Abstract 13405: Retinal Microvascular Abnormalities, Albuminaria, and Atrial Fibrillation Incidence: the ARIC Study
Background: Microvascular abnormalities seen in the retina and assessed in the kidneys as micro-albuminuria may be associated with microvascular abnormalities in coronary beds. Their relationship with atrial fibrillation (AF) remains unstudied.
Methods: We examined the association of retinopathy (in combination with micro-albuminuria) and other retinal vascular signs with AF incidence in a biracial cohort of middle aged men and women.
Results: Of the 10009 study participants at baseline, 7.1% (n =711) had retinopathy (retinal hemorrhage 3%, retinal micro-aneurysms 4%) and 7.2% had micro-albuminuria. During an average follow up of 13.6 (3.7) years, 1100 participants had incident AF. AF incidence rates were 24.4, 16.8, 8.9, and 5.7 per 1000 person-years for those with retinopathy and micro-albuminuria, micro-albuminuria only, retinopathy only, and neither, respectively. The unadjusted relationship between retinopathy/micro-albuminuria with AF incidence is summarized in figure 1.
The age, race, and sex-adjusted hazard ratio (95% confidence intervals) of AF comparing those with retinopathy vs. those without was 1.86 (1.54-2.24). After additional adjustment for blood pressure, diabetes, other CV risk factors, and prevalent CVD, the HR was 1.37 (1.12-1.67). The association of retinal hemorrhage with AF in a model adjusted for covariates as above was 1.60 (1.23-2.07) and it was 1.47 (1.14-1.90) with retinal micro-aneurysms. Though narrowing of retinal venous equivalent showed a non-linear association with AF, there was no association with other retinal micro-vascular signs (AV nicking, focal/generalized narrowing or central retinal arterial equivalent).
Conclusions: Signs of micro-vessel disease in retina and kidneys are independently and interactively associated with higher risk of AF. The mechanisms underlying the association are unclear but may include cardiac remodeling, endothelial dysfunction, autonomic dysfunction, and atrial fibrosis.
- © 2013 by American Heart Association, Inc.