Hyperhomocysteinemia is associated with the presence of retinopathy in type 2 diabetes mellitus - The Hoorn Study

Background: Retinopathy is the leading cause of blindness among patients wi th type 2 diabetes mellitus (DM). Hyperhomocysteinemia is a recently recogn ized risk factor for cardiovascular disease, independent of established ris k factors. Objective: To study the association between the homocysteine level and reti nopathy among subjects with and without DM. Methods: We studied an age-, sex-, and glucose tolerance-stratified random sample of a 50- to 75-year-old general white population in the Hoorn Study (N = 625). Retinal vascular changes (retinopathy) were assessed using ophth almoscopy and/or fundus photography. Hyperhomocysteinemia was defined as a serum total homocysteine level greater than 16 mu mol/L. Results: The prevalence of retinopathy was 9.8% (28/285) in subjects with n ormal glucose tolerance, 11.8% (20/169) in those with impaired glucose tole rance, 9.4% (10/106) in those with newly diagnosed type 2 DM, and 32.3% (21 /65) in those with known type 2 DM. The prevalence of retinopathy was 10.3% (39/380) in subjects without hypertension and 16.3% (40/245) in subjects w ith hypertension; it was 12.0% (64/534) in subjects with a serum total homo cysteine level of 16 mu mol/L orless and 16.5% (15/91) in those with a seru m total homocysteine level of more than 16 mu mol/L. After stratification f or DM and adjustment for age, sex, glycosylated hemoglobin, and hypertensio n, the odds ratio (95% confidence interval) for the relation between retino pathy and hyperhomocysteinemia was 0.97 (95% confidence interval, 0.42-2.82 ) in patients without DM and 3.44 (95% confidence interval, 1.13-10.42) in patients with DM (P=.08 for interaction). Conclusion: The findings suggest that hyperhomocysteinemia may be a risk fa ctor for retinopathy in patients with type 2 DM, but probably not in patien ts without DM.