Elsevier

Ophthalmology

Volume 118, Issue 4, April 2011, Pages 656-662
Ophthalmology

Original article
Retinopathy Signs in People without Diabetes: The Multi-Ethnic Study of Atherosclerosis

https://doi.org/10.1016/j.ophtha.2010.08.007Get rights and content

Objective

To describe the prevalence of retinopathy and associations with cardiovascular risk factors in persons without diabetes in 4 racial/ethnic groups (white, black, Hispanic, and Chinese).

Design

Population-based, cross-sectional study.

Participants

We included 6176 subjects aged 45–84 years without diabetes, selected from 6 United States communities.

Methods

Fundus images were taken using 45° digital camera through dark-adapted pupils and were graded for retinopathy as defined by the Early Treatment Diabetic Retinopathy Study severity scale: microaneurysms, hemorrhages, cotton wool spots, intraretinal microvascular abnormalities, hard exudates, venous beading, and new vessels.

Main Outcome Measures

Retinopathy and the association with cardiovascular risk factors.

Results

Prevalence rates of retinopathy in persons without diabetes were 12.5% overall, varying from 11.9% (white), 13.9% (black), 12.6% (Hispanic), to 17.2% (Chinese). Hypertension was strongly associated with retinopathy (odds ratio [OR], 1.47; 95% confidence interval [CI], 1.23–1.75). After adjusting for age, gender, race, and other parameters, smoking (OR, 1.50; 95% CI, 1.09–2.06) and increased internal carotid intima media thickness (OR, 1.22; 95% CI, 1.05–1.41) were associated with retinopathy. A range of serum inflammatory factors were examined, but none were found to be significant.

Conclusions

Retinopathy in persons without diabetes is common, varies with race/ethnicity, and associated with cardiovascular risk factors, including hypertension, smoking, and carotid artery intima media thickness.

Financial Disclosure(s)

The authors have no proprietary or commercial interest in any of the materials discussed in this article.

Section snippets

Study Population

The Multi-Ethnic Study of Atherosclerosis (MESA) is a prospective cohort study of men and women 45–84 years of age initially free of clinical evidence of CVD and living in 6 United States communities (Baltimore, Maryland; Chicago, Illinois; Forsyth County, North Carolina; Los Angeles County, California; Northern Manhattan, New York; and St. Paul, Minnesota). The study objective of MESA was to identify risk factors for subclinical and clinical CVD. Methods of the study have been reported in

Results

Participant characteristics comparing 4 ethnic groups, including White, Black, Hispanic, and Chinese are shown in Table 1 (available online at http://aaojournal.org). Hypertension was found in 57.7% of black participants compared with 40.9% white persons, 40.4% of Hispanics, and 36.3% of the Chinese participants. Blacks had the highest proportion of smokers, the highest impaired fasting glucose, and the highest mean BMI, systolic and diastolic blood pressures, pulse pressure, and LV

Discussion

The MESA has provided an opportunity to examine the frequency of retinopathy and its relationship to a range of cardiovascular risk factors, as well as biomarkers of inflammation and endothelial cell dysfunction in a large, multiethnic cohort free of clinical CVD at the baseline examination. This study has provided new data on the prevalence of nondiabetic retinopathy and the associated risk factors in 4 racial/ethnic groups. The overall prevalence of nondiabetic retinopathy in the MESA was

References (40)

  • R.J. Tapp et al.

    The prevalence of and factors associated with diabetic retinopathy in the Australian population

    Diabetes Care

    (2003)
  • T.Y. Wong et al.

    Do retinopathy signs in non-diabetic individuals predict the subsequent risk of diabetes?

    Br J Ophthalmol

    (2006)
  • R. Klein et al.

    Hypertension and retinopathy, arteriolar narrowing, and arteriovenous nicking in a population

    Arch Ophthalmol

    (1994)
  • T. Yu et al.

    Retinopathy in older persons without diabetes and its relationship to hypertension

    Arch Ophthalmol

    (1998)
  • R.P. Stolk et al.

    Retinopathy, glucose, and insulin in an elderly population: the Rotterdam Study

    Diabetes

    (1995)
  • H.A. van Leiden et al.

    Blood pressure, lipids, and obesity are associated with retinopathy: the Hoorn Study

    Diabetes Care

    (2002)
  • H.M. Leibowitz et al.

    The Framingham Eye Study monograph: an ophthalmological and epidemiological study of cataract, glaucoma, diabetic retinopathy, macular degeneration, and visual acuity in a general population of 2631 adults, 1973-1975

    Surv Ophthalmol

    (1980)
  • K. Svardsudd et al.

    Hypertensive eye ground changes: prevalence, relation to blood pressure and prognostic importance: the study of men born in 1913

    Acta Med Scand

    (1978)
  • J.R. McDonough et al.

    Blood pressure and hypertensive disease among Negroes and Whites; a study in Evans County, Georgia

    Ann Intern Med

    (1964)
  • T.Y. Wong et al.

    Hypertensive retinopathy

    N Engl J Med

    (2004)

    • Cited by (0)

    Manuscript no. 2010-191.

    Financial Disclosure(s): The authors have no proprietary or commercial interest in any of the materials discussed in this article.

    Supported by contracts N01-HC-95159 through N01-HC-95169 from the National Heart, Lung, and Blood Institute. Additional support was provided by National Institutes of Health grants HL69979-03 (Klein R and Wong TY). The funding agencies had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.

    A full list of participating MESA investigators and institutions can be found at http://www.mesa-nhlbi.org.

    View full text
    Copyright © 2011 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.