R Klein1, B E Klein, S E Moss, K J Cruickshanks. 1. Department of Ophthalmology and Visual Sciences, University of Wisconsin Medical School, Madison 53705-2397, USA. kleinr@epi.ophth.wisc.edu
Abstract
OBJECTIVE: To investigate the association of ocular disease with all-cause and cause-specific mortality in a diabetic population. DESIGN: Geographically defined population-based cohort study. SETTING: An 11-county area in Wisconsin. STUDY POPULATION: Participants were all younger-onset diabetic persons (diagnosed as having diabetes at <30 years of age and taking insulin) and a random sample of older-onset diabetic persons (diagnosed as having diabetes at > or =30 years of age). Diabetic retinopathy, macular edema, visual acuity, and cataract were measured using standardized protocols at baseline examinations from 1980 to 1982, in which 996 younger-onset and 1370 older-onset persons participated. Participants were followed up for 16 years. MAIN OUTCOME MEASURE: All-cause and cause-specific mortality as determined from death certificates. RESULTS: In the younger-onset group, after controlling for age and sex, retinopathy severity, macular edema, cataract, history of cataract surgery, and history of glaucoma at baseline were associated with all-cause and ischemic heart disease mortality. In the older-onset group, after controlling for age and sex, retinopathy and visual impairment were related to all-cause, ischemic heart disease, and stroke mortality. No ocular variable under study was related to cancer mortality in the older-onset group. After controlling for systemic risk factors, visual impairment was associated with all-cause and ischemic heart disease mortality in the younger-onset group. In the older-onset group, retinopathy severity was related to all-cause and stroke mortality, and visual impairment was related to all-cause, ischemic heart disease, and stroke mortality. CONCLUSIONS: Presence of more severe retinopathy or visual impairment in diabetic patients is a risk indicator for increased risk of ischemic heart disease death. Presence of these ocular conditions may identify individuals who should be under care for cardiovascular disease.
OBJECTIVE: To investigate the association of ocular disease with all-cause and cause-specific mortality in a diabetic population. DESIGN: Geographically defined population-based cohort study. SETTING: An 11-county area in Wisconsin. STUDY POPULATION: Participants were all younger-onset diabeticpersons (diagnosed as having diabetes at <30 years of age and taking insulin) and a random sample of older-onset diabeticpersons (diagnosed as having diabetes at > or =30 years of age). Diabetic retinopathy, macular edema, visual acuity, and cataract were measured using standardized protocols at baseline examinations from 1980 to 1982, in which 996 younger-onset and 1370 older-onset persons participated. Participants were followed up for 16 years. MAIN OUTCOME MEASURE: All-cause and cause-specific mortality as determined from death certificates. RESULTS: In the younger-onset group, after controlling for age and sex, retinopathy severity, macular edema, cataract, history of cataract surgery, and history of glaucoma at baseline were associated with all-cause and ischemic heart disease mortality. In the older-onset group, after controlling for age and sex, retinopathy and visual impairment were related to all-cause, ischemic heart disease, and stroke mortality. No ocular variable under study was related to cancer mortality in the older-onset group. After controlling for systemic risk factors, visual impairment was associated with all-cause and ischemic heart disease mortality in the younger-onset group. In the older-onset group, retinopathy severity was related to all-cause and stroke mortality, and visual impairment was related to all-cause, ischemic heart disease, and stroke mortality. CONCLUSIONS: Presence of more severe retinopathy or visual impairment in diabeticpatients is a risk indicator for increased risk of ischemic heart disease death. Presence of these ocular conditions may identify individuals who should be under care for cardiovascular disease.
Authors: Ronald Klein; Emily K Marino; Lewis H Kuller; Joseph F Polak; Russell P Tracy; John S Gottdiener; Gregory L Burke; Larry D Hubbard; Robin Boineau Journal: Br J Ophthalmol Date: 2002-01 Impact factor: 4.638