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Retinal and Cerebral Microvascular Signs and Diabetes

The Age, Gene/Environment Susceptibility-Reykjavik Study

¹ Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, National Institutes of Health (NIH), Bethesda, Maryland
² Division of Epidemiology and Clinical Research, National Eye Institute, NIH, Bethesda, Maryland
³ Icelandic Heart Association, Kopavogur, Iceland
⁴ Department of Ophthalmology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
⁵ Faculty of Medicine, University of Iceland, Reykjavik, Iceland
⁶ Department of Ophthalmology, Landspitali-University Hospital, Reykjavik, Iceland
⁷ Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands

Corresponding author: Dr. Lenore J. Launer, Laboratory of Epidemiology, Demography and Biometry, National Institute on Aging, National Institutes of Health, Gateway Building, Suite 3C-309, 7201 Wisconsin Ave., Bethesda, MD 20892. E-mail: launerl{at}nia.nih.gov

Abbreviations: AGES, Age, Gene/Environment Susceptibility; AV, arteriovenous; CMB, cerebral microbleed; FLAIR, fluid-attenuated inversion recovery; FOV, field of view; FSE, fast spin-echo; GRE-EPI, gradient-echo type echo planar image; IHA, Icelandic Heart Association; MMSE, mini-mental state examination; MRI, magnetic resonance image; NIH, National Institutes of Health; WML, white matter lesion

OBJECTIVE—Diabetes increases the risk for microvascular disease. The retina and the brain both have intricate microvascular systems that are developmentally similar. We sought to examine whether microvascular lesions in the retina and in the brain are associated and whether this association differs among people with and without diabetes.

RESEARCH DESIGN AND METHODS—The analysis included 4,218 participants of the Icelandic population-based Age, Gene/Environment Susceptibility-Reykjavik Study who were born in 1907–1935 and who were previously followed as a part of the Reykjavik Study. Retinal focal arteriolar narrowing, arteriovenous (AV) nicking, and microaneurysms/hemorrhages were evaluated on digital retinal images of both eyes. Cerebral microbleeds (CMBs) were evaluated from magnetic resonance images. Data were analyzed with logistic and multinomial logistic regression models controlling for demographics, major cardiovascular risk factors, cerebral infarcts, and white matter lesions.

RESULTS—Evidence of brain microbleeds was found in 485 (11.5%) people, including 192 with multiple (2) microbleeds. Subjects with signs of retinal microvascular lesions were at a significantly increased likelihood for having multiple CMBs. People with diabetes in combination with the presence of either retinal AV nicking (odds ratio [OR] 2.47 [95% CI 1.42–4.31]) or retinal microaneurysms/hemorrhages (2.28 [1.24–4.18]) were significantly more likely to have multiple CMBs.

CONCLUSIONS—Retinal microvascular abnormalities and brain microbleeds may occur together in older adults. People with both diabetes and signs of retinal microvascular lesions (AV nicking and microaneurysms/hemorrhages) are more likely to have multiple microbleeds in the brain. Microvascular disease in diabetes extends to the brain.

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