Hyperhomocysteinemia Is Associated With the Presence of Retinopathy in Type 2 Diabetes Mellitus: The Hoorn Study | Diabetic Retinopathy | JAMA Internal Medicine | JAMA Network
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Original Investigation
October 23, 2000

Hyperhomocysteinemia Is Associated With the Presence of Retinopathy in Type 2 Diabetes Mellitus: The Hoorn Study

Author Affiliations

From the Institute for Research in Extramural Medicine (Drs Hoogeveen, Eysink, Beks, Dekker, Nijpels, and Bouter) and the Department of Epidemiology and Biostatistics (Dr Kostense), Vrije Universiteit, and the Departments of Ophthalmology (Dr Polak), Clinical Chemistry (Dr Jakobs), and Internal Medicine (Drs Heine and Stehouwer), University Hospital Vrije Universiteit, Amsterdam, the Netherlands.

Arch Intern Med. 2000;160(19):2984-2990. doi:10.1001/archinte.160.19.2984

Background  Retinopathy is the leading cause of blindness among patients with type 2 diabetes mellitus (DM). Hyperhomocysteinemia is a recently recognized risk factor for cardiovascular disease, independent of established risk factors.

Objective  To study the association between the homocysteine level and retinopathy 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 ophthalmoscopy and/or fundus photography. Hyperhomocysteinemia was defined as a serum total homocysteine level greater than 16 µmol/L.

Results  The prevalence of retinopathy was 9.8% (28/285) in subjects with normal glucose tolerance, 11.8% (20/169) in those with impaired glucose tolerance, 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 with hypertension; it was 12.0% (64/534) in subjects with a serum total homocysteine level of 16 µmol/L or less and 16.5% (15/91) in those with a serum total homocysteine level of more than 16 µmol/L. After stratification for DM and adjustment for age, sex, glycosylated hemoglobin, and hypertension, the odds ratio (95% confidence interval) for the relation between retinopathy 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 factor for retinopathy in patients with type 2 DM, but probably not in patients without DM.