive general population. This study investigated associations between both arterial stiffness and small artery retinopathy and the development of hypertension in adults from Japan. Normotensive individuals who underwent a baseline health checkup from 2005 to 2015 and at least 1 annual follow-up were eligible. The cardio-ankle vascular index (CAVI) was measured, and retinal fundus photography was performed at baseline. Follow-up visits included measurement of clinic blood pressure. The primary end point was new-onset hypertension (blood pressure ≥140/90 mm Hg or initiation of antihypertensive medication with self-reported hypertension). The analysis included 34 649 subjects (mean age, 44.2 years; 46.4% male). Mean follow-up duration was 3.18±2.50 years. The cumulative incidence of new-onset hypertension during the 10-year follow-up period was 40% of patients overall, with rates increasing in parallel with baseline CAVI (quartile [Q]1, 23%; Q2, 33%; Q3, 42%; Q4, 58%; P<0.001), and as the severity of retinopathy increased ( P<0.001). CAVI showed good discriminative ability for detecting new-onset hypertension. In multivariate analysis, both CAVI and small artery retinopathy were independent predictors of hypertension development. There was no interaction between CAVI and small artery retinopathy with respect to incident hypertension. In conclusion, we showed that both large and small artery disease predict future hypertension independently of each other and confounding risk factors in a general normotensive population.
Collapse
Affiliation(s)
- Kazuomi Kario
- From the Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K.K., H.K.)
| | - Hiroshi Kanegae
- From the Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K.K., H.K.).,Genki Plaza Medical Center for Health Care, Tokyo, Japan (H.K., T.O.)
| | - Takamitsu Oikawa
- Genki Plaza Medical Center for Health Care, Tokyo, Japan (H.K., T.O.)
| | - Kenji Suzuki
- Japan Health Promotion Foundation, Tokyo, Japan (K.S.)
| |
Collapse
|
17
|
Wei FF, Trenson S, Verhamme P, Vermeer C, Staessen JA. Vitamin K-Dependent Matrix Gla Protein as Multifaceted Protector of Vascular and Tissue Integrity. Hypertension 2019; 73:1160-1169. [PMID: 31006332 PMCID: PMC6510326 DOI: 10.1161/hypertensionaha.119.12412] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Supplemental Digital Content is available in the text.
Collapse
Affiliation(s)
- Fang-Fei Wei
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences (F.-F.W., J.A.S.), University Hospitals Leuven, Belgium
| | - Sander Trenson
- Division of Cardiology (S.T.), University Hospitals Leuven, Belgium
| | - Peter Verhamme
- Centre for Molecular and Vascular Biology, Department of Cardiovascular Sciences, University of Leuven, Belgium (P.V.)
| | - Cees Vermeer
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, The Netherlands (C.V., J.A.S.)
| | - Jan A. Staessen
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences (F.-F.W., J.A.S.), University Hospitals Leuven, Belgium
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, The Netherlands (C.V., J.A.S.)
| |
Collapse
|
18
|
Chyou AC, Klein BEK, Klein R, Barr RG, Cotch MF, Praestgaard A, Wong TY, Lima J, Bluemke DA, Kawut S. Retinal vascular changes and right ventricular structure and function: the MESA-Right Ventricle and MESA-Eye studies. Pulm Circ 2018; 9:2045894018819781. [PMID: 30622700 PMCID: PMC6304712 DOI: 10.1177/2045894018819781] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 11/21/2018] [Indexed: 11/16/2022] Open
Abstract
Retinal vessel diameters have been associated with left ventricular morphology
and function but their relationship with the right ventricle (RV) has not been
studied. We hypothesized that wider retinal venules and narrower retinal
arterioles are associated with RV morphology and function. RV end-diastolic mass
(RVEDM), end-diastolic volume (RVEDV), end-systolic volume (RVESV), stroke
volume (RVSV), and ejection fraction (RVEF) were assessed using cardiac magnetic
resonance imaging (MRI) scans of 4204 participants without clinical
cardiovascular disease at the baseline examination; retinal photography was
obtained at the second examination. Mean diameters of retinal arterioles and
venules were measured and summarized as central retinal vein and artery
equivalents (“veins” and “arteries,” respectively). After adjusting for
covariates, wider veins were associated with greater RVEDM and RVEDV in women
(P = 0.04 and P = 0.02, respectively),
whereas there was an inverse association with RVEDV in men
(P = 0.02). In both sexes, narrower arteries were associated
with lower RVEDM (P < 0.001 in women and
P = 0.002 in men) and smaller RVEDV
(P < 0.001 in women and P = 0.04 in men) in
adjusted models. Narrower arteries were also associated with lower RVEF in men
but this was of borderline significance after adjusting for the LVEF
(P = 0.08). Wider retinal venular diameter was associated
with sex-specific changes in RVEDM and RVEDV in adults without clinical
cardiovascular disease. Narrower retinal arteriolar diameter was associated with
significantly lower RVEDM and smaller RVEDV in both sexes.
Collapse
Affiliation(s)
- Anthony C Chyou
- Division of Cardiology and the Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, New York City, NY, USA
| | - Barbara E K Klein
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Ronald Klein
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - R Graham Barr
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York City, NY, USA
| | - Mary Frances Cotch
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Amy Praestgaard
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Tien Y Wong
- Singapore Eye Research Institute, National University of Singapore, Singapore, Republic of Singapore
| | - Joao Lima
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David A Bluemke
- National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD, USA
| | - Steven Kawut
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
19
|
He Y, Li SM, Kang MT, Liu LR, Li H, Wei SF, Ran AR, Wang N. Association between blood pressure and retinal arteriolar and venular diameters in Chinese early adolescent children, and whether the association has gender difference: a cross-sectional study. BMC Ophthalmol 2018; 18:133. [PMID: 29866094 PMCID: PMC5987453 DOI: 10.1186/s12886-018-0799-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 05/25/2018] [Indexed: 01/16/2023] Open
Abstract
Background To establish the independent association between blood pressure (BP) and retinal vascular caliber, especially the retinal venular caliber, in a population of 12-year-old Chinese children. Methods We have examined 1501 students in the 7th grade with mean age of 12.7 years. A non-mydriatic fundus camera (Canon CR-2, Tokyo, Japan) was used to capture 450 fundus images of the right eyes. Retinal vascular caliber was measured using a computer-based program (IVAN). BP was measured using an automated sphygmomanometer (HEM-907, Omron, Kyoto, Japan). Results The mean retinal arteriolar caliber was 145.3 μm (95% confidence interval [CI], 110.6–189.6 μm) and the mean venular caliber was 212.7 μm (95% CI, 170.6–271.3 μm). After controlling for age, sex, axial length, BMI, waist, spherical equivalent, birth weight, gestational age and fellow retinal vessel caliber, children in the highest quartile of BP had significantly narrower retinal arteriolar caliber than those with lower quartiles (P for trend< 0.05). Each 10-mmHg increase in BP was associated with narrowing of the retinal arterioles by 3.00 μm (multivariable-adjusted P < 0.001), and the results were consist in three BP measurements. The association between BP measures and retinal venular caliber did not persist after adjusting for fellow arteriolar caliber. And there was no significant interaction between BP and sex, age, BMI, and birth status. Conclusions In a large population of adolescent Chinese children, higher BP was found to be associated with narrower retinal arterioles, but not with retinal venules. Sex and other confounding factors had no effect on the relationship of BP and retinal vessel diameter.
Collapse
Affiliation(s)
- Yuan He
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology & Visual Science Key Lab, Beijing Institute of Ophthalmology, Capital Medical University, Beijing, China
| | - Shi-Ming Li
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology & Visual Science Key Lab, Beijing Institute of Ophthalmology, Capital Medical University, Beijing, China
| | - Meng-Tian Kang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology & Visual Science Key Lab, Beijing Institute of Ophthalmology, Capital Medical University, Beijing, China
| | - Luo-Ru Liu
- Anyang Eye Hospital, Anyang, Henan, China
| | - He Li
- Anyang Eye Hospital, Anyang, Henan, China
| | - Shi-Fei Wei
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology & Visual Science Key Lab, Beijing Institute of Ophthalmology, Capital Medical University, Beijing, China
| | - An-Ran Ran
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology & Visual Science Key Lab, Beijing Institute of Ophthalmology, Capital Medical University, Beijing, China
| | - Ningli Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology & Visual Science Key Lab, Beijing Institute of Ophthalmology, Capital Medical University, Beijing, China.
| | | |
Collapse
|
20
|
Köchli S, Endes K, Infanger D, Zahner L, Hanssen H. Obesity, Blood Pressure, and Retinal Vessels: A Meta-analysis. Pediatrics 2018; 141:peds.2017-4090. [PMID: 29743194 DOI: 10.1542/peds.2017-4090] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/06/2018] [Indexed: 01/30/2023] Open
Abstract
CONTEXT Retinal vessel imaging is a noninvasive diagnostic tool used to evaluate cardiovascular risk. Childhood obesity and elevated blood pressure (BP) are associated with retinal microvascular alterations. OBJECTIVE To systematically review and meta-analyze associations between obesity, BP, and physical activity with retinal vessel diameters in children. DATA SOURCES We conducted a literature search through the databases of PubMed, Embase, Ovid, Web of Science, and the Cochrane Register of Controlled Trials. STUDY SELECTION School- and population-based cross-sectional data. DATA EXTRACTION General information, study design, participants, exposure, and outcomes. RESULTS A total of 1751 studies were found, and 30 full-text articles were analyzed for eligibility. Twenty-two articles (18 865 children and adolescents) were used for further assessment and reflection. Eleven articles were finally included in the meta-analysis. We found that a higher BMI is associated with narrower retinal arteriolar (pooled estimate effect size -0.37 [95% confidence interval (CI): -0.50 to -0.24]) and wider venular diameters (0.35 [95% CI: 0.07 to 0.63]). Systolic and diastolic BP are associated with retinal arteriolar narrowing (systolic BP: -0.63 [95% CI: -0.92 to -0.34]; diastolic BP: -0.60 [95% CI -0.95 to -0.25]). Increased physical activity and fitness are associated with favorable retinal vessel diameters. LIMITATIONS Long-term studies are needed to substantiate the prognostic relevance of retinal vessel diameters for cardiovascular risk in children. CONCLUSIONS Our results indicate that childhood obesity, BP, and physical inactivity are associated with retinal microvascular abnormalities. Retinal vessel diameters seem to be sensitive microvascular biomarkers for cardiovascular risk stratification in children.
Collapse
Affiliation(s)
- Sabrina Köchli
- Department of Sport, Exercise and Health, Medical Faculty, University of Basel, Basel-Stadt, Switzerland
| | - Katharina Endes
- Department of Sport, Exercise and Health, Medical Faculty, University of Basel, Basel-Stadt, Switzerland
| | - Denis Infanger
- Department of Sport, Exercise and Health, Medical Faculty, University of Basel, Basel-Stadt, Switzerland
| | - Lukas Zahner
- Department of Sport, Exercise and Health, Medical Faculty, University of Basel, Basel-Stadt, Switzerland
| | - Henner Hanssen
- Department of Sport, Exercise and Health, Medical Faculty, University of Basel, Basel-Stadt, Switzerland
| |
Collapse
|
21
|
Comparisons of microvascular and macrovascular changes in aldosteronism-related hypertension and essential hypertension. Sci Rep 2017; 7:2666. [PMID: 28572599 PMCID: PMC5453943 DOI: 10.1038/s41598-017-02622-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 04/13/2017] [Indexed: 12/21/2022] Open
Abstract
Case-control observational study to evaluate the microvascular and macrovascular changes in patients with hypertension secondary to primary aldosteronism (PA), essential hypertension (EH) and healthy subjects. Measurements of arterial stiffness including augmentation index (AIx) and pulse wave velocity (PWV) were assessed using a TensioClinic arteriograph system. Retinal microcirculation was imaged by a Retinal Vessel Analyzer (RVA) and a non-midriatic camera (Topcon-TRC-NV2000). IMEDOS software analyzed the retinal artery diameter (RAD), retinal vein diameters (RVD) and arteriole-to-venule ratio (AVR) of the vessels coming off the optic disc. Thirty, 39 and 35 patients were included in the PA, EH and control group, respectively. The PA group showed higher PWV values compared only with the control group. The mean brachial and aortic AIx values did not show significant difference between groups. In the PA group, the mean RVD and AVR values were significantly lower than in the EH and control groups, whereas the parameters did not differ between the EH and control groups. In conclusion, AVR appears significantly modified in the PA group compared with the EH group and could represent an early and more reliable indicator of microvascular remodeling.
Collapse
|
22
|
Okubo M, Satoh YI, Hirakawa M, Sasaki K, Masu K, J McHonde G, Ikeda-Kurosawa C, Kurosaka D, Saino T. Different effect of serotonin on intracellular calcium ion dynamics in the smooth muscle cells between rat posterior ciliary artery and vorticose vein. Biomed Res 2017; 37:101-15. [PMID: 27108880 DOI: 10.2220/biomedres.37.101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
5-hydroxytriptamine (5-HT: serotonin) is an important transmitter that causes vessel constriction, although few studies have examined the effect of 5-HT on venous smooth muscles. The intracellular Ca(2+) concentration ([Ca(2+)]i) plays an essential role in stimulus-response coupling in numerous tissue/cells including vascular smooth muscle cells. The present study was performed to examine whether differences between arteries and veins in the response to 5-HT can be detected under confocal microscope with respect to [Ca(2+)]i dynamics. In posterior ciliary arteries of rats, 5-HT induced a [Ca(2+)]i increase. The 5-HT-induced responses were caused by both Ca(2+) influx and mobilization. Agonist and antagonist experiments revealed that arterial smooth muscles possess 5-HT1a, 1b, 2 (Gprotein-coupled type) and 5-HT3 (ion channel type) receptors, and that 5-HT2 in particular plays a major role in these responses. For vorticose veins, the 5-HT-induced responses were also caused by both Ca(2+) influx and mobilization. However, the cAMP dependent pathway (5-HT4-7) was found to be significant in vasocontraction with respect to 5-HT in these vessels. Thus, Ca(2+) mobilization was induced by 5-HT2 and 5-HT4-7 in a vessel-dependent manner, whereas Ca(2+) influx universally was induced by 5-HT3. These results indicate that the posterior ciliary arteries and vorticose veins in the same tissue might differ greatly in their responses to stimulus.
Collapse
Affiliation(s)
- Masatoshi Okubo
- Department of Anatomy (Cell Biology), Iwate Medical University
| | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Wei FF, Zhang ZY, Thijs L, Yang WY, Jacobs L, Cauwenberghs N, Gu YM, Kuznetsova T, Allegaert K, Verhamme P, Li Y, Struijker-Boudier HAJ, Staessen JA. Conventional and Ambulatory Blood Pressure as Predictors of Retinal Arteriolar Narrowing. Hypertension 2016; 68:511-20. [PMID: 27324224 PMCID: PMC4956676 DOI: 10.1161/hypertensionaha.116.07523] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 05/22/2016] [Indexed: 01/07/2023]
Abstract
Supplemental Digital Content is available in the text. At variance with the long established paradigm that retinal arteriolar narrowing trails hypertension, several longitudinal studies, all based on conventional blood pressure (CBP) measurement, proposed that retinal arteriolar narrowing indicates heightened microvascular resistance and precedes hypertension. In 783 randomly recruited Flemish (mean age, 38.2 years; 51.3% women), we investigated to what extent CBP and daytime (10 am to 8 pm) ambulatory blood pressure (ABP) measured at baseline (1989–2008) predicted the central retinal arteriolar equivalent (CRAE) in retinal photographs obtained at follow-up (2008–2015). Systolic/diastolic hypertension thresholds were 140/90 mm Hg for CBP and 135/85 mm Hg for ABP. In multivariable-adjusted models including both baseline CBP and ABP, CRAE after 10.3 years (median) of follow-up was unrelated to CBP (P≥0.14), whereas ABP predicted CRAE narrowing (P≤0.011). Per 1-SD increment in systolic/diastolic blood pressure, the association sizes were −0.95 µm (95% confidence interval, −2.20 to 0.30)/−0.75 µm (−1.93 to 0.42) for CBP and −1.76 µm (−2.95 to −0.58)/−1.48 µm (−2.61 to −0.34) for ABP. Patients with ambulatory hypertension at baseline (17.0%) had smaller CRAE (146.5 versus 152.6 µm; P<0.001) at follow-up. CRAE was not different (P≥0.31) between true normotension (normal CBP and ABP; prevalence, 77.6%) and white-coat hypertension (elevated CBP and normal ABP, 5.4%) and between masked hypertension (normal CBP and elevated ABP, 10.2%) and hypertension (elevated CBP and ABP, 6.8%). In conclusion, the paradigm that retinal arteriolar narrowing precedes hypertension can be explained by the limitations of CBP measurement, including nonidentification of masked and white-coat hypertension.
Collapse
Affiliation(s)
- Fang-Fei Wei
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences (F.-F.W., Z.-Y.Z, L.T., W.-Y.Y, L.J., N.C., Y.-M.G., T.K., J.A.S.), Department of Development and Regeneration (K.A.), Centre for Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences (P.V.), University of Leuven, Leuven, Belgium; Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.L.); and Department of Pharmacology (H.A.J.S.-B.) and R&D Group VitaK (J.A.S.), Maastricht University, Maastricht, The Netherlands
| | - Zhen-Yu Zhang
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences (F.-F.W., Z.-Y.Z, L.T., W.-Y.Y, L.J., N.C., Y.-M.G., T.K., J.A.S.), Department of Development and Regeneration (K.A.), Centre for Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences (P.V.), University of Leuven, Leuven, Belgium; Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.L.); and Department of Pharmacology (H.A.J.S.-B.) and R&D Group VitaK (J.A.S.), Maastricht University, Maastricht, The Netherlands
| | - Lutgarde Thijs
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences (F.-F.W., Z.-Y.Z, L.T., W.-Y.Y, L.J., N.C., Y.-M.G., T.K., J.A.S.), Department of Development and Regeneration (K.A.), Centre for Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences (P.V.), University of Leuven, Leuven, Belgium; Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.L.); and Department of Pharmacology (H.A.J.S.-B.) and R&D Group VitaK (J.A.S.), Maastricht University, Maastricht, The Netherlands
| | - Wen-Yi Yang
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences (F.-F.W., Z.-Y.Z, L.T., W.-Y.Y, L.J., N.C., Y.-M.G., T.K., J.A.S.), Department of Development and Regeneration (K.A.), Centre for Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences (P.V.), University of Leuven, Leuven, Belgium; Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.L.); and Department of Pharmacology (H.A.J.S.-B.) and R&D Group VitaK (J.A.S.), Maastricht University, Maastricht, The Netherlands
| | - Lotte Jacobs
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences (F.-F.W., Z.-Y.Z, L.T., W.-Y.Y, L.J., N.C., Y.-M.G., T.K., J.A.S.), Department of Development and Regeneration (K.A.), Centre for Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences (P.V.), University of Leuven, Leuven, Belgium; Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.L.); and Department of Pharmacology (H.A.J.S.-B.) and R&D Group VitaK (J.A.S.), Maastricht University, Maastricht, The Netherlands
| | - Nicholas Cauwenberghs
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences (F.-F.W., Z.-Y.Z, L.T., W.-Y.Y, L.J., N.C., Y.-M.G., T.K., J.A.S.), Department of Development and Regeneration (K.A.), Centre for Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences (P.V.), University of Leuven, Leuven, Belgium; Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.L.); and Department of Pharmacology (H.A.J.S.-B.) and R&D Group VitaK (J.A.S.), Maastricht University, Maastricht, The Netherlands
| | - Yu-Mei Gu
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences (F.-F.W., Z.-Y.Z, L.T., W.-Y.Y, L.J., N.C., Y.-M.G., T.K., J.A.S.), Department of Development and Regeneration (K.A.), Centre for Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences (P.V.), University of Leuven, Leuven, Belgium; Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.L.); and Department of Pharmacology (H.A.J.S.-B.) and R&D Group VitaK (J.A.S.), Maastricht University, Maastricht, The Netherlands
| | - Tatiana Kuznetsova
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences (F.-F.W., Z.-Y.Z, L.T., W.-Y.Y, L.J., N.C., Y.-M.G., T.K., J.A.S.), Department of Development and Regeneration (K.A.), Centre for Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences (P.V.), University of Leuven, Leuven, Belgium; Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.L.); and Department of Pharmacology (H.A.J.S.-B.) and R&D Group VitaK (J.A.S.), Maastricht University, Maastricht, The Netherlands
| | - Karel Allegaert
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences (F.-F.W., Z.-Y.Z, L.T., W.-Y.Y, L.J., N.C., Y.-M.G., T.K., J.A.S.), Department of Development and Regeneration (K.A.), Centre for Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences (P.V.), University of Leuven, Leuven, Belgium; Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.L.); and Department of Pharmacology (H.A.J.S.-B.) and R&D Group VitaK (J.A.S.), Maastricht University, Maastricht, The Netherlands
| | - Peter Verhamme
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences (F.-F.W., Z.-Y.Z, L.T., W.-Y.Y, L.J., N.C., Y.-M.G., T.K., J.A.S.), Department of Development and Regeneration (K.A.), Centre for Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences (P.V.), University of Leuven, Leuven, Belgium; Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.L.); and Department of Pharmacology (H.A.J.S.-B.) and R&D Group VitaK (J.A.S.), Maastricht University, Maastricht, The Netherlands
| | - Yan Li
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences (F.-F.W., Z.-Y.Z, L.T., W.-Y.Y, L.J., N.C., Y.-M.G., T.K., J.A.S.), Department of Development and Regeneration (K.A.), Centre for Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences (P.V.), University of Leuven, Leuven, Belgium; Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.L.); and Department of Pharmacology (H.A.J.S.-B.) and R&D Group VitaK (J.A.S.), Maastricht University, Maastricht, The Netherlands
| | - Harry A J Struijker-Boudier
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences (F.-F.W., Z.-Y.Z, L.T., W.-Y.Y, L.J., N.C., Y.-M.G., T.K., J.A.S.), Department of Development and Regeneration (K.A.), Centre for Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences (P.V.), University of Leuven, Leuven, Belgium; Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.L.); and Department of Pharmacology (H.A.J.S.-B.) and R&D Group VitaK (J.A.S.), Maastricht University, Maastricht, The Netherlands
| | - Jan A Staessen
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences (F.-F.W., Z.-Y.Z, L.T., W.-Y.Y, L.J., N.C., Y.-M.G., T.K., J.A.S.), Department of Development and Regeneration (K.A.), Centre for Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences (P.V.), University of Leuven, Leuven, Belgium; Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.L.); and Department of Pharmacology (H.A.J.S.-B.) and R&D Group VitaK (J.A.S.), Maastricht University, Maastricht, The Netherlands.
| |
Collapse
|
24
|
Retinal vessel calibres and haemostasis in black and white South Africans: the SABPA study. J Hypertens 2016; 33:2483-90. [PMID: 26398852 DOI: 10.1097/hjh.0000000000000744] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Retinal arteriolar narrowing associates with hypertension development and indicates increased cardiovascular risk. Evidence on whether the retinal vessel calibres are related to the haemostatic system is limited, especially in the black hypertension-prone population with a high stroke incidence. We therefore investigated the relationships between haemostatic markers and retinal vessel calibres. METHODS We performed a cross-sectional study involving 170 black (mean age, 58 years; 44% women) and 189 white (mean age, 49 years; 52% women) teachers, and determined ambulatory blood pressure, haemostatic factors (fibrinogen, von Willebrand factor, D-dimer, plasminogen activator inhibitor-1 and clot lysis time) and retinal vessel calibres (central retinal artery and vein equivalent). The black and white groups were stratified by median split of the retinal arteriolar calibre. RESULTS Both ethnic groups with a smaller arteriolar calibre had higher SBP and narrower venular calibres. In the black population, the central retinal vein equivalent was positively (β = 0.293; P = 0.024) associated with fibrinogen, whereas in the white population, the central retinal artery equivalent (β = -0.256; P = 0.016) was negatively and central retinal vein equivalent (β = 0.234; P = 0.021) positively associated with von Willebrand factor. Furthermore, clot lysis time was negatively associated with the central retinal artery equivalent (β = -0.390; P = 0.014) in the black group and positively associated with the central retinal vein equivalent (β = 0.275; P = 0.008) in the white group. CONCLUSION Relationships between markers of haemostasis and the retinal vessel calibres exist, and vary between ethnicities. Haemostatic alterations are linked to early retinal microvascular changes, and future studies should investigate whether it translates into an elevated stroke risk.
Collapse
|
25
|
Heitmar R, Kalitzeos AA. Reliability of retinal vessel calibre measurements using a retinal oximeter. BMC Ophthalmol 2015; 15:184. [PMID: 26705024 PMCID: PMC4690418 DOI: 10.1186/s12886-015-0174-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 12/15/2015] [Indexed: 11/30/2022] Open
Abstract
Background Summarised retinal vessel diameters are linked to systemic vascular pathology. Monochromatic images provide best contrast to measure vessel calibres. However, when obtaining images with a dual wavelength oximeter the red-free image can be extracted as the green channel information only which in turn will reduce the number of photographs taken at a given time. This will reduce patient exposure to the camera flash and could provide sufficient quality images to reliably measure vessel calibres. Methods We obtained retinal images of one eye of 45 healthy participants. Central retinal arteriolar and central retinal venular equivalents (CRAE and CRVE, respectively) were measured using semi-automated software from two monochromatic images: one taken with a red-free filter and one extracted from the green channel of a dual wavelength oximetry image. Results Participants were aged between 21 and 62 years, all were normotensive (SBP: 115 (12) mmHg; DBP: 72 (10) mmHg) and had normal intra-ocular pressures (12 (3) mmHg). Bland-Altman analysis revealed good agreement of CRAE and CRVE as obtained from both images (mean bias CRAE = 0.88; CRVE = 2.82). Conclusions Summarised retinal vessel calibre measurements obtained from oximetry images are in good agreement to those obtained using red-free photographs.
Collapse
Affiliation(s)
- Rebekka Heitmar
- Aston University, School of Life and Health Sciences, Aston Triangle, Birmingham, B4 7ET, UK.
| | - Angelos A Kalitzeos
- Aston University, School of Life and Health Sciences, Aston Triangle, Birmingham, B4 7ET, UK
| |
Collapse
|
26
|
Wang SB, Mitchell P, Plant AJH, Phan K, Liew G, Thiagalingam A, Burlutsky G, Gopinath B. Metabolic syndrome and retinal microvascular calibre in a high cardiovascular disease risk cohort. Br J Ophthalmol 2015; 100:1041-6. [DOI: 10.1136/bjophthalmol-2015-307637] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 10/18/2015] [Indexed: 11/04/2022]
|
27
|
Heitmar R, Kalitzeos AA, Patel SR, Prabhu-Das D, Cubbidge RP. Comparison of subjective and objective methods to determine the retinal arterio-venous ratio using fundus photography. JOURNAL OF OPTOMETRY 2015; 8:252-257. [PMID: 26386537 PMCID: PMC4591425 DOI: 10.1016/j.optom.2014.07.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 06/23/2014] [Indexed: 06/05/2023]
Abstract
PURPOSE To assess the inter and intra observer variability of subjective grading of the retinal arterio-venous ratio (AVR) using a visual grading and to compare the subjectively derived grades to an objective method using a semi-automated computer program. METHODS Following intraocular pressure and blood pressure measurements all subjects underwent dilated fundus photography. 86 monochromatic retinal images with the optic nerve head centred (52 healthy volunteers) were obtained using a Zeiss FF450+ fundus camera. Arterio-venous ratios (AVR), central retinal artery equivalent (CRAE) and central retinal vein equivalent (CRVE) were calculated on three separate occasions by one single observer semi-automatically using the software VesselMap (ImedosSystems, Jena, Germany). Following the automated grading, three examiners graded the AVR visually on three separate occasions in order to assess their agreement. RESULTS Reproducibility of the semi-automatic parameters was excellent (ICCs: 0.97 (CRAE); 0.985 (CRVE) and 0.952 (AVR)). However, visual grading of AVR showed inter grader differences as well as discrepancies between subjectively derived and objectively calculated AVR (all p<0.000001). CONCLUSION Grader education and experience leads to inter-grader differences but more importantly, subjective grading is not capable to pick up subtle differences across healthy individuals and does not represent true AVR when compared with an objective assessment method. Technology advancements mean we no longer rely on opthalmoscopic evaluation but can capture and store fundus images with retinal cameras, enabling us to measure vessel calibre more accurately compared to visual estimation; hence it should be integrated in optometric practise for improved accuracy and reliability of clinical assessments of retinal vessel calibres.
Collapse
Affiliation(s)
- Rebekka Heitmar
- Aston University, School of Life and Health Sciences, Birmingham, UK.
| | | | - Sunni R Patel
- Topcon Corporation USA, NJ, USA; Toronto Western Hospital, Department of Ophthalmology and Vision Sciences, Toronto, Canada
| | - Diana Prabhu-Das
- Aston University, School of Life and Health Sciences, Birmingham, UK
| | - Robert P Cubbidge
- Aston University, School of Life and Health Sciences, Birmingham, UK
| |
Collapse
|
28
|
Fuchs SC, Pakter HM, Maestri MK, Beltrami-Moreira M, Gus M, Moreira LB, Oliveira MM, Fuchs FD. Are Retinal Vessels Calibers Influenced by Blood Pressure Measured at the Time of Retinography Acquisition? PLoS One 2015; 10:e0136678. [PMID: 26375034 PMCID: PMC4572709 DOI: 10.1371/journal.pone.0136678] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 08/10/2015] [Indexed: 11/19/2022] Open
Abstract
Background Retinal arterial narrowing is associated with higher office blood pressure (BP) and ambulatory blood pressure monitoring, and increased incidence of cardiovascular disease, but it is still unknown if the vessel caliber is associated with BP measured at the time of retinography acquisition. Methods Retinal arteriolar and venular calibers were measured by the microdensitometric method in 448 patients with hypertension. Participants underwent 24-hours ambulatory blood pressure (24-h ABP) monitoring simultaneously with the retinography acquisition. Association between arteriolar and venular calibers with increase of 10 mmHg in the mean 24-hours, daily, and nightly BP, and with BP measured at the time of retinography, was evaluated by ANOVA and multivariate analyses. Results Mean 24-hours, daytime and nighttime systolic and diastolic BP were inversely associated with the arteriolar caliber, but not with the venular caliber. Arteriolar caliber decreased -0.8 (95% CI -1.4 to -0.2) μm per 10-mmHg increase in 24-hours mean systolic BP, adjusted for age, gender, fellow vessel, and duration of hypertension (P = 0.01). The corresponding decreasing in arteriolar caliber by 10 mmHg of increasing in mean diastolic BP was -1.1 μm (-2.0 to -0.2, P = 0.02). The decrease of arteriolar caliber by the same increasing of BP measured at the time of retinography was lower and not statistically significant, particularly for mean diastolic BP and outer arterioles calibers: -1.0 (-1.8 to -0.2) μm in the daytime BP average versus -0.3 (-0.9 to 0.3) at the moment of retinography acquisition. Conclusions These findings suggest that the caliber of arteriolar retinal vessels in patients with uncontrolled hypertension are not significantly influenced by blood pressure measured at the time of retinography acquisition.
Collapse
Affiliation(s)
- Sandra C. Fuchs
- Postgraduate Studies Program in Epidemiology, School of Medicine, Universidade Federal do Rio Grande do Sul, R. Ramiro Barcelos 2600, CEP 90035–003, Porto Alegre, RS, Brazil
- Postgraduate Studies Program in Cardiology, School of Medicine, and Hospital de Clinicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul, R. Ramiro Barcelos 2600, CEP 90035–003, Porto Alegre, RS, Brazil
- * E-mail:
| | - Helena M. Pakter
- Postgraduate Studies Program in Epidemiology, School of Medicine, Universidade Federal do Rio Grande do Sul, R. Ramiro Barcelos 2600, CEP 90035–003, Porto Alegre, RS, Brazil
| | - Marcelo K. Maestri
- Division of Ophthalmology, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, R. Ramiro Barcelos 2350, CEP 90035–003, Porto Alegre, RS, Brazil
| | - Marina Beltrami-Moreira
- Postgraduate Studies Program in Cardiology, School of Medicine, and Hospital de Clinicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul, R. Ramiro Barcelos 2600, CEP 90035–003, Porto Alegre, RS, Brazil
| | - Miguel Gus
- Postgraduate Studies Program in Cardiology, School of Medicine, and Hospital de Clinicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul, R. Ramiro Barcelos 2600, CEP 90035–003, Porto Alegre, RS, Brazil
| | - Leila B. Moreira
- Postgraduate Studies Program in Epidemiology, School of Medicine, Universidade Federal do Rio Grande do Sul, R. Ramiro Barcelos 2600, CEP 90035–003, Porto Alegre, RS, Brazil
- Postgraduate Studies Program in Cardiology, School of Medicine, and Hospital de Clinicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul, R. Ramiro Barcelos 2600, CEP 90035–003, Porto Alegre, RS, Brazil
| | - Manuel M. Oliveira
- Informatics Institute, Universidade Federal do Rio Grande do Sul, Caixa Postal 15064, CEP 91501–970, Porto Alegre, RS, Brazil
| | - Flavio D. Fuchs
- Postgraduate Studies Program in Cardiology, School of Medicine, and Hospital de Clinicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul, R. Ramiro Barcelos 2600, CEP 90035–003, Porto Alegre, RS, Brazil
- National Institute of Science and Technology for Health Technology Assessment (IATS)-CNPq, Hospital de Clinicas de Porto Alegre, UFRGS, Porto Alegre, Brazil
| |
Collapse
|
29
|
McGowan A, Silvestri G, Moore E, Silvestri V, Patterson CC, Maxwell AP, McKay GJ. Evaluation of the Retinal Vasculature in Hypertension and Chronic Kidney Disease in an Elderly Population of Irish Nuns. PLoS One 2015; 10:e0136434. [PMID: 26327531 PMCID: PMC4556713 DOI: 10.1371/journal.pone.0136434] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 08/03/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) and hypertension are global public health problems associated with considerable morbidity, premature mortality and attendant healthcare costs. Previous studies have highlighted that non-invasive examination of the retinal microcirculation can detect microvascular pathology that is associated with systemic disorders of the circulatory system such as hypertension. We examined the associations between retinal vessel caliber (RVC) and fractal dimension (DF), with both hypertension and CKD in elderly Irish nuns. METHODS Data from 1233 participants in the cross-sectional observational Irish Nun Eye Study (INES) were assessed from digital photographs with a standardized protocol using computer-assisted software. Multivariate regression analyses were used to assess associations with hypertension and CKD, with adjustment for age, body mass index (BMI), refraction, fellow eye RVC, smoking, alcohol consumption, ischemic heart disease (IHD), cerebrovascular accident (CVA), diabetes and medication use. RESULTS In total, 1122 (91%) participants (mean age: 76.3 [range: 56-100] years) had gradable retinal images of sufficient quality for blood vessel assessment. Hypertension was significantly associated with a narrower central retinal arteriolar equivalent (CRAE) in a fully adjusted analysis (P = 0.002; effect size = -2.16 μm; 95% confidence intervals [CI]: -3.51, -0.81 μm). No significant associations between other retinal vascular parameters and hypertension or between any retinal vascular parameters and CKD were found. CONCLUSIONS Individuals with hypertension have significantly narrower retinal arterioles which may afford an earlier opportunity for tailored prevention and treatment options to optimize the structure and function of the microvasculature, providing additional clinical utility. No significant associations between retinal vascular parameters and CKD were detected.
Collapse
Affiliation(s)
- Amy McGowan
- Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland
| | - Giuliana Silvestri
- Centre for Experimental Medicine, Queen’s University Belfast, Belfast, Northern Ireland
- Department of Ophthalmology, Royal Victoria Hospital, Belfast, Northern Ireland
| | - Evelyn Moore
- Department of Ophthalmology, Royal Victoria Hospital, Belfast, Northern Ireland
| | - Vittorio Silvestri
- Department of Ophthalmology, Royal Victoria Hospital, Belfast, Northern Ireland
| | | | | | - Gareth J. McKay
- Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland
- * E-mail:
| |
Collapse
|
30
|
Hussain SM, Kähönen M, Raitakari OT, Skilton MR, Witt N, Chaturvedi N, Hutri-Kähönen N, Lehtimäki T, Vaahtoranta-Lehtonen H, Juonala M, Wijetunge S, Hughes AD, McG Thom SA, Metha A, Tapp RJ. Impact of Fetal Growth and Preterm Birth on the Retinal Microvasculature in Mid-Adulthood. Microcirculation 2015; 22:285-93. [DOI: 10.1111/micc.12197] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 02/26/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Sultana Monira Hussain
- Department of Optometry and Vision Sciences; The University of Melbourne; Parkville Victoria Australia
- Department of Epidemiology and Preventive Medicine; Monash University; Melbourne Victoria Australia
| | - Mika Kähönen
- Department of Clinical Physiology; Tampere University Hospital and the University of Tampere; Tampere Finland
| | - Olli T. Raitakari
- The Research Centre of Applied and Preventive Cardiovascular Medicine; University of Turku; Turku Finland
- Department of Clinical Physiology and Nuclear Medicine; Turku University Hospital; Turku Finland
| | - Michael R. Skilton
- Boden Institute of Obesity Nutrition Exercise and Eating Disorders; University of Sydney; Sydney New South Wales Australia
| | - Nicholas Witt
- International Centre for Circulatory Health; NHLI; Imperial College; London and Imperial College Healthcare NHS Trust; London UK
| | - Nish Chaturvedi
- International Centre for Circulatory Health; NHLI; Imperial College; London and Imperial College Healthcare NHS Trust; London UK
| | - Nina Hutri-Kähönen
- Department of Pediatrics; University of Tampere and Tampere University Hospital; Tampere Finland
| | - Terho Lehtimäki
- Department of Clinical Chemistry; Fimlab Laboratories; University of Tampere School of Medicine; Tampere Finland
| | | | - Markus Juonala
- Division of Medicine; Turku University Hospital; Turku Finland
| | - Sumangali Wijetunge
- International Centre for Circulatory Health; NHLI; Imperial College; London and Imperial College Healthcare NHS Trust; London UK
| | - Alun D. Hughes
- International Centre for Circulatory Health; NHLI; Imperial College; London and Imperial College Healthcare NHS Trust; London UK
- Institute of Cardiovascular Science; University College London; London UK
| | - Simon A. McG Thom
- International Centre for Circulatory Health; NHLI; Imperial College; London and Imperial College Healthcare NHS Trust; London UK
| | - Andrew Metha
- Department of Optometry and Vision Sciences; The University of Melbourne; Parkville Victoria Australia
| | - Robyn J. Tapp
- Department of Optometry and Vision Sciences; The University of Melbourne; Parkville Victoria Australia
- The Melbourne School of Population and Global Health; The University of Melbourne; Parkville Victoria Australia
| |
Collapse
|
31
|
Association of open-angle glaucoma loci with incident glaucoma in the Blue Mountains Eye Study. Am J Ophthalmol 2015; 159:31-6.e1. [PMID: 25242315 PMCID: PMC4265734 DOI: 10.1016/j.ajo.2014.09.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 09/12/2014] [Accepted: 09/13/2014] [Indexed: 11/21/2022]
Abstract
Purpose To determine if open-angle glaucoma (OAG)-associated single nucleotide polymorphisms (SNPs) are associated with incident glaucoma and if such genetic information is useful in OAG risk prediction. Design Case-control from within a population-based longitudinal study. Methods study population: Individuals aged over 49 years of age living in the Blue Mountains region west of Sydney and enrolled in the Blue Mountains Eye Study. observation: Cases for this sub-study (n = 67) developed incident OAG between baseline and 10-year visits, in either eye, while controls (n = 1919) had no evidence for OAG at any visit. All participants had an ocular examination and DNA genotyped for reported OAG risk SNPs. main outcome measure: Incident OAG. Results Two loci also known to be associated with cup-to-disc ratio as well as OAG (9p21 near CDKN2B-AS1 and SIX1/SIX6) were both significantly associated with incident OAG in the Blue Mountains Eye Study cohort (P = .006 and P = .004, respectively). The TMCO1 locus was nominally associated (P = .012), while the CAV1/CAV2 and 8q22 loci were not associated. Multivariate logistic regression and neural network analysis both indicated that the genetic risk factors contributed positively to the predictive models incorporating traditional risk factors. Conclusions This study shows that previously reported genetic variations related to OAG and cup-to-disc ratio are associated with the onset of OAG and thus may become useful in risk prediction algorithms designed to target early treatment to those most at risk of developing glaucoma.
Collapse
|
32
|
Rönnbäck C, Grønskov K, Larsen M. Retinal vessel diameters decrease with macular ganglion cell layer thickness in autosomal dominant optic atrophy and in healthy subjects. Acta Ophthalmol 2014; 92:670-4. [PMID: 24612963 DOI: 10.1111/aos.12378] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 01/29/2014] [Indexed: 11/27/2022]
Abstract
PURPOSE To investigate retinal trunk vessel diameters in subjects with autosomal dominant optic atrophy (ADOA) and mutation-free healthy relatives. METHODS This cross-sectional study included 52 ADOA patients with the optic atrophy 1 (OPA1) exon 28 (c.2826_2836delinsGGATGCTCCA) mutation (age 8.6-83.5 years) (best-corrected visual acuity (BCVA) 8-94 Early Treatment Diabetic Retinopathy Study (ETDRS) letters) and 55 mutation-free first-degree healthy relatives (age 8.9-68.7 years, BCVA 80-99). Analysis of fundus photographs provided integrated magnification-corrected measures of retinal vessel diameters (central retinal artery equivalent, CRAE, and central retinal vein equivalent, CRVE). Statistical analysis was corrected for age, gender, spherical equivalent refraction, axial length and mean arterial blood pressure (MABP) in a mixed model analysis. RESULTS Retinal arteries and veins were thinner in ADOA than in healthy controls (CRAE (mean ± 2 standard deviations (SD)) 153.9 ± 41.0 μm and CRVE 236.1 ± 42.0 μm in ADOA, CRAE 172.5 ± 25.0 μm (p = 0.0004) and CRVE 254.2 ± 37.6 μm (p = 0.0019) in healthy controls). MABP was comparable in the two groups (p = 0.18), and in both groups, CRAE decreased with increasing MABP (p = 0.01 and p < 0.0001, respectively). In ADOA, CRAE and CRVE decreased with age (p = 0.011 and p = 0.020, respectively) and CRAE decreased with decreasing BCVA (p = 0.011). In patients with ADOA and in healthy controls, CRAE decreased with decreasing average macular ganglion cell-inner plexiform layer (GC-IPL) thickness (p = 0.0017 and p = 0.0057, respectively). CONCLUSION Narrow retinal arteries and veins were associated not only with the severity of ADOA but with ganglion cell volume in patients with ADOA and in healthy subjects. This suggests that narrow vessels are a consequence rather than the cause of inner retinal hypoplasia or atrophy, although longitudinal studies are needed to confirm this hypothesis.
Collapse
Affiliation(s)
- Cecilia Rönnbäck
- Department of Ophthalmology; Glostrup Hospital; Glostrup Denmark
- Faculty of Health Sciences; University of Copenhagen; Copenhagen Denmark
| | - Karen Grønskov
- Faculty of Health Sciences; University of Copenhagen; Copenhagen Denmark
- Applied Human Molecular Genetics; Kennedy Center; Rigshospitalet; Copenhagen Denmark
| | - Michael Larsen
- Department of Ophthalmology; Glostrup Hospital; Glostrup Denmark
- Faculty of Health Sciences; University of Copenhagen; Copenhagen Denmark
- National Eye Clinic; Kennedy Center; Rigshospitalet; Copenhagen Denmark
| |
Collapse
|
33
|
Gopinath B, Flood VM, Burlutsky G, Louie JCY, Baur LA, Mitchell P. Dairy food consumption, blood pressure and retinal microcirculation in adolescents. Nutr Metab Cardiovasc Dis 2014; 24:1221-1227. [PMID: 24996501 DOI: 10.1016/j.numecd.2014.05.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 05/25/2014] [Accepted: 05/28/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS The relationship between dairy food consumption and dietary calcium intake, and vascular risk factors during adolescence remains unclear. We aimed to prospectively assess whether dairy food consumption (milk, cheese, yoghurt) is associated with blood pressure (BP) and retinal microvascular signs among adolescents. METHODS AND RESULTS As many as 2353 and 1216 participants aged 12 and 17, respectively, were examined. Longitudinal analyses involved 888 subjects with complete baseline and follow-up data. Dairy consumption was assessed from validated semi-quantitative food frequency questionnaires. BP information was collected and retinal vessel caliber was quantified from digital photographs using computer software. In girls, after multivariable adjustment, each serve/day increase in total dairy intake was concurrently associated with 1.04 (p = 0.03) and 1.10 mm Hg (p = 0.02) decreases in mean diastolic and arterial BP, respectively. Also in girls, each serve/day increase in cheese intake over 5 years was concurrently related to 7.18 (p = 0.001), 5.28 (p = 0.002) and 5.79 mm Hg (p = 0.001) decrease in mean systolic, diastolic and arterial BP, respectively. Among girls, each 100 mg/day increase in dietary calcium intake was associated with a concurrent 0.5 (p = 0.01) and 0.3 mm Hg (p = 0.02) decrease in mean systolic and arterial BP, respectively. Cross-sectionally, adolescents in the highest versus lowest tertile of yoghurt intake had ∼ 1.3 μm wider retinal arterioles (p = 0.05) and ∼ 2.0 μm narrower venules (p = 0.04). CONCLUSIONS Consumption of dairy products, particularly cheese, could have a beneficial effect on BP, particularly among girls.
Collapse
Affiliation(s)
- B Gopinath
- Centre for Vision Research, Department of Ophthalmology and Westmead Millennium Institute, University of Sydney, Australia.
| | - V M Flood
- Faculty of Health Sciences, University of Sydney and St Vincent's Hospital, Australia
| | - G Burlutsky
- Centre for Vision Research, Department of Ophthalmology and Westmead Millennium Institute, University of Sydney, Australia
| | - J C Y Louie
- Faculty of Science, Medicine and Health, University of Wollongong, Australia
| | - L A Baur
- University of Sydney Clinical School, The Children's Hospital at Westmead, Australia; School of Public Health, University of Sydney, Australia
| | - P Mitchell
- Centre for Vision Research, Department of Ophthalmology and Westmead Millennium Institute, University of Sydney, Australia
| |
Collapse
|
34
|
Nussbaumer M, Donath L, Fischer M, Schäfer J, Faude O, Zahner L, Schmidt-Trucksäss A, Hanssen H. Effects of acute bouts of endurance exercise on retinal vessel diameters are age and intensity dependent. AGE (DORDRECHT, NETHERLANDS) 2014; 36:9650. [PMID: 24728623 PMCID: PMC4082577 DOI: 10.1007/s11357-014-9650-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 03/24/2014] [Indexed: 05/27/2023]
Abstract
Alterations of retinal vessel diameters are associated with increased cardiovascular risk. We aimed to investigate changes in retinal vessel diameters in response to acute dynamic exercise of different intensities and whether these changes are age dependent. Seventeen healthy seniors (median (IQR) age 68 (65, 69) years) and 15 healthy young adults (median (IQR) age 26 (25, 28) years) first performed a maximal treadmill test (MTT) followed by a submaximal treadmill test (SMTT) and a resting control condition in randomised order. Central retinal arteriolar (CRAE) and central retinal venular (CRVE) diameter equivalents were measured before as well as 5 (t5) and 40 (t40) minutes after exercise cessation using a static retinal vessel analyser. Both exercise intensities induced a significant dilatation in CRAE and CRVE at t5 compared to the control condition (P < 0.001). At t40, the mean increase in CRAE and CRVE was greater for MTT compared to that for SMTT (CRAE 1.7 μm (95 % confidence interval (CI) -0.1, 3.6; P = 0.061); CRVE 2.2 μm (95 % CI 0.4, 4.1; P = 0.019)). However, the estimated difference at t5 between seniors and young adults in their response to MTT compared to SMTT was 5.3 μm (95 % CI 2.0, 8.5; P = 0.002) for CRAE and 4.1 μm (95 % CI -0.4, 8.6; P = 0.076) for CRVE. Wider arteries and veins after maximal versus submaximal exercise for seniors compared to young adults suggest that myogenic vasoconstriction in response to exhaustive exercise may be reduced in seniors. Age-related loss of vascular reactivity has clinical implications since the arteriolar vasoconstriction protects the retinal capillary bed from intraluminal pressure peaks.
Collapse
Affiliation(s)
- M. Nussbaumer
- Department of Sport, Exercise and Health, Division of Sports and Exercise Medicine, Medical Faculty, University of Basel, Birsstrasse 320B, 4052 Basel, Switzerland
| | - L. Donath
- Department of Sport, Exercise and Health, Division of Movement and Exercise Science, Medical Faculty, University of Basel, Basel, Switzerland
| | - M. Fischer
- Department of Sport, Exercise and Health, Division of Sports and Exercise Medicine, Medical Faculty, University of Basel, Birsstrasse 320B, 4052 Basel, Switzerland
| | - J. Schäfer
- Department of Sport, Exercise and Health, Division of Sports and Exercise Medicine, Medical Faculty, University of Basel, Birsstrasse 320B, 4052 Basel, Switzerland
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland
| | - O. Faude
- Department of Sport, Exercise and Health, Division of Movement and Exercise Science, Medical Faculty, University of Basel, Basel, Switzerland
| | - L. Zahner
- Department of Sport, Exercise and Health, Division of Movement and Exercise Science, Medical Faculty, University of Basel, Basel, Switzerland
| | - A. Schmidt-Trucksäss
- Department of Sport, Exercise and Health, Division of Sports and Exercise Medicine, Medical Faculty, University of Basel, Birsstrasse 320B, 4052 Basel, Switzerland
| | - H. Hanssen
- Department of Sport, Exercise and Health, Division of Sports and Exercise Medicine, Medical Faculty, University of Basel, Birsstrasse 320B, 4052 Basel, Switzerland
| |
Collapse
|
35
|
McCanna CD, Myers CE, Lee M, Danforth LG, Moore EL, Meuer SM, Klein R, Klein BEK. Variability of measurement of retinal vessel diameters. Ophthalmic Epidemiol 2014; 20:392-401. [PMID: 24229070 DOI: 10.3109/09286586.2013.848459] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To examine the effects of various cardiovascular, ocular, and lifestyle factors on retinal vessel diameters over short periods of time. METHODS Subjects were invited to have photographs of their retina taken at each of three study visits. The same eye was photographed each time. The photographs were digitized and retinal vessel diameters were measured. Measurements from the retinal photographs taken consecutively (at visit 2 and visit 3), and 1, 3, and 4 weeks apart (between visits 1 and 2, 2 and 3, and 1 and 3, respectively) were compared. RESULTS There were 63 persons who participated in all study visits and had gradable vessel measurements from all five images used in the analysis. Correlations for pairs of study visits were high, and decreased slightly with increasing length of the time interval. For consecutive photographs taken, and 1 week, 3 weeks, and 4 weeks apart, correlations were 0.95, 0.90, 0.91, and 0.86, respectively, for central retinal arteriolar equivalent (CRAE) and 0.95, 0.90, 0.91, and 0.87, respectively, for central retinal venular equivalent (CRVE). We examined the associations of blood pressure levels, smoking habits, time since last eating, exercising, consuming caffeine, and taking anti-hypertensive medication, and image focus with CRAE and CRVE. We found no consistent pattern of association of any of these characteristics with short-term changes in CRAE and CRVE. CONCLUSION Retinal vessel diameters are stable over short intervals of time and none of the factors studied were consistently associated with change in the diameters of either vessel type.
Collapse
Affiliation(s)
- Charles D McCanna
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health , Madison, WI , USA
| | | | | | | | | | | | | | | |
Collapse
|
36
|
Ding J, Wai KL, McGeechan K, lkram MK, Kawasaki R, Xie J, Klein R, Klein BB, Cotch MF, Wang JJ, Mitchell P, Shaw JE, Takamasa K, Sharrett AR, Wong TY. Retinal vascular caliber and the development of hypertension: a meta-analysis of individual participant data. J Hypertens 2014; 32:207-15. [PMID: 24322199 PMCID: PMC4120649 DOI: 10.1097/hjh.0b013e32836586f4] [Citation(s) in RCA: 143] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Microvascular dysfunction has been suggested to be a major pathogenic factor for the development of hypertension. We examined the association between retinal vascular caliber, a marker of systemic microvascular dysfunction, and incident hypertension on a meta-analysis of individual participant data. METHODS We performed a systematic review with relevant studies identified through a search of electronic databases, a review of reference lists, and correspondence with experts. Studies were included if participants were selected from a general population, retinal vascular caliber was measured from photographs using computer-assisted methods at baseline, and individuals were followed up to ascertain the incidence of hypertension. Prespecified individual recorded data from six population-based prospective cohort studies were included. Discrete time proportional odds models were constructed for each study with adjustment for hypertension risk factors. Log odds ratios (ORs) per 20-μm difference were pooled using random-effects meta-analysis. RESULTS Among 10 229 participants without prevalent hypertension, diabetes, or cardiovascular disease, 2599 developed new-onset hypertension during median follow-up periods ranging from 2.9 to 10 years. Both narrower retinal arterioles [pooled multivariate-adjusted OR per 20-μm difference 1.29, 95% confidence interval (CI) 1.20-1.39] and wider venules (OR per 20-μm difference 1.14, 95% CI 1.06-1.23) were associated with an increased risk of hypertension. Each 20 μm narrower arterioles at baseline were associated with a 1.12 mmHg (95% CI 0.25-1.99) greater increase in SBP over 5 years. CONCLUSIONS Retinal arteriolar narrowing and venular widening were independently associated with an increased risk of hypertension. These findings underscore the importance of microvascular remodeling in the pathogenesis of hypertension.
Collapse
Affiliation(s)
- Jie Ding
- Singapore Eye Research Institute, Singapore National Eye Centre, National
University of Singapore, Singapore
- Department of Ophthalmology, National University of Singapore,
Singapore
| | - Khin Lay Wai
- Investigational Medicine Unit, National University of Singapore,
Singapore
| | - Kevin McGeechan
- Sydney School of Public Health, University of Sydney, Australia
| | - M. Kamran lkram
- Singapore Eye Research Institute, Singapore National Eye Centre, National
University of Singapore, Singapore
- Department of Ophthalmology, National University of Singapore,
Singapore
- Eye Academic Clinical Program, Duke-NUS Graduate Medical School,
Singapore
| | - Ryo Kawasaki
- Centre for Eye Research Australia, University of Melbourne, Australia
| | - Jing Xie
- Centre for Eye Research Australia, University of Melbourne, Australia
| | - Ronald Klein
- Department of Ophthalmology & Visual Sciences, School of Medicine
& Public Health, University of Wisconsin, Madison
| | - Barbara B.K. Klein
- Department of Ophthalmology & Visual Sciences, School of Medicine
& Public Health, University of Wisconsin, Madison
| | - Mary Frances Cotch
- Division of Epidemiology and Clinical Applications, National Eye Institute,
National Institutes of Health, Bethesda, Maryland, USA
| | - Jie Jin Wang
- Centre for Eye Research Australia, University of Melbourne, Australia
- Department of Ophthalmology and Westmead Millennium Institute, Centre for
Vision Research, University of Sydney, Sydney
| | - Paul Mitchell
- Department of Ophthalmology and Westmead Millennium Institute, Centre for
Vision Research, University of Sydney, Sydney
| | | | - Kayama Takamasa
- The Global C0E Investigators, Yamagata University, Yamagata, Japan
| | - A. Richey Sharrett
- Department of Epidemiology, John Hopkins Bloomberg School of Public Health,
Baltimore, Maryland, USA
| | - Tien Y. Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, National
University of Singapore, Singapore
- Department of Ophthalmology, National University of Singapore,
Singapore
- Eye Academic Clinical Program, Duke-NUS Graduate Medical School,
Singapore
| | | |
Collapse
|
37
|
Louwies T, Panis LI, Kicinski M, De Boever P, Nawrot TS. Retinal microvascular responses to short-term changes in particulate air pollution in healthy adults. ENVIRONMENTAL HEALTH PERSPECTIVES 2013; 121:1011-6. [PMID: 23777785 PMCID: PMC3764070 DOI: 10.1289/ehp.1205721] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Accepted: 06/17/2013] [Indexed: 05/19/2023]
Abstract
BACKGROUND Microcirculation plays an important role in the physiology of cardiovascular health. Air pollution is an independent risk factor for the development and progression of cardiovascular diseases, but the number of studies on the relation between air pollution and the microcirculation is limited. OBJECTIVES We examined the relationship between short-term changes in air pollution and microvascular changes. METHODS We measured retinal microvasculature using fundus image analysis in a panel of 84 healthy adults (52% female), 22-63 years of age, during January-May 2012. Blood vessels were measured as central retinal arteriolar/venular equivalent (CRAE/CRVE), with a median of 2 measurements (range, 1-3). We used monitoring data on particulate air pollution (PM10) and black carbon (BC). Mixed-effect models were used to estimate associations between CRAE/CRVE and exposure to PM10 and BC using various exposure windows. RESULTS CRAE and CRVE were associated with PM10 and BC concentrations, averaged over the 24 hr before the retinal examinations. Each 10-µg/m3 increase in PM10 was associated with a 0.93-µm decrease (95% CI: -1.42, -0.45; p = 0.0003) in CRAE and a 0.86-µm decrease (95% CI: -1.42, -0.30; p = 0.004) in CRVE after adjusting for individual characteristics and time varying conditions such as ambient temperature. Each 1-µg/m3 increase in BC was associated with a 1.84-µm decrease (95% CI: -3.18, -0.51; p < 0.001) in CRAE. CONCLUSIONS Our findings suggest that the retinal microvasculature responds to short-term changes in air pollution levels. These results support a mechanistic pathway through which air pollution can act as a trigger of cardiovascular events at least in part through effects on the microvasculature.
Collapse
Affiliation(s)
- Tijs Louwies
- Environmental Risk and Health, Flemish Institute for Technological Research (VITO), Mol, Belgium
| | | | | | | | | |
Collapse
|
38
|
Krauskopf K, Van Natta ML, Danis RP, Gangaputra S, Ackatz L, Addessi A, Federman AD, Branch AD, Meinert CL, Jabs DA. Correlates of hypertension in patients with AIDS in the era of highly active antiretroviral therapy. J Int Assoc Provid AIDS Care 2013; 12:325-33. [PMID: 23764503 PMCID: PMC4100586 DOI: 10.1177/2325957413491432] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND It is unclear whether HIV-related factors modify risk of hypertension (HTN). In a cohort of patients with AIDS, the authors determined HTN incidence and prevalence and assessed associated traditional, HIV-specific, and retinal vasculature factors. METHODS Prospective observational cohort included 2390 patients with AIDS (1998-2011). Univariate analysis was used to assess the impact of traditional- and AIDS-related risk factors for HTN prevalence and incidence. Multivariate regression analyses were used to evaluate the adjusted impact of these factors. RESULTS Hypertension prevalence was 22%(95% confidence interval [CI] 21%-24%) and was associated with traditional HTN risk factors (age, black race, and higher weight) as well as diabetes, hyperlipidemia, time since AIDS diagnosis, and higher CD4 counts. Hypertension incidence was 64.1 per 1000 person-years (95% CI 58.7/1000-69.9/1000). Age, race, weight, and diabetes were associated with incident HTN but HIV-specific factors were not. CONCLUSIONS Hypertension, a prevalent cardiovascular risk factor in patients with AIDS, is associated with traditional and metabolic risk factors.
Collapse
Affiliation(s)
- Katherine Krauskopf
- Division of General Internal Medicine, Mount Sinai School of Medicine, New York, NY
| | - Mark L. Van Natta
- Center for Clinical Trials, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Ronald P. Danis
- Fundus Photograph Reading Center, Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, WI
| | - Sapna Gangaputra
- Fundus Photograph Reading Center, Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, WI
| | - Lori Ackatz
- Department of Ophthalmology, Northwestern Medical Faculty Foundation, Chicago, IL
| | - Adrienne Addessi
- Department of Ophthalmology and Department of Pediatrics, Division of Infectious Diseases, New York University School of Medicine, New York, NY
| | - Alex D. Federman
- Division of General Internal Medicine, Mount Sinai School of Medicine, New York, NY
| | - Andrea D. Branch
- Division of Liver Diseases, Mount Sinai School of Medicine, New York, NY
| | - Curtis L. Meinert
- Center for Clinical Trials, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Douglas A. Jabs
- Center for Clinical Trials, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
- Division of Rheumatology, Department of Medicine, Mount Sinai School of Medicine, New York, NY
- Department of Ophthalmology, Mount Sinai School of Medicine, New York, NY
| | | |
Collapse
|
39
|
Sim X, Jensen RA, Ikram MK, Cotch MF, Li X, MacGregor S, Xie J, Smith AV, Boerwinkle E, Mitchell P, Klein R, Klein BEK, Glazer NL, Lumley T, McKnight B, Psaty BM, de Jong PTVM, Hofman A, Rivadeneira F, Uitterlinden AG, van Duijn CM, Aspelund T, Eiriksdottir G, Harris TB, Jonasson F, Launer LJ, Attia J, Baird PN, Harrap S, Holliday EG, Inouye M, Rochtchina E, Scott RJ, Viswanathan A, Li G, Smith NL, Wiggins KL, Kuo JZ, Taylor KD, Hewitt AW, Martin NG, Montgomery GW, Sun C, Young TL, Mackey DA, van Zuydam NR, Doney ASF, Palmer CNA, Morris AD, Rotter JI, Tai ES, Gudnason V, Vingerling JR, Siscovick DS, Wang JJ, Wong TY. Genetic loci for retinal arteriolar microcirculation. PLoS One 2013; 8:e65804. [PMID: 23776548 PMCID: PMC3680438 DOI: 10.1371/journal.pone.0065804] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 04/19/2013] [Indexed: 12/24/2022] Open
Abstract
Narrow arterioles in the retina have been shown to predict hypertension as well as other vascular diseases, likely through an increase in the peripheral resistance of the microcirculatory flow. In this study, we performed a genome-wide association study in 18,722 unrelated individuals of European ancestry from the Cohorts for Heart and Aging Research in Genomic Epidemiology consortium and the Blue Mountain Eye Study, to identify genetic determinants associated with variations in retinal arteriolar caliber. Retinal vascular calibers were measured on digitized retinal photographs using a standardized protocol. One variant (rs2194025 on chromosome 5q14 near the myocyte enhancer factor 2C MEF2C gene) was associated with retinal arteriolar caliber in the meta-analysis of the discovery cohorts at genome-wide significance of P-value <5×10−8. This variant was replicated in an additional 3,939 individuals of European ancestry from the Australian Twins Study and Multi-Ethnic Study of Atherosclerosis (rs2194025, P-value = 2.11×10−12 in combined meta-analysis of discovery and replication cohorts). In independent studies of modest sample sizes, no significant association was found between this variant and clinical outcomes including coronary artery disease, stroke, myocardial infarction or hypertension. In conclusion, we found one novel loci which underlie genetic variation in microvasculature which may be relevant to vascular disease. The relevance of these findings to clinical outcomes remains to be determined.
Collapse
Affiliation(s)
- Xueling Sim
- Center for Statistical Genetics, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Richard A. Jensen
- Cardiovascular Health Research Unit, University of Washington, Seattle, Washington, United States of America
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
| | - M. Kamran Ikram
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Mary Frances Cotch
- Division of Epidemiology and Clinical Applications, National Eye Institute, Intramural Research Program, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Xiaohui Li
- Medical Genetics Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - Stuart MacGregor
- Genetics and Population Health, Queensland Institute of Medical Research, Brisbane, Queensland, Australia
| | - Jing Xie
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - Albert Vernon Smith
- Icelandic Heart Association, Kopavogur Capital Region, Iceland
- Department of Medicine, University of Iceland, Reykjavik, Iceland
| | - Eric Boerwinkle
- Human Genetics Center and Institute of Molecular Medicine, University of Texas Health Science Center at Houston, Houston, Texas, United States of America
| | - Paul Mitchell
- Centre for Vision Research, Department of Ophthalmology and the Westmead Millennium Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Ronald Klein
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, United States of America
| | - Barbara E. K. Klein
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, United States of America
| | - Nicole L. Glazer
- Cardiovascular Health Research Unit, University of Washington, Seattle, Washington, United States of America
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
- Department of Medicine, Boston University, Boston, Massachusetts, United States of America
| | - Thomas Lumley
- Cardiovascular Health Research Unit, University of Washington, Seattle, Washington, United States of America
- Department of Biostatistics, University of Washington, Seattle, Washington, United States of America
- Department of Statistics, University of Auckland, Auckland, New Zealand
| | - Barbara McKnight
- Cardiovascular Health Research Unit, University of Washington, Seattle, Washington, United States of America
- Department of Biostatistics, University of Washington, Seattle, Washington, United States of America
| | - Bruce M. Psaty
- Cardiovascular Health Research Unit, University of Washington, Seattle, Washington, United States of America
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
- Department of Health Services, University of Washington, Seattle, Washington, United States of America
- Group Health Research Institute, Group Health Cooperative, Seattle, Washington, United States of America
| | - Paulus T. V. M. de Jong
- Department of Clinical and Molecular Ophthalmogenetics, The Netherlands Institute of Neuroscience, Amsterdam, The Netherlands
- Department of Ophthalmology, Academic Medical Center, Amsterdam, The Netherlands
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Albert Hofman
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Fernando Rivadeneira
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Andre G. Uitterlinden
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Clinical Chemistry, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Thor Aspelund
- Icelandic Heart Association, Kopavogur Capital Region, Iceland
- Department of Medicine, University of Iceland, Reykjavik, Iceland
| | | | - Tamara B. Harris
- Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Intramural Research Program, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Fridbert Jonasson
- Department of Ophthalmology, University of Iceland, Reykjavik, Iceland
- Department of Ophthalmology, Landspitalinn University Hospital, Reykjavik, Iceland
| | - Lenore J. Launer
- Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Intramural Research Program, National Institutes of Health, Bethesda, Maryland, United States of America
| | | | - John Attia
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
- Department of Medicine, John Hunter Hospital and Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Paul N. Baird
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - Stephen Harrap
- Department of Physiology, University of Melbourne, Melbourne, Victoria, Australia
| | - Elizabeth G. Holliday
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Michael Inouye
- Immunology Division, Walter and Eliza Hall Institute of Medical Research, Victoria, Australia
- Department of Medical Biology, University of Melbourne, Victoria, Australia
| | - Elena Rochtchina
- Centre for Vision Research, Department of Ophthalmology and the Westmead Millennium Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Rodney J. Scott
- School of Biomedical Sciences, University of Newcastle, Newcastle, New South Wales, Australia
| | - Ananth Viswanathan
- National Institutes of Health Research (NIHR) Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital, London, United Kingdom
- University College London Institute of Ophthalmology, London, United Kingdom
| | | | - Guo Li
- Cardiovascular Health Research Unit, University of Washington, Seattle, Washington, United States of America
| | - Nicholas L. Smith
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
- Group Health Research Institute, Group Health Cooperative, Seattle, Washington, United States of America
- Seattle Epidemiologic Research and Information Center, Veterans Affairs Office of Research and Development, Seattle, Washington, United States of America
| | - Kerri L. Wiggins
- Cardiovascular Health Research Unit, University of Washington, Seattle, Washington, United States of America
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Jane Z. Kuo
- Medical Genetics Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - Kent D. Taylor
- Medical Genetics Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - Alex W. Hewitt
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - Nicholas G. Martin
- Genetics and Population Health, Queensland Institute of Medical Research, Brisbane, Queensland, Australia
| | - Grant W. Montgomery
- Genetics and Population Health, Queensland Institute of Medical Research, Brisbane, Queensland, Australia
| | - Cong Sun
- Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Terri L. Young
- Center for Human Genetics, Duke University Medical Center, Durham, North Carolina, United States of America
| | - David A. Mackey
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
- Lions Eye Institute, University of Western Australia, Centre for Ophthalmology and Visual Science, Perth, Western Australia, Australia
| | | | - Alex S. F. Doney
- Medical Research Institute, University of Dundee, Dundee, Scotland, United Kingdom
| | - Colin N. A. Palmer
- Medical Research Institute, University of Dundee, Dundee, Scotland, United Kingdom
| | - Andrew D. Morris
- Medical Research Institute, University of Dundee, Dundee, Scotland, United Kingdom
| | - Jerome I. Rotter
- Medical Genetics Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - E. Shyong Tai
- Department of Medicine, National University of Singapore, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Duke-National University of Singapore Graduate Medical School, Singapore, Singapore
| | - Vilmundur Gudnason
- Icelandic Heart Association, Kopavogur Capital Region, Iceland
- Department of Medicine, University of Iceland, Reykjavik, Iceland
| | - Johannes R. Vingerling
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - David S. Siscovick
- Cardiovascular Health Research Unit, University of Washington, Seattle, Washington, United States of America
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Jie Jin Wang
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
- Centre for Vision Research, Department of Ophthalmology and the Westmead Millennium Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Tien Y. Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
- Department of Ophthalmology, National University of Singapore, Singapore, Singapore
- * E-mail:
| |
Collapse
|
40
|
Klein R, Myers CE, Knudtson MD, Lee KE, Gangnon R, Wong TY, Klein BEK. Relationship of blood pressure and other factors to serial retinal arteriolar diameter measurements over time: the beaver dam eye study. ACTA ACUST UNITED AC 2012; 130:1019-27. [PMID: 22893073 DOI: 10.1001/archophthalmol.2012.560] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To describe the relationship of blood pressure (BP), antihypertensive medication use, and other factors to serial measurements of retinal arteriolar diameters over time in the Beaver Dam Eye Study. METHODS Retinal arteriolar diameter was measured by computer-assisted methods and summarized as central retinal arteriolar equivalent (CRAE) in 4573 persons aged 43 to 99 years at 4 examinations (each separated by 5 years) during a 15-year period. Associations of CRAE with risk factors measured concurrently and 5 years previously were determined using multivariate analyses. RESULTS While adjusting for image quality, refraction, and lens status, age (per 10 years: β estimate, -0.73; P < .001), systolic BP (per 10 mm Hg: concurrent examination, -2.74; P < .001; previous examination, -1.75; P < .001), smoking status (smoker vs nonsmoker: concurrent examination, 4.29; P < .001; previous examination, 1.63; P = .004), body mass index (per category: concurrent examination, -0.51; P = .05; previous examination, -0.22; P = .44), and heavy alcohol consumption (drinking) (current vs past/never heavy drinker: concurrent examination, -2.54; P = .03; previous examination, -2.42; P = .02) were associated with CRAE. In the same model, there were significant interactions between concurrent and previous systolic BP (0.11; P = .003) and between concurrent and previous body mass index (0.12; P = .04). Use of calcium channel blockers at both the concurrent and past examination (vs neither examination, 1.59; P = .01), but not other classes of antihypertensive drugs, was associated with CRAE. CONCLUSIONS Retinal arteriolar diameter is independently associated with past and current systolic BP, calcium channel blocker use, smoking status, body mass index, and heavy drinking during 5-year intervals. The relationships with CRAE are stronger for concurrent than for past measures of these variables.
Collapse
Affiliation(s)
- Ronald Klein
- Department of Ophthalmology & Visual Sciences, University of Wisconsin School of Medicine and Public Health, 610 N Walnut St, 417 WARF, Madison, WI 53726, USA.
| | | | | | | | | | | | | |
Collapse
|
41
|
Cheung CYL, Ikram MK, Sabanayagam C, Wong TY. Retinal microvasculature as a model to study the manifestations of hypertension. Hypertension 2012; 60:1094-103. [PMID: 23045470 DOI: 10.1161/hypertensionaha.111.189142] [Citation(s) in RCA: 168] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The retinal vasculature allows direct noninvasive visualization of the body's mircrovasculature. Because the retina and other end organs (brain and kidney) share similar anatomical features and physiological properties, the retinal vessels offer a unique and easily accessible window to study the health and disease of the human microcirculation. Advanced retinal vascular imaging technologies have been developed to allow a more objective and precise assessment of retinal vascular changes. The changes in the retinal vasculature associated with hypertension can be broadly divided into 3 groups: (1) classic retinal vascular changes in response to blood pressure (referred to as hypertensive retinopathy signs), (2) changes in retinal vascular caliber, and (3) changes in more global geometrical patterns of the retina. In this review, we summarize the current understanding of the relationship between retinal vascular changes and blood pressure, the evidence for the retinal vasculature as a biological model to study the manifestation and early pathogenic correlates of hypertension, the latest advances in retinal vascular imaging technologies, and the future opportunities and challenges of retinal vascular imaging. We suggest that further development of retinal vascular analyses and standardized measurement protocols, evaluation of the clinical use of retinal vascular imaging in assessing cardiovascular risk prediction, and using retinal vascular imaging to test antihypertensive treatments will allow the translation of retinal vascular imaging as a tool to improve the diagnosis, prognosis, and management of hypertension in clinical practice.
Collapse
Affiliation(s)
- Carol Yim-lui Cheung
- Singapore Eye Research Institute, 11 Third Hospital Ave, Singapore 168751, Singapore
| | | | | | | |
Collapse
|
42
|
|
43
|
Gopinath B, Baur LA, Wang JJ, Hardy LL, Teber E, Kifley A, Wong TY, Mitchell P. Influence of Physical Activity and Screen Time on the Retinal Microvasculature in Young Children. Arterioscler Thromb Vasc Biol 2011; 31:1233-9. [DOI: 10.1161/atvbaha.110.219451] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective—
It is not clear whether physical activity and sedentary behavior affect retinal microvascular caliber. We investigated associations among physical activity (outdoor and indoor sporting activities), sedentary behaviors (including screen time, television [TV] viewing, and computer and videogame usage), and retinal microvascular caliber in schoolchildren.
Methods and Results—
Six-year-old students (1765/2238) from a random cluster sample of 34 Sydney schools were examined. Parents completed questionnaires about physical and sedentary activities. Retinal images were taken, and retinal vessel caliber was quantified. After adjusting for age, sex, ethnicity, eye color, axial length, body mass index, birth weight, and mean arterial blood pressure, children who spent more time in outdoor sporting activities (in the highest tertile of activity) had 2.2 μm (95% CI 0.65 to 3.71) wider mean retinal arteriolar caliber than those in the lowest tertile (
P
trend
=0.004). Increasing quartiles of time spent watching TV were associated with narrower mean retinal arteriolar caliber ≈2.3 μm (95% CI 0.73 to 3.92),
P
trend
=0.003.
Conclusion—
These data suggest that physical activity could have a beneficial influence, whereas screen time has a potential adverse influence on retinal microvascular structure. The magnitude of arteriolar narrowing associated with each hour daily of TV viewing is similar to that associated with a 10-mm Hg increase in systolic blood pressure in children.
Collapse
Affiliation(s)
- Bamini Gopinath
- From the Centre for Vision Research, Department of Ophthalmology and Westmead Millennium Institute (B.G., J.J.W., E.T., A.K., P.M.), Menzies Centre for Health Policy (B.G.), and Physical Activity, Nutrition and Obesity Research Group (L.A.B., L.L.H.), University of Sydney, Sydney, New South Wales, Australia; University of Sydney Clinical School, The Children's Hospital at Westmead, Sydney, New South Wales, Australia (L.A.B.); Centre for Eye Research Australia, Department of Ophthalmology, University
| | - Louise A. Baur
- From the Centre for Vision Research, Department of Ophthalmology and Westmead Millennium Institute (B.G., J.J.W., E.T., A.K., P.M.), Menzies Centre for Health Policy (B.G.), and Physical Activity, Nutrition and Obesity Research Group (L.A.B., L.L.H.), University of Sydney, Sydney, New South Wales, Australia; University of Sydney Clinical School, The Children's Hospital at Westmead, Sydney, New South Wales, Australia (L.A.B.); Centre for Eye Research Australia, Department of Ophthalmology, University
| | - Jie Jin Wang
- From the Centre for Vision Research, Department of Ophthalmology and Westmead Millennium Institute (B.G., J.J.W., E.T., A.K., P.M.), Menzies Centre for Health Policy (B.G.), and Physical Activity, Nutrition and Obesity Research Group (L.A.B., L.L.H.), University of Sydney, Sydney, New South Wales, Australia; University of Sydney Clinical School, The Children's Hospital at Westmead, Sydney, New South Wales, Australia (L.A.B.); Centre for Eye Research Australia, Department of Ophthalmology, University
| | - Louise L. Hardy
- From the Centre for Vision Research, Department of Ophthalmology and Westmead Millennium Institute (B.G., J.J.W., E.T., A.K., P.M.), Menzies Centre for Health Policy (B.G.), and Physical Activity, Nutrition and Obesity Research Group (L.A.B., L.L.H.), University of Sydney, Sydney, New South Wales, Australia; University of Sydney Clinical School, The Children's Hospital at Westmead, Sydney, New South Wales, Australia (L.A.B.); Centre for Eye Research Australia, Department of Ophthalmology, University
| | - Erdahl Teber
- From the Centre for Vision Research, Department of Ophthalmology and Westmead Millennium Institute (B.G., J.J.W., E.T., A.K., P.M.), Menzies Centre for Health Policy (B.G.), and Physical Activity, Nutrition and Obesity Research Group (L.A.B., L.L.H.), University of Sydney, Sydney, New South Wales, Australia; University of Sydney Clinical School, The Children's Hospital at Westmead, Sydney, New South Wales, Australia (L.A.B.); Centre for Eye Research Australia, Department of Ophthalmology, University
| | - Annette Kifley
- From the Centre for Vision Research, Department of Ophthalmology and Westmead Millennium Institute (B.G., J.J.W., E.T., A.K., P.M.), Menzies Centre for Health Policy (B.G.), and Physical Activity, Nutrition and Obesity Research Group (L.A.B., L.L.H.), University of Sydney, Sydney, New South Wales, Australia; University of Sydney Clinical School, The Children's Hospital at Westmead, Sydney, New South Wales, Australia (L.A.B.); Centre for Eye Research Australia, Department of Ophthalmology, University
| | - Tien Y. Wong
- From the Centre for Vision Research, Department of Ophthalmology and Westmead Millennium Institute (B.G., J.J.W., E.T., A.K., P.M.), Menzies Centre for Health Policy (B.G.), and Physical Activity, Nutrition and Obesity Research Group (L.A.B., L.L.H.), University of Sydney, Sydney, New South Wales, Australia; University of Sydney Clinical School, The Children's Hospital at Westmead, Sydney, New South Wales, Australia (L.A.B.); Centre for Eye Research Australia, Department of Ophthalmology, University
| | - Paul Mitchell
- From the Centre for Vision Research, Department of Ophthalmology and Westmead Millennium Institute (B.G., J.J.W., E.T., A.K., P.M.), Menzies Centre for Health Policy (B.G.), and Physical Activity, Nutrition and Obesity Research Group (L.A.B., L.L.H.), University of Sydney, Sydney, New South Wales, Australia; University of Sydney Clinical School, The Children's Hospital at Westmead, Sydney, New South Wales, Australia (L.A.B.); Centre for Eye Research Australia, Department of Ophthalmology, University
| |
Collapse
|
44
|
Garcia-Ortiz L, Ramos-Delgado E, Recio-Rodriguez JI, Agudo-Conde C, Martínez-Salgado C, Patino-Alonso MC, Rodriguez-Sanchez E, Gomez-Marcos MA. Peripheral and central arterial pressure and its relationship to vascular target organ damage in carotid artery, retina and arterial stiffness. Development and validation of a tool. The Vaso risk study. BMC Public Health 2011; 11:266. [PMID: 21524299 PMCID: PMC3096907 DOI: 10.1186/1471-2458-11-266] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Accepted: 04/27/2011] [Indexed: 12/22/2022] Open
Abstract
Background Ambulatory blood pressure monitoring (ABPM) shows a better correlation to target organ damage and cardiovascular morbidity-mortality than office blood pressure. A loss of arterial elasticity and an increase in carotid artery intima-media thickness (IMT) has been associated with increased cardiovascular morbidity-mortality. Tools have been developed that allow estimation of the retinal arteriovenous index but not all studies coincide and there are contradictory results in relation to the evolution of the arteriosclerotic lesions and the caliber of the retinal vessels. The purpose of this study is to analyze the relationship between peripheral and central arterial pressure (clinic and ambulatory) and vascular structure and function as evaluated by the carotid artery intima-media thickness, retina arteriovenous index, pulse wave velocity (PWV) and ankle-brachial index in patients with and without type 2 diabetes. In turn, software is developed and validated for measuring retinal vessel thickness and automatically estimating the arteriovenous index. Methods/Design A cross-sectional study involving a control group will be made, with a posterior 4-year follow-up period in primary care. The study patients will be type 2 diabetics, with a control group of non-diabetic individuals. Consecutive sampling will be used to include 300 patients between 34-75 years of age and no previous cardiovascular disease, one-half being assigned to each group. Main measurements: age, gender, height, weight and abdominal circumference. Lipids, creatinine, microalbuminuria, blood glucose, HbA1c, blood insulin, high sensitivity C-reactive protein and endothelial dysfunction markers. Clinic and ambulatory blood pressure monitoring. Carotid ultrasound to evaluate IMT, and retinography to evaluate the arteriovenous index. ECG to assess left ventricle hypertrophy, ankle-brachial index, and pulse wave analysis (PWA) and pulse wave velocity (PWV) with the Sphigmocor System. Discussion We hope to obtain information on the correlation of different ABPM-derived parameters and PWA to organ target damage - particularly vascular structure and function evaluated from the IMT and PWV - and endothelial dysfunction in patients with and without type 2 diabetes. We also hope to demonstrate the usefulness of the instrument developed for the automated evaluation of retinal vascularization in the early detection of alterations in vascular structure and function and in the prognosis of middle-term cardiovascular morbidity. Trial Registration Clinical Trials.gov Identifier: NCT01325064
Collapse
Affiliation(s)
- Luis Garcia-Ortiz
- Unidad de Investigación de Atención Primaria La Alamedilla, Salamanca, Spain.
| | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Liu YP, Richart T, Jin Y, Struijker-Boudierc HA, Staessen JA. Retinal arteriolar and venular phenotypes in a Flemish population: Reproducibility and correlates. Artery Res 2011. [DOI: 10.1016/j.artres.2011.03.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
46
|
Abstract
PURPOSE OF REVIEW The field of childhood hypertension has been changing rapidly since publication of the most recent consensus guidelines contained in the 2004 'Fourth Report'. RECENT FINDINGS Several epidemiologic studies have indicated that the prevalence of hypertension in children and adolescents is on the increase. A major factor behind this increase is the childhood obesity epidemic. There is substantial new information on the frequency of hypertensive target-organ damage in the young, including vascular, cardiac and renal effects. These data have led some authorities to recommend changes in how hypertension is evaluated and managed in the young. SUMMARY There has been significant new knowledge gained about many aspects of childhood hypertension over the past 5 years. Clinicians who care for children and adolescents with high blood pressure should familiarize themselves with these new data and incorporate them into their clinical decision-making.
Collapse
|
47
|
Licht AH, Nübel T, Feldner A, Jurisch-Yaksi N, Marcello M, Demicheva E, Hu JH, Hartenstein B, Augustin HG, Hecker M, Angel P, Korff T, Schorpp-Kistner M. Junb regulates arterial contraction capacity, cellular contractility, and motility via its target Myl9 in mice. J Clin Invest 2010; 120:2307-18. [PMID: 20551518 DOI: 10.1172/jci41749] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2009] [Accepted: 05/05/2010] [Indexed: 01/24/2023] Open
Abstract
Cellular contractility and, thus, the ability to alter cell shape are prerequisites for a number of important biological processes such as cytokinesis, movement, differentiation, and substrate adherence. The contractile capacity of vascular smooth muscle cells (VSMCs) is pivotal for the regulation of vascular tone and thus blood pressure and flow. Here, we report that conditional ablation of the transcriptional regulator Junb results in impaired arterial contractility in vivo and in vitro. This was exemplified by resistance of Junb-deficient mice to DOCA-salt-induced volume-dependent hypertension as well as by a decreased contractile capacity of isolated arteries. Detailed analyses of Junb-deficient VSMCs, mouse embryonic fibroblasts, and endothelial cells revealed a general failure in stress fiber formation and impaired cellular motility. Concomitantly, we identified myosin regulatory light chain 9 (Myl9), which is critically involved in actomyosin contractility and stress fiber assembly, as a Junb target. Consistent with these findings, reexpression of either Junb or Myl9 in Junb-deficient cells restored stress fiber formation, cellular motility, and contractile capacity. Our data establish a molecular link between the activator protein-1 transcription factor subunit Junb and actomyosin-based cellular motility as well as cellular and vascular contractility by governing Myl9 transcription.
Collapse
Affiliation(s)
- Alexander H Licht
- Division of Signal Transduction and Growth Control (A100), German Cancer Research Center (DKFZ), DKFZ-ZMBH Alliance, 69120 Heidelberg, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
TANABE YUSUKE, KAWASAKI RYO, WANG JIEJIN, WONG TIENYIN, MITCHELL PAUL, DAIMON MAKOTO, OIZUMI TOSHIHIDE, KATO TAKEO, KAWATA SUMIO, KAYAMA TAKAMASA, YAMASHITA HIDETOSHI. Retinal Arteriolar Narrowing Predicts 5-Year Risk of Hypertension in Japanese People: The Funagata Study. Microcirculation 2010; 17:94-102. [DOI: 10.1111/j.1549-8719.2009.00006.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
49
|
Retinal vessel diameters and risk of hypertension: the Multiethnic Study of Atherosclerosis. J Hypertens 2010; 27:2386-93. [PMID: 19680136 DOI: 10.1097/hjh.0b013e3283310f7e] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe the prospective relationship of retinal vessel diameters with risk of hypertension in a multiethnic population-based cohort. METHODS The Multi-Ethnic Study of Atherosclerosis is a population-based study of subclinical cardiovascular disease among white, African-American, Hispanic, and Chinese American adults aged 45-84 years. Retinal vessel diameters were measured using a standardized imaging software at the second examination (considered baseline in this analysis) and summarized as the central retinal artery/vein equivalent. Presence of retinopathy and retinal focal arteriolar narrowing and arteriovenous nicking was assessed by trained graders. Incidence of hypertension was defined among participants at risk as systolic blood pressure at least 140 mmHg, diastolic blood pressure at least 90 mmHg, or use of an antihypertensive medication. RESULTS Of the initial 6237 participants at baseline, 2583 were at risk of hypertension. After 3.2 +/- 0.5 years of follow-up, 448 (17.3%) participants developed hypertension. After adjusting for age, sex, race/ethnicity, the average of mean arterial blood pressure in the first and second examination, and other vascular risk factors, persons with narrower retinal arteriolar diameter and wider venular diameter at baseline were more likely to develop hypertension [odds ratio per SD decrease in central retinal artery equivalent 1.20, 95% confidence intervals 1.02, 1.42; and odds ratio per SD increase in central retinal vein equivalent 1.18, 95% confidence interval 1.02, 1.37]. Persons with focal arteriolar narrowing were also more likely to develop hypertension (odds ratio 1.80, 95% confidence interval 1.09, 2.97). CONCLUSION Findings from this multiethnic population confirm that narrower retinal arteriolar diameter and wider venular diameter are associated with the development of hypertension independent of traditional risk factors.
Collapse
|
50
|
SASONGKO MUHAMMADBAYU, WONG TIENYIN, WANG JIEJIN. Retinal Arteriolar Changes: Intermediate Pathways Linking Early Life Exposures to Cardiovascular Disease? Microcirculation 2010; 17:21-31. [DOI: 10.1111/j.1549-8719.2009.00007.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
|