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      Patients with Primary Open-Angle Glaucoma May Develop Ischemic Heart Disease More Often than Those without Glaucoma: An 11-Year Population-Based Cohort Study

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          To investigate whether patients with primary open angle glaucoma (POAG) have a higher proportion of ischemic heart disease (IHD) development.


          A population-based retrospective cohort study, using the National Health Insurance Database (NHID) from 1 st January, 2001, to 31 st December, 2011, in Taiwan.


          3510 subjects with POAG were enrolled into the POAG group and 14040 subjects without glaucoma into the comparison group. The comparison group consisted of randomly selected individuals, matched with the POAG group based on age, gender, and index date (date of enrollment) at a ratio of 1:4. The participants of both groups should have no IHD before the index date, and they were followed until the end of 2011 to see whether they had new-onset IHD or not. Kaplan-Meier curves were used to compare the cumulative incidence of IHD between the two groups. Frailty model, a specialized form of Cox regression analysis, was used to estimate the crude and adjusted hazard ratio (HR) of IHD. Analyses were adjusted by age, gender, and systemic comorbidities (i.e. diabetes, hypertension, hyperlipidemia, atrial fibrillation and congestive heart failure).


          The mean age of the cohort was 57.6±11.0 years. There were slightly more males than females (51.6% vs. 48.4%). A log-rank test comparing Kaplan-Meier curves of the two groups revealed a significantly higher cumulative incidence of IHD in the POAG group ( p-value<0.001). In the univariate analysis by Frailty model, POAG patients had a significantly higher hazard of IHD (unadjusted HR = 2.32; 95% confidence interval 1.93 to 2.79). After adjustment, results remained significant (adjusted HR = 1.41; 95% confidence interval 1.16 to 1.72).


          People with POAG may suffer from IHD more often than those without glaucoma.

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          Most cited references 48

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          The impact of ocular blood flow in glaucoma.

          Two principal theories for the pathogenesis of glaucomatous optic neuropathy (GON) have been described--a mechanical and a vascular theory. Both have been defended by various research groups over the past 150 years. According to the mechanical theory, increased intraocular pressure (IOP) causes stretching of the laminar beams and damage to retinal ganglion cell axons. The vascular theory of glaucoma considers GON as a consequence of insufficient blood supply due to either increased IOP or other risk factors reducing ocular blood flow (OBF). A number of conditions such as congenital glaucoma, angle-closure glaucoma or secondary glaucomas clearly show that increased IOP is sufficient to lead to GON. However, a number of observations such as the existence of normal-tension glaucoma cannot be satisfactorily explained by a pressure theory alone. Indeed, the vast majority of published studies dealing with blood flow report a reduced ocular perfusion in glaucoma patients compared with normal subjects. The fact that the reduction of OBF often precedes the damage and blood flow can also be reduced in other parts of the body of glaucoma patients, indicate that the hemodynamic alterations may at least partially be primary. The major cause of this reduction is not atherosclerosis, but rather a vascular dysregulation, leading to both low perfusion pressure and insufficient autoregulation. This in turn may lead to unstable ocular perfusion and thereby to ischemia and reperfusion damage. This review discusses the potential role of OBF in glaucoma and how a disturbance of OBF could increase the optic nerve's sensitivity to IOP.
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            Tobacco use and risk of myocardial infarction in 52 countries in the INTERHEART study: a case-control study.

            Tobacco use is one of the major avoidable causes of cardiovascular diseases. We aimed to assess the risks associated with tobacco use (both smoking and non-smoking) and second hand tobacco smoke (SHS) worldwide. We did a standardised case-control study of acute myocardial infarction (AMI) with 27,089 participants in 52 countries (12,461 cases, 14,637 controls). We assessed relation between risk of AMI and current or former smoking, type of tobacco, amount smoked, effect of smokeless tobacco, and exposure to SHS. We controlled for confounders such as differences in lifestyles between smokers and non-smokers. Current smoking was associated with a greater risk of non-fatal AMI (odds ratio [OR] 2.95, 95% CI 2.77-3.14, p 21 h per week). Young male current smokers had the highest population attributable risk (58.3%; 95% CI 55.0-61.6) and older women the lowest (6.2%, 4.1-9.2). Population attributable risk for exposure to SHS for more than 1 h per week in never smokers was 15.4% (12.1-19.3). Tobacco use is one of the most important causes of AMI globally, especially in men. All forms of tobacco use, including different types of smoking and chewing tobacco and inhalation of SHS, should be discouraged to prevent cardiovascular diseases.
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              Vascular risk factors for primary open angle glaucoma: the Egna-Neumarkt Study.

               L Bonomi (2000)
              To assess the impact of vascular risk factors on the prevalence of primary open angle glaucoma. Population-based cross-sectional study. Four thousand two hundred ninety-seven patients more than 40 years of age underwent a complete ocular examination in the context of the Egna-Neumarkt Glaucoma Study. Ocular examinations were performed by trained, quality-controlled ophthalmologists according to a predefined standardized protocol including medical interview, blood pressure reading, applanation tonometry, computerized perimetry, and optic nerve head examination. Prevalences of ocular hypertension, primary open-angle glaucoma, normal-tension glaucoma, and other types of glaucoma were determined. Correlation coefficients were calculated for the association between systemic blood pressure and age-adjusted intraocular pressure (IOP) and between age and both intraocular and systemic blood pressures. Odds ratios were computed to assess the risk of primary open-angle glaucoma and normal-tension glaucoma in relation to systemic hypertension or antihypertensive medication, blood pressure levels, diastolic perfusion pressure, and a number of other cardiovascular risk factors. A positive correlation was found between systemic blood pressure and IOP, and an association was found between diagnosis of primary open-angle glaucoma and systemic hypertension. Lower diastolic perfusion pressure is associated with a marked, progressive increase in the frequency of hypertensive glaucoma. No relationship was found between systemic diseases of vascular origin and glaucoma. Our data are in line with those reported in other recent epidemiologic studies and show that reduced diastolic perfusion pressure is an important risk factor for primary open-angle glaucoma.

                Author and article information

                Role: Editor
                PLoS One
                PLoS ONE
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                20 September 2016
                : 11
                : 9
                [1 ]School of Medicine, National Yang-Ming University, Taipei, Taiwan
                [2 ]Department of Ophthalmology, National Yang-Ming University Hospital, Yilan, Taiwan
                [3 ]Department of Education and Research, Taipei City Hospital, Taipei, Taiwan
                [4 ]Community Medicine Research Center and Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
                [5 ]Deputy Superintendent, Taipei City Hospital, Taipei, Taiwan
                [6 ]Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
                [7 ]Institute of Biomedical Science and Rong Hsing Research Center for Translational Medicine, Chung-Hsing University, Taichung, Taiwan
                [8 ]Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
                [9 ]School of Medicine, Chung-Shan Medical University, Taichung, Taiwan
                [10 ]Department of Medical Education, Taichung Veterans General Hospital, Taichung, Taiwan
                [11 ]Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
                Indiana University, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                • Conceptualization: YYC HYH DC HHC CKC PC.

                • Data curation: YYC.

                • Formal analysis: YYC HYH HHC CKC PC.

                • Investigation: YYC DC CKC PC.

                • Methodology: YYC HYH DC CKC PC.

                • Project administration: YYC DC PC.

                • Resources: YYC HHC.

                • Software: YYC HYH HHC.

                • Supervision: HYH DC CKC PC.

                • Validation: YYC HYH DC CKC PC.

                • Visualization: YYC.

                • Writing – original draft: YYC CKC PC.

                • Writing – review & editing: YYC DC CKC PC.

                © 2016 Chen et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                Page count
                Figures: 1, Tables: 2, Pages: 12
                The authors received no specific funding for this work.
                Research Article
                Medicine and Health Sciences
                Eye Diseases
                Medicine and Health Sciences
                Vascular Medicine
                Coronary Heart Disease
                Medicine and Health Sciences
                Coronary Heart Disease
                Medicine and Health Sciences
                Endocrine Disorders
                Diabetes Mellitus
                Medicine and Health Sciences
                Metabolic Disorders
                Diabetes Mellitus
                Medicine and Health Sciences
                Diagnostic Medicine
                Signs and Symptoms
                Medicine and Health Sciences
                Pathology and Laboratory Medicine
                Signs and Symptoms
                Medicine and Health Sciences
                Heart Failure
                Medicine and Health Sciences
                Atrial Fibrillation
                Medicine and Health Sciences
                Vascular Medicine
                Blood Pressure
                People and Places
                Geographical Locations
                Custom metadata
                According to the law restriction of the release of individualized data from the National Health Insurance database, only analytical data in aggregate form are available. Researchers who meet the criteria for access to confidential data may send request to the Collaboration Center of Health Information Application, Ministry of Health and Welfare, Taiwan: stcarolwu@ , address: 4F., No.488, Sec. 6, Zhongxiao E. Rd., Nangang Dist., Taipei City 115, Taiwan.



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