Results of Carotid Doppler and Lipid Profiles in Patients with Ocular Ischemic Disease

Kyeol Han; Chun Cho >Nam; Yu Ra Kim

doi:10.3341/jkos.2015.56.8.1215

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Han, >Nam, and Kim: Results of Carotid Doppler and Lipid Profiles in Patients with Ocular Ischemic Disease

Original Article

J Korean Ophthalmol Soc 2015;56(8):1215-1222.

Published online: 29 August 2015

DOI: https://doi.org/10.3341/jkos.2015.56.8.1215

Results of Carotid Doppler and Lipid Profiles in Patients with Ocular Ischemic Disease

Kyeol Han, MD¹, Chun Cho >Nam, MD, PhD^1,², Yu Ra Kim, MD^1,^2,

¹Department of Ophthalmology, Chonbuk National University Medical School, Jeonju, Korea

²Research Institute of Clinical Medicine, Chonbuk National University Medical School, Jeonju, Korea

Address reprint requests to Yu Ra Kim, MD Department of Ophthalmology, Chonbuk National University Hospital, #20 Geonji-ro Deokjin-gu, Jeonju 561-712, Korea Tel: 82-63-250-1960, Fax: 82-63-250-1960 E-mail: eggyoura@hanmail.net

Received 16 January 201531 March 2015 Accepted 19 June 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To analyze the findings of carotid Doppler and lipid profiles in patients with ischemic ocular disease and as well as the risk and correlation between cardiovascular and ischemic ocular diseases.

Methods

We analyzed the intima-media thickness (IMT) and existence of vascular stenosis using carotid Doppler and blood lip-id profiles of the study patients diagnosed with anterior ischemic optic neuropathy (AION group, n = 45), central retinal vein oc-clusion (CRVO group, n = 34), central retinal artery occlusion (CRAO group, n = 23), or ocular ischemic syndrome (OIS group, n = 27). The study patients who visited Chonbuk National University Hospital from January, 2010 to June, 2013 were compared with healthy control (control group, n = 107).

Results

The average age of the study patients was 60.0 ± 14.1 years and 56.1 ± 9.1 years for the controls. Ipsilateral common carotid artery-IMT was thicker in the OIS and CRAO groups than the control group ( p < 0.01 and <0.01, respectively). The num-ber of patients with carotid stenosis was highest in the OIS group (n = 17, 62.9%) followed by the CRAO group (n = 5, 21.7%), CRVO group (n = 2, 5.9%), and AION group (n = 1, 2.2%). No significant stenosis was found in the control group. Total blood cholesterol was not significantly different between the study patients and controls. Low-density lipoprotein cholesterol was high-er in every patient group than the control group ( p < 0.01, <0.01, <0.05 and <0.01, respectively).

Conclusions

The ischemic ocular disease likely precedes carotid artery disease and dyslipidemia. Therefore, general examina-tions such as carotid Doppler, lipid profile and risk factor evaluations are needed in patients with ischemic ocular disease.

Keywords: Carotid Doppler, Dyslipidemia, Ocular ischemic diseases

References

1. Barnett HJ, Eliasaziw M, Meldrum HE. Drugs and surgery in the prevention of ischemic stroke. N Engl J Med. 1995; 332:238–48.

2. Suh DC, Lee SH, Kim KR. . Pattern of atherosclerotic carotid stenosis in Korean patients with stroke: different involvement of intracranial versus extracranial vessels. AJNR Am J Neuroradiol. 2003; 24:239–44.

3. Ferrières J, Elias A, Ruidavets JB. . Carotid intima-media thickness and coronary heart disease risk factors in a low-risk population. J Hypertens. 1999; 17:743–8.

4. O’Leary DH, Polak JF, Kronmal RA. . Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. Cardiovascular Health Study Collaborative Research Group. N Engl J Med. 1999; 340:14–22.

5. O’Leary DH, Polak JF, Kronmal RA. . Thickening of the car-otid wall. A marker for atherosclerosis in the elderly? Cardiovascular Health Study Collaborative Research Group. Stroke. 1996; 27:224–31.

6. Bullock JD, Falter RT, Downing JE, Snyder HE. Ischemic oph-thalmia secondary to an ophthalmic artery occlusion. Am J Ophthalmol. 1972; 74:486–93.

7. Stamler J, Wentworth D, Neaton JD. Is relationship between serum cholesterol and risk of premature death from coronary heart disease continuous and graded? Findings in 356,222 primary screenees of the Multiple Risk Factor Intervention Trial (MRFIT). JAMA. 1986; 256:2823–8.

8. National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation. 2002; 106:3143–421.

9. Liu J, Grundy SM, Wang W. . Ten-year risk of cardiovascular incidence related to diabetes, prediabetes, and the metabolic syndrome. Am Heart J. 2007; 153:552–8.

10. Handa N, Matsumoto M, Maeda H. . Ultrasonic evaluation ear-ly carotid atherosclerosis. Stroke. 1990; 21:1567–72.

11. Pignoli P, Tremoli E, Poli A. . Intimal plus medial thickness of the arterial wall: a direct measurement with ultrasound imaging. Circulation. 1986; 74:1399–406.

12. Grant EG, Benson CB, Moneta GL. . Carotid artery stenosis: gray-scale and Doppler US diagnosis-Society of Radiologists in Ultrasound Consensus Conference. Radiology. 2003; 229:340–6.

13. Kawasaki T, Koga N, Hikichi Y. . Diagnostic accuracy of car-otid ultrasonography in screening for coronary artery disease. J Cardiol. 2000; 36:295–302.

14. O’Leary DH, Polak JF, Kronmal RA. . Distribution and corre-lates of sonographically detected carotid artery disease in the Cardiovascular Health Study. The CHS Collaborative Research Group. Stroke. 1992; 23:1752–60.

15. Salonen JT, Salonen R. Ultrasound B-mode imaging in ob-servational studies of atherosclerotic progression. Circulation. 1993; 87((3 Suppl)):II56–65.

16. Nowak J, Nilsson T, Sylvén C, Jogestrand T. Potential of carotid ul-trasonography in the diagnosis of coronary artery disease: a com-parison with exercise test and variance ECG. Stroke. 1998; 29:439–46.

17. Kannel WB, McGee D, Gordon T. A general cardiovascular risk profile: the Framingham Study. Am J Cardiol. 1976; 38:46–51.

18. Aminbakhsh A, Mancini GB. Carotid intima-media thickness measurements: what defines an abnormality? A systemic review. Clin Invest Med. 1999; 22:149–57.

19. Schilling H, Mellin KB, Waubke TN. Value of Doppler carotid ar-tery sonography in ophthalmologic diagnosis. Fortschr Ophthalmol. 1991; 88:694–7.

20. Müller M, Wessel K, Mehdorn E. . Carotid artery disease in vascular ocular syndromes. J Clin Neuroophthalmol. 1993; 13:175–80.

21. Hayreh SS, Joos KM, Podhajsky PA, Long CR. Systemic diseases associated with nonarteritic anterior ischemic optic neuropathy. Am J Ophthalmol. 1994; 118:766–80.

22. Kim DH, Hwang JM. Risk factors for Korean patients with anterior ischemic optic neuropathy. J Korean Ophthalmol Soc. 2007; 48:1527–31.

23. Klien BA, Olwin JH. A survey of the pathogenesis of retinal ve-nous occlusion. Emphasis upon choice of therapy and an analysis of the therapeutic results in fifty-three patients. AMA Arch Ophthalmol. 1956; 56:207–47.

24. Klien BA. Sidelights on retinal venous occlusion. Am J Ophthalmol. 1966; 61:25–36.

25. Dodson PM, Galton DJ, Hamilton AM. Blach RK. Retinal vein oc-clusion and the prevalence of lipoprotein abnormalities. Br J Ophthalmol. 1982; 66:161–4.

26. Bandello F, Viganò D'Angelo S, Parlavecchia M. . Hyperco- agulability and high lipoprotein(a) levels in patients with central retinal vein occlusion. Thromb Haemost. 1994; 72:39–43.

27. Matsushima C, Wakabayashi Y, Iwamoto T. . Relationship be-tween retinal vein occlusion and carotid artery lesions. Retina. 2007; 27:1038–43.

28. Peternel P, Keber D, Videcnik V. Carotid arteries in central retinal vessel occlusion as assessed by Doppler ultrasound. Br J Ophthalmol. 1989; 73:880–3.

29. Marin-Sanabria EA, Kondoh T, Yamanaka A, Kohmura E. Ultrasonographic screening of carotid artery in patients with vas-cular retinopathies. Kobe J Med Sci. 2005; 51:7–16.

30. Kimura K, Hashimoto Y, Ohno H. . Carotid artery disease in patients with retinal artery occlusion. Intern Med. 1996; 35:937–40.

31. Douglas DJ, Schuler JJ, Buchbinder D. . The association of central retinal artery occlusion and extracranial carotid artery disease. Ann Surg. 1988; 208:85–90.

32. Park SM, Kim IT. Abnormal systemic findings in patients with acute retinal artery occlusion. J Korean Ophthalmol Soc. 2002; 43:1429–34.

33. Sharma S. The systemic evaluation of acute retinal artery occulsion. Curr Opin Ophthalmol. 1998; 9:1–5.

34. Kearns TP, Hollenhorst RW. Venous stasis retinopathy of occlusive disease of the carotid artery. Proc Staff Meet Mayo Clin. 1963; 38:304–12.

35. Mizener JB, Podhajsky P, Hayreh SS. Ocular ischemic syndrome. Ophthalmology. 1997; 104:859–64.

36. Lee JK, Sohn JH, Yoon YH. A case of ocular ischemic syndrome. J Korean Ophthalmol Soc. 1995; 36:708–12.

37. Seo SJ, Jang HD, Lee SJ, Park JM. The intima media thickness (IMT) as measured by carotid ultrasonography in patients with ret-inal vascular diseases. J Korean Ophthalmol Soc. 2014; 55:541–7.

Figure 1.

Carotid Doppler findings according to group of patients. CCA = common carotid artery; IMT = intima-media thickness; AION = anterior ischemic optic neuropathy; CRVO = central retinal vein occlusions; CRAO = central retinal artery occlusions; OIS = ocular ischemic syndrome.

Table 1.

Constitution of ocular ischemic diseases (n = 129)

Diseases	No. of patients (n)	Constituent ratio (%)
AION	45	34
CRVO	34	26
CRAO	23	17
OIS	27	20

AION = anterior ischemic optic neuropathy; CRVO = central reti-nal vein occlusion; CRAO = central retinal artery occlusion; OIS = ocular ischemic syndrome.

Table 2.

Demographic features and baseline characteristics of patients

		AION (n = 45)	CRVO (n = 34)	CRAO (n = 23)	OIS (n = 27)	Control (n = 107)
Age (years)	57.6 ± 12.2	57.5 ± 14.6	58.6 ± 16.2	61.5 ± 10.1	56.1 ± 9.1	0.264
Gender (M:F)	23:22	21:13	16:7	14:13	77:30	0.08
Diabetes mellitus (%)	16 (36%)∗	12 (35%)∗	8 (35%)∗	10 (37%)∗	16 (15%)	0.12
Hypertension (%)	24 (53%)∗	20 (59%)∗	14 (61%)∗	18 (67%)∗	35 (33%)	0.02
BMI	24.5 ± 3.8	24.4 ± 3.7	25.0 ± 2.9	25.3 ± 3.6	24.0 ± 3.3	0.406

Values are presented as mean ± SD unless otherwise indicated. Analyzed by analysis of variance (ANOVA) with bonferroni correction. AION = anterior ischemic optic neuropathy; CRVO = central retinal vein occlusions; CRAO = central retinal artery occlusions; OIS = ocu-lar ischemic syndrome; BMI = body mass index.

^∗ p-value < 0.05 (vs Control).

Table 3.

Carotid Doppler findings according to group of patients

	AION (n = 45)	CRVO (n = 34)	CRAO (n = 23)	OIS (n = 27)	Control (n = 107)
Ipsilateral CCA-IMT (mm)	0.90 ± 0.31	0.87 ± 0.20	1.14 ± 0.46^∗	1.37 ± 0.32^∗	0.88 ± 0.33
CCA-IMT ≥1.1 mm (%)	6 (13.3)	4 (11.8)	9 (39.1)	21 (77.8)	13 (12.1)
Stenosis ≥50% (%)	1 (2.2)	2 (5.9)	5 (21.7)	17 (62.9)	0

^∗ p-value < 0.05 (vs Control).

Table 4.

Characteristics of objects subdivided with carotid doppler results

	CCA-IMT <1.1 mm	CCA-IMT ≥1.1 mm	p-value
No. of patients (%)	182 (77.4)	54 (22.6)
Age (years)	55.6 ± 11.7	63.1 ± 9.3	<0.01
Sex (M:F)	113:69	37:17	0.294
Diabetus mellitus (%)	48 (26.5%)	14 (26.4%)	0.73
Hypertension (%)	84 (46.4%)	27 (50.9%)	0.98
BMI	24.4 ± 3.6	24.3 ± 2.9	0.56
Total cholesterol (mg/dL)	182.2 ± 33	189.9 ± 41.5	0.15
LDL cholesterol (mg/dL)	105.1 ± 36.4	123.5 ± 36.6	<0.01

Values are presented as mean ± SD unless otherwise indicated. Analyzed by Inderpendent t-test. CCA = common carotid artery; IMT = intima-media thickness; BMI = body mass index; LDL = low-density lipoprotein.

Table 5.

Laboratory findings according to group of patients

	AION (n = 45)	CRVO (n = 34)	CRAO (n = 23)	OIS (n = 27)	Control (n = 107)	p-value
Total cholesterol (mg/dL)	193.8 ± 35.8	181.6 ± 39.6	173.8 ± 34.2	193.4 ± 38.4	180.3 ± 31.7	0.65
LDL (mg/dL)	119.1 ± 29.9^*	122.5 ± 38.7^*	118.7 ± 30.3^*	127.3 ± 33.1^*	94.4 ± 36.5	<0.01
Total cholesterol ≥200 mg/dL (%) LDL-cholesterol ≥130 mg/dL (%)	15 (33.3) 11 (24.4)^*	6 (17.7)14 (41.2)^*	3 (13)3 (13)	12 (44.4) 9 (33.3)^∗	28 (26.2)4 (4.1)	0.064 <0.01

^∗ p-value < 0.05 (vs. Control).

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