The prevalence and risk factors of retinal microvascular abnormalities in older persons: The Cardiovascular Health Study.
OBJECTIVE
To describe the prevalence of retinal microvascular characteristics and their associations with atherosclerosis in elderly, nondiabetic persons.


METHODS
Population-based, cross-sectional study comprising 2050 men and women aged 69 to 97 years without diabetes, living in four communities.


METHODS
Participants underwent retinal photography and standardized grading of retinal microvascular characteristics, including retinopathy (e.g., microaneurysms, retinal hemorrhages), focal arteriolar narrowing, and arteriovenous nicking. In addition, calibers of retinal arterioles and venules were measured on digitized photographs to obtain an estimate of generalized arteriolar narrowing. Atherosclerosis and its risk factors were obtained from clinical examination and laboratory investigations.


METHODS
Prevalence of retinal microvascular abnormalities and their associations with measures of atherosclerosis.


RESULTS
The prevalence of retinal microvascular abnormalities was 8.3% for retinopathy, 9.6% for focal arteriolar narrowing, and 7.7% for arteriovenous nicking. All retinal lesions were associated with hypertension (odds ratios [OR] were 1.8 for retinopathy, 2.1 for focal arteriolar narrowing, 1.5 for arteriovenous nicking, and 1.7 for generalized arteriolar narrowing). After controlling for age, gender, race, mean arterial blood pressure, and antihypertensive medication use, retinopathy was associated with prevalent coronary heart disease (OR, 1.7), prevalent myocardial infarction (OR, 1.7), prevalent stroke (OR, 2.0), presence of carotid artery plaque (OR, 1.9), and increased intima-media thickness of the common carotid (OR, 2.3; fourth vs. first quartile) and internal carotid (OR, 1.8; fourth vs. first quartile) arteries. In contrast, focal arteriolar narrowing, arteriovenous nicking, and generalized arteriolar narrowing were not associated with any measures of atherosclerosis.


CONCLUSIONS
Retinal microvascular abnormalities are common in older persons without diabetes and are related to hypertension. Retinopathy is associated with prevalent coronary heart disease, stroke, and carotid artery thickening, but focal and generalized arteriolar narrowing and arteriovenous nicking are not related to most measures of atherosclerosis. These data suggest that retinal microvascular abnormalities reflect processes associated with hypertension but distinct from atherosclerosis.
Wong
Tien Yin
TY
Singapore Eye Research Institute, Singapore, Republic of Singapore. ophwty@nus.edu.sg
Klein
Ronald
R
Sharrett
A Richey
AR
Manolio
Teri A
TA
Hubbard
Larry D
LD
Marino
Emily K
EK
Kuller
Lewis
L
Burke
Gregory
G
Tracy
Russell P
RP
Polak
Joseph F
JF
Gottdiener
John S
JS
Siscovick
David S
DS
D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D003324:Coronary Artery Disease / Q000453:epidemiology* / Q000503:physiopathology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology* / Q000503:physiopathology; D008297:Male; D015995:Prevalence; D012164:Retinal Diseases / Q000453:epidemiology* / Q000503:physiopathology; D012171:Retinal Vessels / Q000473:pathology*; D012307:Risk Factors; D014481:United States / Q000453:epidemiology