Retinal microvascular dysfunction in hypercholesterolemia

Matthias P Nägele; Jens Barthelmes; Valeria Ludovici; Silviya Cantatore; Michelle Frank; Frank Ruschitzka; Andreas J Flammer; Isabella Sudano

doi:10.1016/j.jacl.2018.07.015

Retinal microvascular dysfunction in hypercholesterolemia

J Clin Lipidol. 2018 Nov-Dec;12(6):1523-1531.e2. doi: 10.1016/j.jacl.2018.07.015. Epub 2018 Aug 18.

Authors

Matthias P Nägele¹, Jens Barthelmes¹, Valeria Ludovici², Silviya Cantatore¹, Michelle Frank¹, Frank Ruschitzka¹, Andreas J Flammer¹, Isabella Sudano³

Affiliations

¹ Cardiology, University Heart Center Zurich, University Hospital Zurich, Zurich, Switzerland.
² Cardiology, University Heart Center Zurich, University Hospital Zurich, Zurich, Switzerland; Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.
³ Cardiology, University Heart Center Zurich, University Hospital Zurich, Zurich, Switzerland. Electronic address: isabella.sudano@usz.ch.

PMID: 30219640
DOI: 10.1016/j.jacl.2018.07.015

Abstract

Background: Hypercholesterolemia is one of the most important contributors to atherosclerosis. Whether hypercholesterolemia also affects the retinal microcirculation is unclear.

Objective: The goal of our study was to assess the association of cholesterol levels with retinal microvascular function using dynamic and static retinal vessel analysis (RVA) in a primary prevention setting.

Methods: This cross-sectional, observational study prospectively recruited 67 patients with hypercholesterolemia without known cardiovascular disease (mean age 64.4 ± 10.4 years; 45% female) and 78 healthy controls (mean age 61.8 ± 11.2 years; 45% female). The primary end point of the study was flicker-induced dilatation of retinal arterioles (FID_art) with secondary exploratory outcomes including venular FID (FID_ven), arteriovenous ratio, flow-mediated dilatation and arterial stiffness as measured with augmentation index and pulse wave velocity. Multiple regression analysis was performed to study the association of cholesterol levels with retinal microvascular function.

Results: FID_art was significantly impaired in patients with hypercholesterolemia compared with healthy controls (mean FID_art 2.1 ± 1.8 vs 3.1 ± 1.8%, P = .001). This association remained when analysis was restricted to dyslipidemic patients without coexisting hypertension or lipid-lowering therapy. No significant differences remained for FID_ven, flow-mediated dilatation, arteriovenous ratio, or arterial stiffness between the groups. Low-density lipoprotein, but not high-density lipoprotein, cholesterol was a significant negative predictor of FID_art in multiple regression analysis.

Conclusion: Hypercholesterolemia is associated with significant retinal microvascular dysfunction as evidenced by a reduction in flicker-induced dilatation of retinal arterioles. Dynamic RVA may be a promising method for the study of retinal microvascular dysfunction in populations at elevated cardiovascular risk.

Keywords: Endothelial dysfunction; Hypercholesterolemia; LDL cholesterol; Microcirculation; Retinal vessel analysis.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Case-Control Studies
Cohort Studies
Cross-Sectional Studies
Female
Humans
Hypercholesterolemia / physiopathology*
Male
Microvessels / physiopathology*
Middle Aged
Regression Analysis
Retinal Vessels / physiopathology*