No abstract

The effect of helmet use on reducing the risk of death in cyclists appears to be distorted by some variables (potential confounders, effect modifiers, or both). Our aim was to provide evidence for or against the hypothesis that cycling area may act as a confounder and effect modifier of the association between helmet use and risk of death of cyclists involved in road crashes. Data were analysed for 24,605 cyclists involved in road crashes in Spain. A multiple imputation procedure was used to mitigate the effect of missing values. We used multilevel Poisson regression with province as the group level to estimate the crude association between helmet use and risk of death, and also three adjusted analyses: (1) for cycling area only, (2) for the remaining variables which may act as confounders, and (3) for all variables. Incidence–density ratios (IDR) and their 95% confidence intervals were calculated. Crude IDR was 1.10, but stratifying by cycling area disclosed a protective, differential effect of helmet use: IDR = 0.67 in urban areas, IDR = 0.34 on open roads. Adjusting for all variables except cycling area yielded similar results in both strata, albeit with a smaller difference between them. Adjusting for cycling area only yielded a strong association (IDR = 0.42), which was slightly lower in the adjusted analysis for all variables (IDR = 0.45). Cycling area can act as a confounder and also appears to act as an effect modifier (albeit to a lesser extent) of the risk of cyclists’ death after a crash.

Funding Acknowledgements Type of funding sources: None. Introduction Control of cardiovascular risk factors is the cornerstone of secondary prevention. However, in patients with retinopathy of vascular etiology (hypertensive, diabetic or atherosclerotic) the benefit of stricter control of lipid in the long term has been little studied. Methods Prospective study of a cohort of 107 patients who underwent fundus and coronary angiography, of which 42 (39.3%) required percutaneous revascularization. During the follow-up, new cardiovascular events and analytical control of cardiovascular risk factors were recorded. Results Mean age was 75.19 ± 11.53 years. 60.7% were men, 78.5% were hypertensive, 32.7% were diabetic, and dyslipidemia was observed in 57%. Initially, 28% had 1-vessel disease, 14% 2-vessel, 8.4% 3-vessel, and 3.8% left common trunk. 0.9% had diabetic retinopathy, 3.7% had hypertensive retinopathy, 1.9% atherosclerotic, 70.1% had a combination of hypertensive and atherosclerotic retinopathy, and 7.5% signs compatible with all types. Initial and final mean values of LDL-c and HDL-c by type of retinopathy are in Table 1.  During follow-up, a significant improvement in LDL-c and HDL-c levels was observed in total patients and in patients with hypertensive and atherosclerotic retinopathy, however globally lipid control was poor and only 18.9% of the total of the sample reached the recommended levels for very high-risk people (<55 LDL-C).  Advanced hypertensive retinopathy patients with a greater reduction in LDL-C during follow-up, recorded lower mortality (p = 0.004). Besides, patients with previous percutaneous revascularization showed a greater decrease in LDL levels at the end of follow-up (69.5 ± 26.1 vs 103 ± 41.47; p <0.001); without significant changes in the rest of parameters.  Conclusions In patients with vascular etiology retinopathy, long-term lipid control is poor. However, patients with hypertensive retinopathy and a greater reduction in LDL-c had lower long-term mortality. Hypertensive retinopathy Initial Final Sig. LDL-Cholesterol (mg / dl) 102,8+/-35,5 75,65+/-28,9 <0,001 HDL-Cholesterol (mg / dl) 42,1+/-10,3 43,46+/-13,1 0,04 Atherosclerotic retinopathy LDL-Cholesterol (mg / dl) 101,2+/-36,8 79,8+/-32,98 <0,001 HDL-Cholesterol (mg / dl) 42,8+/-11,6 45,73+/-13,9 0,03 Diabetic retinopathy LDL-Cholesterol (mg / dl) 89,1+/-35,8 69,8+/-18 0,73 HDL-Cholesterol (mg / dl) 35,2+/-8,7 31,51+/-12,7 0,73

Funding Acknowledgements Type of funding sources: None. Introduction There is little evidence of the association between the different types and degrees of retinopathy and long-term appearance of myocardial perfusion defects assessed by SPECT in patients with suspected ischemic heart disease. Methods Prospective study of 107 patients (75.19 ± 11.53 years; 60.7% male) from a cohort (median follow-up 9.9 years) who underwent coronary angiography and a fundus photography. The myocardial perfusion defects were evaluated by SPECT. Results Baseline characteristics were 60.7% men, 78.5% hypertensive, 32.7% diabetic, and 57% dyslipidemic patients. Retinopathy types were: diabetic: 0.9%, hypertensive 3.7%, atherosclerotic 1.9%, hypertensive-atherosclerotic 70.1%, and all types 8.4% SYNTAX score in coronary angiography was 3.99 ± 7.5. During follow-up, male (p = 0.017) and higher SYNTAX score (p = 0.086) were more frequently associated with pathological myocardial SPECT. In the long term, patients with advanced hypertensive retinopathy (p = 0.012) and atherosclerotic retinopathy (p = 0.027) have perfusion defects more frequently. Male sex (OR 4.13; 95% CI: 0.85-20.14) and grade ≥2 atherosclerotic retinopathy (OR: 2.2. 95% CI: 0.7-7) showed in multivariate analysis a trend as high risk predictors of myocardial perfusion defects. Conclusions Hypertensive and atherosclerotic retinopathy were associated with long-term myocardial perfusion defects. The performance of the fundus as part of the cardiovascular risk study is an useful tool that allows identifying higher risk patients.