title: Impact of long-term measures of glucose and blood pressure on the retinal microvasculature.
abstract: OBJECTIVE
  Retinopathy and retinal microvascular abnormalities are common in adult populations, yet few long-term predictors have been identified. We therefore examined the association between systolic blood pressure (SBP) and fasting plasma glucose, assessed over 18 years, with retinopathy and retinal vascular caliber in 2066 Carotid MRI participants, an Atherosclerosis Risk in Communities ancillary study.
  
  
  METHODS
  Retinopathy and retinal vascular caliber were assessed by retinal photography. Confounder-adjusted weighted regression models were used to examine exposures defined as cumulative, long-term prospective, concurrent, and 18-year change.
  
  
  RESULTS
  Long-term prospective (prevalence odds ratio (POR) per 10 mm Hg: 1.14 (95% CI: 1.01, 1.30)) and cumulative (POR per 10 mm Hg: 1.30 (95% CI: 1.09, 1.56) effects spanning approximately 18 years were found for SBP and retinopathy. The strongest long-term prospective association for plasma glucose and retinopathy was identified at the baseline visit (POR per 10 mg/dl: 1.26 (95% CI: 1.16, 1.38)); sustained glucose elevations over 18 years were also associated with prevalent retinopathy (POR per 10 mg/dl: 1.33 (95% CI: 1.24, 1.43)). Results were robust to the exclusion of participants with diabetes.
  
  
  CONCLUSIONS
  Modest and sustained long-term elevations in glucose and blood pressure are associated with retinopathy and retinal vascular caliber.
authors.affiliation: Department of Epidemiology, University of North Carolina Chapel Hill, 137 E. Franklin St., Suite 306, Chapel Hill, NC 27514, USA. christy_avery@unc.edu
authors.forename: Christy L
authors.initials: CL
authors.lastname: Avery
authors.forename: Anna
authors.initials: A
authors.lastname: Kucharska-Newton
authors.forename: Keri L
authors.initials: KL
authors.lastname: Monda
authors.forename: A
authors.initials: A
authors.lastname: Richey Sharrett
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Mosley
authors.forename: Barbara E
authors.initials: BE
authors.lastname: Klein
authors.forename: Mary Frances
authors.initials: MF
authors.lastname: Cotch
authors.forename: Tien Y
authors.initials: TY
authors.lastname: Wong
authors.forename: Ronald
authors.initials: R
authors.lastname: Klein
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism*; D001794:Blood Pressure; D003930:Diabetic Retinopathy / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology; D005260:Female; D044882:Glucose Metabolism Disorders / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D058437:Hypertensive Retinopathy / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology; D016014:Linear Models; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D055806:Microvessels / Q000473:pathology*; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D011446:Prospective Studies; D012171:Retinal Vessels / Q000473:pathology*; D012307:Risk Factors; D013599:Systole; D013997:Time Factors; D014481:United States / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D001786:Blood Glucose