Liew G, Wong T Y, Mitchell P, Cheung N, Wang J J
Department of Ophthalmology, Centre for Vision Research, University of Sydney, Westmead Hospital, Westmead, NSW, Australia.
Heart. 2009 Mar;95(5):391-4. doi: 10.1136/hrt.2008.146670. Epub 2008 Aug 12.
Retinopathy lesions are fairly common findings in clinic settings and may predict risk of coronary heart disease (CHD).
To examine whether retinopathy independently predicts a risk of CHD-related mortality in people with and without diabetes.
In an Australian population-based cohort of people with (n = 199) and without (n = 2768) diabetes (Blue Mountains Eye Study, total n = 2967), the presence and severity of retinopathy was assessed from retinal photographs. 12-Year cumulative CHD deaths were ascertained from Australian National Death Index records.
Over 12 years, 353 participants (11.9%) had incident CHD-related deaths. Retinopathy was present in 57/199 (28.6%) participants with, and in 268/2768 (9.7%) without, diabetes. The presence of retinopathy increased the CHD mortality rate per person-year by an amount (0.005) equivalent to the presence of diabetes itself (12-year CHD mortality rate per person-year of 0.010 in people with neither diabetes nor retinopathy, 0.015 in those with diabetes alone, 0.016 in those with retinopathy alone). After adjusting for cardiovascular risk factors, retinopathy remained an independent predictor of CHD death both in people with diabetes (hazard ratio (HR) = 2.21, 95% CI 1.20 to 4.05) and in those without diabetes (HR = 1.33, 95% CI 1.02 to 1.83). Moderate retinopathy was associated with adjusted HR = 6.68 (95% CI 2.24 to 20.0) in people with diabetes and adjusted HR = 2.29 (95% CI 1.10 to 4.76) in people without diabetes.
A finding of retinopathy in people with or without diabetes may signal increased CHD risk. The increased CHD mortality associated with retinopathy in people without diabetes was equivalent to the presence of diabetes itself.
视网膜病变在临床环境中是相当常见的发现，并且可能预测冠心病（CHD）风险。
研究视网膜病变是否能独立预测糖尿病患者和非糖尿病患者发生冠心病相关死亡的风险。
在澳大利亚一个基于人群的队列中，纳入了患有糖尿病（n = 199）和未患糖尿病（n = 2768）的人群（蓝山眼研究，总计n = 2967），通过视网膜照片评估视网膜病变的存在情况和严重程度。从澳大利亚国家死亡指数记录中确定12年累积的冠心病死亡人数。
在12年期间，353名参与者（11.9%）发生了与冠心病相关的死亡。患有糖尿病的参与者中有57/199（28.6%）存在视网膜病变，未患糖尿病的参与者中有268/2768（9.7%）存在视网膜病变。视网膜病变的存在使每人每年的冠心病死亡率增加了一定数值（0.005），这与糖尿病本身导致的增加量相当（既无糖尿病也无视网膜病变的人群中每人每年的12年冠心病死亡率为0.010，仅患有糖尿病的人群中为0.015，仅患有视网膜病变的人群中为0.016）。在调整心血管危险因素后，视网膜病变在糖尿病患者（风险比（HR）= 2.21，95%可信区间1.20至4.05）和非糖尿病患者（HR = 1.33，95%可信区间1.02至1.83）中仍然是冠心病死亡的独立预测因素。中度视网膜病变在糖尿病患者中的调整后HR = 6.68（95%可信区间2.24至20.0），在非糖尿病患者中的调整后HR = 2.29（95%可信区间1.10至4.76）。
糖尿病患者和非糖尿病患者中发现视网膜病变可能预示着冠心病风险增加。非糖尿病患者中与视网膜病变相关的冠心病死亡率增加与糖尿病本身导致的增加相当。
