Liew Gerald, Xie Jing, Nguyen Helen, Keay Lisa, Kamran Ikram M, McGeechan Kevin, Klein Barbara Ek, Jin Wang Jie, Mitchell Paul, Klaver Caroline Cw, Lamoureux Ecosse L, Wong Tien Y
Centre for Vision Research, Department of Ophthalmology, The Westmead Institute for Medical Research, The University of Sydney, Sydney, Australia.
School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
Int J Cardiol Cardiovasc Risk Prev. 2023 Mar 5;17:200180. doi: 10.1016/j.ijcrp.2023.200180. eCollection 2023 Jun.
The cardiovascular risk associated with different levels of hypertensive retinopathy, including mild, remains unclear. We performed an individual participant meta-analysis from 6 population-based cohort studies to determine the relationship of hypertensive retinopathy with incident cardiovascular outcomes.
We identified cohort studies that objectively assessed hypertensive retinopathy from photographs, documented incident cardiovascular outcomes, and were population-based. Six studies contributed data from 11,013 individuals at baseline with 5-13 years follow-up. Participants were recruited if they had hypertension and did not have confounding conditions such as diabetic retinopathy. Main outcome measures were incident coronary heart disease (CHD), stroke and a composite endpoint of cardiovascular disease (CHD or stroke). Pooled estimates of incident risk ratios (IRR) were obtained after adjusting for age, gender, systolic blood pressure, serum total cholesterol, high density lipoprotein and smoking.
Among eligible participants with hypertension and without diabetes, there were 1018/9662 (10.5%) incident CHD events, 708/11,013 (6.4%) incident stroke events and 1317/9378 (14.0%) incident CVD events. Mild hypertensive retinopathy was associated with increased risk of CVD (IRR 1.13, 95% CI 1.00 to 1.27) and CHD (IRR 1.17, 95% CI 1.02 to 1.34) but not stroke; moderate hypertensive retinopathy was associated with increased risk of CVD (IRR 1.25 95% CI 1.02 to 1.53) but not stroke or CHD individually.
In persons with hypertension, both mild and moderate hypertensive retinopathy were associated with higher CVD risk.
与不同程度的高血压性视网膜病变（包括轻度病变）相关的心血管风险尚不清楚。我们对6项基于人群的队列研究进行了个体参与者荟萃分析，以确定高血压性视网膜病变与心血管事件发生之间的关系。
我们确定了通过照片客观评估高血压性视网膜病变、记录心血管事件发生情况且基于人群的队列研究。6项研究提供了11,013名个体的基线数据，并进行了5至13年的随访。如果参与者患有高血压且没有糖尿病视网膜病变等混杂疾病，则将其纳入研究。主要结局指标为冠心病（CHD）、中风以及心血管疾病（CHD或中风）的复合终点。在调整年龄、性别、收缩压、血清总胆固醇、高密度脂蛋白和吸烟因素后，获得了事件风险比（IRR）的合并估计值。
在符合条件的高血压且无糖尿病参与者中，发生冠心病事件的有1018/9662（10.5%），发生中风事件的有708/11,013（6.4%），发生心血管疾病事件的有1317/9378（14.0%）。轻度高血压性视网膜病变与心血管疾病风险增加（IRR 1.13，95%CI 1.00至1.27）和冠心病风险增加（IRR 1.17，95%CI 1.02至1.34）相关，但与中风无关；中度高血压性视网膜病变与心血管疾病风险增加（IRR 1.25，95%CI 1.02至1.53）相关，但与中风或冠心病单独无关。
在高血压患者中，轻度和中度高血压性视网膜病变均与较高的心血管疾病风险相关。
