RESUMEN
Introducción: La asociación entre la retinopatía hipertensiva y cardiopatías coronarias es un tema de una larga controversia. La retinopatía hipertensiva ha sido definida como un predictor de mortalidad y morbilidad en pacientes hipertensos desde hace mucho tiempo. Además, estudios recientes han demostrado que la microvasculatura retiniana refleja la patología en los pequeños vasos sistémicos, incluida la microcirculación coronaria. Objetivos: El objetivo fue realizar una revisión sistemática y un análisis cualitativo y cuantitativo mediante un metanálisis para determinar la asociación entre la retinopatía hipertensiva y cardiopatías coronarias. Métodos: Se realizó la búsqueda sistemática de estudios relacionados con el tema. La fuente de búsqueda fue PubMed y Google Scholar. La revisión sistemática y meta-análisis se desarrollaron con las pautas Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA). Resultados: Se demostró que existe una asociación entre la retinopatía hipertensiva y la enfermedad de la arteria coronaria. (P=0,01; RR 1,29; IC 95 por ciento: 1,06 a 1,56), se evaluó la hipertrofia ventricular izquierda como desenlace, se encontró un efecto estadísticamente significativo que asocia a la retinopatía hipertensiva con la hipertrofia ventricular izquierda (p=0,03; RR: 1,71; IC 95 por ciento: 1,31 a 2,24). Conclusiones: Se encontró asociación entre retinopatía hipertensiva y las cardiopatías coronarias más frecuentes (Enfermedad coronaria e HVI)(AU)
Introduction: The association between hypertensive retinopathy and coronary heart disease is a subject of long-standing controversy. Hypertensive retinopathy has long been defined as a predictor of mortality and morbidity in hypertensive patients. In addition, recent studies have shown that the retinal microvasculature reflects pathology in small systemic vessels, including the coronary microcirculation. Objectives: The aim was to perform a systematic review and a qualitative and quantitative analysis by meta-analysis to determine the association between hypertensive retinopathy and coronary heart disease. Methods: A systematic search for studies related to the topic was performed. The search source was PubMed and Google Scholar. The systematic review and meta-analysis were developed using the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Results: An association between hypertensive retinopathy and coronary artery disease was demonstrated (P=0.01; RR 1.29; 95 percent CI: 1.06 to 1.56), left ventricular hypertrophy was evaluated as an outcome, a statistically significant effect was found associating hypertensive retinopathy with left ventricular hypertrophy (P=0.03; RR: 1.71; 95 percent CI: 1.31 to 2.24). Conclusions: An association was found between hypertensive retinopathy and the most frequent coronary heart diseases (coronary artery disease and LVH)(AU)
Asunto(s)
Humanos , Masculino , Femenino , Enfermedad Coronaria/mortalidad , Retinopatía Hipertensiva/mortalidad , Estudios TransversalesRESUMEN
BACKGROUND AND AIMS: Retinopathy and vascular calcification (VC) are representative markers of microvascular and macrovascular dysfunction in patients with chronic kidney disease (CKD). However, their relationship and combined effects on clinical outcomes remain undetermined. METHODS AND RESULTS: We included 523 patients with nondialysis-dependent CKD stage 3-5 who had been examined with fundus photography for diabetic or hypertensive retinopathy. Simple radiographs were analyzed for the presence of VC. The clinical significance of VC of the abdominal aorta and iliofemoral artery (apVC) and retinopathy was evaluated in terms of the rate of renal function decline and composite of any cardiovascular event or death. CKD patients with retinopathy showed higher prevalence of apVC than those without retinopathy (25.6% vs. 12.5%, P < 0.001).The presence of retinopathy was independently associated with apVC (OR 2.13, 95% CI 1.31, 3.49). In multivariate analysis, compared with subjects with neither apVC nor retinopathy, the coexistence of both apVC and retinopathy were independently associated with rapid renal function decline (ß = -1.51; 95% CI -2.40, -0.61), whereas apVC or retinopathy alone were not. Compared with subjects with neither apVC nor retinopathy, the HRs for composite end points were 1.05 (95% CI 0.48, 2.27), 1.79 (95% CI 1.14, 2.80), and 2.07 (95% CI 1.17, 3.67) for patients with apVC only, those with retinopathy only, and those with both apVC and retinopathy, respectively. CONCLUSION: The coexistence of VC and retinopathy was independently associated with CKD progression and cardiovascular events or deaths, and its combined effect was stronger than any separate condition.
Asunto(s)
Retinopatía Diabética/epidemiología , Retinopatía Hipertensiva/epidemiología , Insuficiencia Renal Crónica/epidemiología , Neovascularización Retiniana , Calcificación Vascular/epidemiología , Anciano , Distribución de Chi-Cuadrado , Comorbilidad , Retinopatía Diabética/diagnóstico , Retinopatía Diabética/mortalidad , Retinopatía Diabética/patología , Progresión de la Enfermedad , Supervivencia sin Enfermedad , Femenino , Humanos , Retinopatía Hipertensiva/diagnóstico , Retinopatía Hipertensiva/mortalidad , Retinopatía Hipertensiva/patología , Estimación de Kaplan-Meier , Riñón/fisiopatología , Masculino , Persona de Mediana Edad , Análisis Multivariante , Oportunidad Relativa , Prevalencia , Modelos de Riesgos Proporcionales , Insuficiencia Renal Crónica/diagnóstico , Insuficiencia Renal Crónica/mortalidad , Insuficiencia Renal Crónica/fisiopatología , República de Corea/epidemiología , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Calcificación Vascular/diagnóstico por imagen , Calcificación Vascular/mortalidadRESUMEN
BACKGROUND: Retinopathy is associated with increased mortality risk in general populations. We evaluated the joint effect of retinopathy and chronic kidney disease (CKD) on mortality in a representative sample of U.S. adults. STUDY DESIGN: Prospective cohort study. SETTING & PARTICIPANTS: 7,640 adults from NHANES (National Health and Nutrition Examination Survey) 1988-1994 with mortality linkage through December 31, 2006. PREDICTORS: CKD, defined as low estimated glomerular filtration rate (<60 mL/min/1.73 m2) or albuminuria (urine protein-creatinine ratio ≥30 mg/g), and retinopathy, defined as the presence of microaneurysms, hemorrhages, exudates, microvascular abnormalities, or other evidence of diabetic retinopathy by fundus photograph. OUTCOMES: All-cause and cardiovascular mortality. MEASUREMENTS: Multivariable-adjusted Cox proportional hazards. RESULTS: Overall, 4.6% of participants had retinopathy and 15% had CKD. Mean age was 56 years, 53% were women, and 81% were non-Hispanic whites. The prevalence of retinopathy in patients with CKD was 11%. We identified 2,634 deaths during 14.5 years' follow-up. In multivariable analyses, compared with individuals with neither CKD nor retinopathy, HRs for all-cause mortality were 1.02 (95% CI, 0.75-1.38), 1.52 (95% CI, 1.35-1.72), and 2.39 (95% CI, 1.77-3.22) for individuals with retinopathy only, those with CKD only, and those with both CKD and retinopathy, respectively. Corresponding HRs for cardiovascular mortality were 0.96 (95% CI, 0.50-1.84), 1.72 (95% CI, 1.47-2.00), and 2.96 (95% CI, 2.11-4.15), respectively. There was a significant synergistic interaction between retinopathy and CKD on all-cause mortality (P=0.04). LIMITATIONS: The presence of retinopathy was evaluated only once. Small sample size of some of the subpopulations studied. CONCLUSIONS: In the presence of CKD, retinopathy is a strong predictor of mortality in this adult population.
Asunto(s)
Enfermedades Cardiovasculares/mortalidad , Retinopatía Hipertensiva/mortalidad , Encuestas Nutricionales/tendencias , Ensayos Clínicos Controlados Aleatorios como Asunto/tendencias , Insuficiencia Renal Crónica/mortalidad , Anciano , Enfermedades Cardiovasculares/diagnóstico , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Humanos , Retinopatía Hipertensiva/diagnóstico , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Prospectivos , Insuficiencia Renal Crónica/diagnósticoRESUMEN
BACKGROUND: It is unclear whether mild hypertensive retinopathy is a risk factor for mortality. This study examined whether mild hypertensive retinopathy could be a risk factor for cardiovascular mortality in subjects with and without hypertension. METHODS AND RESULTS: In this cohort study, 87 890 individuals (29 917 men and 57 973 women) 40 to 79 years of age in 1993 were followed up until 2008. Retinal photography was classified as normal, grade 1, or grade 2 based on the Keith-Wagener-Barker system. Risk ratios for all-cause and cause-specific mortality for each classification were calculated with Cox proportional hazards regression models. Covariates included age, systolic blood pressure, antihypertensive medication use, and other cardiovascular risk factors. Multivariable hazard ratios for total cardiovascular disease mortality were 1.24 (95% confidence interval [CI], 1.12-1.38) and 1.23 (95% CI, 1.03-1.47) for grades 1 and 2 among men and 1.12 (95% CI, 1.01-1.24) and 1.44 (95% CI, 1.24-1.68) for grades 1 and 2 among women, respectively. Hazard ratios for total stroke mortality were 1.31 (95% CI, 1.13-1.53) and 1.38 (95% CI, 1.08-1.77) for grades 1 and 2 among men and 1.30 (95% CI, 1.12-1.50) and 1.70 (95% CI, 1.36-2.11) for grades 1 and 2 among women, respectively. For both hypertensive and normotensive subjects of each sex, multivariable hazard ratios for all-cause mortality, total cardiovascular mortality, and total stroke mortality were significantly higher for grade 1 or 2 compared with normal. CONCLUSIONS: Mild hypertensive retinopathy is a risk factor for cardiovascular mortality independently of cardiovascular risk factors among men and women with and without hypertension.