Chen Xiaoyun, Si Hongyu, Fu Yihang, Yang Weimin, Luo Yan, Xiao Wei
State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Sun Yat-Sen University, Guangzhou, 510060, China.
State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, 54 South Xianlie Road, Guangzhou, 510060, People's Republic of China.
BMC Public Health. 2024 Dec 23;24(1):3572. doi: 10.1186/s12889-024-21117-0.
Retinal microvascular abnormalities (RMA) reflect cumulative microvascular damage from systemic diseases and aging. However, little is known about the association between RMA and long-term survival outcomes. This study aimed to examine the relationships between RMA and the risk of all-cause and specific-cause mortality among U.S. adults.
Individuals aged ≥ 40 years were included from the U.S. National Health and Nutrition Examination Survey, 2005-2008. RMA and its subtypes, including retinopathy, arteriovenous nicking (AVN), focal arteriolar narrowing (FAN) and Hollenhorst plaque (HP), were manually graded from retinal photographs. Associations between RMA and the risk of all-cause and cause-specific mortality were examined with Cox regression analysis.
This cohort study of 5775 adults included 2881 women (weighted proportion, 52.6%) and 2894 men (weighted, 47.4%), with a weighted mean (SE) age of 56.6 (0.4) years. RMA were present in 1251 participants (weighted, 17.9%), of whom 710 (weighted, 9.8%) had retinopathy, 635 (weighted, 9.3%) had AVN, 64 (weighted, 1.0%) had FAN, and 21 (weighted, 0.3%) had HP. During a median of 12.2 years (range, 0.1-15.0 years) of follow-up, 1488 deaths occurred, including 452 associated with cardiovascular disease (CVD), 341 associated with cancer, and 695 associated with other causes. After adjusting confounding factors, the presence of any RMA and retinopathy at baseline was associated with higher risk of all-cause mortality (HR, 1.26; 95%CI, 1.07-1.47; HR, 1.36; 95%CI, 1.09-1.71, respectively), CVD mortality (HR, 1.36; 95%CI, 1.06-1.73; HR, 1.53; 95%CI, 1.04-2.26, respectively) and other-cause mortality (HR, 1.33; 95%CI, 1.06-1.67; HR, 1.55; 95%CI, 1.20-2.01, respectively). Additionally, FAN was significantly associated with an increased risk of other-cause mortality (HR, 2.06; 95%CI, 1.16-3.65). Although AVN was not associated with mortality in the whole population, it was significantly related to higher risks of all-cause and CVD death in those with obesity (HR, 1.68; 95%CI, 1.12-2.52; HR, 1.96; 95%CI, 1.23-3.13, respectively).
This study revealed that the presence of RMA is independently associated with greater risks of all-cause, CVD and other-cause mortality in adults aged 40 years or older.
视网膜微血管异常（RMA）反映了全身性疾病和衰老导致的微血管累积损伤。然而，关于RMA与长期生存结局之间的关联知之甚少。本研究旨在探讨美国成年人中RMA与全因死亡风险及特定病因死亡风险之间的关系。
纳入2005 - 2008年美国国家健康与营养检查调查中年龄≥40岁的个体。从视网膜照片中对RMA及其亚型进行人工分级，包括视网膜病变、动静脉交叉压迹（AVN）、局灶性小动脉狭窄（FAN）和Hollenhorst斑块（HP）。采用Cox回归分析检验RMA与全因死亡风险及病因特异性死亡风险之间的关联。
这项对5775名成年人的队列研究包括2881名女性（加权比例为52.6%）和2894名男性（加权比例为47.4%），加权平均（SE）年龄为56.6（0.4）岁。1251名参与者存在RMA（加权比例为17.9%），其中710名（加权比例为9.8%）有视网膜病变，635名（加权比例为9.3%）有AVN，64名（加权比例为1.0%）有FAN，21名（加权比例为0.3%）有HP。在中位随访12.2年（范围为0.1 - 15.0年）期间，发生了1488例死亡，其中452例与心血管疾病（CVD）相关，341例与癌症相关，695例与其他原因相关。在调整混杂因素后，基线时存在任何RMA和视网膜病变均与全因死亡风险升高相关（HR分别为1.26；95%CI为1.07 - 1.47；HR为1.36；95%CI为1.09 - 1.71）、CVD死亡风险升高相关（HR分别为1.36；95%CI为1.06 - 1.73；HR为1.53；95%CI为1.04 - 2.26）以及其他原因死亡风险升高相关（HR分别为1.33；95%CI为1.06 - 1.67；HR为1.55；95%CI为1.20 - 2.01）。此外，FAN与其他原因死亡风险增加显著相关（HR为2.06；95%CI为1.16 - 3.65）。虽然AVN在整个人口中与死亡率无关，但在肥胖人群中，它与全因死亡和CVD死亡的较高风险显著相关（HR分别为1.68；95%CI为1.12 - 2.52；HR为1.96；95%CI为1.23 - 3.13）。
本研究表明，RMA的存在与40岁及以上成年人的全因、CVD和其他原因死亡的更高风险独立相关。
