Prediction of incident stroke events based on retinal vessel caliber: a systematic review and individual-participant meta-analysis.
The caliber of the retinal vessels has been shown to be associated with stroke events. However, the consistency and magnitude of association, and the changes in predicted risk independent of traditional risk factors, are unclear. To determine the association between retinal vessel caliber and the risk of stroke events, the investigators combined individual data from 20,798 people, who were free of stroke at baseline, in 6 cohort studies identified from a search of the Medline (National Library of Medicine, Bethesda, Maryland) and EMBASE (Elsevier B.V., Amsterdam, the Netherlands) databases. During follow-up of 5-12 years, 945 (4.5%) incident stroke events were recorded. Wider retinal venular caliber predicted stroke (pooled hazard ratio = 1.15, 95% confidence interval: 1.05, 1.25 per 20-micron increase in caliber), but the caliber of retinal arterioles was not associated with stroke (pooled hazard ratio = 1.00, 95% confidence interval: 0.92, 1.08). There was weak evidence of heterogeneity in the hazard ratio for retinal venular caliber, which may be attributable to differences in follow-up strategies across studies. Inclusion of retinal venular caliber in prediction models containing traditional stroke risk factors reassigned 10.1% of people at intermediate risk into different, mostly lower, risk categories.
McGeechan
Kevin
K
Singapore Eye Research Institute, National University of Singapore, 11 Third Hospital Avenue, Singapore 168751, Singapore.
Liew
Gerald
G
Macaskill
Petra
P
Irwig
Les
L
Klein
Ronald
R
Klein
Barbara E K
BE
Wang
Jie Jin
JJ
Mitchell
Paul
P
Vingerling
Johannes R
JR
de Jong
Paulus T V M
PT
Witteman
Jacqueline C M
JC
Breteler
Monique M B
MM
Shaw
Jonathan
J
Zimmet
Paul
P
Wong
Tien Y
TY
D000368:Aged; D005451:Fluorescein Angiography; D006801:Humans; D008875:Middle Aged; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012161:Retinal Artery / Q000033:anatomy & histology / Q000473:pathology; D012169:Retinal Vein / Q000033:anatomy & histology / Q000473:pathology; D012171:Retinal Vessels / Q000033:anatomy & histology / Q000473:pathology*; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology*