What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Microvascular dysfunction (n=1991). Intervention: Cardiovascular risk factors (fasting plasma glucose). Primary outcome: Retinal arteriolar %-dilation (Regression coefficient -0.12 SD, 95% CI -0.17;-0.07, p=<0.001).

October 27, 2017Open Access

Cardiovascular risk factors as determinants of retinal and skin microvascular function: The Maastricht Study

Q: What are the key findings of this study?

Higher fasting plasma glucose was inversely associated with retinal arteriolar dilation (regression coefficient -0.12 SD) and skin hyperemia, independent of other cardiovascular risk factors.

Key Result

Higher fasting plasma glucose was inversely associated with retinal arteriolar dilation (regression coefficient -0.12 SD) and skin hyperemia, independent of other cardiovascular risk factors.

Study Design

Type

Cross-Sectional (n=1,991)

Structured PICO

Population

1,991 adults (aged 40-75 years) from the Maastricht Study (a type 2 diabetes-enriched population-based cohort in the southern Netherlands), mean age 59.7, 51% men.

Outcome

Microvascular function measured as flicker light-induced retinal arteriolar %-dilation and heat-induced skin %-hyperemiasurrogate

Traditional cardiovascular risk factors like age and fasting plasma glucose are inversely associated with retinal and skin microvascular function, suggesting a shared pathophysiology with macrovascular disease.

Main Result

Effect estimate: Regression coefficient -0.12 SD (95% CI -0.17;-0.07)

p-value: p=<0.001

Limitations

Cross-sectional design limits the ability to establish causal relationships.
Potential unmeasured determinants such as dietary habits and physical activity were not included.
Findings may not generalize to other estimates of microvascular function or responses elicited via different stimuli.

Abstract

OBJECTIVE: Microvascular dysfunction is an important underlying mechanism of microvascular diseases. Determinants (age, sex, hypertension, dyslipidemia, hyperglycemia, obesity, and smoking) of macrovascular diseases affect large-artery endothelial function. These risk factors also associate with microvascular diseases. We hypothesized that they are also determinants of microvascular (endothelial) function. METHODS: In The Maastricht Study, a type 2 diabetes-enriched population-based cohort study (n = 1991, 51% men, aged 59.7±8.2 years), we determined microvascular function as flicker light-induced retinal arteriolar %-dilation and heat-induced skin %-hyperemia. Multiple linear regression analyses were used to assess the associations of cardiovascular risk factors (age, sex, waist circumference, total-to-high-density lipoprotein (HDL) cholesterol ratio, fasting plasma glucose (FPG), 24-h systolic blood pressure, and cigarette smoking) with retinal and skin microvascular function. RESULTS: In multivariate analyses, age and FPG were inversely associated with retinal and skin microvascular function (regression coefficients per standard deviation (SD) were -0.11SD (95%CI: -0.15;-0.06) and -0.12SD (-0.17;-0.07) for retinal arteriolar %-dilation and -0.10SD (-0.16;-0.05) and -0.11SD (-0.17;-0.06) for skin %-hyperemia, respectively. Men and current smokers had -0.43SD (-0.58;-0.27) and -0.32SD (-0.49;-0.15) lower skin %-hyperemia, respectively. 24-h systolic blood pressure, waist circumference, and total-to-HDL cholesterol ratio were not statistically significantly associated with these microvascular functions. CONCLUSIONS: Associations between cardiovascular risk factors and retinal and skin microvascular function show a pattern that is partly similar to the associations between cardiovascular risk factors and macrovascular function. Impairment of microvascular function may constitute a pathway through which an adverse cardiovascular risk factor pattern may increase risk of diseases that are partly or wholly of microvascular origin.

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