Retinal microvascular signs and risk of stroke and stroke mortality.
OBJECTIVE
The purpose of this study was to assess the relation of retinal microvascular signs and incident stroke and stroke mortality in an older population.


METHODS
The authors took retinal photographs on baseline participants (3,654 patients aged 49+ years) of the Blue Mountains Eye Study (1992 to 1994). They assessed the presence of retinopathy (microaneurysms, retinal hemorrhages) in participants without diabetes and retinal arteriolar signs in all participants using standardized grading protocols. Incident stroke/TIA/cerebrovascular death (combined stroke events) were identified at follow-up examinations during 1997 to 1999.


RESULTS
During a 7-year period, 859 participants died, 97 (11.3%) of which died of cerebrovascular causes. Of survivors, 24 had confirmed incident stroke, and 11 had incident TIA. Combined stroke events were more frequent in participants with retinopathy (5.7%), with moderate/severe arteriovenous nicking (4.2%), or with focal arteriolar narrowing (7.2%) compared with those without (1.9%). After controlling for age, sex, systolic blood pressure, smoking, and self-rated health, retinopathy was significantly associated with combined stroke events (relative risk [RR] 1.7, 95% CI 1.0 to 2.8) in persons without diabetes. This association was stronger in those without severe hypertension (RR 2.7, CI 1.2 to 6.2) or in persons with two or more retinal microvascular signs (RR 2.7, CI 1.5 to 5.2). Generalized or focal arteriolar narrowing or arteriovenous nicking was not independently associated with combined stroke events after multivariate adjustment.


CONCLUSIONS
In older Australians without diabetes, retinopathy signs predict stroke or stroke-related death independent of traditional stroke risk factors.
Mitchell
P
P
Centre for Vision Research, Department of Ophthalmology, Westmead Millennium and Save Sight Institutes, University of Sydney, Australia. paul_mitchell@wmi.usyd.edu.au
Wang
J J
JJ
Wong
T Y
TY
Smith
W
W
Klein
R
R
Leeder
S R
SR
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000473:pathology; D001160:Arterioles / Q000473:pathology / Q000503:physiopathology; D001315:Australia / Q000453:epidemiology; D015984:Causality; D002536:Cerebral Arteries / Q000473:pathology* / Q000503:physiopathology; D002561:Cerebrovascular Disorders / Q000453:epidemiology* / Q000503:physiopathology; D015897:Comorbidity; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000503:physiopathology; D015994:Incidence; D002532:Intracranial Aneurysm / Q000453:epidemiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009026:Mortality; D011237:Predictive Value of Tests; D012161:Retinal Artery / Q000473:pathology* / Q000503:physiopathology; D012164:Retinal Diseases / Q000453:epidemiology* / Q000503:physiopathology; D012166:Retinal Hemorrhage / Q000453:epidemiology / Q000503:physiopathology; D012307:Risk Factors; D020521:Stroke / Q000401:mortality* / Q000503:physiopathology