The relationship of retinopathy in persons without diabetes to the 15-year incidence of diabetes and hypertension: Beaver Dam Eye Study

Trans Am Ophthalmol Soc. 2006;104:98-107.


Purpose: To examine the relationship of retinopathy in persons without diabetes mellitus to the 15-year cumulative incidence of diabetes mellitus and hypertension.

Methods: A total of 3,402 persons 43 to 86 years of age without diabetes mellitus (1,879 without diabetes or hypertension) at the time of a baseline examination in 1988-1990 had follow-up examinations in 1993-1995, 1998-2000, and/or 2003-2005. Diabetes mellitus was defined by a combination of history, serum glucose levels, and glycosylated hemoglobin levels, and hypertension was defined as systolic blood pressure >/=140 mm Hg or diastolic blood pressure >/=90 mm Hg and/or use of antihypertensive medications. Retinopathy at baseline was determined by masked gradings of stereoscopic fundus photographs using standardized protocols.

Results: Retinopathy was present in 7.3% of the nondiabetic persons in the cohort and 5.4% of the nondiabetic, nonhypertensive cohort at baseline. The 15-year cumulative incidence of diabetes was 12.5% and of hypertension 54.1%. While controlling for age, persons with retinopathy were more likely to develop diabetes mellitus (odds ratio, 95% confidence interval, P value: 1.70, 1.17-2.48, P = .005) and hypertension (1.62, 1.18-2.23, P = .003) than persons without retinopathy. While controlling for other risk factors (eg, blood pressure, glucose level, cardiovascular disease history), the associations of retinopathy with incident diabetes mellitus (1.35, 0.90-2.03, P = .15) and hypertension (1.48, 1.05-2.07, P = .02) became attenuated but remained statistically significant for hypertension. In stratified analyses, retinopathy was associated with incident diabetes in persons younger than 65 years (1.80, 1.12-2.89, P = .02)

Conclusions: While controlling for other risk factors, retinopathy in nondiabetic individuals is associated with the incidence of hypertension and, in younger persons, with the incidence of diabetes mellitus.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Blood Glucose / analysis
  • Blood Pressure
  • Blood Pressure Determination
  • Cholesterol / blood
  • Diabetes Mellitus / diagnosis
  • Diabetes Mellitus / epidemiology*
  • Diabetic Retinopathy / diagnosis
  • Diabetic Retinopathy / epidemiology*
  • Female
  • Follow-Up Studies
  • Glycated Hemoglobin A / analysis
  • Humans
  • Hypertension / diagnosis
  • Hypertension / epidemiology*
  • Incidence
  • Male
  • Middle Aged
  • Risk Factors
  • Wisconsin / epidemiology


  • Blood Glucose
  • Glycated Hemoglobin A
  • Cholesterol