Vascular outcome in men with asymptomatic retinal cholesterol emboli. A cohort study.
OBJECTIVE
To determine whether asymptomatic retinal cholesterol embolism is a risk factor for vascular events.


METHODS
Cohort study with retrospectively selected controls.


METHODS
A Veterans Affairs medical center.


METHODS
70 consecutive patients with asymptomatic retinal cholesterol emboli on dilated ocular examination in an eye clinic and 70 controls without retinal emboli. Controls were matched to patients for sex; age; prevalence of hypertension, diabetes mellitus, and ischemic heart disease; serum cholesterol level; and smoking history.


METHODS
Stroke, myocardial infarction, and death.


RESULTS
During a mean follow-up of 3.4 years, stroke occurred at an annual rate of 8.5% among patients and 0.8% among controls (adjusted relative risk, 9.9; 95% CI, 2.3 to 43.1; P = 0.002). Nineteen strokes occurred, 17 in patients and 2 in controls; all were nonfatal cerebral infarctions. Twelve of the 17 that occurred in patients were in a carotid artery territory ipsilateral to the qualifying retinal cholesterol embolus and 5 were in another vascular territory. Ocular infarction or hemorrhagic stroke did not occur. Nonfatal myocardial infarction or vascular death occurred at an annual rate of 7.7% among patients and 4.9% among controls (adjusted relative risk, 1.4; 95% CI, 0.7 to 2.9; P = 0.39).


CONCLUSIONS
Asymptomatic retinal cholesterol embolism is an important risk factor for cerebral infarction independent of commonly recognized vascular risk factors.
Bruno
A
A
Veterans Affairs Medical Center, Albuquerque, New Mexico.
Jones
W L
WL
Austin
J K
JK
Carter
S
S
Qualls
C
C
D000368:Aged; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000401:mortality; D002544:Cerebral Infarction / Q000209:etiology* / Q000401:mortality; D017700:Embolism, Cholesterol / Q000150:complications*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality; D016016:Proportional Hazards Models; D012164:Retinal Diseases / Q000150:complications*; D012189:Retrospective Studies; D012307:Risk Factors