Retinal Vessel Calibers in Predicting Long-Term Cardiovascular Outcomes: The Atherosclerosis Risk in Communities Study.
BACKGROUND
Narrower retinal arterioles and wider retinal venules have been associated with negative cardiovascular outcomes. We investigated whether retinal vessel calibers are associated with cardiovascular outcomes in long-term follow-up and provide incremental value over the 2013 American College of Cardiology/American Heart Association Pooled Cohort Equations in predicting atherosclerotic cardiovascular disease events.


METHODS
A total of 10 470 men and women without prior atherosclerotic cardiovascular disease events or heart failure in the ARIC Study (Atherosclerosis Risk in Communities) underwent retinal photography at visit 3 (1993-1995).


RESULTS
During a mean follow-up of 16 years, there were 1779 incident coronary heart disease events, 548 ischemic strokes, 1395 heart failure events, and 2793 deaths. Rates of all outcomes were higher in those with wider retinal venules and narrower retinal arterioles. Subjects with wider retinal venules (hazard ratio [HR], 1.13; 95% confidence interval [CI], 1.08-1.18; HR, 1.18; 95% CI, 1.07-1.31; and HR, 1.10; 95% CI, 1.00-1.20 per 1-SD increase) and narrower retinal arterioles (HR, 1.06; 95% CI, 1.01-1.11; HR, 1.14; 95% CI, 1.03-1.26; and HR, 1.13; 95% CI, 1.03-1.24 per 1-SD decrease) had a higher risk of death and stroke in both sexes and incident coronary heart disease in women but not men (interaction P=0.02) after adjustment for the Pooled Cohort Equations risk score variables. The association between retinal vessel caliber and heart failure was nonsignificant after adjustment for systolic blood pressure. Among women with Pooled Cohort Equations-predicted 10-year atherosclerotic cardiovascular disease event risk <5% (overall risk, 3.9%), women in the narrowest arteriolar quartile had a 10-year event rate of 5.6% compared with 2.8% for women in the widest quartile (5.0% versus 3.4% for wider versus narrower venules). Retinal vessel caliber reclassified 21% of low-risk women (11% of all women) as intermediate risk (>5%).


CONCLUSIONS
Narrower retinal arterioles and wider retinal venules conferred long-term risk of mortality and ischemic stroke in both sexes and coronary heart disease in women. These measures serve as an inexpensive, reproducible biomarker that added incremental value to current practice guidelines in atherosclerotic cardiovascular disease event risk prediction in low-risk women.
From Cardiovascular Division (S.B.S, B.D., P.E.G., A.G., H.F., M.D.C., S.D.S.) and Department of Radiology, Division of Cardiovascular Imaging (S.B.S, P.E.G., A.G., H.F., M.D.C.), Brigham and Women's Hospital, Boston, MA; and Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health University of Wisconsin, Madison (B.E.K., R.K.).
Sara B
SB
Seidelmann
From Cardiovascular Division (S.B.S, B.D., P.E.G., A.G., H.F., M.D.C., S.D.S.) and Department of Radiology, Division of Cardiovascular Imaging (S.B.S, P.E.G., A.G., H.F., M.D.C.), Brigham and Women's Hospital, Boston, MA; and Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health University of Wisconsin, Madison (B.E.K., R.K.).
Brian
B
Claggett
From Cardiovascular Division (S.B.S, B.D., P.E.G., A.G., H.F., M.D.C., S.D.S.) and Department of Radiology, Division of Cardiovascular Imaging (S.B.S, P.E.G., A.G., H.F., M.D.C.), Brigham and Women's Hospital, Boston, MA; and Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health University of Wisconsin, Madison (B.E.K., R.K.).
Paco E
PE
Bravo
From Cardiovascular Division (S.B.S, B.D., P.E.G., A.G., H.F., M.D.C., S.D.S.) and Department of Radiology, Division of Cardiovascular Imaging (S.B.S, P.E.G., A.G., H.F., M.D.C.), Brigham and Women's Hospital, Boston, MA; and Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health University of Wisconsin, Madison (B.E.K., R.K.).
Ankur
A
Gupta
From Cardiovascular Division (S.B.S, B.D., P.E.G., A.G., H.F., M.D.C., S.D.S.) and Department of Radiology, Division of Cardiovascular Imaging (S.B.S, P.E.G., A.G., H.F., M.D.C.), Brigham and Women's Hospital, Boston, MA; and Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health University of Wisconsin, Madison (B.E.K., R.K.).
Hoshang
H
Farhad
From Cardiovascular Division (S.B.S, B.D., P.E.G., A.G., H.F., M.D.C., S.D.S.) and Department of Radiology, Division of Cardiovascular Imaging (S.B.S, P.E.G., A.G., H.F., M.D.C.), Brigham and Women's Hospital, Boston, MA; and Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health University of Wisconsin, Madison (B.E.K., R.K.).
Barbara E
BE
Klein
From Cardiovascular Division (S.B.S, B.D., P.E.G., A.G., H.F., M.D.C., S.D.S.) and Department of Radiology, Division of Cardiovascular Imaging (S.B.S, P.E.G., A.G., H.F., M.D.C.), Brigham and Women's Hospital, Boston, MA; and Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health University of Wisconsin, Madison (B.E.K., R.K.).
Ronald
R
Klein
From Cardiovascular Division (S.B.S, B.D., P.E.G., A.G., H.F., M.D.C., S.D.S.) and Department of Radiology, Division of Cardiovascular Imaging (S.B.S, P.E.G., A.G., H.F., M.D.C.), Brigham and Women's Hospital, Boston, MA; and Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health University of Wisconsin, Madison (B.E.K., R.K.).
Marcelo
M
Di Carli
From Cardiovascular Division (S.B.S, B.D., P.E.G., A.G., H.F., M.D.C., S.D.S.) and Department of Radiology, Division of Cardiovascular Imaging (S.B.S, P.E.G., A.G., H.F., M.D.C.), Brigham and Women's Hospital, Boston, MA; and Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health University of Wisconsin, Madison (B.E.K., R.K.). ssolomon@bwh.harvard.edu.
Scott D
SD
Solomon
D000328:Adult; D050197:Atherosclerosis / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000503:physiopathology; D015415:Biomarkers; D002545:Brain Ischemia / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000503:physiopathology; D003327:Coronary Disease / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012161:Retinal Artery / Q000473:pathology / Q000503:physiopathology; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000503:physiopathology
D015415:Biomarkers
cardiovascular diseases; death; stroke; women
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