European Heart Journal Advance Access originally published online on July 10, 2007
European Heart Journal 2007 28(16):1984-1992; doi:10.1093/eurheartj/ehm221
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Retinal vessel diameter and cardiovascular mortality: pooled data analysis from two older populations
1 Centre for Vision Research, Department of Ophthalmology, Westmead Hospital, and The Westmead Millennium Institute, University of Sydney, Australia
2 Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
3 Centre for Eye Research Australia, University of Melbourne, Australia
4 Singapore Eye Research Institute, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
Received 19 August 2006; revised 3 May 2007; accepted 10 May 2007; online publish-ahead-of-print 10 July 2007.
* Corresponding author. Tel: +61 2 9845 5006; fax: +61 2 9845 8345. E-mail address: jiejin_wang{at}wmi.usyd.edu.au
See page 1915 for the editorial comment on this article (doi:10.1093/eurheartj/ehm281)
Aims: The retinal microvasculature may reflect pre-clinical changes in the cerebral and coronary microcirculations. We assessed whether smaller retinal arterioles and larger venules predicted coronary heart disease (CHD)- and stroke-mortality.
Methods and results: We pooled data from the Beaver Dam Eye Study (n = 4926, aged 43–86) and the Blue Mountains Eye Study (n = 3654, aged 49–97). Retinal vessel diameters were measured from digitized retinal photographs. Change point models were used to assess and document the existence of threshold effects. We defined smaller arterioles as diameters within the narrowest quintile and larger venules as diameters within the widest quintile, with other quintiles as the reference. Of 8550 participants, 7494 (88%) with complete data were included, of whom 653 died from CHD and 299 from stroke over 10–12 years follow-up. After multivariable adjustment, each standard deviation (SD) increase in arteriolar diameter, or SD decrease in venular diameter, was not found to be significantly associated with either CHD-mortality or stroke-mortality. However, smaller arterioles [hazard ratio (HR) 1.34, 95% confidence interval (CI) 1.11–1.62] and larger venules (HR 1.24, CI 1.02–1.52), predicted increased risk of CHD-mortality. These associations were mainly evident among persons aged 43–69 (smaller arterioles: HR 1.70, CI 1.27–2.28; larger venules: HR 1.41, CI 1.06–1.89). Smaller arterioles (HR 1.64, CI 1.00–2.67) and larger venules (HR 1.53, CI 0.94–2.47) were also associated with an increased risk of stroke-mortality among persons aged 43–69.
Conclusion: Retinal vessel diameter may predict risk of CHD and stroke deaths in middle-aged persons.
Key Words: Retinal microvasculature • Mortality • Stroke • Coronary heart disease • Population-based cohort • Beaver Dam Eye Study • Blue Mountains Eye Study
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