Cardiology, University Heart Center Zurich, University Hospital Zurich, Zurich, Switzerland.
Cardiology, University Heart Center Zurich, University Hospital Zurich, Zurich, Switzerland; Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.
J Clin Lipidol. 2018 Nov-Dec;12(6):1523-1531.e2. doi: 10.1016/j.jacl.2018.07.015. Epub 2018 Aug 18.
Hypercholesterolemia is one of the most important contributors to atherosclerosis. Whether hypercholesterolemia also affects the retinal microcirculation is unclear.
The goal of our study was to assess the association of cholesterol levels with retinal microvascular function using dynamic and static retinal vessel analysis (RVA) in a primary prevention setting.
This cross-sectional, observational study prospectively recruited 67 patients with hypercholesterolemia without known cardiovascular disease (mean age 64.4 ± 10.4 years; 45% female) and 78 healthy controls (mean age 61.8 ± 11.2 years; 45% female). The primary end point of the study was flicker-induced dilatation of retinal arterioles (FID) with secondary exploratory outcomes including venular FID (FID), arteriovenous ratio, flow-mediated dilatation and arterial stiffness as measured with augmentation index and pulse wave velocity. Multiple regression analysis was performed to study the association of cholesterol levels with retinal microvascular function.
FID was significantly impaired in patients with hypercholesterolemia compared with healthy controls (mean FID 2.1 ± 1.8 vs 3.1 ± 1.8%, P = .001). This association remained when analysis was restricted to dyslipidemic patients without coexisting hypertension or lipid-lowering therapy. No significant differences remained for FID, flow-mediated dilatation, arteriovenous ratio, or arterial stiffness between the groups. Low-density lipoprotein, but not high-density lipoprotein, cholesterol was a significant negative predictor of FID in multiple regression analysis.
Hypercholesterolemia is associated with significant retinal microvascular dysfunction as evidenced by a reduction in flicker-induced dilatation of retinal arterioles. Dynamic RVA may be a promising method for the study of retinal microvascular dysfunction in populations at elevated cardiovascular risk.
高胆固醇血症是动脉粥样硬化最重要的致病因素之一。高胆固醇血症是否也会影响视网膜微循环尚不清楚。
本研究旨在评估在一级预防环境中，使用动态和静态视网膜血管分析（RVA）评估胆固醇水平与视网膜微血管功能之间的相关性。
这项横断面、观察性研究前瞻性招募了 67 名无已知心血管疾病的高胆固醇血症患者（平均年龄 64.4±10.4 岁；45%为女性）和 78 名健康对照者（平均年龄 61.8±11.2 岁；45%为女性）。研究的主要终点是视网膜小动脉闪烁诱导扩张（FID），次要探索性终点包括静脉 FID（FID）、动静脉比、血流介导的扩张和动脉僵硬度，分别通过增强指数和脉搏波速度测量。进行多元回归分析以研究胆固醇水平与视网膜微血管功能的相关性。
与健康对照组相比，高胆固醇血症患者的 FID 明显受损（平均 FID 2.1±1.8%比 3.1±1.8%，P=0.001）。当分析仅限于无并存高血压或降脂治疗的血脂异常患者时，这种相关性仍然存在。两组间 FID、血流介导的扩张、动静脉比或动脉僵硬度无显著差异。多元回归分析显示，低密度脂蛋白胆固醇，而不是高密度脂蛋白胆固醇，是 FID 的显著负预测因子。
高胆固醇血症与显著的视网膜微血管功能障碍相关，表现在闪烁诱导的视网膜小动脉扩张减少。动态 RVA 可能是研究处于心血管风险升高的人群视网膜微血管功能障碍的一种很有前途的方法。
