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J.J. Wang, S. Cugati, M.D. Knudtson, E. Rochtchina, R. Klein, B.E. K. Klein, T.Y. Wong, P. Mitchell, Centre for Vision Research; Retinal Arteriolar Emboli, Retinal Vein Occlusion and Stroke–Related Mortality: Pooled–Data Analysis From Two Older Populations . Invest. Ophthalmol. Vis. Sci. 2006;47(13):919.
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To assess whether either retinal arteriolar emboli or retinal vein occlusion signals an increased risk of stroke–related mortality in older people.
At baseline, the Beaver Dam Eye Study (BDES) examined 4926 persons aged 43–86 years (1988–90) and the Blue Mountains Eye Study (BMES) examined 3654 persons aged 49–97 years (1992–94). Retinal arteriolar emboli and retinal vein occlusion were assessed via grading of retinal photographs. Deaths and causes of death were obtained from either death certificates (BDES) or Australian National Death Index (BMES). Mortality rates were calculated as number of deaths per 1000 person–year. Cox regression models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) after adjusting for age, gender, body mass index, hypertension (systolic BP≥140, diastolic BP≥90 or use of anti–hypertensive medications), diabetes, current smoking status and study site.
There were 111 baseline participants with retinal arteriolar emboli (BDES n=61, BMES n=50) and 104 with retinal vein occlusion (BDES n=38, BMES n=66). Photographic data were available for 8384 persons (98% of 8580 seen at baseline). Of this group, 344 (4.1%) died from stroke or stroke related–conditions. The 12–year cumulative stroke–related mortality rate was three–fold among participants with, than without emboli at baseline (11.7% vs 4.0%), with age–standardized stroke–related mortality rates of 11.4 vs 4.5 per 1000 person–year, respectively. The increased risk associated with retinal embolism was independent of age and gender (age–sex–adjusted HR 2.3, CI 1.3–4.1), and traditional vascular risk factors (multivariate adjusted HR 2.3, CI 1.3–4.0). Persons with than without retinal vein occlusion did not have an increased risk of subsequent stroke mortality (12–year cumulative mortality rate 7.7 % vs 4.0% and age–standardized mortality rates 5.1 vs 4.5 per 1000 person–year; age–sex–adjusted HR 1.0, CI 0.5–2.0 and multivariate adjusted HR 1.1, CI 0.6–2.3).
Pooled BDES and BMES data indicate that the presence of retinal emboli more than doubles the risk of subsequent stroke–related mortality, independent of other risk factors. Retinal vein occlusion is not associated with stroke–related mortality.
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