المؤلفون: Michael Y. Tsai, Ronald E. Gangnon, Andrew D. Paterson, Ronald Klein, Karen J. Cruickshanks, Barbara E.K. Klein, Chelsea E. Myers, Kristine E. Lee

المصدر: JAMA Ophthalmology. 133:1054

مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Adolescent, Fundus Oculi, Blood Pressure, Fundus (eye), Gastroenterology, Macular Edema, Article, chemistry.chemical_compound, Wisconsin, Risk Factors, Diabetes mellitus, Internal medicine, Photography, medicine, Humans, Lipoprotein oxidation, Child, Macular edema, Aged, Glycated Hemoglobin, Type 1 diabetes, Diabetic Retinopathy, medicine.diagnostic_test, business.industry, Incidence, Fundus photography, Diabetic retinopathy, Middle Aged, medicine.disease, Lipoproteins, LDL, Ophthalmology, Cholesterol, Diabetes Mellitus, Type 1, Endocrinology, chemistry, Child, Preschool, Female, Glycated hemoglobin, business

الوصف: Importance Studies have shown oxidized low-density lipoprotein to be associated with the incidence of proliferative retinopathy and other complications of type 1 diabetes mellitus. Because low-risk interventions are available to modify oxidized low-density lipoprotein, it is important to examine the relationships between this factor and the incidence of proliferative retinopathy and of macular edema, 2 important causes of visual impairment in people with type 1 diabetes. Objective To determine the association of oxidized low-density lipoprotein with the worsening of diabetic retinopathy and the incidence of proliferative retinopathy and of macular edema. Design, Setting, and Participants Of 996 participants with type 1 diabetes in the Wisconsin Epidemiologic Study of Diabetic Retinopathy, 730 were examined up to 4 times (1990-1992, 1994-1996, 2005-2007, and 2012-2014) over 24 years and had assays of oxidized low-density lipoprotein and fundus photographs gradable for diabetic retinopathy and macular edema. Analyses started July 2014 and ended February 2015. Main Outcomes and Measures Worsening of diabetic retinopathy, incidence of proliferative diabetic retinopathy, and incidence of macular edema as assessed via grading of color stereo film fundus photographs. The levels of oxidized low-density lipoprotein collected from serum samples at the time of each examination were measured in 2013 and 2014 from frozen serum. Results The cohort at baseline had a mean (SD) level of oxidized low-density lipoprotein of 30.0 (8.5) U/L. While adjusting for duration of diabetes, glycated hemoglobin A 1c level, and other factors, we found that neither the level of oxidized low-density lipoprotein at the beginning of a period nor the change in it over a certain period was associated with the incidence of proliferative diabetic retinopathy (hazard ratio [HR], 1.11 [95% CI, 0.91-1.35], P = .30; odds ratio [OR], 1.77 [95% CI, 0.99-3.17], P = .06), the incidence of macular edema (HR, 1.04 [95% CI, 0.83-1.29], P = .74; OR, 1.08 [95% CI, 0.44-2.61], P = .87), or the worsening of diabetic retinopathy (HR, 0.94 [95% CI, 0.83-1.07], P = .34; OR, 1.32 [95% CI, 0.83-2.09], P = .24). Conclusions and Relevance Our findings do not provide evidence for a relationship between increasing levels of serum oxidized low-density lipoprotein and the incidence of macular edema or the worsening of diabetic retinopathy in persons with type 1 diabetes. The potential increase in the HR for incident proliferative retinopathy, with an increase in oxidized low-density lipoprotein level over the preceding period, warrants further investigation of this relationship.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::16d6813b6b88e5c99aa162740ca6c681Test
https://doi.org/10.1001/jamaophthalmol.2015.2239Test

المؤلفون: Ronald E. Gangnon, Kristine E. Lee, Chelsea E. Myers, Ronald Klein, Barbara E.K. Klein

المصدر: Archives of Ophthalmology. 130

مصطلحات موضوعية: Adult, Blood Glucose, Male, medicine.medical_specialty, Retinal Artery, Blood Pressure, Article, Macular Edema, chemistry.chemical_compound, Risk Factors, Internal medicine, Diabetes mellitus, medicine, Humans, Macular edema, Glycemic, Glycated Hemoglobin, Diabetic Retinopathy, business.industry, Incidence, Incidence (epidemiology), Retinal, Diabetic retinopathy, Odds ratio, Middle Aged, medicine.disease, Retinal Vein, Surgery, Ophthalmology, Diabetes Mellitus, Type 1, Blood pressure, Diabetes Mellitus, Type 2, chemistry, Disease Progression, Cardiology, Female, business

الوصف: To describe the relationship of change in retinal vessel diameters to the subsequent 6-year incidence and progression of diabetic retinopathy (DR) and incidence of proliferative diabetic retinopathy (PDR) and macular edema (ME) in persons with diabetes mellitus.A total of 1098 persons with diabetes who had DR graded from fundus photographs and had computer-assisted measurements of the central retinal arteriolar equivalent (CRAE) and central retinal venular equivalent(CRVE) participated in examinations in 1980-1982, 1984-1986, and 1990-1992.During the first 4-year period, the mean change in CRAE and CRVE was −0.37 and 2.54 μm, respectively.The 6-year incidence and progression of DR and the incidence of PDR and ME from 1984-1986 to 1990-1992 were 56%, 39%, 15%, and 11%, respectively. In multivariate analyses, while controlling for duration, diabetes type, and other factors, an increase of 10 μm in CRVE from 1980-1982 to 1984-1986 was associated with increases in the 6-year incidence of DR (odds ratio [OR],1.26; 95% CI, 1.10-1.43), progression of DR (OR, 1.21;95% CI, 1.12-1.30), incidence of PDR (OR, 1.19; 95%CI, 1.07-1.32), and incidence of ME (OR, 1.16; 95% CI,1.03-1.31). No interactions of these associations by diabetes type were found (data not shown). Change in CRAE was unrelated to the incidence or progression of DR (data not shown).Independent of DR severity level, glycemic control, and other factors, widening of the retinal venular but not arteriolar diameter was associated with subsequent incidence and progression of DR. The CRVE may provide additional information regarding the risk of incidence and progression of DR beyond traditional risk factors.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::52729dafaf2b3a78881dc14fb3638554Test
https://doi.org/10.1001/archophthalmol.2011.2560Test

المؤلفون: Robert Gardiner, Trudy Strand, Michael Mauer, Paul Goodyer, Samy Suissa, Bernard Zinman, Chelsea E. Myers, Sandra Donnelly, Ronald Klein, Barbara E.K. Klein, Alan R. Sinaiko

المصدر: Archives of Ophthalmology. 128:198

مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Adolescent, medicine.drug_class, Population, Angiotensin-Converting Enzyme Inhibitors, Blood Pressure, Calcium channel blocker, Losartan, Article, chemistry.chemical_compound, Hydrochlorothiazide, Double-Blind Method, Enalapril, Venules, Heart Rate, Arteriole, medicine.artery, Internal medicine, Image Processing, Computer-Assisted, medicine, Humans, Amlodipine, education, Glycated Hemoglobin, education.field_of_study, business.industry, Lisinopril, Retinal Vessels, Retinal, Blood Pressure Monitoring, Ambulatory, Middle Aged, Circadian Rhythm, Arterioles, Ophthalmology, Diabetes Mellitus, Type 1, Blood pressure, Endocrinology, chemistry, cardiovascular system, Cardiology, Female, business, Angiotensin II Type 1 Receptor Blockers, circulatory and respiratory physiology, medicine.drug

الوصف: Higher mean arterial blood pressure (MABP) has been consistently shown to be related to narrower retinal arterioles.1-6 Most studies showing this relation have been cross-sectional and involved general populations of middle to older-aged persons and individuals with hypertension. There are few studies which have examined whether increases in blood pressure (BP) over time are related to a subsequent decrease in the retinal arteriolar diameter and whether antihypertensive treatment affects retinal arteriolar and venular diameters.7-11 In a cross-sectional study in a general population, a history of use of an angiotensin-receptor-converting enzyme inhibitor (ACEI) was not related to retinal arteriolar or venular caliber.7 In the Anglo-Scandinavian Cardiac Outcomes Trial, involving 712 hypertensive individuals, despite similar blood pressure levels, persons randomized to a calcium channel blocker, amlodipine had a smaller arteriolar length to diameter ratio, a measure of retinal arteriolar narrowing, compared to those randomized to a beta blocker, atenolol.10 While the data suggest that blood pressure lowering is associated with a decrease in retinal arteriolar narrowing due to hypertension, it is not certain whether drugs, such as amlodipine, alters small artery structure independent of BP reduction during antihypertensive treatment. There were no differences in venular measures between treatment groups in this study. In another study involving non-diabetic hypertensive patients, treatment with losartan, an angiotensin-receptor blocker (ARB) led to an increase in the retinal arteriolar but did not affect the venular diameter.8 In a randomized controlled clinical trial in men with untreated hypertension, an ACEI, enalapril, but not a diuretic, hydrochlorothiazide, was shown to reduce narrowing of retinal arterioles.9 In a small study of 25 men with untreated hypertension randomized to treatment with an amlodipine or lisinopril over a one year period, blood pressure reduction using both treatments were associated with a reduction in arteriolar narrowing but had no effect on venular diameter.11 There are no comparable data on the effect of ACEI or ARB on retinal arteriolar diameter in normotensive persons with type 1 diabetes mellitus (T1DM). Understanding the relation of these drugs to retinal arteriolar narrowing and venular widening is important because the latter are thought to be markers of microvascular changes in the cerebral, coronary, peripheral, and renal circulations, and possibly of pathogenetic processes damaging to other targets of diabetic microvascular injury.4,5,12-20 In this report, we examine the relation of ACEI or ARB treatment and blood pressure to changes in retinal vessel caliber in a randomized controlled clinical trial of normotensive normoalbuminuric (NA) persons with T1DM.21

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::c24b6ca9374e979a15ce1b5b87efb796Test
https://doi.org/10.1001/archophthalmol.2009.391Test