Mutlu Unal, Ikram M Kamran, Wolters Frank J, Hofman Albert, Klaver Caroline C W, Ikram M Arfan
From the Departments of Epidemiology (U.M., M.K.I., F.J.W., A.H., C.C.W.K., M.A.I.), Ophthalmology (U.M., C.C.W.K.), and Radiology (M.A.I.), Erasmus Medical Center, Rotterdam, The Netherlands; Singapore Eye Research Institute, Singapore National Eye Center, Singapore, Singapore (M.K.I.); Duke-NUS Graduate Medical School, National University of Singapore, Singapore, Singapore (M.K.I.); and Department of Neurology, Rudolf Magnus Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands (M.K.I.).
Hypertension. 2016 Feb;67(2):281-7. doi: 10.1161/HYPERTENSIONAHA.115.06619. Epub 2015 Nov 30.
Retinal vascular diameters are associated with (sub)clinical cardiovascular disease and short-term cardiovascular mortality, but their association with long-term mortality is uncertain. We studied the association of retinal vascular diameters with cause-specific mortality in the general adult Dutch population during 25 years of follow-up. From 1990 to 1993, arteriolar and venular diameters were measured semiautomatically on digitized images in 5674 persons (mean age 68.0 years, 59% women) from the population-based Rotterdam study. Follow-up for mortality was complete till March 2015. Associations between vascular diameters and mortality were examined using Cox proportional hazards models, adjusting for age, sex, cardiovascular risk factors, and the fellow vessel diameter. During 85 770 person-years (mean±SD: 15.1±6.67), 3794 (66.8%) persons died, of whom 1034 due to cardiovascular causes. We found that narrower arterioles and wider venules were associated with higher risk of mortality (adjusted hazard ratio [95% confidence interval] per SD decrease 1.04 [1.00-1.08] and increase 1.07 [1.03-1.12], respectively). For arterioles, these associations were strongest for cardiovascular mortality, whereas venules showed consistent associations for cardiovascular and noncardiovascular mortality. Importantly, these associations remained unchanged after excluding the first 10 years of follow-up as immortal person-time. We found evidence for effect modification with stronger associations in persons <70 years (venules only) and smokers (P value for interaction<0.01). We replicated our findings in another independent cohort from the Rotterdam Study of 3106 persons with 19 880 person-years of follow-up and 144 deaths (hazard ratio for venules 1.22 [1.00-1.49]). Markers of retinal microvasculature are associated with long-term mortality in the general adult Dutch population.
视网膜血管直径与（亚）临床心血管疾病及短期心血管死亡率相关，但其与长期死亡率的关联尚不确定。我们研究了在25年随访期间，荷兰普通成年人群中视网膜血管直径与特定病因死亡率之间的关联。1990年至1993年，在基于人群的鹿特丹研究中，对5674人（平均年龄68.0岁，59%为女性）的数字化图像进行半自动测量，获取小动脉和小静脉直径。至2015年3月，死亡率随访完整。使用Cox比例风险模型检验血管直径与死亡率之间的关联，并对年龄、性别、心血管危险因素及对侧血管直径进行校正。在85770人年（均值±标准差：15.1±6.67）期间，3794人（66.8%）死亡，其中1034人死于心血管病因。我们发现，较窄的小动脉和较宽的小静脉与较高的死亡风险相关（每标准差降低和增加的校正风险比[95%置信区间]分别为1.04[1.00 - 1.08]和1.07[1.03 - 1.12]）。对于小动脉，这些关联在心血管死亡率方面最为显著，而小静脉在心血管和非心血管死亡率方面均呈现一致关联。重要的是，在排除随访的前10年作为非真实人时后，这些关联保持不变。我们发现了效应修饰的证据，在年龄<70岁的人群（仅小静脉）和吸烟者中关联更强（交互作用P值<0.01）。我们在鹿特丹研究的另一个独立队列中重复了我们的发现，该队列有3106人，随访19880人年，144人死亡（小静脉的风险比为1.22[1.00 - 1.49]）。视网膜微血管标志物与荷兰普通成年人群的长期死亡率相关。
