Wong Tien Y, Cheung Ning, Islam F M Amirul, Klein Ronald, Criqui Michael H, Cotch Mary Frances, Carr J Jeffrey, Klein Barbara E K, Sharrett A Richey
Centre for Eye Research Australia, Department of Ophthalmology, School of Medicine, University of Melbourne, Australia.
Am J Epidemiol. 2008 Jan 1;167(1):51-8. doi: 10.1093/aje/kwm256. Epub 2007 Sep 24.
Microvascular disease, reflected by retinal vascular changes, has been shown to predict clinical coronary heart disease. Whether retinal vascular changes are associated with subclinical coronary artery disease is unclear and was examined in this study. The authors conducted a multiethnic, population-based study of 6,147 persons aged 45-84 years, sampled from six US communities in 2002-2004, who were free of clinical cardiovascular disease. Coronary artery calcification (CAC), a noninvasive measure of subclinical coronary artery disease, was assessed by cardiac computed tomography scanning and categorized into three groups of increasing severity: none (average CAC score = 0), mild (1-100), and moderate-to-severe (>100). Retinopathy signs and retinal vascular caliber were graded from retinal photographs following standardized protocols. After adjustment for age, gender, race/ethnicity, blood pressure, diabetes, lipid profile, smoking, and other risk factors, retinopathy was associated with having a moderate-to-severe CAC score (odds ratio = 1.43, 95% confidence interval: 1.18, 1.75). This association remained significant in both men and women and in persons with and without diabetes or hypertension. Variations in retinal vascular caliber were not significantly associated with CAC score. This study shows that retinopathy signs are independently associated with CAC, supporting the concept that common pathophysiologic processes may underlie both micro- and macrovascular disease.
视网膜血管变化所反映的微血管疾病已被证明可预测临床冠心病。视网膜血管变化是否与亚临床冠状动脉疾病相关尚不清楚，本研究对此进行了探讨。作者开展了一项基于人群的多民族研究，研究对象为2002年至2004年从美国六个社区抽取的6147名45 - 84岁且无临床心血管疾病的人群。通过心脏计算机断层扫描评估亚临床冠状动脉疾病的一种非侵入性指标——冠状动脉钙化（CAC），并将其分为严重程度递增的三组：无（平均CAC评分 = 0）、轻度（1 - 100）和中度至重度（>100）。按照标准化方案从视网膜照片中对视网膜病变体征和视网膜血管管径进行分级。在对年龄、性别、种族/民族、血压、糖尿病、血脂谱、吸烟及其他危险因素进行校正后，视网膜病变与中度至重度CAC评分相关（比值比 = 1.43，95%置信区间：1.18，1.75）。这种关联在男性和女性以及患有和未患有糖尿病或高血压的人群中均保持显著。视网膜血管管径的变化与CAC评分无显著关联。本研究表明，视网膜病变体征与CAC独立相关，支持了微血管和大血管疾病可能具有共同病理生理过程这一概念。
