title: Retinal vessel diameter and cardiovascular mortality: pooled data analysis from two older populations.
abstract: OBJECTIVE
  The retinal microvasculature may reflect pre-clinical changes in the cerebral and coronary microcirculations. We assessed whether smaller retinal arterioles and larger venules predicted coronary heart disease (CHD)- and stroke-mortality.
  
  
  RESULTS
  We pooled data from the Beaver Dam Eye Study (n = 4926, aged 43-86) and the Blue Mountains Eye Study (n = 3654, aged 49-97). Retinal vessel diameters were measured from digitized retinal photographs. Change point models were used to assess and document the existence of threshold effects. We defined smaller arterioles as diameters within the narrowest quintile and larger venules as diameters within the widest quintile, with other quintiles as the reference. Of 8550 participants, 7494 (88%) with complete data were included, of whom 653 died from CHD and 299 from stroke over 10-12 years follow-up. After multivariable adjustment, each standard deviation (SD) increase in arteriolar diameter, or SD decrease in venular diameter, was not found to be significantly associated with either CHD-mortality or stroke-mortality. However, smaller arterioles [hazard ratio (HR) 1.34, 95% confidence interval (CI) 1.11-1.62] and larger venules (HR 1.24, CI 1.02-1.52), predicted increased risk of CHD-mortality. These associations were mainly evident among persons aged 43-69 (smaller arterioles: HR 1.70, CI 1.27-2.28; larger venules: HR 1.41, CI 1.06-1.89). Smaller arterioles (HR 1.64, CI 1.00-2.67) and larger venules (HR 1.53, CI 0.94-2.47) were also associated with an increased risk of stroke-mortality among persons aged 43-69.
  
  
  CONCLUSIONS
  Retinal vessel diameter may predict risk of CHD and stroke deaths in middle-aged persons.
authors.affiliation: Centre for Vision Research, Department of Ophthalmology, Westmead Hospital, and The Westmead Millennium Institute, University of Sydney, Australia. jiejin_wang@wmi.usyd.edu.au
authors.forename: Jie Jin
authors.initials: JJ
authors.lastname: Wang
authors.forename: Gerald
authors.initials: G
authors.lastname: Liew
authors.forename: Ronald
authors.initials: R
authors.lastname: Klein
authors.forename: Elena
authors.initials: E
authors.lastname: Rochtchina
authors.forename: Michael D
authors.initials: MD
authors.lastname: Knudtson
authors.forename: Barbara E K
authors.initials: BE
authors.lastname: Klein
authors.forename: Tien Yin
authors.initials: TY
authors.lastname: Wong
authors.forename: George
authors.initials: G
authors.lastname: Burlutsky
authors.forename: Paul
authors.initials: P
authors.lastname: Mitchell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003327:Coronary Disease / Q000209:etiology / Q000401:mortality / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012164:Retinal Diseases / Q000401:mortality / Q000473:pathology*; D012171:Retinal Vessels / Q000473:pathology*; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000401:mortality / Q000473:pathology*