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Retinal vessel caliber linked to incidence of hypertension, cardiovascular disease
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The incidence of hypertension and lower extremity arterial disease in African Americans with type 1 diabetes mellitus can be independently predicted from baseline retinal vessel caliber, according to a study.
In a retrospective study, 468 African Americans with type 1 diabetes mellitus were examined at baseline and at 6-year follow-up and assessed for hypertension and presence of cardiovascular disease, stroke and lower extremity arterial disease.
“Results of the study indicate that narrower retinal arteriolar diameter at baseline is an independent predictor of the 6-year incidence of any [cardiovascular disease] and [lower extremity arterial disease], and baseline larger retinal venular diameter is an independent predictor of the 6-year incidence of hypertension in African Americans with type 1 [diabetes mellitus],” the study authors said.
Narrower central retinal arteriolar equivalent at baseline predicted the 6-year incidence of lower extremity arterial disease (P = .007), heart disease or stroke (P = .01), and any cardiovascular disease (P = .001). Larger retinal venular diameter predicted the 6-year incidence of hypertension (P = .008).
“Whether such measurements may be used in the future to monitor treatments for hypertension or [diabetes mellitus] and its complications that specifically target the microvasculature remains to be determined,” the authors said.
Perspective
Back to TopTien Wong, MD, PhD
Despite significant advances, cardiovascular diseases (CVD) and other complications of diabetes remain a leading cause of morbidity and mortality among working-aged people in the United States. While clinicians routinely try to estimate a patient’s risk of CVD based on traditional risk factors (eg, diabetes duration, glycemic and blood pressure control), the failure of these risk factors to accurately classify a patient’s risks suggests that more needs to be done. The present study is an extension of current research that suggests that retinal vessel measurements using software applied to retinal photographs may provide additional information to help predict CVD and other complications of diabetes. The key take-home message is that in African Americans with type 1 diabetes, retinal vascular caliber changes (narrower arteriolar caliber and wider venular caliber) measured from fundus photographs are independent predictors of CVD and lower extremity arterial disease, irrespective of the traditional risk factors.
While the direct clinical value of this study remains uncertain, it provides further support for the concept that changes in retinal vessel caliber are a specific expression of microvascular dysfunction related to diabetes, and that these subtle changes can now be detected, measured and monitored over time with the use of retinal image analysis. Thus, it is possible that retinal caliber changes may in the future be a biomarker of how well diabetes is controlled in an individual patient and may therefore provide information regarding his/her risk of CVD and other complications.
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Arch Ophthalmol. 2012;130(5):561-567.
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