Abstract
We aimed to investigate whether health-related quality of life (HRQoL) is associated with retinal vascular caliber, an indicator of subclinical cardiovascular disease risk. 1600 students aged between 11–19 years (821 girls and 779 boys) were examined during 2009–2011. Retinal vessel caliber was measured from digital retinal images. HRQoL was assessed by the Pediatric Quality of Life Inventory (PedsQL). In the overall cohort, each 1-unit increase in PedsQL total score and the psychosocial summary score was associated with ~0.05 μm narrowing in retinal arteriolar caliber (multivariable-adjusted p-value = 0.01). Participants in the lowest versus highest tertile of PedsQL total score, psychosocial summary, social and school item scores had significantly wider retinal arteriolar caliber: 161.7 μm versus 160.2 μm (p = 0.02); 161.6 μm versus 160.0 μm (p = 0.02); 161.6 μm versus 159.9 μm (p = 0.002); and 161.6 μm versus 159.9 μm (p = 0.01), respectively. Significant interactions (p < 0.05) were observed between gender and PedsQL total score with retinal arteriolar calibre. In boys, inverse associations were observed between PedsQL total score (p = 0.01), psychosocial summary (p = 0.01), and social scores (p = 0.01) and retinal arteriolar caliber. No significant associations were observed between PedsQL scores and retinal vessel caliber in girls. Diminished HRQoL in adolescents was independently associated with structural retinal microvascular changes.
Highlights
Health-related quality of life (HRQoL) refers to the subset of quality of life directly related to an individual’s health[1], which as defined by the World Health Organization includes physical, mental, and social well-being[2,3]
Significant differences were observed between boys and girls in regards to ethnic distribution, systolic and diastolic blood pressure (BP), axial length and in PedsQL total score, physical summary, emotional and social domain scores
Boys compared to girls were more likely to be Caucasian, have higher systolic BP, axial length and PedsQL total scores (Table 2)
Summary
Health-related quality of life (HRQoL) refers to the subset of quality of life directly related to an individual’s health[1], which as defined by the World Health Organization includes physical, mental, and social well-being[2,3]. Poor HRQoL has been shown to be a marker of morbidity and mortality in patients with coronary heart disease, even after controlling for traditional vascular risk factors[4,5,6]. HRQoL has been reported to be associated with several cardiovascular risk factors, including obesity[7,8], diabetes[9] and smoking[10]. Microvascular abnormality may underlie the association between subsets of HRQoL, mental wellbeing, and vascular disease[11,12,13]. Structural retinal microvascular changes have shown to be associated with cardiovascular disease risk factors, including obesity and hypertension[19,20]. We hypothesize that lower HRQol scores is independently associated with modest structural retinal microvascular changes in adolescents. The epidemiological data from this study will help elucidate whether microvasculature structural alterations might be involved in the early mechanisms leading to cardiovascular disease and impaired HRQoL in later life
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