Retinal Vessel Calibers in Predicting Long-Term Cardiovascular Outcomes

Abstract

Background Narrower retinal arterioles and wider retinal venules have been associated with negative cardiovascular outcomes. We investigated whether retinal vessel calibers are associated with cardiovascular outcomes in long-term follow-up and provide incremental value over the 2013 American College of Cardiology/American Heart Association pooled cohort equations (PCE) in predicting Atherosclerotic Cardiovascular Disease Events (ASCVE). Methods 10,470 men and women without prior ASCVE or heart failure (HF) in the Atherosclerosis Risk in Communities (ARIC) study underwent retinal photography at visit 3 (1993–1995). Results During a mean follow up of 16 years, there were 1779 incident CHD events, 548 ischemic strokes, 1395 HF events and 2793 deaths. Rates of all outcomes were higher in those with wider retinal venules and narrower retinal arterioles. Subjects with wider retinal venules [hazard ratio (HR) 1.13 (95% CI: 1.08–1.18), HR 1.18 (1.07–1.31) and HR 1.10 (1.00–1.20) per standard deviation (SD) increase] and narrower retinal arterioles [HR 1.06 (1.01–1.11), HR 1.14 (1.03–1.26) and HR 1.13 (1.03–1.24) per SD decrease] had a higher risk of death and stroke in both sexes as well as incident CHD in women but not men (interaction p=0.02) after adjustment for the PCE risk-score variables. The association between retinal vessel caliber and HF was non-significant after adjustment for systolic blood pressure. Among women with PCE-predicted 10-year ASCVE risk <5% (overall risk 3.9%), women in the narrowest arteriolar quartile had a 10-year event-rate of 5.6% compared to 2.8% for the widest quartile (5.0% vs. 3.4% for wider vs. narrower venules). Retinal vessel caliber reclassified 21% of low-risk women (11% of all women) as intermediate-risk (>5%). Conclusions Narrower retinal arterioles and wider retinal venules conferred long-term risk of mortality and ischemic stroke in both genders and CHD in women. These measures serve as an inexpensive, reproducible biomarker that added incremental value to current practice guidelines in ASCVE risk prediction in low-risk women.

Endothelial dysfunction in cardiovascular disease and Flammer syndrome—similarities and differences

“…The smaller and larger diameters are approximately normally distributed which allows for calculation of the equivalents according to Parr and Hubbard [58][59][60]. The ratio is a cardiovascular risk factor and predictor of long-term outcome [61].…”

“…Over 16 years of follow-up in 10,470 initially healthy individuals, it was shown that narrower retinal arterioles and wider venules confer a significant risk for ischemic stroke and all-cause mortality [61].…”

Associations of retinal microvascular caliber with intermediate phenotypes of large arterial function and structure: A systematic review and meta‐analysis

“…Technological advances now allow non‐invasive assessment of the microcirculation in large studies, most commonly by quantification of the retinal microvasculature . Adverse phenotypes of the retinal microcirculation (narrower retinal arteriolar and wider venular caliber) have also been associated with adverse CVD outcomes . For instance, the large Atherosclerosis Risk in Communities Study showed that, over a 16 years follow‐up period, generally healthy subjects with narrower arteriolar caliber and wider venular caliber had a higher risk of ischemic stroke in both sexes (hazard ratio 1.10, 95% CI 1.00 to 1.20 and 1.14, 95%CI 1.03 to 1.26, respectively) .…”

A new unified framework for the early detection of the progression to diabetic retinopathy from fundus images

“…A number of retinal [1,2,3], cardiovascular [4] and systemic diseases [5] can be identified by studying the retinal vasculature and the morphological changes. Although retinal vascular alterations are subtle, early recognition of the signs can be paramount for helping prevent ophthalmologic complications and vision loss.…”