Pulse lineResearch With Heart Logo

Retinal microvascular abnormalities and risk of lacunar stroke: Atherosclerosis Risk in Communities Study.

TitleRetinal microvascular abnormalities and risk of lacunar stroke: Atherosclerosis Risk in Communities Study.
Publication TypeJournal Article
Year of Publication2010
AuthorsYatsuya H, Folsom AR, Wong TY, Klein R, Klein BEK, A Sharrett R
Corporate AuthorsARIC Study Investigators
JournalStroke
Volume41
Issue7
Pagination1349-55
Date Published2010 Jul
ISSN1524-4628
KeywordsAged, Arterioles, Atherosclerosis, Brain Infarction, Cohort Studies, Female, Follow-Up Studies, Humans, Male, Microvessels, Middle Aged, Prospective Studies, Residence Characteristics, Retinal Vessels, Risk Factors, Stroke
Abstract

BACKGROUND AND PURPOSE: The retinal microvasculature reflects cumulative small-vessel damage from hypertension and other vascular processes. No study has prospectively examined retinal findings in relation to the incidence of clinical lacunar stroke in comparison with other ischemic stroke subtypes.

METHODS: In 10 496 adults initially free of stroke, we related retinal findings imaged during 1993 to 1995 with the incidence of hospitalized ischemic strokes through 2005.

RESULTS: During a median of 11.2 years of follow-up, 338 incident ischemic strokes occurred (66 lacunar, 192 nonlacunar thrombotic, and 80 cardioembolic). Generalized arteriolar narrowing as measured by the central retinal arteriole equivalent was associated with an increased incidence of lacunar stroke (multivariate-adjusted hazard ratio [HR] per 1-SD decrement of central retinal arteriole equivalent=1.67; 95% CI, 1.23-2.26) but was not associated with other ischemic stroke subtypes. Generalized venular widening as measured by the central retinal venule equivalent was also positively associated with only lacunar stroke (multivariate-adjusted HR per 1-SD increment=1.44; 95% CI, 1.09-1.91). Retinal microvascular abnormalities were positively associated with lacunar stroke incidence (HR for focal arteriolar narrowing=2.22; 95% CI, 1.11=4.48; for arteriovenous nicking, HR=2.38; 95% CI, 1.20-4.71), whereas retinopathy signs (microaneurysms, retinal hemorrhages, and others) were positively associated with nonlacunar thrombotic (HR=2.41; 95% CI, 1.47-3.95) and cardioembolic (HR=2.25; 95% CI, 1.09-4.65) stroke incidence.

CONCLUSIONS: A narrower central retinal arteriole equivalent, wider central retinal venule equivalent, focal arteriolar narrowing, and arteriovenous nicking were predictive of lacunar stroke. Retinal imaging is useful in understanding the pathophysiology and mechanisms of cerebral small-vessel disease.

DOI10.1161/STROKEAHA.110.580837
Alternate JournalStroke
PubMed ID20522816
PubMed Central IDPMC2894269
Grant ListN01HC55020 / HL / NHLBI NIH HHS / United States
N01HC55018 / HL / NHLBI NIH HHS / United States
N01-HC-55022 / HC / NHLBI NIH HHS / United States
N01-HC-55016 / HC / NHLBI NIH HHS / United States
N01HC55022 / HL / NHLBI NIH HHS / United States
N01-HC-55021 / HC / NHLBI NIH HHS / United States
N01HC55015 / HL / NHLBI NIH HHS / United States
N01 HC055019 / HC / NHLBI NIH HHS / United States
N01-HC-55019 / HC / NHLBI NIH HHS / United States
N01-HC-55015 / HC / NHLBI NIH HHS / United States
N01-HC-55020 / HC / NHLBI NIH HHS / United States
N01HC55016 / HL / NHLBI NIH HHS / United States
N01HC55019 / HL / NHLBI NIH HHS / United States
N01-HC-55018 / HC / NHLBI NIH HHS / United States
N01HC55021 / HL / NHLBI NIH HHS / United States