title: Hypertensive retinopathy and cerebral small vessel disease in Amerindians living in rural Ecuador: The Atahualpa Project.
abstract: BACKGROUND
  Diagnosis of cerebral small vessel disease (SVD) is a challenge in remote areas where MRI is not available. Hypertensive retinopathy (HTRP) has shown to correlate with SVD in different ethnic groups, but there is no information from indigenous Latin American people. We assessed the usefulness of retinal photographs to detect cases with SVD among Amerindians living in rural Ecuador.
  
  
  METHODS
  Atahualpa residents aged ≥60years with arterial hypertension or prehypertension were identified during a door-to-door survey. A confocal line scanning laser ophthalmoscope was used to identify and grade HTRP (according to the Keith-Wagener-Barker classification). MRIs were read with attention to the presence of white matter hyperintensities (WMH) of presumed vascular origin and lacunar infarcts. Using logistic regression models, we evaluated whether HTRP was independently associated with neuroimaging signatures of SVD.
  
  
  RESULTS
  Of 323 eligible candidates, 241 (75%) were enrolled. MRI readings revealed moderate-to-severe WMH in 49 (20%) cases and lacunar infarcts in 29 (12%). HTRP Grade 1 was noticed in 90 (37%) individuals and Grade 2-3 in 42 (17%). After adjusting for demographics and cardiovascular risk factors, multivariate analyses showed a significant association between Grades 2-3 HTRP and moderate-to-severe WMH (OR: 3.87, 95% C.I.: 1.64-9.13) but not with lacunar infarcts (OR: 2.22, 95% C.I.: 0.83-5.92).
  
  
  CONCLUSIONS
  Amerindians with HTRP Grades 2-3 are almost four times more likely to have SVD-related subcortical damage than those with no- or only Grade 1-HTRP. Retinal photographs might allow recognition of people who need further investigation and therapy.
authors.affiliation: School of Medicine, Universidad Espíritu Santo - Ecuador, Guayaquil, Ecuador. Electronic address: oscardelbrutto@hotmail.com.
authors.forename: Oscar H
authors.initials: OH
authors.lastname: Del Brutto
authors.affiliation: Vanderbilt University Medical Center, Nashville, TN, United States.
authors.forename: Robertino M
authors.initials: RM
authors.lastname: Mera
authors.affiliation: Humana Visión Ophthalmological Center, Guayaquil, Ecuador.
authors.forename: Eduardo M
authors.initials: EM
authors.lastname: Viteri
authors.affiliation: School of Medicine, Universidad Espíritu Santo - Ecuador, Guayaquil, Ecuador.
authors.forename: Joaquín
authors.initials: J
authors.lastname: Pólit
authors.affiliation: School of Medicine, Universidad Espíritu Santo - Ecuador, Guayaquil, Ecuador.
authors.forename: Ernesto A
authors.initials: EA
authors.lastname: Ledesma
authors.affiliation: School of Medicine, Universidad Espíritu Santo - Ecuador, Guayaquil, Ecuador.
authors.forename: José A
authors.initials: JA
authors.lastname: Cano
authors.affiliation: School of Medicine, Universidad Espíritu Santo - Ecuador, Guayaquil, Ecuador.
authors.forename: Karin J
authors.initials: KJ
authors.lastname: Plaza
authors.affiliation: Community Center, The Atahualpa Project, Atahualpa, Ecuador.
authors.forename: Mauricio
authors.initials: M
authors.lastname: Zambrano
authors.affiliation: School of Medicine, Universidad Espíritu Santo - Ecuador, Guayaquil, Ecuador.
authors.forename: Aldo F
authors.initials: AF
authors.lastname: Costa
mesh_terms: D000368:Aged; D059345:Cerebral Small Vessel Diseases / Q000000981:diagnostic imaging* / Q000208:ethnology*; D003430:Cross-Sectional Studies; D004484:Ecuador / Q000208:ethnology; D005260:Female; D006801:Humans; D058437:Hypertensive Retinopathy / Q000000981:diagnostic imaging* / Q000208:ethnology*; D007199:Indians, South American / Q000208:ethnology*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods; D012424:Rural Population / Q000639:trends; D011795:Surveys and Questionnaires
keywords: Cerebral small vessel disease; Hypertensive retinopathy; Lacunar infarcts; Population study; White matter hyperintensities