title: Retinal microvascular abnormalities and MRI-defined subclinical cerebral infarction: the Atherosclerosis Risk in Communities Study.
abstract: OBJECTIVE
  Retinal microvascular abnormalities reflect cumulative small vessel damage from elevated blood pressure and may reflect subclinical cerebral microvascular changes. We examined their associations with MRI-defined cerebral infarcts.
  
  
  METHODS
  Population-based, cross-sectional study of 1684 persons 55 to 74 years of age without a history of clinical stroke, sampled from 2 US southeastern communities. Retinal photographs were obtained and graded for presence of retinal microvascular abnormalities, including arteriovenous nicking, focal arteriolar narrowing, retinal hemorrhages, soft exudates and microaneurysms. Photographs were also digitized, and retinal vessel diameters were measured and summarized as the arteriole-to-venule ratio (AVR). Cerebral MRI scans were graded for presence of cerebral infarct, defined as a lesion > or =3 mm diameter in a vascular distribution with typical imaging characteristics.
  
  
  RESULTS
  There were a total of 183 MRI cerebral infarcts. After adjustment for age, gender, race, 6-year mean arterial blood pressure, diabetes, and other stroke risk factors, cerebral infarcts were associated with retinal microvascular abnormalities, with odds ratios 1.90 (95% CI, 1.25 to 2.88) for arteriovenous nicking, 1.89 (95% CI, 1.22 to 2.92) for focal arteriolar narrowing, 2.95 (95% CI, 1.30 to 6.71) for blot hemorrhages, 2.08 (95% CI, 0.69, 6.31) for soft exudates, 3.17 (95% CI, 1.05 to 9.64) for microaneurysms, and 1.74 (95% CI, 0.95 to 3.21) for smallest compared with largest AVR. In stratified analyses, these associations were only present in persons with hypertension.
  
  
  CONCLUSIONS
  Retinal microvascular abnormalities are associated with MRI-defined subclinical cerebral infarcts independent of stroke risk factors. These data suggest that retinal photography may be useful for studying subclinical cerebrovascular disease in population-based studies.
authors.affiliation: National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
authors.forename: Lawton S
authors.initials: LS
authors.lastname: Cooper
authors.forename: Tien Y
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: R Nick
authors.initials: RN
authors.lastname: Bryan
authors.forename: Larry D
authors.initials: LD
authors.lastname: Hubbard
authors.forename: David J
authors.initials: DJ
authors.lastname: Couper
authors.forename: Gerardo
authors.initials: G
authors.lastname: Heiss
authors.forename: Paul D
authors.initials: PD
authors.lastname: Sorlie
mesh_terms: D000368:Aged; D050197:Atherosclerosis / Q000473:pathology*; D002544:Cerebral Infarction / Q000175:diagnosis / Q000473:pathology*; D002561:Cerebrovascular Disorders / Q000473:pathology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D015233:Models, Statistical; D016017:Odds Ratio; D010781:Photography; D012160:Retina / Q000469:parasitology; D012164:Retinal Diseases / Q000175:diagnosis; D012171:Retinal Vessels / Q000473:pathology*; D012307:Risk Factors; D020521:Stroke / Q000473:pathology