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Biomedical subjects

Ronald Klein

Publications and source records attributed to Ronald Klein.

At least 199 records · Page 11Linked to original sources
PubMed2002

Retinal arteriolar narrowing and risk of coronary heart disease in men and women. The Atherosclerosis Risk in Communities Study.

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.

Aged↗
PubMed2002

The association of cataract and cataract surgery with the long-term incidence of age-related maculopathy: the Beaver Dam eye study.

OBJECTIVE: To examine the association between cataract and cataract surgery and the 10-year incidence of age-related maculopathy (ARM). METHODS: A population-based cohort study of persons aged 43 to 86 years at baseline, living in Beaver Dam, Wis, of whom 3684 participated in a 5-year and 2764 in a 10-year follow-up. We used standardized protocols for physical examination, blood collection, health history, slitlamp and retroillumination photography of the lenses to determine the presence of cataract, and stereoscopic color fundus photography to determine the presence of ARM. We used the Kaplan-Meier (product-limit) survival approach and discrete linear logistic regression in analyses. MAIN OUTCOME MEASURES: The risk ratios (RRs) of persons with cataract or cataract surgery at baseline. RESULTS: While controlling for age, sex, systolic blood pressure, history of heavy drinking and smoking, and vitamin use, cataract at baseline was associated with incidence of early ARM (RR, 1.30; 95% confidence interval [CI], 1.04-1.63), soft indistinct drusen (RR, 1.38; 95% CI, 1.08-1.75), increased retinal pigment (RR, 1.38; 95% CI, 1.07-1.79), and progression of ARM (RR, 1.37; 95% CI, 1.06-1.77). We found no association with the incidence of late ARM. In contrast, cataract surgery before baseline was associated with incidence of late ARM (RR, 3.81; 95% CI, 1.89-7.69), increased retinal pigment (RR, 1.89; 95% CI, 1.18-3.03), retinal pigment epithelial depigmentation (RR, 1.95; 95% CI, 1.17-3.25), pure geographic atrophy (RR, 3.18; 95% CI, 1.33-7.60), exudative macular degeneration (RR, 4.31; 95% CI, 1.71-10.9), and progression of ARM (RR, 1.97; 95% CI, 1.29-3.02), but not with the incidence of early ARM. CONCLUSIONS: These findings indicate an association of cataract with subsequent risk for early ARM. Cataract surgery increased the risk for late ARM.

Adult↗
PubMed2002

Reliability of retinal photography in the assessment of retinal microvascular characteristics: the Atherosclerosis Risk in Communities Study.

PURPOSE: Retinal microvascular characteristics, as graded from retinal photography, have been shown to predict stroke. We evaluated the reliability of retinal photographic grading in the Atherosclerosis Risk in Communities Study. DESIGN: Cohort study. METHODS: Retinal photographs were taken of all subjects who attended the third Atherosclerosis Risk in Communities Study examination (1993 to 1995). These were graded using standardized protocols. Focal retinal characteristics were graded using a "light box" system. Generalized retinal arteriolar narrowing was quantified from computer-assisted measurements of digitized photographs. Two sub-studies were conducted to investigate the reliability of these grading methods. In the Individual Variability Study, selected subjects (n = 206) had two retinal photographs taken on one day, and a further one or two photographs taken 3 weeks later. In the Grader Variability Study, a stratified random sample of photographs had repeat retinal grading (n = 495 photographs for light box grading; n = 276 photographs for computer-assisted grading). RESULTS: Reliability of the computer-assisted quantification of generalized retinal arteriolar narrowing was high in both studies (reliability coefficients 0.64 to 0.69 for Individual Variability Study, and 0.79 to 0.83 for the Grader Variability Study). There was more variability for focal abnormalities graded using the light box system. Variability for Individual Variability Study (same individuals, repeat photographs) tended to be greater than for the Grader Variability Study (same photographs, repeat gradings). CONCLUSION: Retinal microvascular characteristics, especially computer-assisted quantification of generalized retinal arteriolar narrowing, can be ascertained reliably by standardized photographic grading methods, supporting the validity of their associations with cardiovascular disease. However, these characteristics appear to vary somewhat between eyes and over time in a single individual.

Aged↗
PubMed2002

Risk factors for Type II diabetes and diabetic retinopathy in a mexican-american population: Proyecto VER.

PURPOSE: Risk factors for type II diabetes and diabetic retinopathy were determined in a population-based study of Mexican-Americans. DESIGN: Proyecto VER (Vision, Evaluation, and Research) is a cross-sectional study in a random sample of the self-described Hispanic populations in Tucson and Nogales, Arizona, age 40 and older. METHODS: Of 6,659 eligible subjects, 4,774 (72%) participated in the home questionnaire and clinic visit. Diabetes was defined as self-report of a physician diagnosis or hemoglobin A(1c) value of > or = 7.0%. Only type II diabetes was included. Diabetic retinopathy was assessed on stereo fundus photographs of all persons with diabetes. Questions were asked about demographic, personal, socioeconomic, and diabetes related variables. RESULTS: 1023 (21.4%) of the sample had type II diabetes, and 68% were in the low-income group (annual income less than $20,000). Diabetes was associated with Native-American ancestry, higher acculturation, low income, less education, and increasing body mass index after age and gender adjustment. Persons with previously undiscovered diabetes were more likely to have no regular source of care, no insurance, and currently smoke compared with persons with known diabetes. Only low income was related to proliferative retinopathy, once adjusted for other factors (odds ratio [OR] = 3.93, 95%, confidence limitations [CL] = 1.31-11.80). CONCLUSIONS: Several socioeconomic and other factors were associated with diabetes, but few were related to diabetic retinopathy. Persons in the low-income group appeared to be at greater risk of diabetes and the ocular complications of diabetes compared with those with more income. Further longitudinal studies in this population are needed to confirm the associations.

Adult↗
PubMed2002

Is early age-related maculopathy related to cognitive function? The Atherosclerosis Risk in Communities Study.

PURPOSE: Age-related maculopathy (ARM) and cognitive impairment are both neurodegenerative disorders associated with aging and have been hypothesized to share common pathogenic pathways. We describe the association between cognitive function and ARM in middle-aged persons. DESIGN: Population-based, cross-sectional study involving participants of the Atherosclerosis Risk in Communities Study, an ongoing cardiovascular investigation of persons 51 to 70 years of age, examined every 3 years between 1987 to 1998. METHODS: At visit three (1993-1995), retinal photographs were obtained and evaluated for ARM using a modification of the Wisconsin ARM Grading System. Cognitive function was assessed using standardized tests (Delayed Word Recall, Digit Symbol, and Word Fluency) at visits two (1990-1992) and four (1996-1998) and averaged for analysis. Severe cognitive impairment was defined as scores falling in the lowest 10th percentile of the population. RESULTS: Data were available in 9286 persons after exclusion of persons with stroke or using antipsychotic medication. After adjusting for age, gender, race, education, diabetes, hypertension, cigarette smoking, and alcohol consumption, persons with severe cognitive impairment based on Word Fluency Test scores were more likely to have early ARM (odds ratio [OR]: 1.6, 95% confidence interval [CI]: 1.1-2.2) and its components, soft drusen (OR: 1.6; 95% CI: 1.1-2.3) and pigmentary abnormality (OR: 1.5; 95% CI: 0.9-2.5) than those without severe impairment. However, severe cognitive impairment in scores of the other two cognitive function tests was not associated with ARM. CONCLUSION: These population-based data suggest a weak association between cognitive function and early ARM in middle-aged persons.

Arteriosclerosis↗
PubMed2002

Prevention of visual loss from diabetic retinopathy.

Despite the results of clinical trials showing the efficacy of panretinal and focal photocoagulation of proliferative retinopathy with high-risk characteristics for severe visual loss and for clinically significant macular edema, retinopathy remains an important cause of visual loss. Because these treatments are associated with cost, may not always prevent visual loss, and may result in complications, other nonsurgical interventions have been sought to prevent visual loss from retinopathy. Data from epidemiological studies showed an association between hyperglycemia, hypertension, and dyslipidemia and the incidence and progression of retinopathy and macular edema in people with diabetes. These findings resulted in a number of clinical trials that have shown the efficacy of intensive control of hyperglycemia and hypertension in reducing the incidence and progression of diabetic retinopathy. Despite these findings, the majority of persons with diabetes fail to achieve American Diabetes Association-targeted guidelines for glycosylated hemoglobin, blood pressure, and lipid levels. Thus, new approaches for achieving normalization of blood glucose levels are needed and new clinical trials are underway to assess these new interventions.

Blindness↗
PubMed2002

HLA-DR3 and DR4 and their relation to the incidence and progression of diabetic retinopathy.

PURPOSE: Cross-sectional data from the Wisconsin Epidemiologic Study of Diabetic Retinopathy indicated that patients with HLA-DR4, but not DR3, were more likely to have prevalent proliferative retinopathy than those without both antigens. We describe the relation of HLA-DR3 and DR4 antigens to the 14-year incidence and progression of diabetic retinopathy and macular edema in this cohort. DESIGN: A population-based cohort study. PARTICIPANTS: A probability sample of male and female patients receiving primary care for diabetes in 11 counties of southern Wisconsin. METHODS: Participants were invited for a baseline examination in 1980 to 1982, with follow-up examinations at 4, 10, and 14 years later. At the 4-year examination, a random sample of participants (n = 428) diagnosed with diabetes before the age of 30 and taking insulin were selected for HLA-DR typing. MAIN OUTCOME MEASURES: Fourteen-year incidence and progression of diabetic retinopathy and macular edema based on masked stereoscopic fundus photographic grading. RESULTS: There was no relation between HLA-DR3 and DR4 status with the 14-year incidence and progression of diabetic retinopathy, progression to proliferative retinopathy, and incidence of macular edema. Patients with either HLA-DR3 or DR4 were less likely to progress to proliferative retinopathy compared with those who were negative for both, although these relations were not statistically significant. The associations did not vary after adjusting for hypertension status, baseline retinopathy, and glycosylated hemoglobin levels, or after stratifying by duration of diabetes (less than 10 years vs. 10 years or more) and age at diagnosis of diabetes (less than 15 years vs. 15 years or more). Furthermore, 10-year mortality and 14-year nephropathy rates did not differ by HLA-DR3 or DR4 status, suggesting that selective mortality did not explain the pattern of associations seen. CONCLUSIONS: In contrast to the initial cross-sectional findings, these data suggest that HLA-DR3 or DR4 status is unrelated to 14-year incidence and progression of diabetic retinopathy. The discrepancy may be related to increasing homogeneity of retinopathy and diminishing power to detect small differences, but it may also reflect the uncertain and inconsistent effects of HLA-DR3 or DR4 on the development and progression of diabetic retinopathy.

Adult↗
PubMed2002

Causes of blindness and visual impairment in a population-based sample of U.S. Hispanics.

OBJECTIVE: To describe the causes of blindness and visual impairment in a population-based sample of Hispanics. DESIGN: A cross-sectional study. PARTICIPANTS: A random sample of 4774 Hispanic residents of Santa Cruz and Pima Counties in Southern Arizona aged 40 years and older who participated in Proyecto VER (Vision Evaluation and Research). TESTING: Subjects were interviewed and underwent a thorough ophthalmic examination. Presenting and best-corrected visual acuity was determined using the Early Treatment of Diabetic Retinopathy Study protocol, followed by a standardized ophthalmic examination to determine the causes of visual loss. Anterior and posterior segment specialists in ophthalmology confirmed the causes. MAIN OUTCOME MEASURES: Causes of visual loss (best-corrected acuity worse than 20/40). RESULTS: The response rate of eligible participants was more than 70%. Best-corrected acuity in the better seeing eye worse than 20/40 increased from 0.3% in those aged 40 to 49 to 5.6% in those aged 65 and older. The leading cause was cataract, accounting for 42% of all visual loss, followed by age-related macular degeneration (15%), and diabetic retinopathy (13%). Among 14 people who were bilaterally blind, open-angle glaucoma was the leading cause. Women had higher age-adjusted prevalence of severe cataract compared with men and were more likely to be visually impaired from cataract, diabetic retinopathy, and open-angle glaucoma, although gender differences were not statistically significant. CONCLUSIONS: Causes of visual impairment differ from those reported in Caucasian populations, with open-angle glaucoma being the leading cause of blindness. Further work on gender-based obstacles to eye care in the Hispanic community may be warranted.

Adult↗
PubMed2002

The association of atherosclerosis, vascular risk factors, and retinopathy in adults with diabetes : the atherosclerosis risk in communities study.

PURPOSE: The aim of this report is to describe the prevalence of retinopathy and its associations with atherosclerosis and vascular risk factors in people with diabetes. DESIGN: Cross-sectional study. PARTICIPANTS: Persons with diabetes, having gradable fundus photographs, from a biracial population-based cohort of adults (ages 51-72 years), and living in four United States communities (Forsyth County, North Carolina; the city of Jackson, Mississippi; suburbs of Minneapolis, Minnesota; and Washington County, Maryland) were studied from 1993 to 1995. METHODS: Lesions typical of diabetic retinopathy were detected by grading a 45 degrees color fundus photograph of one eye of each participant, using a modification of the Airlie House classification system. MAIN OUTCOME MEASURE: Severity of diabetic retinopathy (none, minimal nonproliferative, moderate nonproliferative, severe nonproliferative, and proliferative) and macular edema. RESULTS: Retinopathy was detected in 328/1600 (20.5%) of those with diabetes; 114/1724 (6.6%) had hard exudate, 28/1600 (1.8%) had proliferative diabetic retinopathy, and 27/1662 (1.6%) had macular edema. The prevalence of diabetic retinopathy was higher in blacks (27.7%) compared with whites (16.7%). Controlling for duration of diabetes, serum glucose, systolic blood pressure, and type of diabetes medications taken, severity of retinopathy was associated with carotid artery intima-media wall thickness (odds ratio [OR]/0.1-mm thickness 1.09; 95% confidence interval [CI], 1.01, 1.17; P = 0.01), serum albumin (OR/0.1 g/dl 0.94; 95% CI, 0.88, 0.99; P = 0.02), but not race (OR blacks versus whites,1.24; 95% CI, 0.88, 1.75; P = 0.21). Severity of diabetic retinopathy was not associated with coronary artery disease or stroke history or any of the plasma lipids studied. Controlling for age, gender, duration of diabetes, serum glucose, and type of diabetes medications taken, the presence of retinal hard exudates was associated with plasma low-density lipoprotein cholesterol (OR/10 mg/dl 1.18; 95% CI, 1.09, 1.29; P < 0.001), and plasma Lp(a) (OR/10 mg/dl 1.02; 95% CI, 1.00, 1.05; P = 0.04) but not race or blood pressure. CONCLUSIONS: These data suggest that plasma lipids are associated with the presence of hard exudate and that carotid artery intima-media wall thickness is associated with retinopathy, but other manifestations of atherosclerosis and most of its risk factors are not associated with severity of diabetic retinopathy.

Aged↗
PubMed2002

Ten-year incidence and progression of age-related maculopathy: The Beaver Dam eye study.

PURPOSE: The aim of the study was to describe the 10-year incidence and progression of retinal drusen, retinal pigmentary abnormalities, and signs of late age-related maculopathy. DESIGN: Population-based cohort study. PARTICIPANTS: The study included 4926 persons, 43 to 86 years of age at the time of a baseline examination from 1988 through 1990, living in Beaver Dam, Wisconsin, of whom 3684 participated in a 5-year follow-up examination and 2764 participated in a 10-year follow-up. METHODS: Characteristics of drusen and other lesions typical of age-related maculopathy were determined by grading stereoscopic color fundus photographs using the Wisconsin Age-Related Maculopathy Grading System. MAIN OUTCOMES MEASURES: Incidence of drusen type and size, pigmentary abnormalities, geographic atrophy, and exudative degeneration. RESULTS: The 10-year incidence of early age-related maculopathy was 12.1% and of late age-related maculopathy it was 2.1%. There was a statistically significant increased incidence of age-related maculopathy lesions with age (P < 0.05). Individuals 75 years of age or older at baseline had significantly (P < 0.01) higher 10-year incidences of the following characteristics than people 43 to 54 years of age: larger sized drusen (125 micro m-249 micro m, 26.3% vs. 3.3%; > or =250 micro m, 16.2% vs. 1.0%), soft indistinct drusen (22.2% vs. 2.2%), retinal pigment abnormalities (19.5% vs. 0.8%), exudative macular degeneration (4.1% vs. 0%), and pure geographic atrophy (3.1% vs. 0%). Compared with those with small numbers of only small, hard drusen (1-2), those with large numbers of only hard drusen (8 or more) had an increased 10-year incidence of both soft drusen (12.3% vs. 6.7%) and pigmentary abnormalities (4.9% vs. 1.7%). Eyes with soft indistinct drusen or retinal pigmentary abnormalities at baseline, were more likely to develop late age-related macular degeneration at follow-up than eyes without these lesions (15.1% vs. 0.4% and 20.0% vs. 0.8%, respectively). CONCLUSIONS: These population-based estimates document the high incidence of signs of age-related maculopathy in people 75 years of age or older. Our findings demonstrate that large numbers of hard drusen predict the incidence of soft drusen and pigmentary abnormalities and that the presence of the latter lesions significantly increases the risk for the development of geographic atrophy and exudative macular degeneration.

Adult↗
PubMed2002

Incidence of age-related cataract over a 10-year interval: the Beaver Dam Eye Study.

UNLABELLED: OBJECTIVE OR PURPOSE: To describe the cumulative incidence of age-related cataracts and cataract surgery over a 10-year interval. DESIGN: Prospective epidemiologic study. PARTICIPANTS: Persons 43 to 86 years of age participating in the Beaver Dam Eye Study (n = 4926 at baseline, 2764 for baseline, 5-year and 10-year follow-ups). METHODS: Questionnaires and examinations were performed according to standardized protocols in a clinic setting in the town of Beaver Dam, Wisconsin. Lens photographs were obtained with specially modified cameras and were graded according to codified rules by trained graders. MAIN OUTCOME MEASURES: Nuclear, cortical, and posterior subcapsular cataracts and cataract surgery. RESULTS: In right eyes, incident nuclear cataract occurred in 19.4%, cortical cataract in 17.4%, posterior subcapsular cataract in 6.1%, and cataract surgery in 10.8%. Incidence increased for all end points with age. Women had significantly higher incidences of nuclear cataract and cataract surgery than men. Time trends seem to be influencing the incidence of cataract surgery. CONCLUSIONS: Age-related cataracts are common events in aging. Age-specific cataract surgery incidence seems to be increasing.

Adult↗
PubMed2002

Reliability of computer-assisted retinal vessel measurementin a population.

The purpose of the study was to assess the intergrader and intragrader reliability of computer-assisted retinal vessel dia-meter measurement in a defined, community-based population. Retinal photographs from participants in the Blue Mountains Eye Study were digitized using standard techniques. A grader identified all retinal vessels located 0.5-1.0 disc diameter from the optic disc margin,and a computer program measured the width of these vessels. Intergrader and intragrader reliability was assessed on a random sub-sample of 184 and 97 images, respectively, using quadratic weighted kappa(kappa) and correlation analysis (R2). Intergrader reliability was high for summary indices of retinal arteriolar (kappa = 0.85, R2 = 0.88)and venular (kappa = 0.90, R2 = 0.90)diameters, and their ratio, the arteriole-to-venule ratio (kappa = 0.75, R2 = 0.79).Intragrader reliability was also high, with kappa values ranging from 0.80 to 0.93 and from 0.80 to 0.92 for graders 1 and 2, respectively. It is concluded that the retinal vessel diameters could be reliably measured using computer-assisted software and may be used for population-based research.

Aged↗
PubMed2002

Relation of blood homocysteine and its nutritional determinants to age-related maculopathy in the third National Health and Nutrition Examination Survey.

BACKGROUND: Blood homocysteine and its nutritional determinants folate and cyanocobalamin (vitamin B-12) have been shown to affect the risk of vascular disease. The pathogenesis of age-related maculopathy (ARM) is related to adverse vascular changes. OBJECTIVE: The objective was to evaluate the associations between homocysteine, its nutritional determinants, and ARM in persons aged >or= 40 y participating in the third National Health and Nutrition Examination Survey. DESIGN: A nonmydriatic fundus photograph of one eye, taken in a mobile examination center, was used to ascertain ARM status. Phlebotomy was performed for measurement of homocysteine, cyanocobalamin, and erythrocyte folate in participants of phase 2 of the survey (n = 3828). Logistic regressions were used to compute odds ratios and 95% CIs by quintile of serum analyte by using sample weights and jackknife replication methods to adjust for the complex survey design. The final analyses were adjusted for potential risk factors that influenced odds ratios. RESULTS: Total serum homocysteine, red blood cell folate, and serum cyanocobalamin were unrelated to ARM in the overall sample. However, red blood cell folate was inversely related to one type of early ARM lesion (soft drusen) in non-Hispanic blacks. CONCLUSIONS: ARM does not appear to be associated with homocysteine or its dietary determinants in this survey. There is a need for further investigation to rule out potential associations in subgroups with low folate status that may not have been detected because of the cross-sectional survey design.

Adult↗
PubMed2002

Retinal arteriolar emboli: epidemiology and risk of stroke.

Retinal arteriolar emboli can be found in approximately 1% of adults more than 40 years of age. The frequency of retinal emboli increases with age and are more common in men than in women. Bilateral retinal emboli are rare, although multiple emboli in a single eye may be seen in up to one third of cases. Retinal emboli are associated with the presence of carotid artery plaque and stenosis, hypertension, cigarette smoking, and, possibly, diabetes. There are few prospective studies regarding the risk of stroke associated with retinal emboli. Available data suggest that retinal emboli in otherwise asymptomatic people are associated with a higher risk of stroke and stroke mortality, independent of conventional risk factors. Therefore, these patients are likely to benefit from a careful cardiovascular evaluation for risk stratification. Whether carotid ultrasound and other vascular imaging studies should be performed routinely for all patients with asymptomatic retinal emboli remains uncertain.

Age Distribution↗
PubMed2002

The relation of atherosclerotic cardiovascular disease to retinopathy in people with diabetes in the Cardiovascular Health Study.

AIMS: To describe the association of retinopathy with atherosclerosis and atherosclerotic risk factors in people with diabetes. METHODS: 296 of the 558 people classified as having diabetes by the American Diabetes Association criteria, from a population based cohort of adults (ranging in age from 69 to 102 years) living in four United States communities (Allegheny County, Pennsylvania; Forsyth County, North Carolina; Sacramento County, California; and Washington County, Maryland) were studied from 1997 to 1998. Lesions typical of diabetic retinopathy were determined by grading a 45 degrees colour fundus photograph of one eye of each participant, using a modification of the Airlie House classification system. RESULTS: Retinopathy was present in 20% of the diabetic cohort, with the lowest prevalence (16%), in those 80 years of age or older. Retinopathy was detected in 20.3% of the 296 people with diabetes; 2.7% of the 296 had signs of proliferative retinopathy and 2.1% had signs of macular oedema. The prevalence of diabetic retinopathy was higher in black people (35.4%) than white (16.0%). Controlling for age, sex, and blood glucose, retinopathy was more frequent in black people than white (odds ratio (OR) 2.26, 95% confidence interval (CI) 1.01, 5.05), in those with longer duration of diabetes (OR (per 5 years of diabetes) 1.42, 95% CI 1.18, 1.70), in those with subclinical cardiovascular disease (OR 1.49, 95% CI 0.51, 4.31), or coronary heart disease or stroke (OR 3.23, 95% CI 1.09, 9.56) than those without those diseases, in those with higher plasma low density lipoprotein (LDL) cholesterol (OR (per 10 mg/dl of LDL cholesterol) 1.12, 95% CI 1.02, 1.23), and in those with gross proteinuria (OR 4.76, 95% CI 1.53, 14.86). CONCLUSION: Data from this population based study suggest a higher prevalence of retinopathy in black people than white people with diabetes and the association of cardiovascular disease, elevated plasma LDL cholesterol, and gross proteinuria with diabetic retinopathy. However, any conclusions or explanations regarding associations described here must be made with caution because only about one half of those with diabetes mellitus were evaluated.

Age of Onset↗
PubMed2002

Retinal microvascular abnormalities and cognitive impairment in middle-aged persons: the Atherosclerosis Risk in Communities Study.

BACKGROUND AND PURPOSE: Cerebral microvascular disease has been hypothesized to contribute to cognitive impairment, but few clinical data are available. Here, we examine the relation of retinal microvascular abnormalities with cognitive function in middle-aged persons free of stroke. METHODS: The Atherosclerosis Risk in Communities Study is a population-based study with examinations every 3 years from 1987 through 1998. At visit 3, when participants were 51 to 70 years of age, retinal photographs were obtained and evaluated for retinal microvascular abnormalities according to standardized protocols. Cognitive function was assessed with standardized tests (Delayed Word Recall Test, Digit Symbol Subtest, and Word Fluency Test) at visits 2 and 4 and averaged for analysis. Persons with stroke or taking central nervous system-relevant medications were excluded, leaving 8734 with data for this study. RESULTS: After education, diabetes mellitus, blood pressure, carotid intima-media thickness, and other risk factors were controlled for, retinopathy was associated with lower cognitive test scores. The adjusted odds ratios for persons with Delayed Word Recall scores 2 SD or lower than the mean were 2.60 [95% confidence interval (CI), 1.30 to 2.91] for any retinopathy, 3.00 (95% CI, 1.81 to 4.98) for microaneurysms, 3.39 (95% CI, 1.99 to 5.78) for retinal hemorrhage, and 3.07 (95% CI, 1.53 to 6.17) for soft exudates. Results were similar for the other 2 cognitive tests and in people with and without diabetes and hypertension. CONCLUSIONS: Retinopathy is independently associated with poorer cognitive function in middle-aged persons without stroke, suggesting that cerebral microvascular disease may contribute to the development of cognitive impairment.

Aged↗
PubMed2002

Components of the metabolic syndrome and risk of cardiovascular disease and diabetes in Beaver Dam.

OBJECTIVE: To determine whether components of the metabolic syndrome precede the 5-year incidence of cardiovascular disease and diabetes. RESEARCH DESIGN AND METHODS: A population of individuals aged 43-84 years was evaluated from 1988 to 1990 and again 5 years later. Medical history, blood pressure, and laboratory measures were obtained at both examinations following the same protocols. Subjects without diabetes were classified according to level of glycemia, high blood pressure, high-risk lipid levels, high uric acid levels, and proteinuria at baseline. History of incident myocardial infarction, angina, stroke, and diabetes was obtained at follow-up. RESULTS: Of the 4,423 subjects without diabetes, 6.9% had elevated levels of glycemia, 18.4% had high blood pressure, 82.7% had high-risk lipid levels (either high serum total cholesterol or low HDL cholesterol or high ratio of these two levels), 27% had elevated uric acid levels, 33.2% had high BMI, and 3.3% had proteinuria (> or =30 mg/dl). The risk of incident cardiovascular disease 5 years later increased with the number of the components present; 2.5% of those with one component developed cardiovascular disease, whereas 14.9% of those with four or more components developed cardiovascular disease. Of those with one component, diabetes developed in 1.1% 5 years later, whereas diabetes developed in 17.9% of those with four or more components. CONCLUSIONS: Components of the metabolic syndrome are common and are associated with incident cardiovascular disease and diabetes after 5 years. Interventions to alter BMI, lipid levels, and blood pressure may decrease incident diabetes and cardiovascular disease.

Adult↗