The Missing Link: Retinal Vascular Tortuosity And Coronary Microvascular Disease Are Both Associated With Low Good Cholesterol (HDL)

Abstract

Purpose: : Micro-vascular disease and endothelial dysfunction may appear earlier than macro-vascular coronary artery disease (CAD) in patients with known risk factors. Our hypothesis is that the retinal vascular abnormalities are the reflection of coronary micro-vascularisation and this represents a unique "window" on a "difficultly" accessible world.

Methods: : 86 patients (30% women) aged 60 ±, 5 with a history of coronary heart disease or with one or more cardiovascular risk factors and who have recently (< 3 months) undergone a coronary angiogram, were recruited in the protocol. Standardized protocols were used for blood collection and a blinded investigator provided a global evaluation (Gensini score) for the extent of CAD for each patient. Finally, all patients had an evaluation of their retinal fundus using a non-midriatic digital camera, ratio arteriole / venules caliber (A/V), central retinal arteriolar equivalent (CRAE), central retinal venular equivalent (CRVE) and measure of vessels tortuosity were quantitatively analyzed by using validated SIVA program1.

Results: : In multi-level linear regression model, wider retinal veinular caliber and greater retinal vascular tortuosity were significantly associated with lower HDL (p<0.005). High blood pressure was associated with narrower retinal arteriolar narrowing (p<0.001). These associations remained significant in both men and women and in patients with and without diabetes or blood hypertension.

Conclusions: : Low HDL and high systolic blood pressure were significantly associated with microvascular damage in retinal fundus. These findings provide the first evidence that the retinal microvascularisation reflects the endothelium dysfunction condition on the vascular scheme and may lead us to the early detection of CAD.

Clinical Trial: : http://www.clinicaltrials.gov NCT01027988

Keywords: imaging/image analysis: clinical • clinical (human) or epidemiologic studies: risk factor assessment • retina