Hyperhomocysteinemia is associated with the presence of retinopathy in type 2 diabetes mellitus: the Hoorn study

E K Hoogeveen, P J Kostense, P E Eysink, B C Polak, P J Beks, C Jakobs, J M Dekker, G Nijpels, R J Heine, L M Bouter, C D Stehouwer

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BACKGROUND: Retinopathy is the leading cause of blindness among patients with type 2 diabetes mellitus (DM). Hyperhomocysteinemia is a recently recognized risk factor for cardiovascular disease, independent of established risk factors.

OBJECTIVE: To study the association between the homocysteine level and retinopathy among subjects with and without DM.

METHODS: We studied an age-, sex-, and glucose tolerance-stratified random sample of a 50- to 75-year-old general white population in the Hoorn Study (N = 625). Retinal vascular changes (retinopathy) were assessed using ophthalmoscopy and/or fundus photography. Hyperhomocysteinemia was defined as a serum total homocysteine level greater than 16 micromol/L.

RESULTS: The prevalence of retinopathy was 9.8% (28/285) in subjects with normal glucose tolerance, 11.8% (20/169) in those with impaired glucose tolerance, 9.4% (10/106) in those with newly diagnosed type 2 DM, and 32.3% (21/65) in those with known type 2 DM. The prevalence of retinopathy was 10.3% (39/380) in subjects without hypertension and 16.3% (40/245) in subjects with hypertension; it was 12.0% (64/534) in subjects with a serum total homocysteine level of 16 micromol/L or less and 16.5% (15/91) in those with a serum total homocysteine level of more than 16 micromol/L. After stratification for DM and adjustment for age, sex, glycosylated hemoglobin, and hypertension, the odds ratio (95% confidence interval) for the relation between retinopathy and hyperhomocysteinemia was 0.97 (95% confidence interval, 0.42-2.82) in patients without DM and 3.44 (95% confidence interval, 1.13-10.42) in patients with DM (P =.08 for interaction).

CONCLUSION: The findings suggest that hyperhomocysteinemia may be a risk factor for retinopathy in patients with type 2 DM, but probably not in patients without DM. Arch Intern Med. 2000;160:2984-2990

Original languageEnglish
Pages (from-to)2984-2990
Number of pages7
JournalArchives of Internal Medicine
Issue number19
Publication statusPublished - 23 Oct 2000


  • Aged
  • Cross-Sectional Studies
  • Diabetic Retinopathy
  • Female
  • Humans
  • Hyperhomocysteinemia
  • Logistic Models
  • Male
  • Middle Aged
  • Retinal Diseases
  • Risk Factors
  • Journal Article
  • Research Support, Non-U.S. Gov't


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