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© 2002 by the American Diabetes Association, Inc.
Epidemiology/Health Services/Psychosocial Research |
Blood Pressure, Lipids, and Obesity Are Associated With Retinopathy
The Hoorn Study
1 Department of Ophthalmology, VU University Medical Center, Amsterdam, the Netherlands
2 Institute for Research in Extramural Medicine, VU University Medical Center, Amsterdam, the Netherlands
3 Department of Endocrinology, VU University Medical Center, Amsterdam, the Netherlands
4 Department of Internal Medicine, VU University Medical Center, Amsterdam, the Netherlands
OBJECTIVE—To study potential risk factors for retinopathy in diabetic and nondiabetic individuals.
RESEARCH DESIGN AND METHODS—The Hoorn Study is a population-based study including 2,484 50- to 74-year-old Caucasians. A subsample of 626 individuals stratified by age, sex, and glucose tolerance underwent extensive measurements during 1989–1992, including ophthalmologic examination and two-field 45-degree fundus photography. The prevalence of (diabetic) retinopathy was assessed among individuals with normal glucose metabolism (NGM) and impaired glucose metabolism (IGM) and individuals with newly diagnosed diabetes mellitus (NDM) and known diabetes mellitus (KDM) (new World Health Organization 1999 criteria).
RESULTS—The prevalence of retinopathy was 9% in NGM, 11% in IGM, 13% in NDM, and 34% in KDM. Retinopathy worse than minimal nonproliferative diabetic retinopathy was present in 8% in KDM and 0–2% in other glucose categories. The prevalence of retinopathy was positively associated with elevated blood pressure, BMI, cholesterol, and triglyceride serum levels in all glucose categories. The age-, sex-, and glucose metabolism category–adjusted odds ratios were 1.5 (95% CI 1.2–1.9), 1.3 (1.0–1.7), and 1.3 (1.0–1.6) per SD increase of systolic blood pressure, BMI, and total cholesterol concentration, respectively, and 1.2 (1.0–1.5) per 50% increase of triglyceride level. Elevated blood pressure and plasma total and LDL cholesterol levels showed associations with retinal hard exudates.
CONCLUSIONS—Retinopathy is a multifactorial microvascular complication, which, apart from hyperglycemia, is associated with blood pressure, lipid concentrations, and BMI.
Abbreviations: IGM, impaired glucose metabolism • KDM, known diabetes mellitus • NDM, newly diagnosed diabetes mellitus • NGM, normal glucose metabolism • NPDR, nonproliferative diabetic retinopathy • OGTT, oral glucose tolerance test • UKPDS, U.K. Prospective Diabetes Study • VUMC, VU University Medical Center • WHO 1999, new diagnostic criteria for diabetes of the World Health Organization • WHR, waist-to-hip ratio
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