Retinal Vessel Calibers in Predicting Long-Term Cardiovascular Outcomes: The Atherosclerosis Risk in Communities
Sara B Seidelmann1, Brian Claggett1, Paco E Bravo1
1From 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.).
Insights
Retinal vessel caliber, specifically narrower arterioles and wider venules, predicts long-term cardiovascular risk. This inexpensive biomarker improves risk assessment, especially for women, by identifying individuals needing closer monitoring for atherosclerotic cardiovascular disease.
Area of Science:
- Ophthalmology
- Cardiology
- Public Health
Background:
- Retinal microvasculature changes, including narrower arterioles and wider venules, are linked to adverse cardiovascular outcomes.
- Existing risk prediction models for atherosclerotic cardiovascular disease (ASCVD) may not fully capture all risk factors.
Purpose of the Study:
- To investigate the association between retinal vessel calibers and long-term cardiovascular outcomes.
- To determine if retinal vessel caliber provides incremental predictive value beyond the 2013 American College of Cardiology/American Heart Association Pooled Cohort Equations (PCE).
Main Methods:
- Retinal photography was performed on 10,470 participants in the Atherosclerosis Risk in Communities (ARIC) Study without prior ASCVD events or heart failure.
- Participants were followed for a mean of 16 years to ascertain incident coronary heart disease, ischemic stroke, heart failure, and mortality.
Main Results:
- Wider retinal venules and narrower retinal arterioles were associated with increased risk of mortality, ischemic stroke, and coronary heart disease (in women).
- Retinal vessel caliber reclassified 21% of women initially categorized as low-risk by PCE into an intermediate-risk category.
- Associations with heart failure were not significant after adjusting for systolic blood pressure.
Conclusions:
- Narrower retinal arterioles and wider retinal venules are independent long-term predictors of mortality, ischemic stroke, and coronary heart disease (in women).
- Retinal vessel caliber is an inexpensive, reproducible biomarker that enhances ASCVD risk prediction, particularly in low-risk women.
- These findings support the integration of retinal vessel caliber assessment into routine cardiovascular risk evaluation.
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.
Related Concept Videos
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
01:30Coronary Artery Disease I: Introduction
01:26Coronary Artery Disease IV: Preventive Measures
01:27Atherosclerosis II: Clinical Manifestations and Diagnostic Tests
01:26Atherosclerosis III: Management
01:21Peripheral Arterial Disease II: Clinical Manifestations and Diagnostic Evaluation