Retinal arteriolar narrowing and risk of coronary heart disease in men and women - The atherosclerosis risk in communities study
Retinal arteriolar narrowing and risk of coronary heart disease in men and women - The atherosclerosis risk in communities study
复制标题
DOI：
10.1001/jama.287.9.1153
复制
发表时间：
2002-03-06
影响因子：
120.7
通讯作者：
Hubbard, LD
中科院分区：
文献类型：
--
作者：
Wong, TY;Klein, R;Hubbard, LD
背景微血管过程被假设在女性冠心病（CHD）的发生中比男性发挥更大的作用;然而，前瞻性的临床数据是有限的。目的研究视网膜小动脉狭窄，高血压和炎症引起的微血管损伤的标志物，与健康中年女性和男性冠心病事件之间的关系。设计，设置，社区动脉粥样硬化风险研究是一项正在进行的前瞻性、基于人群的队列研究，于1987-1989年在4个美国社区启动。对9648例年龄在51 ~ 72岁之间的第三次检查（1993-1995年）中无CHD的女性和男性进行了视网膜照相。为了量化视网膜小动脉狭窄，照片进行了数字化，测量个体小动脉和小静脉直径，并计算汇总小动脉-小静脉比（AVR）。主要结果测量与视网膜小动脉狭窄相关的冠心病风险。在女性中，在控制了过去6年的平均动脉血压、糖尿病、吸烟、血脂水平和其他危险因素后，AVR的每一个SD降低都与任何CHD事件的风险增加相关（相对危险度[RR]，1.37; 95%可信区间[CI]，1.08-1.72）和急性心肌梗死（RR，1.50; 95% CI，1.10-2.04）。与此相反，男性中AVR与任何冠心病事件无关（RR，1.00; 95%CI，0.84-1.18），与急性心肌梗死无关（RR，1.08; 95%CI，0.85-1.38）。未来的工作需要证实这些发现。
Context Microvascular processes have been hypothesized to play a greater role in the development of coronary heart disease (CHD) in women than in men; however, prospective clinical data are limited.Objective To examine the association between retinal arteriolar narrowing, a marker of microvascular damage from hypertension and inflammation, and incident CHD in healthy middle-aged women and men.Design, Setting, and Participants The Atherosclerosis Risk in Communities Study, an ongoing prospective, population-based cohort study in 4 US communities initiated in 1987-1989. Retinal photographs were taken in 9648 women and men aged 51 to 72 years without CHD at the third examination (1993-1995). To quantify retinal arteriolar narrowing, the photographs were digitized, individual arteriolar and venular diameters were measured, and a summary arteriole-to-venule ratio (AVR) was calculated.Main Outcome Measure Risk of CHD associated with retinal arteriolar narrowing.Results During an average 3.5 years of follow-up, 84 women and 187 men experienced incident CHD events. In women, after controlling for mean arterial blood pressure averaged over the previous 6 years, diabetes, cigarette smoking, plasma lipid levels, and other risk factors, each SD decrease in the AVR was associated with an increased risk of any incident CHD (relative risk [RR], 1.37; 95% confidence interval [CI], 1.08-1.72) and of acute myocardial infarction (RR, 1.50; 95% CI, 1.10-2.04). In contrast, AVR was unrelated to any incident CHD in men (RR, 1,00; 95% CI, 0.84-1.18) or to acute myocardial infarction (RR, 1.08; 95% CI, 0.85-1.38).Conclusion Retinal arteriolar narrowing is related to risk of CHD in women but not in men, supporting a more prominent microvascular role in the development of CHD in women than in men. Future work is needed to confirm these findings.