Hypertension is closely related to microvascular abnormalities and there is increasing interest in agents that target the microvasculature. The effect of aspirin on the microvasculature has not been well studied. We examined the cross-sectional and longitudinal associations between regular aspirin use and retinal microvascular signs.
We digitized retinal photographs from participants of the Blue Mountains Eye Study cohort (1992-1994, n = 3654, aged over 49 years, and 1997-1999, n = 2335) and used a computer-assisted method to measure average retinal arteriolar and venular diameters. Information on the frequency of aspirin use was collected, with regular aspirin use defined as weekly or daily.
Regular aspirin users comprised 21.2% (n = 775) of the baseline population. At baseline and in individuals who were on one or more antihypertensive medication, regular aspirin use was found to be associated with retinal arterioles on average 3.6 mum (95% confidence interval 1.0, 6.2) wider than those of non-users or occasional aspirin users, after adjusting for age, blood pressure, smoking, diabetes, non-steroidal anti-inflammatory drug use and other variables. Increasing frequency of aspirin use was associated with increasing retinal arteriolar diameter (Ptrend < 0.01). At 5-year follow-up, regular users of aspirin and antihypertensive medication(s) had wider retinal arterioles than those who used aspirin less regularly. Neither antihypertensive medication use alone nor aspirin use alone was associated with wider retinal vessels.
Our finding of a possible association between the combined use of aspirin and antihypertensive agent(s) and wider retinal arteriolar diameter warrants further investigation into the effects of aspirin on the microvasculature.
[Show abstract][Hide abstract] ABSTRACT: The retinal vasculature is a unique site where the microcirculation can be noninvasively imaged in vivo. This presents an opportunity to study otherwise inaccessible structural features of the microcirculation. Recently, a number of population-based studies have developed quantitative methods of measuring these retinal signs, and investigated how these signs relate to metabolic disorders such as diabetes, hypertension, obesity, and metabolic syndrome. These studies have reported fairly consistent associations of retinopathy lesions, arteriolar narrowing and venular dilation with these metabolic disorders, suggesting a microvascular component in either the pathogenesis or manifestation of these disorders. Further, several of these signs have been associated with future risk of cardiovascular outcomes, such as coronary heart disease and stroke, independently of traditional risk factors. This review will examine in detail the evidence linking retinal vascular signs with metabolic disorders and discuss their implications for research and clinical practice.
[Show abstract][Hide abstract] ABSTRACT: To assess the prevalence of retinopathy and its relationship to sociodemographic and clinical characteristics in a population-based cohort of adult Latinos without diabetes mellitus.
This was a population-based, cross-sectional study comprising 6357 Latinos, 40 years of age and older, from six census tracts in La Puente, Los Angeles, California. An interviewer-administered questionnaire assessed sociodemographic factors and medical history. Color fundus photographs were taken and graded in a masked manner according to a modified Airlie House Classification Grading System. Participants underwent a physical examination that included height, weight, blood pressure, random serum glucose, and glycosylated hemoglobin measurements. Univariate and multivariate logistic regression analyses were used to assess associations between sociodemographic and clinical characteristics and retinopathy in persons without diabetes.
The prevalence of retinopathy among individuals without diabetes in the Los Angeles Latino Eye Study (LALES) population was 6.6% (95% confidence interval 5.9%-7.4%). Stepwise logistic regression indicated that stage II hypertension (World Health Organization 2003 Guidelines), male gender, current smoking status, and obesity (body mass index >or= 30 kg/m(2)) were associated with retinopathy (odds ratio = 4.3, 1.6, 1.4, and 1.3, respectively). No statistically significant associations with retinopathy were present for Native American ancestry; country of origin; health insurance status; history of cardiovascular disease; or history of aspirin, oral contraceptive, or hormone replacement therapy.
The data suggest that the prevalence of retinopathy in nondiabetic individuals among Latinos of primarily Mexican ancestry is significant. Independent risk indicators for retinopathy in the study population are hypertension, male gender, current smoking status, and obesity.
[Show abstract][Hide abstract] ABSTRACT: Quantitative studies of retinal vascular caliber using new computer-assisted retinal imaging systems have allowed physicians and researchers to understand the influence of systemic, environmental, and genetic factors on retinal vascular caliber. Retinal vascular caliber changes reflect cumulative response to aging, cardiovascular risk factors, inflammation, nitric oxide-dependent endothelial dysfunction, and other processes. Recent epidemiological studies have shown that changes in retinal arteriolar and venular caliber size may reflect the differential effects of a range of systemic, environmental, and genetic risk factors. Narrower retinal arteriolar caliber and smaller arteriovenous ratio are associated with older age; higher levels of past, current, and future blood pressure and obesity; and predict the incidence of diabetes and coronary heart disease. Wider retinal venular caliber, in contrast, is associated with younger age; impaired fasting glucose and diabetes; dyslipidemia; obesity; systemic marker of inflammation, endothelial dysfunction, and cigarette smoking; and predicts the risk of stroke and coronary heart disease. New data from family and twin studies indicate a significant genetic contribution to retinal vascular caliber, an area that is under investigation. Elucidating the complete range of systemic, environmental, and genetic factors linked with retinal vascular caliber changes may provide critical insight into the etiology, pathogenesis, and natural history of early vascular disease not only in the eye but elsewhere in the body.
Survey of Ophthalmology 01/2009; 54(1):74-95. DOI:10.1016/j.survophthal.2008.10.003 · 3.85 Impact Factor
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