Inflammation and vascular endothelial dysfunction are associated with retinopathy

Abstract

Abstract: : Purpose: The exact pathogenesis of retinopathy in diabetic and non–diabetic individuals still remains unclear, but may involve chronic, low–grade inflammation and dysfunction of the vascular endothelium. The aim of this study was to investigate the association of inflammation and vascular endothelial dysfunction with prevalent retinopathy in both diabetic and non–diabetic individuals. Methods: A subsample of 625 individuals, aged 50–75 years and stratified for age, sex and glucose tolerance status, of a population–based cohort study underwent an extensive physical examination. An ophthalmological examination was performed, including funduscopy and two–field 45–degree fundus photography in mydriasis in both eyes. Plasma levels of CRP, sICAM–1, vWf, sVCAM–1, and urinary albumin–to–creatinine ratio were assessed, and combined in summarizing Z–scores for inflammation and endothelial dysfunction. Results: The prevalence of retinopathy was positively associated with tertiles of CRP and sICAM–1, but not with tertiles of vWf and sVCAM–1. The highest tertile of the inflammatory Z–score was associated with a 1.9–fold (1.0–3.6) higher risk for retinopathy in all subjects, adjusted for age, sex and glucose tolerance status. The highest tertiles of sVCAM–1 and of the endothelial dysfunction Z–score were associated with an age– and sex–adjusted 4.2–fold (1.3–14.2) and 5.0–fold (1.3–19.8) higher risk for retinopathy, respectively, among diabetic individuals only. The associations of the inflammatory and endothelial dysfunction Z–scores were independent of systolic and diastolic blood pressure, body mass index, total cholesterol and each other. Conclusions: Inflammatory activity was associated with retinopathy in both diabetic and non–diabetic individuals. Endothelial dysfunction was associated with retinopathy in diabetic individuals only. These associations were independent of other risk factors for retinopathy and of each other, and suggest involvement of inflammatory processes and endothelial dysfunction in the pathogenesis of retinopathy.

Keywords: diabetic retinopathy • inflammation • vascular cells