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Published on: March 26, 2020
Vascular outcome in men with asymptomatic retinal cholesterol emboli. A cohort study
A Bruno1, W L Jones, J K Austin
1Veterans Affairs Medical Center, Albuquerque, New Mexico.
Insights
Asymptomatic retinal cholesterol emboli significantly increase stroke risk. This finding highlights the importance of identifying these silent vascular threats for better patient outcomes.
Area of Science:
- Ophthalmology
- Neurology
- Vascular Medicine
Background:
- Retinal cholesterol emboli, often asymptomatic, may indicate underlying systemic atherosclerosis.
- The association between silent retinal emboli and future vascular events requires further investigation.
Purpose of the Study:
- To investigate whether asymptomatic retinal cholesterol embolism serves as a predictive risk factor for subsequent vascular events, particularly stroke.
Main Methods:
- A cohort study design was employed, comparing 70 patients with asymptomatic retinal cholesterol emboli to 70 matched controls.
- Patients and controls were matched based on key demographic and clinical factors including age, sex, hypertension, diabetes, ischemic heart disease, cholesterol levels, and smoking history.
- Vascular events, including stroke, myocardial infarction, and death, were the primary outcome measures.
Main Results:
- Patients with asymptomatic retinal cholesterol emboli experienced a significantly higher annual stroke rate (8.5%) compared to controls (0.8%), with an adjusted relative risk of 9.9.
- The majority of strokes in the patient group occurred within the carotid artery territory ipsilateral to the retinal embolus.
- Rates of nonfatal myocardial infarction and vascular death did not significantly differ between the groups.
Conclusions:
- Asymptomatic retinal cholesterol embolism is identified as a significant and independent risk factor for cerebral infarction.
- These findings underscore the clinical relevance of detecting silent retinal emboli in risk stratification for cerebrovascular disease.
Objective:
To determine whether asymptomatic retinal cholesterol embolism is a risk factor for vascular events.
Design:
Cohort study with retrospectively selected controls.
Setting:
A Veterans Affairs medical center.
Patients:
70 consecutive patients with asymptomatic retinal cholesterol emboli on dilated ocular examination in an eye clinic and 70 controls without retinal emboli. Controls were matched to patients for sex; age; prevalence of hypertension, diabetes mellitus, and ischemic heart disease; serum cholesterol level; and smoking history.
Measurements:
Stroke, myocardial infarction, and death.
Results:
During a mean follow-up of 3.4 years, stroke occurred at an annual rate of 8.5% among patients and 0.8% among controls (adjusted relative risk, 9.9; 95% CI, 2.3 to 43.1; P = 0.002). Nineteen strokes occurred, 17 in patients and 2 in controls; all were nonfatal cerebral infarctions. Twelve of the 17 that occurred in patients were in a carotid artery territory ipsilateral to the qualifying retinal cholesterol embolus and 5 were in another vascular territory. Ocular infarction or hemorrhagic stroke did not occur. Nonfatal myocardial infarction or vascular death occurred at an annual rate of 7.7% among patients and 4.9% among controls (adjusted relative risk, 1.4; 95% CI, 0.7 to 2.9; P = 0.39).
Conclusion:
Asymptomatic retinal cholesterol embolism is an important risk factor for cerebral infarction independent of commonly recognized vascular risk factors.
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