title: Retinal Vessel Tortuosity and Its Relation to Traditional and Novel Vascular Risk Markers in Persons with Diabetes.
abstract: To investigate the association between retinal vascular tortuosity and traditional- and vascular-related risk factors in persons with diabetes.
  
  
  
  We recruited 224 diabetic patients. Retinal vascular tortuosity was measured from fundus photographs. Association of tortuosity with the following factors was assessed after adjusting for significant co-factors: diabetes duration, HbA1c, systolic blood pressure (SBP), cholesterol and body mass index (BMI), flicker-light induced retinal vasodilatation, and markers of endothelial function and inflammation (skin microvacular responses to acetylcholine iontophoresis, soluble e-selectin, inter-cellular adhesion molecule-1, vascular cell adhesion molecule-1, endothelin-1, total nitrite, C-reactive protein).
  
  
  
  Adjusting for age and gender, longer diabetes duration was associated with more tortuous retinal arterioles (mean difference in arteriolar tortuosity 5.85 × 10(-5), 95% Confidence Interval 1.44-10.3 × 10(-5); p = 0.016; ≤10 versus >10 years duration). Reduced flicker-light induced retinal vasodilatation was associated with tortuous arterioles and venules (mean difference in arteriolar tortuosity 5.62 × 10(-5), 4.50-6.72 × 10(-5); p < 0.001 and in venules 5.94 × 10(-5), 3.33-8.55 × 10(-5); p < 0.001; comparing highest versus lowest tertile of flicker-light vasodilatation). These associations remained after adjusting for co-factors. Diabetes duration explained about 36% and flicker-light vasodilatation 25% of the variation in retinal arteriolar tortuosity. No associations were found between retinal arteriolar or venular tortuosity and HBA1c, SBP, cholesterol, BMI and serum markers of endothelial function.
  
  
  
  Increased retinal arteriolar tortuosity was related to longer diabetes duration and reduced flicker-light induced vasodilatory response, suggesting that retinal vascular tortuosity in adults with diabetes may be influenced by multiple diabetes-related physio-pathological changes.
authors.affiliation: a Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne , Melbourne , Victoria , Australia .|b Department of Ophthalmology, Faculty of Medicine , Gadjah Mada University , Yogyakarta , Indonesia .
authors.forename: Muhammad Bayu
authors.initials: MB
authors.lastname: Sasongko
authors.affiliation: a Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne , Melbourne , Victoria , Australia .|c Singapore Eye Research Institute, Singapore National Eye Centre , Singapore .
authors.forename: Tien Yin
authors.initials: TY
authors.lastname: Wong
authors.affiliation: a Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne , Melbourne , Victoria , Australia .
authors.forename: Thanh T
authors.initials: TT
authors.lastname: Nguyen
authors.affiliation: c Singapore Eye Research Institute, Singapore National Eye Centre , Singapore .
authors.forename: Carol Y
authors.initials: CY
authors.lastname: Cheung
authors.affiliation: d Baker IDI Heart and Diabetes Institute , Melbourne , Victoria , Australia .
authors.forename: Jonathan E
authors.initials: JE
authors.lastname: Shaw
authors.affiliation: a Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne , Melbourne , Victoria , Australia .|e Department of Public Health , Yamagata University Faculty of Medicine , Japan .
authors.forename: Ryo
authors.initials: R
authors.lastname: Kawasaki
authors.affiliation: a Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne , Melbourne , Victoria , Australia .|c Singapore Eye Research Institute, Singapore National Eye Centre , Singapore .
authors.forename: Ecosse L
authors.initials: EL
authors.lastname: Lamoureux
authors.affiliation: a Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne , Melbourne , Victoria , Australia .|f Centre for Vision Research, Westmead Millennium Institute, University of Sydney , Sydney , Australia.
authors.forename: Jie Jin
authors.initials: JJ
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001160:Arterioles / Q000473:pathology; D015415:Biomarkers / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications*; D003930:Diabetic Retinopathy / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010775:Photic Stimulation; D011446:Prospective Studies; D012171:Retinal Vessels / Q000473:pathology / Q000503:physiopathology*; D012307:Risk Factors; D014664:Vasodilation / Q000502:physiology*; D014699:Venules / Q000473:pathology; D055815:Young Adult
chemical_list: D015415:Biomarkers
keywords: Diabetes; diabetic complications; retinal images; risk markers; tortuosity