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Retinal microvascular abnormalities and incident stroke: the Atherosclerosis Risk in Communities Study.

TitleRetinal microvascular abnormalities and incident stroke: the Atherosclerosis Risk in Communities Study.
Publication TypeJournal Article
Year of Publication2001
AuthorsWong TY, Klein R, Couper DJ, Cooper LS, Shahar E, Hubbard LD, Wofford MR, Sharrett AR
JournalLancet
Volume358
Issue9288
Pagination1134-40
Date Published2001 Oct 06
ISSN0140-6736
KeywordsArteriosclerosis, Diabetes Mellitus, Type 2, Female, Hemodynamics, Humans, Incidence, Male, Middle Aged, Retinal Diseases, Retinal Vessels, Risk Factors, Smoking, Stroke, Surveys and Questionnaires, United States
Abstract

BACKGROUND: Retinal microvascular abnormalities reflect damage from hypertension and other vascular processes. We examined the relation of such abnormalities to incident stroke.

METHODS: A cohort of 10358 men and women (aged 51 to 72 years) living in four US communities underwent retinal photography and standard grading for retinal microvascular abnormalities. The calibres of all retinal arterioles and venules were measured after digital conversion of the photographs, and a summary arteriole-to-venule ratio (AVR) was calculated as an index of arteriolar narrowing (smaller AVR indicates greater narrowing). Cases of incident stroke admitted to hospital were identified and validated by case record reviews.

FINDINGS: Over an average of 3.5 years, 110 participants had incident strokes. After adjustment for age, sex, race, 6-year mean arterial blood pressure, diabetes, and other stroke risk factors, most retinal microvascular characteristics were predictive of incident stroke, with adjusted relative risks of 2.58 (1.59-4.20) for any retinopathy, 3.11 (1.71-5.65) for microaneurysms, 3.08 (1.42-6.68) for soft exudates, 2.55 (1.27-5.14) for blot haemorrhages, 2.26 (1.00-5.12) for flame-shaped haemorrhages, and 1.60 (1.03-2.47) for arteriovenous nicking. The relative risk of stroke increased with decreasing AVR (p=0.03). The associations were similar for ischaemic strokes specifically, and for strokes in individuals with hypertension, either with or without diabetes.

INTERPRETATION: Retinal microvascular abnormalities are related to incident stroke. The findings support a microvascular role in the pathogenesis of stroke. They suggest that retinal photography may be useful for cerebrovascular-risk stratification in appropriate populations.

DOI10.1016/S0140-6736(01)06253-5
Alternate JournalLancet
PubMed ID11597667
Grant ListN01-C-55019 / / PHS HHS / United States
N01-HC-35125 / HC / NHLBI NIH HHS / United States
N01-HC-35126 / HC / NHLBI NIH HHS / United States
N01-HC-55015 / HC / NHLBI NIH HHS / United States
N01-HC-55016 / HC / NHLBI NIH HHS / United States
N01-HC-55018 / HC / NHLBI NIH HHS / United States
N01-HC-55020 / HC / NHLBI NIH HHS / United States
N01-HC-55021 / HC / NHLBI NIH HHS / United States
N01-HC-55022 / HC / NHLBI NIH HHS / United States