The Role of Vitamin D in Retinal Diseases in Aging

描述(申请人提供)：随着美国老龄化人口的增长，患有糖尿病视网膜病变(DR)和老年性黄斑变性(AMD)等威胁视力的老年患者的数量预计在未来几十年内将会增加。找出预防或延缓视力威胁疾病的新的可改变因素具有重要意义，因为这将减少治疗此类慢性病的医疗费用负担，并延长老年人可以独立和参与诸如驾驶、阅读、锻炼和食物准备等视力依赖活动的年限。维生素D缺乏和不足在美国老龄化人口的很大一部分中很普遍，维生素D已经被证明具有抗炎和抗血管生成的特性，除了潜在地调节血压和血糖控制。这项拟议研究的长期目标是更好地了解维生素D状态在老年人中高度流行的视网膜疾病中的作用。很少有研究调查维生素D状态和糖尿病视网膜病变之间的联系；尽管有强有力的生物学基础支持维生素D状态是糖尿病视网膜病变发生和进展的潜在的可改变的危险因素。与此同时，两项大型流行病学研究表明，维生素D缺乏或不足的人(25-羟基维生素D(25(OH)D&lt；50nmol/L)更有可能患上AMD，但尚未对AMD的发病率和维生素D状况进行前瞻性研究。我们假设，维生素D缺乏或不足的人，与维生素D充足的人相比，更有可能患有AMD和DR，更有可能发展为AMD。这项建议的目的是利用老年(45-岁)社区动脉粥样硬化风险(ARIC)人群、混血(非裔美国人和高加索人)队列的数据，调查维生素D状况与DR和AMD之间的关系。我们建议使用以前收集的数据，包括DR和AMD状态的分级视网膜照片，以及从1987-1995年收集的ARIC研究参与者的血清25(OH)D浓度分析，以及目前在后续研究(2011-2013年)中获得的分级视网膜照片。具体地说，我们建议调查在访问2(1990-1992)中评估的维生素D状况与1)在访问3(1993-1995)中评估的糖尿病患者中是否存在DR以及2)在访问3(1993-1995)中评估11,532名参与者中是否存在AMD之间的联系。第三，我们还建议首次调查1990-1992年评估的维生素D状况与AMD的发病或进展(1993-1995年至2011-2013年)之间的关系，抽样调查约2346名ARIC参与者。这项研究将促进我们对维生素D与老年人常见的威胁视力的眼病的关系的理解，并可能导致预防或减缓这些疾病进展的新疗法。 公共卫生相关性：糖尿病视网膜病变(DR)和老年性黄斑变性(AMD)是老年人常见的威胁视力的眼病。目前的工作表明，具有足够维生素D状态的人患AMD的可能性较小，但关于维生素D和DR之间的关系的研究很少。利用一项基于人群的、对非洲裔美国人和高加索男性和女性老龄化的纵向研究数据，我们的目的是调查维生素D状态与流行的DR和AMD之间的联系；第二，我们首次建议调查维生素D状态与AMD的发生或进展之间的关系。

DESCRIPTION (provided by applicant): The number of aging individuals with the vision threatening diseases of diabetic retinopathy (DR) and age- related macular degeneration (AMD) is projected to increase in the coming decades as the aging population of the United States grows. Identifying new modifiable factors that prevent or delay vision threatening disease is significant because it will reduce the burden of health care costs for treatment of such chronic diseases and extend the years that the elderly can be independent and participate in such vision dependent activities as driving, reading, exercise, and food preparation. Vitamin D deficiency and inadequacy is prevalent in a large portion of the aging US population, and vitamin D has been shown to have anti-inflammatory and anti- angiogenic properties, in addition to potentially modulating blood pressure and glucose control. The long-term goal of the proposed research is to better understand the role of vitamin D status in retinal diseases highly prevalent in aging individuals. Minimal research has investigated the association between vitamin D status and DR; although a strong biologic rationale supports vitamin D status as a potential modifiable risk factor for DR development and progression. At the same time, research in two large epidemiologic studies show that people with vitamin D deficiency or inadequacy (25-hydroxyvitamin D (25(OH)D)<50 nmol/L) are more likely to have prevalent AMD, but no prospective studies of AMD incidence and vitamin D status have been conducted. We hypothesize that individuals with deficient or inadequate vitamin D status, compared to individuals with adequate status, will be more likely to have AMD and DR and be more likely to develop AMD. The purpose of this proposal is to investigate associations between vitamin D status and both DR and AMD using data from the aging (45-64 years) Atherosclerosis Risk in Communities (ARIC) population-based, biracial (African American and Caucasian) cohort. We propose to use previously collected data, including graded retinal photographs for DR and AMD status, and assayed serum 25(OH)D concentrations from ARIC study participants collected from 1987-1995, as well as graded retinal photographs currently being obtained in a follow-up study (2011-2013). Specifically, we propose to investigate the association between vitamin D status, assessed at Visit 2 (1990-1992), and 1) the presence of DR assessed at Visit 3 (1993-1995) among 1,657 individuals with diabetes and 2) the presence of AMD assessed at Visit 3 (1993-1995) among 11,532 participants. Third, we also proposed to investigate, for the first time, the association between vitamin D status, assessed in 1990-1992, and the incidence or progression of AMD (from 1993-1995 to 2011-2013) in a sample of approximately 2,346 ARIC participants. This study will advance our understanding of vitamin D status in relation to common vision-threatening eye diseases in the elderly and could lead to new therapies for the prevention or reduced progression of these diseases. PUBLIC HEALTH RELEVANCE: Diabetic retinopathy (DR) and age-related macular degeneration (AMD) are common vision-threatening eye diseases among the elderly. Current work suggests that persons with adequate vitamin D status are less likely to have AMD, but little work exists on the relationship of vitamin D and DR. Using data from a population-based, longitudinal study of aging African American and Caucasian men and women, we purpose to investigate the association between vitamin D status and prevalent DR and AMD; and second, we propose to investigate, for the first time, the association between vitamin D status and incidence or progression of AMD.