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TY Wong, R Klein, BE K Klein, SS Meuer, LD Hubbard, JM Tielsch; Retinal Arteriolar Narrowing And Ten-Year Cardiovascular Mortality: A Population-Based Case Control Study . Invest. Ophthalmol. Vis. Sci. 2002;43(13):4397.
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Purpose:Retinal arteriolar narrowing reflects persistent damage from hypertension and independently predicts stroke. We examined its association with 10-year cardiovascular mortality. Methods:Population-based, case-control study nested in the Beaver Dam Eye Study (age 43-84 years). Cases were participants who died from coronary heart disease or stroke between the baseline exam in 1988-90 and 1999 (n=413). Three controls per case were selected from the baseline cohort, frequency matched on 5-year age intervals and gender (n=1198). To obtain an estimate of generalized arteriolar narrowing, retinal photographs of cases and controls obtained at baseline were digitized and diameters of individual retinal vessels were measured and summarized by a computer program. Generalized arteriolar narrowing was defined as arteriolar diameters falling in the narrowest 20th percentile of the population. Results:After controlling for systolic blood pressure, diabetes, cigarette smoking, total cholesterol and other risk factors, generalized retinal arteriolar narrowing was associated with increased cardiovascular mortality (odds ratios [OR] of 1.5, 95% confidence interval [CI]: 1.1, 2.1). The association was stronger in younger persons 43-74 years of age (OR 1.9, 95% CI: 1.2, 2.9), particularly in those without hypertension or diabetes (OR 2.7, 95% CI: 1.1, 7.0). The association was also stronger for cardiovascular deaths occurring in the first 5 years of follow-up (OR 2.1, 95% CI: 1.2, 3.9) and for coronary heart disease deaths in women (OR: 3.7, 95% CI: 1.4, 10.7). Conclusion:Retinal arteriolar narrowing is independently associated with increased cardiovascular mortality, particularly in younger people. The data support the concept that a quantitative assessment of retinal microvascular changes may provide unique information regarding cardiovascular risk and mortality.
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