title: Retinal arteriolar narrowing and risk of coronary heart disease in men and women. The Atherosclerosis Risk in Communities Study.
abstract: BACKGROUND
  Microvascular processes have been hypothesized to play a greater role in the development of coronary heart disease (CHD) in women than in men; however, prospective clinical data are limited.
  
  
  OBJECTIVE
  To examine the association between retinal arteriolar narrowing, a marker of microvascular damage from hypertension and inflammation, and incident CHD in healthy middle-aged women and men.
  
  
  METHODS
  The Atherosclerosis Risk in Communities Study, an ongoing prospective, population-based cohort study in 4 US communities initiated in 1987-1989. Retinal photographs were taken in 9648 women and men aged 51 to 72 years without CHD at the third examination (1993-1995). To quantify retinal arteriolar narrowing, the photographs were digitized, individual arteriolar and venular diameters were measured, and a summary arteriole-to-venule ratio (AVR) was calculated.
  
  
  METHODS
  Risk of CHD associated with retinal arteriolar narrowing.
  
  
  RESULTS
  During an average 3.5 years of follow-up, 84 women and 187 men experienced incident CHD events. In women, after controlling for mean arterial blood pressure averaged over the previous 6 years, diabetes, cigarette smoking, plasma lipid levels, and other risk factors, each SD decrease in the AVR was associated with an increased risk of any incident CHD (relative risk [RR], 1.37; 95% confidence interval [CI], 1.08-1.72) and of acute myocardial infarction (RR, 1.50; 95% CI, 1.10-2.04). In contrast, AVR was unrelated to any incident CHD in men (RR, 1.00; 95% CI, 0.84-1.18) or to acute myocardial infarction (RR, 1.08; 95% CI, 0.85-1.38).
  
  
  CONCLUSIONS
  Retinal arteriolar narrowing is related to risk of CHD in women but not in men, supporting a more prominent microvascular role in the development of CHD in women than in men. Future work is needed to confirm these findings.
authors.affiliation: Department of Ophthalmology, National University of Singapore, 10 Kent Ridge Crescent, Singapore 119260. ophwty@nus.edu.sq
authors.forename: Tien Yin
authors.initials: TY
authors.lastname: Wong
authors.forename: Ronald
authors.initials: R
authors.lastname: Klein
authors.forename: A Richey
authors.initials: AR
authors.lastname: Sharrett
authors.forename: Bruce B
authors.initials: BB
authors.lastname: Duncan
authors.forename: David J
authors.initials: DJ
authors.lastname: Couper
authors.forename: James M
authors.initials: JM
authors.lastname: Tielsch
authors.forename: Barbara E K
authors.initials: BE
authors.lastname: Klein
authors.forename: Larry D
authors.initials: LD
authors.lastname: Hubbard
mesh_terms: D000368:Aged; D001160:Arterioles; D001161:Arteriosclerosis / Q000503:physiopathology*; D003327:Coronary Disease / Q000453:epidemiology*; D003941:Diagnostic Techniques, Ophthalmological; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D010781:Photography / Q000379:methods; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012164:Retinal Diseases / Q000175:diagnosis / Q000503:physiopathology*; D012171:Retinal Vessels / Q000473:pathology; D012307:Risk Factors; D012737:Sex Factors