Associations between retinal microvascular structure and the severity and extent of coronary artery disease

Gopinath, Bamini; Chiha, Joseph; Plant, Adam; Thiagalingam, Aravinda; Burlutsky, George; Kovoor, Pramesh; Liew, Gerald; Mitchell, Paul

doi:10.1016/j.atherosclerosis.2014.06.018

Cited by 44 publications

(40 citation statements)

References 46 publications

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“…With advances in technology, imaging of the fundus is relatively inexpensive, accurate, reproducible, and radiation-free. The retinal arterioles [measured as the central retinal arteriolar equivalent (CRAE)], retinal venules [measured as the central retinal venular equivalent (CRVE)] and retinal microvascular abnormalities have been associated with atherosclerotic cardiovascular disease events (ASCVE, defined as incident CHD and ischemic stroke) 2–4 : incident CHD 5–8 particularly in women, incident stroke 6, 9–13 and cardiovascular mortality 7, 14–17 . While fundus photography has been recognized as a promising imaging modality to evaluate the pathogenesis of cardiovascular diseases, its ability to be applied as a test to predict ASCVE in the clinical setting has yet to be evaluated using current practice guidelines.…”

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confidence: 99%

Retinal Vessel Calibers in Predicting Long-Term Cardiovascular Outcomes

et al. 2016

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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 (PCE) in predicting Atherosclerotic Cardiovascular Disease Events (ASCVE). Methods 10,470 men and women without prior ASCVE or heart failure (HF) in the Atherosclerosis Risk in Communities (ARIC) study underwent retinal photography at visit 3 (1993–1995). Results During a mean follow up of 16 years, there were 1779 incident CHD events, 548 ischemic strokes, 1395 HF 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% CI: 1.08–1.18), HR 1.18 (1.07–1.31) and HR 1.10 (1.00–1.20) per standard deviation (SD) increase] and narrower retinal arterioles [HR 1.06 (1.01–1.11), HR 1.14 (1.03–1.26) and HR 1.13 (1.03–1.24) per SD decrease] had a higher risk of death and stroke in both sexes as well as incident CHD in women but not men (interaction p=0.02) after adjustment for the PCE risk-score variables. The association between retinal vessel caliber and HF was non-significant after adjustment for systolic blood pressure. Among women with PCE-predicted 10-year ASCVE risk <5% (overall risk 3.9%), women in the narrowest arteriolar quartile had a 10-year event-rate of 5.6% compared to 2.8% for the widest quartile (5.0% vs. 3.4% for wider vs. 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 genders and CHD in women. These measures serve as an inexpensive, reproducible biomarker that added incremental value to current practice guidelines in ASCVE risk prediction in low-risk women.

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confidence: 99%

Retinal Vessel Calibers in Predicting Long-Term Cardiovascular Outcomes

et al. 2016

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“…Experimental and observational studies provide evidence that disease begins in the microvasculature and then progresses in the macrovasculature before manifesting as clinical disease (41–44). In an experimental study, it has been shown that microvascular endothelial dysfunction occurred earlier than macrovascular endothelial dysfunction in rats with adjuvant-induced arthritis (43).…”

Section: Discussionmentioning

confidence: 99%

“…In a prospective cohort study, microvascular disease was observed to be a predictor for the development of major peripheral artery disease during a 5-year follow-up in patients with type 2 diabetes (42). Another study reported that an unhealthy retinal microvascular profile, namely, narrower retinal arterioles and wider venules were associated with more severe coronary artery disease among women (44). Changes in the retinal venular (but not arteriolar) caliber appear to predict future cerebrovascular events (41).…”

Section: Discussionmentioning

confidence: 99%

Shiftwork and the Retinal Vasculature Diameters Among Police Officers

Charles

Claudia

et al. 2017

Journal of Occupational &Amp; Environmental Medicine

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Objective To investigate associations of central retinal arteriolar equivalent (CRAE), a measure of retinal arteriolar width, and central retinal venular equivalents (CRVE), a measure of retinal venular width, with shiftwork in 199 police officers (72.9% male). Methods Shiftwork (day, afternoon, night) was assessed using electronic payroll records. Four digital retinal images per officer were taken. Mean diameters of the retinal vasculature were compared across shifts using ANOVA/ANCOVA. Results Among all officers (mean age=46.6±6.8 years), shiftwork was not significantly associated with CRAE or CRVE. However, among current and former smokers, night shift officers had a wider mean (±SE) CRVE (230.0±4.5 μm) compared with day shift officers (215.1±3.5 μm); adjusted p=0.014. Conclusions Night shift schedule in current and former smokers is associated with wider retinal venules. Reasons for this association are not known. Longitudinal studies are warranted.

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“…Recent studies have implicated narrowing of retinal arterioles in coronary artery disease, incident stroke and hypertension, independent of vascular risk factors [7,8]. Variations in vessel diameter are thought to be due to chronic structural microvascular changes, such as intimal thickening, medial hyperplasia, hyalinization and sclerosis, as well as systematic inflammatory states [2,3,[7][8][9]. AF pathogenesis has also been linked to inflammatory states [5,6].…”

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confidence: 97%

“…Between June 2009 and January 2012, data were collected from 1680 participants who presented to Westmead Hospital (Sydney, Australia) for evaluation of potential coronary artery disease (CAD) by coronary angiography, as described in [3]. Examinations and measurements included a detailed medical history questionnaire, visual acuity testing, biochemical, peripheral blood pressure measurements, invasively measured blood pressure measurements, blood count analysis, and retinal photography data.…”

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confidence: 99%