Retinal Vessel Calibers in Predicting Long-Term Cardiovascular Outcomes: The Atherosclerosis Risk in Communities...

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.