Regular aspirin use and retinal microvascular signs: the Blue Mountains Eye Study
ABSTRACT 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: IMPORTANCE Retinal vessel diameters are being measured to examine their relationship with ocular and systemic disease and, in some studies, to calculate the risk of disease. Important factors that directly affect retinal vessel diameters, such as medication use, should be considered when estimating these associations. OBJECTIVE To quantify the association between selected medications and supplements and retinal vessel diameters. DESIGN, SETTING, AND PARTICIPANTS In a prospective cohort investigation, 4926 participants (aged 43-86 years at baseline) in the Beaver Dam Eye Study were evaluated every 5 years during 20 years of follow-up from 1988 to 2010. MAIN OUTCOMES AND MEASURES Central retinal arteriolar equivalent and central retinal venular equivalent measured from the Early Treatment Diabetic Retinopathy Study fundus photograph field 1. RESULTS After Bonferroni correction, the use of any blood pressure medication (β = 0.75; P = .04), specifically calcium channel blockers (β = -1.02; P < .001), was significantly associated with wider central retinal arteriolar equivalent adjusting for refraction, photograph focus, age, systolic blood pressure, height, examination phase, educational level, smoking and drinking histories, and presence of diabetes mellitus and emphysema. Use of prostaglandin analogues was marginally associated with narrower central retinal arteriolar equivalent (β = -2.04; P = .09); β-blockers (β = -1.02; P = .10) and oral corticosteroids (β = 2.13; P = .07) were marginally associated with changes in the central retinal venular equivalent. CONCLUSIONS AND RELEVANCE Several medications are associated with central retinal arteriolar and venular equivalents. Prostaglandin analogues, calcium channel blockers, and oral corticosteroids have the largest relative effects. After Bonferroni correction was applied, the use of calcium channel blockers was most strongly associated with change in the central retinal arteriolar equivalent. The presence of factors that are associated with retinal vessel diameters should be considered when using retinal vessel diameter as an outcome or when using these measures to assess the risk of systemic or ocular disease.Jama Ophthalmology 12/2013; 132(1). DOI:10.1001/jamaophthalmol.2013.6326 · 3.83 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: The retinal microvasculature is a ‘window’ to the systemic circulation. Advancement of computer-assisted techniques to assess vascular structural characteristics from retinal images offers a unique opportunity in circulation research via a direct view of the human microcirculatory system in vivo. Recent studies demonstrate that retinal vascular caliber changes are predictive of development of hypertension, cardiovascular events and Type 2 diabetes mellitus. More importantly, a number of major cardiovascular (e.g., elevated blood pressure, diabetes, lipid levels and obesity) and lifestyle-related (e.g., smoking and alcohol consumption) risk factors are found to be associated with the variations of small vessel caliber. Retinal vascular caliber may therefore represent sub-clinical alterations proceeding to clinical stages of cardiovascular events. Further studies of other parameters of retinal microvascular structure (e.g., tortuosity and branching angle) to determine their associations with genetic factors and responses to treatment strategies may provide clinical applications of these measures on the changes of retinal microvasculature.Expert Review of Ophthalmology 06/2010; 5(3):353-363. DOI:10.1586/eop.10.27
- [Show abstract] [Hide abstract]
ABSTRACT: OBJECTIVE To determine whether regular aspirin use is associated with a higher risk for developing age-related macular degeneration (AMD) by using analyzed data from a 15-year prospective cohort. METHODS A prospective analysis was conducted of data from an Australian population-based cohort with 4 examinations during a 15-year period (1992-1994 to 2007-2009). Participants completed a detailed questionnaire at baseline assessing aspirin use, cardiovascular disease status, and AMD risk factors. Age-related macular degeneration was graded side-by-side from retinal photographs taken at each study visit to assess the incidence of neovascular (wet) AMD and geographic atrophy (dry AMD) according to the international AMD classification. RESULTS Of 2389 baseline participants with follow-up data available, 257 individuals (10.8%) were regular aspirin users and 63 of these (24.5%) developed neovascular AMD. Persons who were regular aspirin users were more likely to have incident neovascular AMD: the 15-year cumulative incidence was 9.3% in users and 3.7% in nonusers. After adjustment for age, sex, smoking, history of cardiovascular disease, systolic blood pressure, and body mass index, persons who were regular aspirin users had a higher risk of developing neovascular AMD (odds ratio [OR], 2.46; 95% CI, 1.25-4.83). The association showed a dose-response effect (multivariate-adjusted P = .01 for trend). Aspirin use was not associated with the incidence of geographic atrophy (multivariate-adjusted OR, 0.99; 95% CI, 0.59-1.65). CONCLUSION Regular aspirin use is associated with increased risk of incident neovascular AMD, independent of a history of cardiovascular disease and smoking.JAMA Internal Medicine 01/2013; 173(4):1-7. DOI:10.1001/jamainternmed.2013.1583 · 13.25 Impact Factor