title: Hyperhomocysteinemia is associated with the presence of retinopathy in type 2 diabetes mellitus: the Hoorn study.
abstract: BACKGROUND
  Retinopathy is the leading cause of blindness among patients with type 2 diabetes mellitus (DM). Hyperhomocysteinemia is a recently recognized risk factor for cardiovascular disease, independent of established risk factors.
  
  
  OBJECTIVE
  To study the association between the homocysteine level and retinopathy among subjects with and without DM.
  
  
  METHODS
  We studied an age-, sex-, and glucose tolerance-stratified random sample of a 50- to 75-year-old general white population in the Hoorn Study (N = 625). Retinal vascular changes (retinopathy) were assessed using ophthalmoscopy and/or fundus photography. Hyperhomocysteinemia was defined as a serum total homocysteine level greater than 16 micromol/L.
  
  
  RESULTS
  The prevalence of retinopathy was 9.8% (28/285) in subjects with normal glucose tolerance, 11.8% (20/169) in those with impaired glucose tolerance, 9.4% (10/106) in those with newly diagnosed type 2 DM, and 32.3% (21/65) in those with known type 2 DM. The prevalence of retinopathy was 10.3% (39/380) in subjects without hypertension and 16.3% (40/245) in subjects with hypertension; it was 12.0% (64/534) in subjects with a serum total homocysteine level of 16 micromol/L or less and 16.5% (15/91) in those with a serum total homocysteine level of more than 16 micromol/L. After stratification for DM and adjustment for age, sex, glycosylated hemoglobin, and hypertension, the odds ratio (95% confidence interval) for the relation between retinopathy and hyperhomocysteinemia was 0.97 (95% confidence interval, 0.42-2.82) in patients without DM and 3.44 (95% confidence interval, 1.13-10.42) in patients with DM (P =.08 for interaction).
  
  
  CONCLUSIONS
  The findings suggest that hyperhomocysteinemia may be a risk factor for retinopathy in patients with type 2 DM, but probably not in patients without DM. Arch Intern Med. 2000;160:2984-2990
authors.affiliation: Institute for Research in Extramural Medicine, Vrije Universiteit, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands. ellenhgv@casema.net.
authors.forename: E K
authors.initials: EK
authors.lastname: Hoogeveen
authors.forename: P J
authors.initials: PJ
authors.lastname: Kostense
authors.forename: P E
authors.initials: PE
authors.lastname: Eysink
authors.forename: B C
authors.initials: BC
authors.lastname: Polak
authors.forename: P J
authors.initials: PJ
authors.lastname: Beks
authors.forename: C
authors.initials: C
authors.lastname: Jakobs
authors.forename: J M
authors.initials: JM
authors.lastname: Dekker
authors.forename: G
authors.initials: G
authors.lastname: Nijpels
authors.forename: R J
authors.initials: RJ
authors.lastname: Heine
authors.forename: L M
authors.initials: LM
authors.lastname: Bouter
authors.forename: C D
authors.initials: CD
authors.lastname: Stehouwer
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D003930:Diabetic Retinopathy / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D020138:Hyperhomocysteinemia / Q000453:epidemiology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012164:Retinal Diseases / Q000175:diagnosis / Q000453:epidemiology; D012307:Risk Factors