Abstract
Purpose :
Changes in retinal vascular morphology are related to cardiovascular morbidity. Here, we assessed the association between retinal fractal dimension (FD) and incident cardiovascular (CV) events in an ophthalmic hospital-attending population in London, United Kingdom.
Methods :
A retrospective cohort study, the AlzEye project, linking retinal imaging of patients aged ≥ 40 years with systemic disease data from hospital admissions between January 1st 2008 and March 31st 2018. Cardiovascular event diagnoses were myocardial infarction and ischaemic stroke, as defined by the International Classification of Diseases, 10th revision codes. Retinal FD was calculated from macular-centered color photographs using the Vascular Assessment and Measurement Platform for Images of the Retina. Odds ratios (OR) from multivariable logistic regression examined the association between incident CV events and retinal FD adjusting for known confounders.
Results :
Among a cohort of 62,143 patients, 674 had a CV event at one year, 1731 at three years, and 2330 at five years. Those, who had a CV event, were older (72.2 +/- 11.9 vs 68.8 +/- 12.4, p<0.001) and more likely to be men (53.1% vs 47.9%, p<0.001), diabetic (60.4% vs 46.6%, p<0.001) and hypertensive (90.5% vs 80.5%, p<0.001). Retinal FD was reduced in patients with an incident CV event (1.50 versus 1.51, p<0.001). After adjustment by age, sex, hypertension and diabetes mellitus, retinal FD was inversely associated with incident CV events with similar ORs for one-year, three-year and five-year incidence (one-year, 0.91, 0.85-0.97, three-year 0.91, 0.87-0.95, five-year 0.90, 0.87-0.93 per standard deviation increase). Effect modification by sex was apparent. Stratification by sex showed significant association of retinal FD with female sex only (five-year incident events, Female: 0.86, 0.81-0.92, Male 0.96, 0.90-1.02 per standard deviation increase).
Conclusions :
An inverse relationship was found between retinal FD and incident CV events but only among those of female sex. Subsequent research will assess other retinal vascular indices, the contribution of longitudinal oculomic biomarkers and prediction rather than etiological objectives.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.