Update on the role of cigarette smoking in coronary artery disease

The association between cigarette smoking and ocular diseases.

Importance Diabetic macular edema (DME) is a leading cause of vision loss in persons with diabetes mellitus. Although there are national estimates for the prevalence of diabetic retinopathy and its risk factors among persons with diabetes, to our knowledge, no comparable estimates are available for DME specifically. Objectives To estimate the prevalence of DME in the US population and to identify associated risk factors. Design, Setting, and Participants A cross-sectional analysis of 1038 participants aged 40 years or older with diabetes and valid fundus photographs in the 2005 to 2008 National Health and Nutrition Examination Survey. Main Outcomes and Measures The overall prevalence of DME and its prevalence according to age, race/ethnicity, and sex. Results Of the 1038 persons with diabetes analyzed for this study, 55 had DME, for an overall weighted prevalence of 3.8% (95% CI, 2.7%-4.9%) or approximately 746 000 persons in the US 2010 population aged 40 years or older. We identified no differences in the prevalence of DME by age or sex. Multivariable logistic regression analysis showed that the odds of having DME were higher for non-Hispanic blacks than for non-Hispanic whites (odds ratio [OR], 2.64; 95% CI, 1.19-5.84; P  = .02). Elevated levels of glycosylated hemoglobin A 1c (OR, 1.47; 95% CI, 1.26-1.71 for each 1%; P P Conclusions and Relevance These results suggest a greater burden of DME among non-Hispanic blacks, individuals with high levels of hemoglobin A 1c , and those with longer duration of diabetes. Given recent treatment advances in reducing vision loss and preserving vision in persons with DME, it is imperative that all persons with diabetes receive early screening; this recommendation is even more important for those at higher risk for DME.

https://jamanetwork.com/journals/jamaophthalmology/articlepdf/1895297/eoi140073.pdf

Prevalence of and Risk Factors for Diabetic Macular Edema in the United States

A discrete event simulation describes the screening and natural history of eye disease in patients with diabetes, using the POST simulation software. Discrete event simulation, unlike other modeling techniques, can show the interaction between screening and the two main diabetic eye disease processes. Results show that there is a tradeoff between screening frequency, screening sensitivity and patient compliance. The extent to which screening is cost effective is not clear cut. We have little data on the cost of blindness and different views on the appropriate quality-of-life values to assume. The model can be extended to evaluate prevention and treatment for all the complications of diabetes.

Screening for diabetic retinopathy.

Cigarette Smoking and Retinal Carotenoids: Implications for Age-related Macular Degeneration

A sample of 181 diabetics with diabetic retinopathy was statistically investigated with regard to association of smoking with proliferative retinopathy. The numbers of patients with proliferative retinopathy rose with increasing tobacco consumption. In nonsmokers no association existed between diabetes duration and proliferative retinopathy, but in smokers the number with proliferative retinopathy rose with increasing diabetes duration.

Margaret E Paetkau

Papers

Cigarette Smoking and Diabetic Retinopathy