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R. Klein, C. E. Myers, K. E. Lee, B. E. K. Klein; The 15-Year Cumulative Incidence and Associated Risk Factors for Retinopathy in Nondiabetic Persons: The Beaver Dam Eye Study. Invest. Ophthalmol. Vis. Sci. 2010;51(13):1238.
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Retinopathy in nondiabetic persons is associated with cardiovascular disease morbidity and mortality, yet little is known about the long-term epidemiology of these lesions. The objective was to investigate the relationship of systemic factors to the 15-year cumulative incidence of retinopathy in nondiabetic persons in the Beaver Dam Eye Study.
We included 3,017 persons, 43 to 86 years of age at the time of a baseline examination in 1988-90 and with information collected in follow-up in 1993-95, and/or 1998-2000, and/or 2003-05. Stereoscopic color fundus photographs were graded in a masked fashion using standardized protocols to determine the presence of retinopathy as defined by the ETDRS severity scale. The main outcome measure was cumulative incidence of retinopathy accounting for competing risk of death or diabetes.
The 15-year cumulative incidence in the nondiabetic cohort was 14.2%. In multivariate analyses, older age (hazard ratio [HR] per age group 1.13, 95% confidence interval [CI] 1.01-1.27), higher systolic blood pressure (HR per 10 mmHg 1.15, 95% CI 1.07-1.20), presence of chronic kidney disease (CKD) (HR 1.51, 95% CI 1.12-2.00) and wider retinal vessel diameter (HR per 15 µm 1.02, 95% CI 1.01-1.02) at baseline were associated with incidence of retinopathy. In a separate model, the 15-year incidence of retinopathy was higher in those whose blood pressure was elevated despite use of antihypertensive medications compared with those whose blood pressure was controlled with antihypertensive medications or those who were normotensive. There were no relations of body mass index, lipids, glycosylated hemoglobin, cigarette smoking, markers of inflammation, endothelial dysfunction and oxidative stress, hematologic factors, or use of aspirin to retinopathy incidence.
These data show systolic blood pressure and CKD are related to an increased incidence of retinopathy in nondiabetic persons and suggest that control of blood pressure is related to a lower incidence of retinopathy relative to uncontrolled blood pressure.
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