ASSOCIATION OF HYPERTENSIVE RETINOPATHY WITH ANGIOGRAPHIC SEVERITY OF CORONARY ARTERY DISEASE DETERMINED BY SYNTAX SCORE
AbstractBackground: Hypertension is a leading cause of morbidity among developing and developed countries. Hypertensive Retinopathy is a micro vascular complication of long standing hypertension while CAD is a macro vascular complication. The main objective of the study was to determine the association between worsening grade of hypertensive retinopathy with angiographic severity of coronary artery disease (CAD) measured by Syntax Score. Methods: This was a cross sectional study which was conducted after approval from IRB. All patients with history of hypertension, who underwent coronary angiography, were included in the study. After a detailed history and physical exam, all included patients were subjected to fundoscopy. Patients were categorized into 4 groups according to Keith et al classification of hypertensive retinopathy: No HR, Mild HR, Moderate HR and Severe HR. Patients were also categorized into three groups on the basis of angiographic severity of CAD by syntax score (SS): Mild CAD (SS<22), Moderate CAD (SS: 22-32) and Severe CAD (SS>32). Data was analysed in SPSS Version 20.0. Categorical and continuous variables were described as frequencies/percentages and Mean±SD respectively. Results: A total of 370 patients were included in the study out of which 205 were males with a mean age of 55.3±10.07 years. Mean duration of hypertension was 8.1±2.7 years with a mean SBP of 130.1±37.2 mmHg and mean DBP of 90.3±17.3 mmHg. Patients with no HR, mild HR, moderate HR and severe HR had a mean SS of 11.7±4.5, 17.1±3.9, 26.3±5.1 and 37.9±5.1 respectively. Significant association was found between HR and severity of CAD with a chi square value of 285.53 (p<0.001). PORs for worsening grade of HR with severity of CAD increased from 0.341 (p<0.001) for mild HR to 2.33 (p<0.001) times for severe HR. Conclusion: A higher grade of hypertensive retinopathy is significantly associated to a higher angiographic severity of CAD by syntax score.Keywords: Coronary Artery Disease; Syntax Score; Hypertensive Retinopathy
Roth GA, Johnson C, Abajobir A, Abd-Allah F, Abera SF, Abyu G, et al. Global, regional, and national burden of cardiovascular diseases for 10 causes, 1990 to 2015. J Am Coll Cardiol 2017;70(1):1–25.
Wong TY, Klein R, Klein BE, Tielsch JM, Hubbard L, Nieto FJ. Retinal microvascular abnormalities and their relationship with hypertension, cardiovascular disease, and mortality. Surv Ophthalmol 2001;46(1):59–80.
Kim GH, Youn HJ, Kang S, Choi YS, Moon JI. Relation between grade II hypertensive retinopathy and coronary artery disease in treated essential hypertensives. Clin Exp Hypertens 2010;32(7):469–73.
Wong TY, Kamineni A, Klein R, Sharrett AR, Klein BE, Siscovick DS, et al. Quantitative retinal venular caliber and risk of cardiovascular disease in older persons: the cardiovascular health study. Arch Intern Med 2006;166(21):2388–94.
Wang JJ, Liew G, Wong TY, Smith W, Klein R, Leeder SR, et al. Retinal vascular calibre and the risk of coronary heart disease-related death. Heart 2006;92(11):1583–7.
Duncan BB, Wong TY, Tyroler HA, Davis CE, Fuchs FD. Hypertensive retinopathy and incident coronary heart disease in high risk men. Br J Ophthalmol 2002;86(9):1002–6.
Wong TY, Cheung N, Islam FA, Klein R, Criqui MH, Cotch MF, et al. Relation of retinopathy to coronary artery calcification: the multi-ethnic study of atherosclerosis. Am J Epidemiol 2007;167(1):51–8.
Sianos G, Morel MA, Kappetein AP, Morice MC, Colombo A, Dawkins K, et al. The SYNTAX Score: an angiographic tool grading the complexity of coronary artery disease. EuroIntervention 2005;1(2):219–27.
Mills KT, Bundy JD, Kelly TN, Reed J, Kearney PM, Reynolds K, et al. Global Disparities of Hypertension Prevalence and Control: A Systematic Analysis of Population-based Studies From 90 Countries. Circulation 2016;134(6):441–50.
Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: analysis of worldwide data. Lancet 2005;365(9455):217–23.
Lawes CM, Vander Hoorn S, Rodgers A. Global burden of blood-pressure-related disease, 2001. Lancet 2008;371(9623):1513–8.
Forouzanfar MH, Alexander L, Anderson HR, Bachman VF, Biryukov S, Brauer M, et al. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2015;386(10010):2287–323.
Wong TY, Mitchell P. Hypertensive retinopathy. N Engl J Med 2004;351(22):2310–7.
Wong TY, Klein R, Sharrett AR, Duncan BB, Couper DJ, Tielsch JM, et al. Retinal arteriolar narrowing and risk of coronary heart disease in men and women: the Atherosclerosis Risk in Communities Study. JAMA 2002;287(9):1153–9.
Wong TY, Klein R, Couper DJ, Cooper LS, Shahar E, Hubbard LD, et al. Retinal microvascular abnormalities and incident stroke: the Atherosclerosis Risk in Communities Study. Lancet 2001;358(9288):1134–40.