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PAD Linked to Glaucoma in Large Population-Based Study
By Mark S. Lesney
Peripheral arterial disease was significantly associated with glaucoma, according to the results of a large, population-based study of persons of Malay descent with and without diabetes.
That association persisted while researchers controlled for a variety of cardiovascular-risk–associated variables, including hypertension, diabetes, and body-mass index (BMI). However, it was stronger in people with diabetes, according to a report published in the Archives of Ophthalmology (2009;127:888-93).
Study participants composed a subset of the 3,280 individuals examined in the Singapore Malay Eye Study between August 2004 and June 2006. That 922-person subset (45.7% of whom were men) included all patients known to have diabetes mellitus (611 individuals) and every fifth systematically and randomly sampled participant without diabetes (311 individuals), according to Dr. V. Swetha E. Jeganathan of Singapore Eye Research Institute and her colleagues in the United Kingdom, Australia, and Singapore. An ankle-brachial index (ABI) assessment was performed on all 922 individuals.
Peripheral arterial disease was deemed present if the ABI was 0.9 or less. Glaucoma was diagnosed using International Society of Geographical and Epidemiological Ophthalmology criteria.
PAD was present in 79 (8.6%) of the study individuals, and 42 (4.6%) had glaucoma. Persons with PAD were more likely to have glaucoma (11.4% vs. 3.9%, with an age- and a sex-adjusted odds ratio [OR] of 2.80). Glaucoma also was significantly associated with higher intraocular pressure (IOP, age- and sex-adjusted mean, 16.4 vs. 15.5), and with a larger vertical cup-disc ratio (CDR, age- and sex-adjusted mean, 0.45 vs. 0.40).
The association of glaucoma with PAD remained while investigators controlled for hypertension, diabetes, BMI, serum triglyceride levels, and beta-blocker use (multivariable-associated OR 2.55). The association of glaucoma with PAD also was stronger in people with diabetes (multivariable-associated OR 2.91). Formal testing of interaction, however, showed no statistically significant association between diabetes and the association of PAD with either glaucoma, IOP, or vertical CDR, the authors stated.
There was no significant association seen between PAD and any of the subset types of glaucoma—30 patients with primary open-angle glaucoma, 2 with primary angle-closure glaucoma, 8 with pseudophakic glaucoma, 1 with pseudoexfoliation glaucoma, and 1 with glaucoma of an unspecified type. The lack of an association possibly was because of the very low sample sizes, the researchers noted.
“In summary, we demonstrate a novel association of PAD with glaucoma in an Asian population, independent of cardiovascular risk factors,” the researchers stated. “These findings provide further support to the concept that vascular processes and mechanisms that are pressure independent are associated with glaucomatous optic neuropathy. Nevertheless, the results of our study should be interpreted with caution, because the study sample included a high proportion of persons with diabetes and was limited by the small number of glaucoma cases.”
Further research is necessary to determine the relevance of the study to the general population, and to clarify the temporal relationship of PAD with the different glaucoma subtypes, Dr. Jeganathan and her colleagues concluded.
The authors reported that they had no financial disclosures. The study was funded by the National Medical Research Council, Singapore.
That association persisted while researchers controlled for a variety of cardiovascular-risk–associated variables, including hypertension, diabetes, and body-mass index (BMI). However, it was stronger in people with diabetes, according to a report published in the Archives of Ophthalmology (2009;127:888-93).
Study participants composed a subset of the 3,280 individuals examined in the Singapore Malay Eye Study between August 2004 and June 2006. That 922-person subset (45.7% of whom were men) included all patients known to have diabetes mellitus (611 individuals) and every fifth systematically and randomly sampled participant without diabetes (311 individuals), according to Dr. V. Swetha E. Jeganathan of Singapore Eye Research Institute and her colleagues in the United Kingdom, Australia, and Singapore. An ankle-brachial index (ABI) assessment was performed on all 922 individuals.
Peripheral arterial disease was deemed present if the ABI was 0.9 or less. Glaucoma was diagnosed using International Society of Geographical and Epidemiological Ophthalmology criteria.
PAD was present in 79 (8.6%) of the study individuals, and 42 (4.6%) had glaucoma. Persons with PAD were more likely to have glaucoma (11.4% vs. 3.9%, with an age- and a sex-adjusted odds ratio [OR] of 2.80). Glaucoma also was significantly associated with higher intraocular pressure (IOP, age- and sex-adjusted mean, 16.4 vs. 15.5), and with a larger vertical cup-disc ratio (CDR, age- and sex-adjusted mean, 0.45 vs. 0.40).
The association of glaucoma with PAD remained while investigators controlled for hypertension, diabetes, BMI, serum triglyceride levels, and beta-blocker use (multivariable-associated OR 2.55). The association of glaucoma with PAD also was stronger in people with diabetes (multivariable-associated OR 2.91). Formal testing of interaction, however, showed no statistically significant association between diabetes and the association of PAD with either glaucoma, IOP, or vertical CDR, the authors stated.
There was no significant association seen between PAD and any of the subset types of glaucoma—30 patients with primary open-angle glaucoma, 2 with primary angle-closure glaucoma, 8 with pseudophakic glaucoma, 1 with pseudoexfoliation glaucoma, and 1 with glaucoma of an unspecified type. The lack of an association possibly was because of the very low sample sizes, the researchers noted.
“In summary, we demonstrate a novel association of PAD with glaucoma in an Asian population, independent of cardiovascular risk factors,” the researchers stated. “These findings provide further support to the concept that vascular processes and mechanisms that are pressure independent are associated with glaucomatous optic neuropathy. Nevertheless, the results of our study should be interpreted with caution, because the study sample included a high proportion of persons with diabetes and was limited by the small number of glaucoma cases.”
Further research is necessary to determine the relevance of the study to the general population, and to clarify the temporal relationship of PAD with the different glaucoma subtypes, Dr. Jeganathan and her colleagues concluded.
The authors reported that they had no financial disclosures. The study was funded by the National Medical Research Council, Singapore.
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