title: Retinopathy and risk of congestive heart failure.
abstract: BACKGROUND
  Congestive heart failure (CHF) affects a substantial proportion of adults including those without preexisting coronary heart disease. The pathogenesis of CHF is uncertain, but microvascular disease has been hypothesized as a possible factor.
  
  
  OBJECTIVE
  To determine the relationship of retinopathy, a marker of systemic microvascular disease, to risk of CHF.
  
  
  METHODS
  Population-based, prospective 7-year cohort study in 4 US communities using the Atherosclerosis Risk in Communities Study database. Participants (n = 11,612, aged 49 to 73 years) had retinal photographs taken between 1993 and 1995. The photographs were graded according to a standardized protocol for the presence of retinopathy (eg, microaneurysms, retinal hemorrhages, soft exudates), arteriovenous nicking, focal arteriolar narrowing, and generalized arteriolar narrowing.
  
  
  METHODS
  Association between retinopathy and incident CHF, identified from hospitalization and death records.
  
  
  RESULTS
  The 7-year cumulative incidence of CHF was 5.4% (492 events). Participants with retinopathy had a higher incidence of CHF compared with those without retinopathy (15.1% vs 4.8%, P<.001). After controlling for age, sex, race, preexisting coronary heart disease, mean arterial blood pressure, diabetes, glucose level, cholesterol level, smoking, body mass index, and study site, the presence of retinopathy was associated with a 2-fold higher risk of CHF (relative risk, 1.96; 95% confidence interval, 1.51-2.54). Among participants without preexisting coronary heart disease, diabetes, or hypertension, retinopathy was associated with a 3-fold higher risk of CHF (relative risk, 2.98; 95% confidence interval, 1.50-5.92).
  
  
  CONCLUSIONS
  Retinopathy is an independent predictor of CHF, even in persons without preexisting coronary heart disease, diabetes, or hypertension. This suggests that microvascular disease may play an important role in the development of heart failure in the general population. Some asymptomatic persons with retinopathy on an ophthalmologic examination may benefit from further assessment of CHF risk.
authors.affiliation: Centre for Eye Research Australia, University of Melbourne, Victoria, Australia. ophwty@nus.edu.sg
authors.forename: Tien Y
authors.initials: TY
authors.lastname: Wong
authors.forename: Wayne
authors.initials: W
authors.lastname: Rosamond
authors.forename: Patricia P
authors.initials: PP
authors.lastname: Chang
authors.forename: David J
authors.initials: DJ
authors.lastname: Couper
authors.forename: A Richey
authors.initials: AR
authors.lastname: Sharrett
authors.forename: Larry D
authors.initials: LD
authors.lastname: Hubbard
authors.forename: Aaron R
authors.initials: AR
authors.lastname: Folsom
authors.forename: Ronald
authors.initials: R
authors.lastname: Klein
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006333:Heart Failure / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012164:Retinal Diseases / Q000453:epidemiology / Q000503:physiopathology*; D012171:Retinal Vessels; D012307:Risk Factors