Purpose

To examine associations between retinal vessel morphometry and cardiometabolic risk factors in older British men and women.

Design

Retinal imaging examination as part of the European Prospective Investigation into Cancer—Norfolk Eye Study.

Participants

Retinal imaging and clinical assessments were carried out in 7411 participants. Retinal images were analyzed using a fully automated validated computerized system that provides novel measures of vessel morphometry.

Methods

Associations between cardiometabolic risk factors, chronic disease, and retinal markers were analyzed using multilevel linear regression, adjusted for age, gender, and within-person clustering, to provide percentage differences in tortuosity and absolute differences in width.

Main Outcomes Measures

Retinal arteriolar and venular tortuosity and width.

Results

In all, 279 802 arterioles and 285 791 venules from 5947 participants (mean age, 67.6 years; standard deviation [SD], 7.6 years; 57% female) were analyzed. Increased venular tortuosity was associated with higher body mass index (BMI; 2.5%; 95% confidence interval [CI], 1.7%–3.3% per 5 kg/m²), hemoglobin A1c (HbA1c) level (2.2%; 95% CI, 1.0%–3.5% per 1%), and prevalent type 2 diabetes (6.5%; 95% CI, 2.8%–10.4%); wider venules were associated with older age (2.6 μm; 95% CI, 2.2–2.9 μm per decade), higher triglyceride levels (0.6 μm; 95% CI, 0.3–0.9 μm per 1 mmol/l), BMI (0.7 μm; 95% CI, 0.4–1.0 per 5 kg/m²), HbA1c level (0.4 μm; 95% CI, –0.1 to 0.9 per 1%), and being a current smoker (3.0 μm; 95% CI, 1.7–4.3 μm); smoking also was associated with wider arterioles (2.1 μm; 95% CI, 1.3–2.9 μm). Thinner venules were associated with high-density lipoprotein (HDL) (1.4 μm; 95% CI, 0.7–2.2 per 1 mmol/l). Arteriolar tortuosity increased with age (5.4%; 95% CI, 3.8%–7.1% per decade), higher systolic blood pressure (1.2%; 95% CI, 0.5%–1.9% per 10 mmHg), in females (3.8%; 95% CI, 1.4%–6.4%), and in those with prevalent stroke (8.3%; 95% CI, –0.6% to 18%); no association was observed with prevalent myocardial infarction. Narrower arterioles were associated with age (0.8 μm; 95% CI, 0.6–1.0 μm per decade), higher systolic blood pressure (0.5 μm; 95% CI, 0.4–0.6 μm per 10 mmHg), total cholesterol level (0.2 μm; 95% CI, 0.0–0.3 μm per 1 mmol/l), and HDL (1.2 μm; 95% CI, 0.7–1.6 μm per 1 mmol/l).

Conclusions

Metabolic risk factors showed a graded association with both tortuosity and width of retinal venules, even among people without clinical diabetes, whereas atherosclerotic risk factors correlated more closely with arteriolar width, even excluding those with hypertension and cardiovascular disease. These noninvasive microvasculature measures should be evaluated further as predictors of future cardiometabolic disease.

中文翻译：

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欧洲癌症前瞻性调查中视网膜血管测量与心脏代谢危险因素的关联——诺福克研究

目的

研究英国老年男性和女性视网膜血管形态测量与心脏代谢危险因素之间的关联。

设计

视网膜成像检查作为欧洲癌症前瞻性调查 - 诺福克眼科研究的一部分。

参加者

对 7411 名参与者进行了视网膜成像和临床评估。使用经过验证的全自动计算机系统对视网膜图像进行分析，该系统提供了血管形态测量的新颖测量方法。

方法

使用多级线性回归分析心脏代谢危险因素、慢性疾病和视网膜标志物之间的关联，并根据年龄、性别和人内聚类进行调整，以提供弯曲度的百分比差异和宽度的绝对差异。

主要成果措施

视网膜小动脉和小静脉的迂曲度和宽度。

结果

总共分析了 5947 名参与者（平均年龄，67.6 岁；标准差 [SD]，7.6 岁；57% 女性）的 279 802 条小动脉和 285 791 条小静脉。^{静脉曲张度增加与较高的体重指数（BMI；2.5%；95% 置信区间 [CI]，每 5 kg/m 2} 1.7%–3.3%）、糖化血红蛋白 ( HbA1c) 水平（2.2%；95% CI）相关，每 1% 1.0%–3.5%），以及流行的 2 型糖尿病（6.5%；95% CI，2.8%–10.4%）；较宽的小静脉与年龄较大（2.6 μm；95% CI，每十年 2.2–2.9 μm）、较高的甘油三酯水平（0.6 μm；95% CI，每 1 mmol/l 0.3–0.9 μm）、BMI（0.7 μm； 95% CI，0.4–1.0 每 5 kg/m ²），HbA1c 水平（0.4 μm；95% CI，每 1% –0.1 至 0.9），并且当前吸烟者（3.0 μm；95% CI，1.7–4.3）微米）；吸烟还与较宽的小动脉有关（2.1 μm；95% CI，1.3–2.9 μm）。细静脉与高密度脂蛋白 (HDL) 相关（1.4 μm；95% CI，0.7–2.2 每 1 mmol/l）。小动脉迂曲度随着年龄的增长（5.4%；95% CI，每十年 3.8%–7.1%）、收缩压升高（1.2%；95% CI，每 10 mmHg 0.5%–1.9%）而增加，女性为（3.8%；95% CI，每 10 mmHg）。 95% CI，1.4%–6.4%），以及常见中风患者（8.3%；95% CI，–0.6% 至 18%）；没有观察到与流行的心肌梗塞之间的关联。较窄的小动脉与年龄（0.8 μm；95% CI，每十年 0.6-1.0 μm）、较高的收缩压（0.5 μm；95% CI，0.4-0.6 μm/10 mmHg）、总胆固醇水平（0.2 μm；0.2 μm；95% CI，0.4-0.6 μm/10 mmHg）相关。 95% CI，0.0–0.3 μm 每 1 mmol/l) 和 HDL (1.2 μm；95% CI，0.7–1.6 μm 每 1 mmol/l)。

结论

代谢危险因素与视网膜小静脉的曲折度和宽度呈分级相关，即使在没有临床糖尿病的人群中也是如此，而动脉粥样硬化危险因素与小动脉宽度的相关性更密切，甚至排除患有高血压和心血管疾病的人。应进一步评估这些无创微血管测量作为未来心脏代谢疾病的预测因子。