title: Low-grade inflammation and endothelial dysfunction explain the association between retinopathy and left ventricular ejection fraction in men: an 8-year follow-up of the Hoorn Study.
abstract: OBJECTIVE
  The aim of this study was to prospectively investigate the association of retinopathy with changes in left ventricular (LV) function.
  
  
  METHODS
  Within the Hoorn Study, a population-based cohort study of diabetes in The Netherlands, retinal photography and echocardiography were performed in the year 2000 (baseline) and 2008 (follow-up). Retinopathy was graded according to the Eurodiab classification and further defined as absent or present retinopathy. LV systolic and diastolic functions were assessed by LV ejection fraction (%), LV mass (g/m(2.7)) and left atrial (LA) volume indices and the ratio of LV inflow (E) and early diastolic lengthening (e') velocities. Linear regression analyses stratified for sex were completed to investigate associations of retinopathy with changes in LV function in participants with impaired glucose metabolism and type 2 diabetes.
  
  
  RESULTS
  One hundred forty-seven participants (58% men, mean age 66) were included in the study, of whom 13.6% were present with retinopathy at baseline. LV ejection fraction was similar among participants with and without retinopathy (60.2% versus 60.7%) at baseline. Eight years later, retinopathy was significantly associated with a lower LV ejection fraction (β -8.0 95% CI -15.37 to -0.68) in men, independent of risk factors. Microvascular endothelial dysfunction ([ED] β -4.87 95% CI -13.40 to 3.67) and low-grade inflammation ([LGI] β -5.30 95% CI -13.72 to 3.12) both diminished the association. No significant associations between retinopathy and other LV function parameters were observed.
  
  
  CONCLUSIONS
  Retinopathy was significantly associated with a lower LV ejection fraction in men but not in women. LGI and ED might explain the observed association.
authors.affiliation: EMGO Institute for Health and Care research, VU University Medical Center, Amsterdam, The Netherlands; Department of Ophthalmology, VU University Medical Center, Amsterdam, The Netherlands. Electronic address: iwalraven@vumc.nl.
authors.forename: Iris
authors.initials: I
authors.lastname: Walraven
authors.affiliation: EMGO Institute for Health and Care research, VU University Medical Center, Amsterdam, The Netherlands; Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands; Sanquin Research, Department of Donor Studies, Amsterdam, The Netherlands.
authors.forename: Katja
authors.initials: K
authors.lastname: van den Hurk
authors.affiliation: EMGO Institute for Health and Care research, VU University Medical Center, Amsterdam, The Netherlands; Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Esther
authors.initials: E
authors.lastname: van 't Riet
authors.affiliation: Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Otto
authors.initials: O
authors.lastname: Kamp
authors.affiliation: Department of Internal Medicine and Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Casper G
authors.initials: CG
authors.lastname: Schalkwijk
authors.affiliation: Department of Internal Medicine and Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Coen D A
authors.initials: CD
authors.lastname: Stehouwer
authors.affiliation: Department of Physiology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Walter J
authors.initials: WJ
authors.lastname: Paulus
authors.affiliation: EMGO Institute for Health and Care research, VU University Medical Center, Amsterdam, The Netherlands; Department of Ophthalmology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Annette C
authors.initials: AC
authors.lastname: Moll
authors.affiliation: EMGO Institute for Health and Care research, VU University Medical Center, Amsterdam, The Netherlands; Department of Ophthalmology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Jacqueline M
authors.initials: JM
authors.lastname: Dekker
authors.affiliation: EMGO Institute for Health and Care research, VU University Medical Center, Amsterdam, The Netherlands; Department of Ophthalmology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Bettine C P
authors.initials: BC
authors.lastname: Polak
authors.affiliation: EMGO Institute for Health and Care research, VU University Medical Center, Amsterdam, The Netherlands; Department of General Practice, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Giel
authors.initials: G
authors.lastname: Nijpels
mesh_terms: D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D003925:Diabetic Angiopathies / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D003930:Diabetic Retinopathy / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D004452:Echocardiography; D004730:Endothelium, Vascular / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D007249:Inflammation / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D016277:Ventricular Function, Left / Q000502:physiology
keywords: Echocardiography; Epidemiology; Heart failure; Left ventricular dysfunction retinopathy; Type 2 diabetes