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S. Kaushik, J.J. Wang, P. Mitchell, Blue Mountains Eye Study; Retinal Arteriolar Wall Opacification in Older Persons: Prevalence, Risk Factors and Associated Mortality . Invest. Ophthalmol. Vis. Sci. 2006;47(13):930.
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© ARVO (1962-2015); The Authors (2016-present)
To assess the prevalence, risk factors and mortality associated with retinal arteriolar wall opacification in an older population.
Retinal photographs of 3654 Blue Mountains Study baseline participants (49+ years, 82.4% response rate) were graded for the presence and severity of arteriolar wall opacification by comparison with standard photographs. Associations with age, sex, blood pressure, inflammatory markers, biochemistry profile (lipids and other parameters), lifestyle and health risk behaviors were assessed using logistic regression. Deaths were obtained via data linkage with the Australian National Death Index database, and hazard ratios (HR) assessed using Cox regression.
The prevalence of arteriolar wall opacification in 2800 subjects with grading completed was 20.0% (mild 17.9%, severe 2.1%). The prevalence decreased with age (23.1%, 25.9%, 19.3% and 12.5% for age groups <60, 60–69, 70–79 and 80+ years, respectively, p(trend)<0.0001). In multivariate analyses, arteriolar wall opacification was associated with age (odds ratio, OR per decade, 0.82, 95% confidence interval, CI, 0.75–0.91), current (OR 1.4 CI 1.1–1.8) and past smoking (OR 1.2, CI 1.0–1.5), serum glucose (OR per SD 1.17 CI 1.08–1.26), platelet count (OR per SD 0.91 CI 0.83–0.99) and presence of diabetes (OR 1.7 CI 1.3–2.2). Mean arterial blood pressure was not associated with any arteriolar wall opacification (OR per SD 1.07 CI 0.98–1.17) but was weakly associated with severe opacification (OR per SD 1.03 CI 1.01–1.05). Heavy alcohol consumption (OR 3.8, CI 1.4–10.2 for persons consuming 4+ drinks per day) and higher serum glucose (OR per SD 1.10, CI 1.01–1.21) were associated with severe opacification. No significant association was found between haematocrit, fibrinogen or white cell count and arteriolar wall opacification. In persons aged 49–74 years, but not those older at baseline, presence of arteriolar wall opacification was associated with an increased risk of both all–cause mortality (HR 1.4, CI 1.2–1.7) and vascular mortality (coronary heart disease– or stroke–related death, HR 1.5, CI 1.1–2.1).
Retinal arteriolar wall opacification was associated with diabetes, blood glucose, smoking, heavy drinking, blood platelets and mortality in this older population. The higher mortality associated with this sign could partly explain its reverse association with age, as could the presence of age–related media opacities.
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