Temporal changes and rural-urban differences in cardiovascular disease risk factors and mortality in China.

We summarize several studies, from the last 10 years, of temporal changes and rural-urban differences in the risk factors of cardiovascular disease (CVD) in China to indicate the influences of economic modernization. Two national blood pressure surveys have shown that the prevalence of hypertension increased from 5.1% to 7.7% between 1958-1959 and 1979-1980. Throughout China hypertension is more prevalent in urban areas than in rural areas. Within the Shanghai region body mass index, blood pressure, and total serum cholesterol were higher in urban districts than in rural areas. Rural-urban differences in lipid levels were also found in the Beijing and Guangzhou regions. A related four-year followup study showed that total serum cholesterol and triglycerides increased markedly in both urban and rural areas of Guangzhou. In Shanghai part-time farmers who worked in factories had a higher age-adjusted prevalence of definite hypertension than farmers who worked full-time in the fields (5.0% versus 2.3%). In a prospective study in Wuhan a new productivity-based salary system was associated with increased serum cholesterol and blood pressure. Age-adjusted CVD mortality increased from 1973 to 1982 in a rapidly industrializing county in the Shanghai metropolitan region. The results from several studies indicate that China is undergoing the expected increase in modernization-related CVD risk factors and mortality, especially in urban metropolitan regions.     

Iodine deficiency in pregnancy--a continuing public health problem

Iodine prophylaxis in Poland started in 1997 and is based on mandatory iodzation of household salt with 20-40 mg KI/ 1 kg, supplementation of bottle fed infants with iodized formulas with 10,0 microg KI/100 ml, and a voluntary supplementation of pregnant and breast feeding women with additional 100-150 microg of iodine/ day. Last evaluation of efficacy of the iodine prophylaxis performed in 2003 by WHO and International Council for the Control of Iodine Deficiency Disorders allocated Poland within the group of the European countries with sufficient iodine supplementation on the population level. However according to data of the Institute of Mather and Chield in Poland, around 50 % of pregnant women only is additionally supplemented with iodine. Iodine deficiency during pregnancy even as a moderate iodine deficiency, creates a risk of mental retardation, perinatal complication like low and very low births weigt of neonates with increased perinatal mortality rate and late consequences in adult life: metabolic syndrom and type 2 diabetes. Another limitation of the actual model of iodine prophylaxis in Poland, it is too high consumption of natrum chloride (over 5,0 g of household salt/day/ capita). It is around 50% over WHO recommendation. Intensive preventive program against hypertension, type 2 diabetes, atherosclerosis, osteoporosis and some neoplasmatic diseases includes limitation of natrum chloride consumption- as one of the risk factors. Therefore new scope of the National Programme for Elimination of Iodine Deficiency will include: a special prorgramme for the iodization of animal food according to european standard, increased rate of pregnant women additionally supplemented with iodine, strengthening public awarness on necessary increase of milk consumption especially in pregnancy and in children and continouse monitoring system of biologic effects and technologic quality of the model of iodine prophylaxis.     

Long-term changes in numbers of geese stopping over and wintering in south-western Poland

South-western Poland belongs to the key staging areas for geese in Europe, supporting some 100000 birds in recent years. We compared goose counts conducted in the 1970s, 1990s and during 2009–2011 in this region, and linked the findings to the recent assessments of trends in the flyway-populations. Numbers increased several dozen times between the first two counts and have stabilized to the present. More than 14% of the flyway Tundra Bean Goose (Anser fabalis rossicus) stopped over in SW Poland on passage. Smaller numbers of White-fronted Goose (A. albifrons), Greylag Goose (A. anser), and four other rarer species, have all increased since the 1970s. The likely factors responsible for these changes are mild weather conditions, increased availability of large water bodies and shifts in winter ranges of particular species. Temporal mismatch between SW Poland and the total flyways in Bean and White-fronted Geese was recorded when we compared the long-term and the short-term population trends. Increasing reports of other species in SW Poland match the general tendencies in Europe. These data document that regional trends are not a simple reflection of those in flyways as a whole. To understand changes in goose populations a re-established international count network is desired.     

Frequency of under- and overweight among children and adolescents during the economic transition in Poland

The aim of this study is to examine the prevalence of underweight, overweight and obesity, using International Obesity Task Force (IOTF) criteria, in four cohorts of children and adolescents living in Poland in different economic eras: communist economy (1977/1978), crisis of the 1980s (1987/1988), political and economic transformation (1992/1994) and the free market economy (2002/2004). Analysis was conducted on a database including 10,934 records for children of the age 7–18 years. In Poland, in the last 26 years of economic and political transformations, the epidemic of obesity was not noticed but the growing incidence of children and adolescents with body mass deficit was observed (p < 0.0001) (20.2% of girls in 2002/2004 vs. 11.0% in 1977/1978 and 12.1% of boys in 2002/2004 vs. 7.2% in 1977/1978). Lower parental education and a higher number of children in a family resulted in a higher prevalence of underweight (odds ratio [OR] fluctuated from 1.26 to 1.63). The social effects of the political transformation in Poland significantly affected families with low socio-economic status (SES), and especially more eco-sensitive boys. This result is opposite to the trends observed in Western countries and makes an important contribution to the current knowledge of the course of further changes in weight-to-height ratio at a global scale.     

慢性高血压合并妊娠发生子痫前期的危险因素分析

目的:探讨慢性高血压合并妊娠发生子痫前期的危险因素,为筛查慢性高血压孕妇合并子痫前期提供参考依据。方法:选取2009年3月~2013年7月我院收治的慢性高血压妊娠患者116例,根据是否合并子痫前期分为慢性高血压合并妊娠组(NHDP组)和慢性高血压合并子痫前期组(HDP组),比较两组患者不同孕期的血压、尿蛋白水平以及血液生化检测指标间的差异。结果:两组间年龄、孕次、孕前尿蛋白水平、孕早期及孕中期的平均动脉压、尿蛋白水平间差异均无统计学意义(P0.05)。HDP组孕前体质指数、孕晚期的平均动脉压、尿蛋白水平、Hb、UA、LDH、FDP均较NHPD组显著升高(P0.05),两组间Plt水平差异无统计学意义(P0.05)。logistic回归分析发现Hb、UA及FDP是慢性高血压妊娠患者并发子痫前期的危险因素。结论:凝血状况、血清尿酸水平及肾功能变化是慢性高血压合并妊娠者发生子痫前期的危险因素。     

Biological costs of economic transition: Stress levels during the transition from communism to capitalism in Poland

At the end of the 1980s, Poland began the transformation from an essentially one-party communist system to a politically pluralistic democratic system. These political and economic changes had major social consequences, among others unemployment and a sharp decrease in real personal income. The aim of the study was to investigate the possible relationship between stress in adult men, measured by the Allostatic Load, and the socio-economic deterioration during the first part of the economic transition. The Allostatic Load included eleven markers assessing adverse nutritional intake, cardiovascular activity, inflammatory processes, and lung, hepatic and renal functions. The results indicate a significantly higher risk of metabolic dysregulation in men examined after 1990, compared to men from previous years. After adjustment for socioeconomic variables and lifestyle variables, men examined in 1991 had a 31% greater risk of higher Allostatic Load compared with men examined in 1985 (OR = 1.31; p = 0.0541), in 1992, this risk was 50% greater (OR = 1.50; p < 0.01), and in 1993, the risk was 66% greater (OR = 1.66; p < 0.05). The conclusion is drawn that significantly more stressogenic factors for men were those directly connected with the financial situation of their families, than a sudden but short increase of prices for goods and services.     

Cardiovascular risk in women after metabolic complications in pregnancy

Hypertensive pregnancy disorders complicate 10% of all pregnancies. In this article we discuss the spectrum of hypertensive conditions that may occur during pregnancy. Recent studies have consistently shown that hypertensive disorders in pregnancy implicate a two-fold higher risk for the development of hypertension and cardiovascular disease later in life. To optimise preventive management of cardiovascular disease in women with previous complicated pregnancies, we therefore recommend monitoring of hypertension and other cardiac risk factors at an early stage in life. Furthermore, the obstetric history should be routinely incorporated in cardiovascular risk assessment in women who seek medical attention for hypertension and/or cardiac symptoms. (Neth Heart J 2007;15:415-7.)     

老年原发性高血压患者脉搏波传导速度与心脑血管危险因素关系的研究

目的:探讨老年原发性高血压患者脉搏波传导速度与心脑血管危险因素关系。方法:随机选取2012年5月至2012年8月在我院体检的160例新诊老年原发性高血压患者及120例健康个体,所有个体均未接受治疗,采用动脉硬化检测仪测定患者肱踝脉搏波传导速度(baPWV),同时测量身高、腰围、体重、血压、总胆固醇(TC)、甘油三酯(TG)、空腹血糖(FBS)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、尿酸(UA)、肌酐(Cr)等指标,探讨老年原发性高血压患者高脂血症、吸烟、肥胖、糖尿病等危险因素与baPWV指标变化的关系。结果:不同血压分级的老年原发性高血压患者之间肱踝脉搏波传导速度值存在显著差异(P0.01)。合并冠心病、肥胖、糖尿病、吸烟、高脂血症等危险因素的高血压患者baPWV值显著高于单纯性原发性高血压患者(P0.01)。多元回归分析表明:吸烟史(P0.01)、冠心病史(P0.01)、糖尿病史(P0.01)、年龄(P0.01)、腰围(P0.01)、血压(P0.01)、HDL-C(P0.01)、TC(P0.01)、FBS(P0.01)、LDL-C(P0.01)、Cr(P0.01)是baPWV升高的独立风险因素。结论:老年原发性高血压患者存在不同程度的的动脉僵硬增高,常见心脑血管风险因素同样影响老年原发性高血压患者僵硬度。     

Association of urinary levels of 6-sulfatoxymelatonin (aMT6s) with prevalent and incident hypertension

Laboratory studies indicate that melatonin has beneficial vascular effects. However, epidemiologic studies on the relationship between endogenous levels of melatonin and hypertension in humans are limited. We examined the association of quartile levels of 6-sulfatoxymelatonin (aMT6s) in first morning urines with prevalent and incident hypertension in 777 postmenopausal women who were originally part of a case–control study of breast cancer nested in the Women’s Health Initiative Observational Study. A total of 321 prevalent and 172 incident cases of hypertension were studied. In cross-sectional analyses, higher quartile level of aMT6s was associated with lower odds of hypertension (Q4 versus Q1; odds ratio = 0.57; 95% confidence interval [CI]: 0.3–0.9), after adjustment for age, body mass index and other risk factors. We also examined the association between baseline aMT6s levels and risk of incident hypertension. Compared to women in the lowest quartile of urinary aMT6s, the multivariable-adjusted hazard ratios and 95% CIs of incident hypertension for women in the second, third and highest quartile were 1.16 (0.8–1.8), 0.96 (0.6–1.5) and 1.02 (0.6–1.6), respectively. The mean change in systolic and diastolic blood pressure over 3 years also did not vary by baseline quartile levels of aMT6s. Although we found no evidence of a prospective association between urinary levels of aMT6s and risk of incident hypertension in postmenopausal women, our cross-sectional results provide some possible evidence of a role for physiologic levels of melatonin in hypertension. Additional larger studies are warranted, preferably with a wider range of ages, both genders and multiple melatonin measurements.     

The rising incidence of type 1 diabetes in south-eastern Poland. A study of the 0-29 year-old age group, 1980-1999

INTRODUCTION: Studies carried out over the last few years have provided information about the increase in the incidence of type 1 diabetes in different parts of the world including the European countries bordering Poland. THE AIM OF STUDY: The aim of this study was to determine the long-term trends in the incidence of type 1 diabetes over the 20 years between 1980 and 1999 and to compare the incidence during the decades preceding and following the 1989 economic and political transformation in Poland. MATERIAL AND METHODS: The registration of type 1 diabetes among people aged 0-29 was drawn up according to the DERI recommendations using three data sources. We calculated the age-standardised incidence rates for five-year age groups and determined the long-term trend in the incidence of type 1 diabetes in south-eastern Poland. RESULTS: A significant growth in the incidence of type 1 diabetes was observed among people aged 0-29 in the Rzeszów Province in the period between 1980 and 1999. The mean age-standardised incidence rate was 6.1/100,000, and a statistically significant difference was noted between the 1980s and the 1990s (5.3 [95%CI 4.5-6.0] and 6.8 [95%CI 5.9-7.6]). The male incidence of 6.7 significantly exceeded that for females--5.5/100,000. There was also a higher incidence in the group aged 0-14 in comparison with the group aged 15-29 (6.4 and 5.8/100,000 respectively). The highest incidence was found in boys aged 10-14 (11.5/100,000) and a significantly rising trend was observed in children of 0-4 years old. CONCLUSIONS: The mean incidence of type 1 diabetes among the study population was low. Nevertheless, we demonstrated a significantly increasing trend in the incidence during the 20-year observation period. The incidence in the 1990s, both in general and for males, was significantly higher when compared to the 1980s.     

Adenomas – Genetic factors in colorectal cancer prevention

Colorectal cancer is the second most common type of cancer both in Europe and Poland. During the last 30 years more than a 3-fold increase has been observed in Poland due to environmental and genetic factors. Almost all colorectal malignancies are related to the formation and malignant transformation of colorectal dysplasia and adenoma. Efforts aiming to decrease the number of colorectal cancer deaths are focused on the disease early detection. Genetic diagnosis for hereditary syndromes predisposing to colorectal cancer has been developed and is a part of the routine treatment. Most cancers are sporadic. They often develop from polyps in the colon. In addition to the genetic events described in the 1990s, showing the adenoma transformation into carcinoma that has been a prime example of malignant transformation for a long time, there are also other possibilities of neoplastic transformation. The recognition of colorectal cancer risk factors make sense as their nature is lifestyle- and diet-related. In this review paper those risk factors are presented and the prevention of colorectal cancer is discussed taking into account genetic factors.     

Alterations to plasma membrane lipid contents affect the biophysical properties of erythrocytes from individuals with hypertension

Genetic and environmental factors may contribute to high blood pressure, which is termed essential hypertension. Hypertension is a major independent risk factor for cardiovascular disease, stroke and renal failure; thus, elucidation of the etiopathology of hypertension merits further research. We recently reported that the platelets and neutrophils of patients with hypertension exhibit altered biophysical characteristics. In the present study, we assessed whether the major structural elements of erythrocyte plasma membranes are altered in individuals with hypertension. We compared the phospholipid (phosphatidylcholine, phosphatidylethanolamine, phosphatidylserine, sphingosine) and cholesterol contents of erythrocytes from individuals with hypertension (HTN) and healthy individuals (HI) using LC/MS-MS. HTN erythrocytes contained higher phosphatidylcholine, phosphatidylethanolamine and phosphatidylserine contents and a lower cholesterol content than HI erythrocytes. Furthermore, atomic force microscopy revealed important morphological changes in HTN erythrocytes, which reflected the increased membrane fragility and fluidity and higher levels of oxidative stress observed in HTN erythrocytes using spectrophotofluorometry, flow cytometry and spectrometry. This study reveals that alterations to the lipid contents of erythrocyte plasma membranes occur in hypertension, and these alterations in lipid composition result in morphological and physiological abnormalities that modify the dynamic properties of erythrocytes and contribute to the pathophysiology of hypertension.     

Overweight trends among Polish schoolchildren before and after the transition from communism to capitalism

This study aims to reveal the secular trends in body mass index (BMI) and the prevalence of overweight and obesity among Polish schoolchildren between the years 1966–2012, during which intense socio-political changes took place. Four surveys were conducted in several districts of Poland looking at 69,746 schoolchildren aged 7–18. Significant increase in mean BMI as well as in the prevalence of overweight and obesity was observed. During this time the highest increase in both mean BMI and excess weight was observed between 1988 and 2012, i.e. after the political transformation, resulting in the improvement of living conditions. However, with respect to girls in late adolescence, between these years, the mean BMI as well as the prevalence of overweight were leveling off, while the percentage of boys with excess body fat in the same developmental category significantly increased in 2012. In the years 1966–1978 and 1978–1988 the pattern of changes in the prevalence of overweight and obesity reflected the social and economic circumstances, i.e. temporary economic improvements, or deepening political crises and food shortage. In conclusion, the weight status of schoolchildren strongly reflects socio-political changes that took place in Poland, as well as in most of the Central European countries in the last half century.     

Relationships of BMI to Cardiovascular Risk Factors Differ by Ethnicity

The burden of cardiovascular risk associated with obesity disproportionately affects African Americans and little is known about ethnic/racial differences in the relationship of obesity to cardiometabolic risk. This report assesses whether obesity is similarly associated with cardiometabolic risk factors in African Americans and whites of European ancestry. Cross‐sectional observational data from the Jackson Heart Study (JHS) and the Framingham Heart Study (FHS) were compared. This analysis uses participants aged 35–74 years with BMI >18.5 kg/m², and free of prevalent cardiovascular disease (CVD), from the initial JHS clinical examination (2000–2004) and the FHS Offspring (1998–2001) and Third Generation (2002–2005) cohorts. Participants were evaluated for the presence of lipid abnormalities, hypertension, and diabetes. Overall, 4,030 JHS (mean age 54 years, 64% women) and 5,245 FHS (mean age 51 years, 54% women) participants were available for analysis. The prevalence of all risk factors except high triglycerides and low high‐density lipoprotein (HDL) was substantially higher in JHS (all P < 0.001) and BMI was associated with increasing prevalence of most CVD risk factors within each race. For diabetes mellitus, hypertension, and low HDL, steeper relationships to BMI were observed in FHS than in JHS (P values <0.001–0.016). There were larger proportional increases in risk factor prevalence with increasing BMI in whites than in African Americans. The higher prevalence rates of cardiometabolic risk factors at nearly all levels of BMI in African Americans, however, suggest that additional factors contribute to the burden of CVD risk in African Americans.     

高血压患者饮食习惯、传统制剂服用现状调查及其影响因素分析

目的:调查高血压患者饮食习惯以及传统制剂服用现状,并分析饮食习惯与高血压患病的关系以及传统制剂服用的影响因素。方法:按照简单随机抽样法,采用自制调查问卷对呼和浩特市3个镇共8个行政村成年常住农村村民进行问卷调查,调查内容包括人口学特征、饮食习惯等内容,并采用多因素logistic回归分析饮食习惯与高血压患病的关系以及高血压患者传统制剂服用的影响因素。结果:呼和浩特市高血压患病率为22.68%。多因素logistic回归结果显示,较高的BMI、高血压家族史、饮酒史、泡菜咸菜、油炸食品、红肉(猪/牛/羊肉)/动物内脏、海产品是高血压独立危险因素(OR=1.257、1.451、1.358、1.317、1.108、1.146、1.373,P<0.05),奶制品、豆制品、新鲜果蔬是高血压保护因素(OR=0.797、0.868、0.903,P<0.05)。高血压患者传统制剂服用率为16.90%。多因素logistic回归结果显示,年龄≥60岁、文化程度高中以下、不了解高血压知识是高血压患者传统制剂服用的危险因素(OR=1.342、1.545、1.142,P<0.05)。结论:呼和浩特市农村成年村民高血压患病率较高,不良饮食习惯(饮食偏咸、油腻等)是高血压独立危险因素,高龄、文化程度低、不了解高血压知识的高血压患者传统制剂服用率较高,应加强农村居民合理膳食、保持均衡饮食习惯的宣传教育以及农村高血压患者用药规范。     

高脂血症合并高血压患者临床特征及疾病严重程度的危险因素分析

摘要 目的：分析高脂血症合并高血压患者临床特征及疾病严重程度的危险因素。方法：回顾性分析2021年12月-2022年12月我院收治的高血压和高脂症患者共532例,依据其血压和血脂水平分为高血脂组（n=240）和高血脂合并高血压组（n=292）。比较两组临床资料,采用二分类Logistic回归分析影响高脂血症合并高血压患者病情严重程度的独立危险因素。结果：高血脂合并高血压组的吸烟史、家族史、患有糖尿病史、高血脂病史一年以上人数占比及血清甘油三酯（TG）、总胆固醇（TC）、低密度脂蛋白（LDL）、高密度脂蛋白（HDL）、血尿酸（UA）、C反应蛋白（CRP）水平均与高血脂组有差异（P<0.05）。高血脂合并高血压重度组有吸烟史、家族史、患有糖尿病、高血压病及血清UA、CRP水平均高于中度组（P<0.05）。二分类Logistic回归分析结果显示,有吸烟史、家族史、患有糖尿病、高血压病及血清UA、CRP水平升高是影响高脂血症合并高血压患者病情严重程度的独立危险因素（P<0.05）。结论：吸烟史、家族史、患有糖尿病、高血压病,UA含量以及CRP水平升高是影响高脂血症合并高血压患者病情严重程度的独立危险因素,可作为临床提示高脂血症合并高血压病情发展的指标。     

Cardiac Health in Women With Metabolic Syndrome: Clinical Aspects and Pathophysiology

Although the classical cardiovascular risk factors (e.g., smoking and hypertension) are becoming more effectively managed, a continuous increase of the so‐called “cardiometabolic risk” is noted. Starting from this century, the nomenclature “metabolic syndrome” has become more popular to identify a cluster of disorders including obesity, dyslipidemia, hypertension, and insulin resistance. It is a primary risk factor for diabetes and cardiovascular disease in both genders. Interestingly, the metabolic diseases display a distinct gender disparity with an apparent “female advantage” in the premenopausal women compared with age‐matched men. However, women usually lose such “sex protection” following menopause or affliction of metabolic syndrome especially insulin resistance. A controversy exists in the medical literature concerning whether metabolic syndrome is a real syndrome or simply a cluster of risk factors. Several scenarios are speculated to contribute to the gender dimorphism in the cardiovascular sequelae in patients with metabolic syndrome including sex hormones, intrinsic organ function, and the risk factor profile (e.g., hypertension, dyslipidemia, obesity, sedentary lifestyle, and atherogenic diet). With the alarming rise of obesity prevalence, heart problems in metabolic syndrome continue to rise with a distinct gender dimorphism. Although female hearts seem to better tolerate the stress insults compared with the male counterparts, the female sex hormones such as estrogen can interact with certain risk factors to precipitate myopathic changes in the hearts. This synthetic review of recent literature suggests a role of gender disparity in myopathic factors and risk attributable to each metabolic component in the different prevalence of metabolic syndrome.     

Economic transition and household food consumption: A study of Bulgaria from 1985 to 2002

Major economic transitions typically entail changes in the availability of and purchasing power for different types of foods leading to long-term changes in the composition of the diet. Bulgaria, a former Eastern Bloc country, underwent a difficult and protracted transition from a centralized to market economy with acute economic crises and a much slower recovery of income levels than in Poland, the Czech Republic, and Hungary. Using annual data from the Bulgarian National Household Survey, we study changes in the reported consumption of major foods (excluding alcoholic drinks) and their constituent macronutrients from 1985 to 2002, examining also the differences in dietary patterns between the period prior to and following the transition. The consumption of most major food items decreased, resulting in a fall in per capita energy consumption of 429 kcal/day (1.80 MJ/d), following the economic transition of 1991. As expected, the consumption of foods that were more expensive per unit of energy decreased greater than cheaper foods, -34% for animal products and -19% for visible fats, but only -10% for carbohydrates. These changes are related to the changes in income and market prices as well as the general negative trend in economic growth and hyperinflation in the mid-1990s. Thus, Bulgaria experienced a decrease in food consumption without significant changes in the dietary pattern following the economic transition of 1991. The fact that part of this decline may be attributed to continued economic challenges suggests that future transitions in the diet may be expected as economic development proceeds.     

Gender differences in dementia risk factors

Background: With the aging of the population, dementia has become an important health concern in most countries. There is a growing body of literature on the importance of cardiovascular risk factors in the development of Alzheimer's disease (AD), vascular dementia, and mixed dementia (AD with cerebrovascular disease).Objective: This article reviews the role of major risk factors in dementia between both sexes.Methods: The MEDLINE, PubMed, and HealthSTAR databases were searched between 1966 and January 2007 for English-language articles on the risk factors for dementia.Results: The distribution and prevalence of major risk factors between the sexes and age groups are varied. Female sex has been associated with increased risk of the development of AD. In women aged >75 years, rates of hypertension, hyperlipidemia, and diabetes are higher than in similarly aged men. Apolipoprotein E ε 4 genotype status appears to have a greater deleterious effect on gross hippocampal pathology and memory performance in women compared with men. Midlife hypertension and hypercholesterolemia in both sexes predict a higher risk of developing AD in later life. Diabetes is increasing in frequency to a greater extent in women than in men, and is associated with a substantial risk for cognitive impairment. Dementia in women (probably) and in men (possibly) is influenced by obesity in the middle of life.Conclusions: It remains critical that large prospective clinical trials be designed to assess the effect of optimum management of vascular risk factors on cognitive functioning and dementia as the primary outcome, and include women and men in numbers adequate for assessment of gender effects.     

Prospective cohort study of retinal vessel diameters and risk of hypertension

Objective To examine the relation between diameters of the retinal arterioles and 10 year incidence of hypertension.Design Population based prospective cohort study.Setting Beaver Dam eye study.Participants 2451 normotensive people aged 43 to 84 years.Main outcome measures Diameters of retinal arterioles and venules measured from digitised photographs of the retina taken at baseline. Measurements summarised as the arteriole:venule ratio, with a lower ratio indicating smaller arteriolar diameters. Incident hypertension, defined as systolic blood pressure ≥140 mm Hg, diastolic blood pressure ≥90 mm Hg, or use of antihypertensive drugs during follow up.Results 721 participants developed hypertension over a 10 year period. Those with lower arteriole:venule ratio had a higher cumulative incidence of hypertension (incidences of 17.4%, 24.1%, 31.0%, and 45.1%, respectively, for decreasing quarters of distribution of arteriole:venule ratio). After adjustment for age and sex, participants with arteriole:venule ratios in the lowest quarter had a threefold higher risk of hypertension (odds ratio 2.95, 95% confidence interval 2.77 to 3.88) than those with ratios in the highest quarter. This association remained significant after further adjustment for baseline systolic and diastolic blood pressure and other risk factors (1.82, 1.39 to 2.40, for lowest versus highest ratio quarters).Conclusions Narrowed retinal arterioles are associated with long term risk of hypertension, suggesting that structural alterations of the microvasculature may be linked to the development of hypertension.