A possible link between the pseudoexfoliation syndrome and coronary artery disease

Çıtırık, Mehmet; Acaroğlu, Gölge; Batman, Coşar; Yildiran, L; Zilelioğlu, Orhan

doi:10.1038/sj.eye.6702177

Cited by 82 publications

(68 citation statements)

References 23 publications

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“…4 A number of recent reports have suggested that PEX syndrome is related to many cardiovascular and cerebrovascular diseases such as transient ischaemic attacks, 11 a history of angina pectoris, arterial hypertension, MI, or stroke, 12 aneurysms of the abdominal aorta, 13 and asymptomatic myocardial dysfunction. 14 In their study, Citirik et al 5 reported that the prevalence of PEX syndrome was significantly higher in patients with documented CAD, and the prevalence of CAD was also significantly higher in patients with PEX syndrome. In the other study, PEX syndrome has been found to be positively associated with the risk for CAD among patients with age Z50, and it has been suggested that PEX syndrome is a risk factor for CAD.…”

Section: Myocardial Ischaemia and Pseudoexfoliation Syndrome N Demir mentioning

confidence: 94%

“…The patients who had the typical greyish deposits on the anterior lens capsule and the pupillary border were included in the PEX group. 5 Echocardiography was performed using a Vivid 7 ultrasound system (GE Healthcare, Chalfont St Giles, UK). Two-dimensional and transmitral velocity (E) measurements were performed according to the recommendations of the American Society of Echocardiography.…”

Section: Methodsmentioning

confidence: 99%

“…5,6 In our study, we investigated whether or not PEX syndrome is associated with subclinical myocardial ischaemia by means of the use of TDI in patients with no documented CAD.…”

Section: Myocardial Ischaemia and Pseudoexfoliation Syndrome N Demir mentioning

confidence: 99%

“…4 In addition, it has been found that the prevalence of PEX syndrome was significantly higher in patients with documented coronary artery disease (CAD), a history of myocardial infarction (MI), or ischaemia. 5,6 Tissue Doppler imaging (TDI) is a useful method for quantification of regional myocardial wall motion abnormalities related to myocardial ischaemia. [7][8][9] In this study, we aimed to investigate whether or not subclinical myocardial ischaemia exists in patients with PEX syndrome using TDI.…”

Section: Introductionmentioning

confidence: 99%

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Assessment of myocardial ischaemia using tissue Doppler imaging in pseudoexfoliation syndrome

Demir

Ulus

Yücel

et al. 2011

Eye

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Purpose Pseudoexfoliation (PEX) syndrome is characterized by the widespread deposition of abnormal extracellular fibrillary material on many ocular and extraocular tissues. We aimed to investigate the association between PEX syndrome and subclinical myocardial ischaemia, using tissue Doppler echocardiography. Methods Thirty-two patients with pseudoexfoliation syndrome (mean age: 66±9 years, 22 men) and 25 healthy individuals (mean age: 67 ± 8 years, 13 men) were included in the study. Patients with overt coronary artery disease, congestive heart failure, valvular heart disease, cardiomyopathy, and left ventricular hypertrophy were excluded from the study. Tissue Doppler imaging was performed at the septal, lateral, anterior, and inferior mitral annuluses. Differences between the groups were evaluated by the unpaired t-test and the Mann-Whitney U-test, with a P-value of o0.05 considered significant. Results Baseline clinical characteristics, twodimensional, and Doppler echocardiography parameters were similar in the PEX and control groups. Peak systolic velocities at the septal, lateral, anterior, and inferior annuluses were significantly lower in patients with PEX syndrome (Po0.001, 0.01, 0.02, and 0.02, respectively). The early diastolic velocity at the septal annulus, and the ratio of early/late diastolic velocity at the lateral annulus were significantly lower in the study group (P ¼ 0.03). Conclusion PEX syndrome is a common disorder of extracellular matrix. Our data suggest that there may also be an association between PEX syndrome and subclinical myocardial ischaemia in patients who have no signs and symptoms of ischaemia. Thus, we think that ophthalmologists should consider informing their PEX syndrome patients' general practitioners about a possible cardiac risk.

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Section: Myocardial Ischaemia and Pseudoexfoliation Syndrome N Demir mentioning

confidence: 94%

Section: Methodsmentioning

confidence: 99%

“…5,6 In our study, we investigated whether or not PEX syndrome is associated with subclinical myocardial ischaemia by means of the use of TDI in patients with no documented CAD.…”

Section: Myocardial Ischaemia and Pseudoexfoliation Syndrome N Demir mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Assessment of myocardial ischaemia using tissue Doppler imaging in pseudoexfoliation syndrome

Demir

Ulus

Yücel

et al. 2011

Eye

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“…The relationship between PEX and vascular diseases has been investigated in many studies. 4,6,7,8,[24][25][26][27][28][29] However, there are also studies reporting that PEX is not associated with arterial hypertension, ischemic heart disease, and cerebrovascular diseases. 27,[30][31][32][33][34] Arterial hypertension is an important risk factor for the progression of cardiovascular diseases, stroke, and chronic renal diseases.…”

Section: Discussionmentioning

confidence: 99%

Renal artery stenosis and abdominal aorta aneurysm in patients with pseudoexfoliation syndrome

Gönen

Gümüş

2013

Eye

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Purpose To evaluate the renal arteries and abdominal aorta in patients with pseudoexfoliation syndrome (PEX). Design Prospective, case-control study. Methods The study involved 49 patients with PEX and 42 control subjects. Abdominal aorta and renal arteries were examined by Doppler ultrasonography. In both renal arteries (proximal and distal portions) and abdominal aorta, the peak systolic velocity (PSV) was measured. Renal artery stenosis (RAS) was defined as the renal artery PSV 4150 cm/s or renal-to-aortic ratio (RAR) 43.0. Patients who had an abdominal aortic diameter 43 cm were recorded. Computed tomographic angiography was performed to confirm these findings in patients with RAS and/or abdominal aorta aneurysm. Results The mean PSV in the proximal renal artery was 88.3 cm/s in PEX group and 79.5 cm/s in control group (P ¼ 0.314); in distal renal artery was 91.7 cm/s in PEX group and 93.0 cm/s in control group (P ¼ 0.794); in abdominal aorta was 76.0 cm/s in PEX group and 65.2 cm/s in control group (P ¼ 0.046). RAS was observed in nine patients with PEX and in only one patient without PEX (P ¼ 0.017). Seven out of 10 patients with RAS (six patients in PEX group; one patient in control group) had hypertension. Abdominal aorta aneurysm was observed in four patients in PEX group but not in control group (P ¼ 0.061). Conclusions Our study has demonstrated that there is a significant association between PEX and RAS. The abdominal aorta aneurysm may be seen in patients with PEX.

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Association of Pseudoexfoliation With Systemic Vascular Diseases in a South Indian Population

Haripriya

Ratukondla

et al. 2017

JAMA Ophthalmol

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IMPORTANCE Ocular pseudoexfoliation (PEX) syndrome may be associated with systemic vascular diseases, which might suggest a broader health significance of PEX, although previous reports are conflicting.OBJECTIVE To determine whether prespecified vascular risk factors and cardiac abnormalities are more common among patients with PEX than among control individuals without PEX. DESIGN, SETTING, AND PARTICIPANTSThis cross-sectional analysis of patients recruited into the Aravind Pseudoexfoliation study included South Indian patients older than 40 years with or without PEX who required cataract surgery. Surgical procedures were performed at 4 tertiary Aravind eye hospitals in Tamil Nadu, India, from December 2, 2010, through March 26, 2012. Nine hundred thirty patients with PEX and 476 non-PEX controls underwent detailed ocular examinations, including specific ocular features reflecting PEX. Patients also underwent evaluation for multiple systemic potential cardiovascular diseases and their risk factors. The data collection for this analysis on systemic vascular diseases started on December 2, 2010, and ended on April 30, 2014. This study analysis was specified in the study protocol. MAIN OUTCOMES AND MEASURESFive cardiovascular outcomes compared between patients with and without PEX included blood glucose, cholesterol, and homocysteine levels; blood pressure; and cardiac morbidity (defined by electrocardiographic [ECG] abnormalities). RESULTSThe study analysis included 930 patients in the PEX group and 476 in the non-PEX group. The mean (SD) ages of patients in the PEX and non-PEX groups were 64.8 (6.8) and 59.9 (7.3) years (P < .001), respectively. More patients in the PEX group were men (470 [50.5%] vs 460 women [49.5%]) than in the non-PEX group (201 [42.2%] vs 275 women [57.8%]; P < .001). In multivariable analyses adjusting for age and sex, higher systolic blood pressure values were noted for the PEX group (difference [Δ], 4.0 mm Hg; 95% CI, 1.7-6.2 mm Hg; P = .001). Also, patients in the PEX group were more likely to demonstrate an ECG abnormality than in the non-PEX group (odds ratio, 1.64; 95% CI, 1.04-2.60; P = .03). Pseudoexfoliation was not observed to be associated with a higher level of blood glucose (Δ, 6.2 mg/dL; 95% CI, −2.0 to 14.3 mg/dL; P = .14), serum cholesterol (Δ, −0.6 mg/dL; 95% CI, −5.1 to 4.0 mg/dL; P = .81), or serum homocysteine level (Δ, 0.004 mg/L; 95% CI, −0.12 to 0.14; P = .96).CONCLUSIONS AND RELEVANCE Of the 5 cardiovascular outcomes examined in South Indian patients requiring cataract surgery, PEX was associated with higher systolic blood pressure and more frequent ECG abnormalities but not with higher blood glucose, serum cholesterol, or serum homocysteine levels. Patients with PEX are more likely to require attention to blood pressure and cardiac morbidity.

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A possible link between the pseudoexfoliation syndrome and coronary artery disease

Cited by 82 publications

References 23 publications

Assessment of myocardial ischaemia using tissue Doppler imaging in pseudoexfoliation syndrome

Assessment of myocardial ischaemia using tissue Doppler imaging in pseudoexfoliation syndrome

Renal artery stenosis and abdominal aorta aneurysm in patients with pseudoexfoliation syndrome

Association of Pseudoexfoliation With Systemic Vascular Diseases in a South Indian Population

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