This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (34)  • Contact me when this article is cited  Related Content  • Related letter  • Similar articles in this journal  Topic Collections  • Aging/ Geriatrics  • Alert me on articles by topic  Social Bookmarking   What's this?

The Cardiovascular Health Study

Tien Yin Wong, MD, PhD; Aruna Kamineni, MPH; Ronald Klein, MD, MPH; A. Richey Sharrett, MD, DrPH; Barbara E. Klein, MD, MPH; David S. Siscovick, MD, MPH; Mary Cushman, MD, MSc; Bruce B. Duncan, MD, PhD

Arch Intern Med. 2006;166:2388-2394.

Background  Small vessel disease may contribute to the risk of cardiovascular disease in older persons. We describe the relation of retinal vascular caliber to incident coronary heart disease (CHD) and stroke in elderly persons.

Methods  Prospective population-based cohort study composed of 1992 men and women aged 69 to 97 years living in 4 US communities. Retinal arteriolar and venular calibers were measured from retinal photographs using a computer-assisted method. Incident CHD and stroke events were ascertained using standardized methods.

Results  After 5 years of follow-up, there were 115 incident CHD events and 113 incident stroke events. Participants with larger retinal venular caliber had a higher incidence of CHD (11.7%; 95% confidence interval [CI], 8.7%-15.8%, vs 8.1%; 95% CI, 5.7%-11.6%), comparing largest with smallest venular caliber quartiles, and stroke (8.4%; 95% CI, 6.0-11.7, vs 5.8%; 95% CI, 3.9-8.4). At multivariable analysis, controlling for age, sex, race, arteriolar caliber, systolic and diastolic blood pressure, diabetes, glucose concentration, cigarette smoking, pack-years of smoking, and high-density-lipoprotein and low-density lipoprotein cholesterol levels, larger retinal venular caliber was associated with incident CHD (rate ratio, 3.0; 95% CI, 1.6-5.7, comparing largest with smallest venular caliber quartiles; P_trend = .001) and incident stroke (rate ratio, 2.2; 95% CI, 1.1-4.3; P_trend = .02). Additional adjustment for C-reactive protein and common and internal carotid artery intimal-media thickness had minimal effect on these associations. At multivariable analysis, smaller retinal arteriolar caliber was associated with incident CHD (rate ratio, 2.0; 95% CI, 1.1-3.7, comparing largest with smallest arteriolar caliber quartiles; P = .03) but not stroke (rate ratio,1.1; 95% CI, 0.5-2.2; P = .73).

Conclusion  Larger retinal venular caliber is independently associated with risk of cardiovascular disease in elderly persons.

Author Affiliations: Centre for Eye Research Australia, University of Melbourne and Singapore Eye Research Institute, Yong Loo Lin School of Medicine, National University of Singapore (Dr Wong); Departments of Biostatistics (Ms Kamineni) and Medicine and Epidemiology (Dr Siscovick), University of Washington, Seattle; Department of Ophthalmology, University of Wisconsin, Madison (Drs R. Klein and B. E. Klein); Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (Dr Sharrett); Departments of Medicine and Pathology, University of Vermont, Burlington (Dr Cushman); and Graduate Studies Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil (Dr Duncan).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED LETTER

Retinal Vasculature Findings Do Not Add Information About Cardiovascular Risk
Erlon Oliveira de Abreu Silva
Arch Intern Med. 2007;167(11):1209-1210.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Prediction of Incident Stroke Events Based on Retinal Vessel Caliber: A Systematic Review and Individual-Participant Meta-Analysis
McGeechan et al.
Am J Epidemiol 2009;170:1323-1332.
ABSTRACT | FULL TEXT  

Retinal Vascular Caliber and Extracranial Carotid Disease in Patients With Acute Ischemic Stroke: The Multi-Centre Retinal Stroke (MCRS) Study
De Silva et al.
Stroke 2009;40:3695-3699.
ABSTRACT | FULL TEXT  

Quantitative Genetic Analysis of the Retinal Vascular Caliber: The Australian Twins Eye Study
Sun et al.
Hypertension 2009;54:788-795.
ABSTRACT | FULL TEXT  

Meta-analysis: Retinal Vessel Caliber and Risk for Coronary Heart Disease
McGeechan et al.
ANN INTERN MED 2009;151:404-413.
ABSTRACT | FULL TEXT  

Open-Angle Glaucoma and the Risk of Stroke Development: A 5-Year Population-Based Follow-Up Study
Ho et al.
Stroke 2009;40:2685-2690.
ABSTRACT | FULL TEXT  

Differences in retinal vessels support a distinct vasculopathy causing lacunar stroke
Doubal et al.
Neurology 2009;72:1773-1778.
ABSTRACT | FULL TEXT  

Vital Exhaustion and Retinal Microvascular Changes in Cardiovascular Disease: Atherosclerosis Risk in Communities Study
Cheung et al.
Psychosom. Med. 2009;71:308-312.
ABSTRACT | FULL TEXT  

Retinopathy predicts coronary heart disease mortality
Liew et al.
Heart 2009;95:391-394.
ABSTRACT | FULL TEXT  

Retinal Microvascular Caliber and Chronic Kidney Disease in an Asian Population
Sabanayagam et al.
Am J Epidemiol 2009;169:625-632.
ABSTRACT | FULL TEXT  

Retinal microvascular abnormalities and stroke: a systematic review
Doubal et al.
J. Neurol. Neurosurg. Psychiatry 2009;80:158-165.
ABSTRACT | FULL TEXT  

Glycemic Index, Retinal Vascular Caliber, and Stroke Mortality
Kaushik et al.
Stroke 2009;40:206-212.
ABSTRACT | FULL TEXT  

Assessing New Biomarkers and Predictive Models for Use in Clinical Practice: A Clinician's Guide
McGeechan et al.
Arch Intern Med 2008;168:2304-2310.
ABSTRACT | FULL TEXT  

Retinal Vascular Imaging: A New Tool in Microvascular Disease Research
Liew et al.
Circ Cardiovasc Imaging 2008;1:156-161.
ABSTRACT | FULL TEXT  

Evidence of Arteriolar Narrowing in Low-Birth-Weight Children
Mitchell et al.
Circulation 2008;118:518-524.
ABSTRACT | FULL TEXT  

Birth Weight and Retinal Vascular Changes
Lim and Cheung
Hypertension 2008;51:e56-e56.
FULL TEXT  

Retinal Vascular Caliber, Blood Pressure, and Cardiovascular Risk Factors in an Asian Population: The Singapore Malay Eye Study
Sun et al.
IOVS 2008;49:1784-1790.
ABSTRACT | FULL TEXT  

Low Birth Weight and Retinal Vascular Caliber in Young Children
Cheung et al.
Pediatrics 2008;121:862-863.
FULL TEXT  

Retinal Signs and Stroke: Revisiting the Link Between the Eye and Brain
Baker et al.
Stroke 2008;39:1371-1379.
ABSTRACT | FULL TEXT  

Low Birthweight Is Associated With Narrower Arterioles in Adults
Liew et al.
Hypertension 2008;51:933-938.
ABSTRACT | FULL TEXT  

Relation of Retinopathy to Coronary Artery Calcification: The Multi-Ethnic Study of Atherosclerosis
Wong et al.
Am J Epidemiol 2008;167:51-58.
ABSTRACT | FULL TEXT  

Dietary fiber intake and retinal vascular caliber in the Atherosclerosis Risk in Communities Study
Kan et al.
Am. J. Clin. Nutr. 2007;86:1626-1632.
ABSTRACT | FULL TEXT  

Long-term Effects of Smoking on Retinal Microvascular Caliber
Kifley et al.
Am J Epidemiol 2007;166:1288-1297.
ABSTRACT | FULL TEXT  

Retinal Vascular Changes in Pre-Diabetes and Prehypertension: New findings and their research and clinical implications
Nguyen et al.
Diabetes Care 2007;30:2708-2715.
FULL TEXT  

Retinal Vasculature Findings Do Not Add Information About Cardiovascular Risk
Silva
Arch Intern Med 2007;167:1209-1210.
FULL TEXT  

Retinal Vasculature Findings Do Not Add Information About Cardiovascular Risk--Reply
Wong
Arch Intern Med 2007;167:1210-1210.
FULL TEXT