March 2012
Volume 53, Issue 14
ARVO Annual Meeting Abstract  |   March 2012
Retinal Microvascular Signs and the Long-term Risk of Stroke
Author Affiliations & Notes
  • Yi-Ting Ong
    NUS Graduate School for Integrative Sciences and Engineering,
    Department of Ophthalmology, Yong Loo Lin School of Medicine,
    National University of Singapore, Singapore, Singapore
  • Ronald Klein
    Ophthalmology and Visual Sciences, Univ of Wisconsin Sch of Med & Pub Hlth, Madison, Wisconsin
  • Barbara E. Klein
    Ophthalmology & Visual Sciences, University of Wisconsin-Madison, Madison, Wisconsin
  • Paul Mitchell
    Ophthalmology, University of Sydney, Sydney, Australia
  • A. Richey Sharrett
    Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
  • David J. Couper
    Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina
  • Tien Y. Wong
    Department of Ophthalmology, Yong Loo Lin School of Medicine,
    Singapore Eye Research Institute,
    National University of Singapore, Singapore, Singapore
  • Mohammad K. Ikram
    Singapore Eye Research Institute,
    National University of Singapore, Singapore, Singapore
    Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands
  • Atherosclerosis Risk In Communities Study
    National University of Singapore, Singapore, Singapore
  • Footnotes
    Commercial Relationships  Yi-Ting Ong, None; Ronald Klein, None; Barbara E. Klein, None; Paul Mitchell, None; A. Richey Sharrett, None; David J. Couper, None; Tien Y. Wong, None; Mohammad K. Ikram, None
  • Footnotes
    Support  National Heart, Lung, and Blood Institute contracts N01-HC-55015, N01-HC-55016, N01-HC-55018, N01-HC-55019, N01-HC-55020, N01-HC-55021, and N01-HC-55022.
Investigative Ophthalmology & Visual Science March 2012, Vol.53, 997. doi:
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      Yi-Ting Ong, Ronald Klein, Barbara E. Klein, Paul Mitchell, A. Richey Sharrett, David J. Couper, Tien Y. Wong, Mohammad K. Ikram, Atherosclerosis Risk In Communities Study; Retinal Microvascular Signs and the Long-term Risk of Stroke. Invest. Ophthalmol. Vis. Sci. 2012;53(14):997.

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      © ARVO (1962-2015); The Authors (2016-present)

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Purpose: : Retinal vascular abnormalities have been related to several age-related cerebrovascular diseases. However, data on the prediction of long-term risk of stroke are lacking. We aimed to examine the association between retinal microvascular abnormalities and the long-term risk of stroke and stroke subtypes.

Methods: : A total of 10,650 participants age 49-73 at the 1993-1995 examination, who had gradable retinal photographs, no history of stroke at baseline and data on incident stroke, were included from the Atherosclerosis Risk In Communities (ARIC) Study. Trained graders assessed the retinal photographs for qualitative retinopathy signs (i.e., retinal mircoaneurysms, hard and soft exudates, haemorrhages) and retinal arteriolar signs (focal arteriolar narrowing and arterio-venous nicking) and quantitative indices of vascular caliber (central retinal arteriole and venule equivalents). Incident events of stroke and its subtypes cerebral infarction and intracerebral hemorrhage were identified and validated via case record review over time.

Results: : After a mean follow-up period of 13 years, 503 persons developed an incident stroke, of which 444 were cerebral infarctions and 47 intracerebral hemorrhages. After adjustment for age, gender, race, center, mean arterial blood pressure and other stroke risk factors, participants with any signs of retinopathy were at an increased risk of developing a stroke [hazard ratios (HR): 1.99; 95% confidence intervals (CI): 1.50-2.64], as were persons with arterio-venous nicking [HR: 1.33; 95%CI: 1.06-1.67]. When examining stroke subtypes, presence of retinopathy signs [HR: 1.85; 95% CI: 1.36-2.51] and arterio-venous nicking [HR: 1.33; 95% CI: 1.05-2.69] was associated with cerebral infarction. Results remained similar after stratification for diabetic status. Neither retinal arteriolar, venular calibre nor focal arteriolar narrowing was associated with the risk of incident stroke and its subtypes.

Conclusions: : Retinopathy is associated with long-term stroke risk, independent of traditional stroke risk factors, particularly in relation to cerebral infarctions.

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

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