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Retinal Vessel Diameters and Risk of Impaired Fasting Glucose or Diabetes

The Rotterdam Study

¹ Department of Epidemiology and Biostatistics, Erasmus Medical Center, Rotterdam, the Netherlands
² Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
³ Netherlands Institute for Health Sciences, Erasmus Medical Center, Rotterdam, the Netherlands
⁴ The Netherlands Ophthalmic Research Institute, Royal Netherlands Academy of Arts and Sciences (KNAW), the Netherlands
⁵ Department of Ophthalmology, Academic Medical Center, Amsterdam, the Netherlands

Address correspondence and reprint requests to P.T.V.M. de Jong, The Netherlands Ophthalmic Research Institute, KNAW, Meibergdreef 47, 1105 BA Amsterdam, Netherlands. E-mail: p.dejong{at}ioi.knaw.nl

Key Words: AVR, arteriorlar-to-venular ratio

The association between a smaller retinal arteriolar-to-venular ratio (AVR) and incident diabetes may be due to arteriolar narrowing, venular dilatation, or both. We investigated associations between baseline vessel diameters and incident impaired fasting glucose or diabetes in a population-based cohort (aged 55 years). Baseline retinal vessel diameters (1990–1993) were measured on digitized images of 2,309 subjects with a normal glucose tolerance test (postload glucose <7.8 mmol/l). At follow-up (1997–1999), impaired fasting glucose was defined as 6.1–7.0 mmol/l and diabetes as 7.0 mmol/l and/or antidiabetic medication use. Odds ratios (ORs) per SD increase in venular diameters were 1.13 (95% CI 1.00–1.29) for impaired fasting glucose and 1.09 (0.90–1.33) for diabetes. ORs per SD decrease in arteriolar diameters were 1.12 (0.98–1.27) and 1.08 (0.89–1.31) and per SD decrease in AVR were 1.29 (1.13–1.46) and 1.19 (0.98–1.45). After adjustment for cardiovascular risk factors, the associations were unaltered for venules and disappeared for arterioles. After stratification on age, associations between venular dilatation and impaired fasting glucose (1.23 [1.02–1.47]) or diabetes (1.18 [0.89–1.56]) were mainly present in participants aged <70 years. In conclusion, in our study, the risk of impaired fasting glucose and diabetes with AVR was explained by venular dilatation rather than arteriolar narrowing, warranting more focus on the causes of this dilatation.

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