Retinal arteriolar narrowing and risk of coronary heart disease in men and women. The Atherosclerosis Risk in Communities Study.
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.
Wong
Tien Yin
TY
Department of Ophthalmology, National University of Singapore, 10 Kent Ridge Crescent, Singapore 119260. ophwty@nus.edu.sq
Klein
Ronald
R
Sharrett
A Richey
AR
Duncan
Bruce B
BB
Couper
David J
DJ
Tielsch
James M
JM
Klein
Barbara E K
BE
Hubbard
Larry D
LD
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