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JJ Wang, P Mitchell, LM Sherry, W Smith, TY Wong, R Klein, LD Hubbard, SR Leeder; Generalized Retinal Arteriolar Narrowing Predicts 5-year Cardio-vascular and Cerebro-vascular Mortality: Findings from the Blue Mountains Eye Study . Invest. Ophthalmol. Vis. Sci. 2002;43(13):4396.
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Purpose:Coronary heart disease (CHD) and stroke represent the first and third most frequent causes of death. Developing effective screening measures for persons at high risk of these events is an important public health goal. Preliminary data from the Blue Mountains Eye Study (BMES) suggested that manually graded focal retinal microvascular abnormalities were associated with subsequent stroke. In the current study, we aimed to assess whether generalized arteriolar narrowing predicts 5-year CHD or stroke mortality in a random subsample (n=1500) of the BMES population. Methods:Participants (n=3654, aged 49+ years) in baseline examinations of the BMES (1992-94) were re-examined during 1997-99. Retinal photographs of right eyes in each participant were digitized and the diameters of all retinal arterioles and venules passing through a circumferential zone 0.5 to 1.0 disc diameters from the optic disc margin were measured objectively using a computer-based program. A summarized estimate for central retinal arteriolar equivalent (CRAE) represents an average diameter of the arterioles. Deaths and causes of death were obtained from Australian National Death Index. Results:Retinal photographs gradable for retinal vessel diameter were obtained in 1402/1500 random participants. At the time follow-up data were censored, 106 cardiovascular-related deaths (CHD or stroke) and 8 incident surviving stroke cases were confirmed. The age-adjusted relative risk (RR) for cardiovascular-related death was 2.3 (95% CI 1.2-4.4) for the lowest (narrowest) compared with highest quintiles of CRAE. After adjusting for age, sex, systolic blood pressure, smoking, self-rated health and diabetes, the RR for cardiovascular-related death was 2.2 (95% CI 1.0-4.7) for the lowest compared with highest quintiles, and the RR for either cardiovascular-related death or incident stroke was 2.4 (95% CI 1.1-5.2). Conclusion:These findings suggest that generalized retinal arteriolar narrowing predicts cardiovascular events, independently of blood pressure and other known vascular risk factors.
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