Blood Pressure, Lipids, and Obesity Are Associated With Retinopathy

The Hoorn Study

  1. Hendrik A. van Leiden, MD12,
  2. Jacqueline M. Dekker, PHD2,
  3. Annette C. Moll, MD, PHD12,
  4. Giel Nijpels, MD, PHD2,
  5. Robert J. Heine, MD, PHD23,
  6. Lex M. Bouter, PHD2,
  7. Coen D.A. Stehouwer, MD, PHD24 and
  8. Bettine C.P. Polak, MD, PHD12
  1. 1Department of Ophthalmology, VU University Medical Center, Amsterdam, the Netherlands
  2. 2Institute for Research in Extramural Medicine, VU University Medical Center, Amsterdam, the Netherlands
  3. 3Department of Endocrinology, VU University Medical Center, Amsterdam, the Netherlands
  4. 4Department 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.


    • Address correspondence and reprint requests to Hendrik A. van Leiden, MD, VU University Medical Center, Department of Ophthalmology, P.O. BOX 7057, 1007 MB Amsterdam, The Netherlands. E-mail: ha.vanleiden{at}

      Received for publication 14 December 2001 and accepted in revised form 13 May 2002.

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