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(Hypertension. 2006;47:975.)
© 2006 American Heart Association, Inc.

Original Articles

Abnormalities of Retinal Microvascular Structure and Risk of Mortality From Ischemic Heart Disease and Stroke

Nicholas Witt; Tien Y. Wong; Alun D. Hughes; Nish Chaturvedi; Barbara E. Klein; Richard Evans; Mary McNamara; Simon A. McG Thom; Ronald Klein

From the Department of Clinical Pharmacology (N.W., A.D.H., N.C., R.E., M.M., S.A.M.T.), National Heart and Lung Institute Division, International Centre for Circulatory Health, Faculty of Medicine, Imperial College London, United Kingdom; Centre for Eye Research Australia (T.Y.W.), University of Melbourne, Australia; and Department of Ophthalmology and Visual Sciences (B.E.K., R.K.), University of Wisconsin Medical School, Madison.

Correspondence to Alun D. Hughes, Department of Clinical Pharmacology, Imperial College London, St Mary’s Hospital, London W2 1NY, United Kingdom. E-mail a.hughes{at}imperial.ac.uk

Abnormalities of the retinal microcirculation are found in hypertension and diabetes and predict cardiovascular mortality. This study examined the relationship between abnormalities of the retinal microvasculature and death from ischemic heart disease (IHD) and stroke. A population-based, nested case-control study was undertaken within the Beaver Dam Eye Study. Subjects (43 to 74 years) who died of IHD (n=126) or stroke (n=28) over a 10-year period were age and gender matched with controls subjects (n=528; case:control matching, 1:4). Retinal photographs of cases and controls were digitized and analyzed using a computer-based technique. Increased risk of IHD death was associated with a suboptimal relationship of arteriolar diameters at bifurcation (P=0.02 unadjusted) and decreased retinal arteriolar tortuosity (P=0.011 unadjusted). These associations remained significant after adjustment for age, sex, past history of cardiovascular disease, and other known cardiovascular risk factors. Increased arteriolar length:diameter ratio, a measure of generalized arteriolar narrowing, was associated with increased stroke mortality (P=0.02 unadjusted). This association was independent of age and gender but was attenuated by adjustment for systolic blood pressure (P=0.15). Other quantitative measures of the retinal microvascular network (eg, venular tortuosity and arteriolar and venular bifurcation angle) were not associated with death from IHD or stroke. Retinal microvascular abnormalities are predictive of death from IHD and stroke. A detailed assessment of the retinal microvascular network from digitized photographs may be useful in the noninvasive assessment of target organ damage and cardiovascular risk.

Key Words: stroke • cardiovascular diseases • coronary diseases • microcirculation

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