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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).

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