Liao Duanping, Wong Tien Yin, Klein Ronald, Jones Daniel, Hubbard Larry, Sharrett A Richey
Department of Health Evaluation Sciences, Pennsylvania State University College of Medicine, A210, 600 Centerview Dr, Hershey, PA 17033, USA.
Stroke. 2004 Apr;35(4):837-42. doi: 10.1161/01.STR.0000120310.43457.AD. Epub 2004 Feb 26.
Both carotid atherosclerosis and cerebral arteriolosclerosis are associated with stroke. However, the relationship between carotid atherosclerosis and cerebral arteriolosclerosis is unknown. We examined the association between carotid artery stiffness, a marker of early atherosclerosis, and retinal arteriolar narrowing, a marker of arteriolosclerosis, in healthy middle-aged people.
This population-based, cross-sectional study involved 8031 men and women 45 to 64 years of age. Carotid arterial stiffness was estimated from high-resolution ultrasonic echo tracking of the left common carotid artery and was defined as adjusted arterial diameter change (AADC, micro, adjusted for diastolic blood pressure, pulse pressure and pulse pressure squared, and diastolic arterial diameter and height, with smaller AADC reflecting greater arterial stiffness). Generalized retinal arteriolar narrowing was estimated from measurements of diameters of retinal vessels from digitized retinal photographs and summarized as the arteriole-to-venule ratio (AVR, with smaller AVR indicating greater retinal arteriolar narrowing).
After controlling for age, sex, ethnicity, hypertension, diabetes, and cigarette smoking, decreasing AADC was associated with decreasing AVR. The mean AADCs, comparing the lowest and highest quartiles of AVR, were 394 (SE, 4) and 409 (SE, 4) micro, respectively (P<0.01). The pattern of the graded association between carotid arterial stiffness and generalized retinal arteriolar narrowing was similar among persons with and without hypertension.
Greater stiffness of the carotid arteries is related to generalized narrowing of the retinal arterioles independent of blood pressure and other vascular factors. This supports a relationship between macrovascular and microvascular disease processes important in stroke pathogenesis.
颈动脉粥样硬化和脑小动脉硬化均与中风相关。然而，颈动脉粥样硬化与脑小动脉硬化之间的关系尚不清楚。我们在健康的中年人中研究了早期动脉粥样硬化标志物颈动脉僵硬度与小动脉硬化标志物视网膜小动脉狭窄之间的关联。
这项基于人群的横断面研究纳入了8031名45至64岁的男性和女性。通过对左颈总动脉进行高分辨率超声回声跟踪来估计颈动脉僵硬度，并将其定义为调整后的动脉直径变化（AADC，单位为微米，经舒张压、脉压和脉压平方以及舒张期动脉直径和身高校正，AADC越小表明动脉僵硬度越大）。通过对数字化视网膜照片中的视网膜血管直径进行测量来估计广义视网膜小动脉狭窄，并将其总结为小动脉与小静脉比值（AVR，AVR越小表明视网膜小动脉狭窄越严重）。
在控制了年龄、性别、种族、高血压、糖尿病和吸烟因素后，AADC降低与AVR降低相关。比较AVR最低和最高四分位数时的平均AADC分别为394（标准误，4）和409（标准误，4）微米（P<0.01）。在有高血压和无高血压的人群中，颈动脉僵硬度与广义视网膜小动脉狭窄之间的分级关联模式相似。
颈动脉僵硬度增加与视网膜小动脉的广义狭窄相关，且独立于血压和其他血管因素。这支持了在中风发病机制中起重要作用的大血管和微血管疾病过程之间的关系。
