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 (PCE) in predicting Atherosclerotic Cardiovascular Disease Events (ASCVE).
Methods—10,470 men and women without prior ASCVE or heart failure (HF) in the Atherosclerosis Risk in Communities (ARIC) study underwent retinal photography at visit 3 (1993-1995).
Results—During a mean follow up of 16 years, there were 1779 incident CHD events, 548 ischemic strokes, 1395 HF 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% CI: 1.08-1.18), HR 1.18 (1.07-1.31) and HR 1.10 (1.00-1.20) per standard deviation (SD) increase] and narrower retinal arterioles [HR 1.06 (1.01-1.11), HR 1.14 (1.03-1.26) and HR 1.13 (1.03-1.24) per SD decrease] had a higher risk of death and stroke in both sexes as well as incident CHD in women but not men (interaction p=0.02) after adjustment for the PCE risk-score variables. The association between retinal vessel caliber and HF was non-significant after adjustment for systolic blood pressure. Among women with PCE-predicted 10-year ASCVE risk <5% (overall risk 3.9%), women in the narrowest arteriolar quartile had a 10-year event-rate of 5.6% compared to 2.8% for the widest quartile (5.0% vs. 3.4% for wider vs. 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 genders and CHD in women. These measures serve as an inexpensive, reproducible biomarker that added incremental value to current practice guidelines in ASCVE risk prediction in low-risk women.
- Received May 10, 2016.
- Revision received August 24, 2016.
- Accepted September 14, 2016.