Satoshi Matsuoka1,2, Hidehiro Kaneko1,3, Tatsuya Kamon1, Yuta Suzuki1,4, Yuichiro Yano5,6, Akira Okada7, Hidetaka Itoh1, Kojiro Morita8, Akira Fukui9, Katsuhito Fujiu1,2, Nobuaki Michihata10, Taisuke Jo10, Norifumi Takeda1, Hiroyuki Morita1, Sunao Nakamura2, Takashi Yokoo9, Akira Nishiyama11, Koichi Node12, Hideo Yasunaga13, Issei Komuro1. 1. The Department of Cardiovascular Medicine, The University of Tokyo. 2. The Department of Cardiology, New Tokyo Hospital. 3. The Department of Advanced Cardiology, The University of Tokyo. 4. Department of Rehabilitation Science, Graduate School of Medical Sciences, Kitasato University. 5. YCU Center for Novel and Exploratory Clinical Trials, Yokohama City University Hospital. 6. The Department of Family Medicine and Community Health, Duke University. 7. Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo. 8. Global Nursing Research Center, Graduate School of Medicine, the University of Tokyo. 9. Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine. 10. The Department of Health Services Research, The University of Tokyo. 11. Department of Pharmacology, Faculty of Medicine, Kagawa University. 12. Department of Cardiovascular Medicine, Saga University. 13. The Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo.
Abstract
AIM: We investigated whether retinal arteriolosclerosis (RA) could be used for cardiovascular disease (CVD) risk stratification of individuals categorized according to the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) Blood Pressure (BP) guideline. METHODS: We studied 291,522 participants without a history of CVD and not taking any BP-lowering medications from the JMDC Claims Database. RA was defined as Keith-Wagener-Barker system grade ≥ 1. Each participant was classified into one of the six groups: (1) normal or elevated BP without RA, (2) normal or elevated BP with RA, (3) stage 1 hypertension without RA, (4) stage 1 hypertension with RA, (5) stage 2 hypertension without RA, and (6) stage 2 hypertension with RA. RESULTS: Median (interquartile range) age was 46 (40-53) years, and 141,397 (48.5%) of the participants were men. During a mean follow-up of 1,223±830 days, 527 myocardial infarction (MI), 5,718 angina pectoris, 2,890 stroke, and 5,375 heart failure (HF) events occurred. Multivariable Cox regression analyses revealed that the risk of CVD increased with BP category, and this association was pronounced by the presence of RA. Compared with normal or elevated BP without RA, the hazard ratios (HRs) for MI (HR 1.17, 95% CI 0.93-1.47) were higher in stage 1 hypertension without RA. The HRs for MI further increased in stage 1 hypertension with RA (1.86 [1.17-2.95]). This association was present in stroke and HF. CONCLUSION: Incorporation of the assessment for RA may facilitate the CVD risk stratification of people classified based on the 2017 ACC/AHA BP guideline, particularly for those categorized in stage 1 hypertension.
AIM: We investigated whether retinal arteriolosclerosis (RA) could be used for cardiovascular disease (CVD) risk stratification of individuals categorized according to the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) Blood Pressure (BP) guideline. METHODS: We studied 291,522 participants without a history of CVD and not taking any BP-lowering medications from the JMDC Claims Database. RA was defined as Keith-Wagener-Barker system grade ≥ 1. Each participant was classified into one of the six groups: (1) normal or elevated BP without RA, (2) normal or elevated BP with RA, (3) stage 1 hypertension without RA, (4) stage 1 hypertension with RA, (5) stage 2 hypertension without RA, and (6) stage 2 hypertension with RA. RESULTS: Median (interquartile range) age was 46 (40-53) years, and 141,397 (48.5%) of the participants were men. During a mean follow-up of 1,223±830 days, 527 myocardial infarction (MI), 5,718 angina pectoris, 2,890 stroke, and 5,375 heart failure (HF) events occurred. Multivariable Cox regression analyses revealed that the risk of CVD increased with BP category, and this association was pronounced by the presence of RA. Compared with normal or elevated BP without RA, the hazard ratios (HRs) for MI (HR 1.17, 95% CI 0.93-1.47) were higher in stage 1 hypertension without RA. The HRs for MI further increased in stage 1 hypertension with RA (1.86 [1.17-2.95]). This association was present in stroke and HF. CONCLUSION: Incorporation of the assessment for RA may facilitate the CVD risk stratification of people classified based on the 2017 ACC/AHA BP guideline, particularly for those categorized in stage 1 hypertension.
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