CARDIOVASCULAR MEDICINE

Retinal vascular calibre and the risk of coronary heart disease-related death

J J Wang¹, G Liew¹, T Y Wong², W Smith³, R Klein⁴, S R Leeder⁵, P Mitchell¹

¹ Centre for Vision Research, Department of Ophthalmology, Westmead Millennium Institute, University of Sydney, Sydney, Australia
² Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia
³ Centre for Clinical Epidemiology & Biostatistics, University of Newcastle, Newcastle, Australia
⁴ Department of Ophthalmology & Visual Science, University of Wisconsin-Madison, Madison, Wisconsin, USA
⁵ Faculty of Medicine, University of Sydney, Sydney, Australia

Correspondence to:
Dr Jie Jin Wang
Centre for Vision Research, Department of Ophthalmology, University of Sydney, Westmead Hospital, Hawkesbury Rd, Westmead, NSW, Australia, 2145; jiejin_wang{at}wmi.usyd.edu.au

Objective: To examine whether retinal vascular calibre independently predicts risk of coronary heart disease (CHD) -related death.

Methods: In a population-based cohort study of 3654 Australians aged 49 years, retinal arteriolar and venular calibres were measured from baseline retinal photographs and the arteriole to venule ratio (AVR) was calculated. CHD-related death was confirmed from the Australian National Death Index.

Results: Over nine years, 78 women (4.1%) and 114 men (7.8%) had incident CHD-related deaths. In people aged 49–75 years, wider venules were associated with CHD death, with relative risk (RR) 1.8 (95% confidence interval (CI) 1.1 to 2.7) and RR 2.0 (95% CI 1.1 to 3.6) per standard deviation (SD) increase in venular calibre for men and women, respectively, after adjustment for traditional risk factors. Additionally, in women aged 49–75 years, smaller AVR and narrower arterioles were associated with CHD death (RR 1.5, 95% CI 1.1 to 2.2, and RR 1.9, 95% CI 1.0 to 3.5 per SD decrease in AVR and arteriolar calibre, respectively, after adjustment). These associations were not observed in people aged > 75 years.

Conclusions: These findings suggest that microvascular disease processes may have a role in CHD development in middle-aged people, particularly in women. Retinal photography may be useful in cardiovascular risk prediction.

Abbreviations: ARIC, Atherosclerosis Risk In Communities; AVR, arteriole to venule ratio; CHD, coronary heart disease; HDL, high density lipoprotein; ICD, International Classification of Diseases; NDI, National Death Index; RR, relative risk; WISE, Women’s Ischemia Syndrome Evaluation

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