Retinopathy Predicts Coronary Heart Disease Mortality

Gerald Liew ¹, Tien Wong ², Paul Mitchell ¹, Ning Cheung ³ and Jie Jin Wang ^1*

¹ University of Sydney, Australia
² National University of Singapore, Singapore
³ University of Melbourne, Australia

^* To whom correspondence should be addressed. E-mail: jiejin_wang{at}wmi.usyd.edu.au.

Accepted 3 June 2008

Abstract

Background - Retinopathy lesions are fairly common findings in clinic settings and may predict risk of coronary heart disease (CHD).

Objective - To examine whether retinopathy independently predicts risk of coronary heart disease (CHD)-related mortality in persons with and without diabetes.

Methods - In an Australian population-based cohort of persons with (n=199) and without (n=2768) diabetes (Blue Mountains Eye Study, total n=2967), we assessed the presence and severity of retinopathy from retinal photographs. 12-year cumulative CHD deaths were ascertained from Australian National Death Index records.

Results - Over 12 years, 353 participants (11.9%) had incident CHD-related deaths. Retinopathy was present in 57/199 (28.6%) participants with, and in 268/2768 (9.7%) without diabetes. The presence of retinopathy increased the CHD mortality rate per person-years by an equivalent amount (0.005) as the presence of diabetes itself (12-year CHD mortality rate per person-years of 0.010 in persons with neither diabetes nor retinopathy, 0.015 with diabetes alone, 0.016 with retinopathy alone). After adjusting for cardiovascular risk factors, retinopathy remained an independent predictor of CHD death both in persons with diabetes (Hazard Ratio [HR] 2.21, 95% confidence interval [CI] 1.20-4.05) and in those without diabetes (HR 1.33, CI 1.02-1.83). Moderate retinopathy was associated with adjusted HR 6.68 (CI 2.24-20.0) in persons with diabetes, and adjusted HR 2.29 (CI 1.10-4.76), in persons without diabetes.

Conclusions - A finding of retinopathy in persons with or without diabetes may signal increased CHD risk. The increased CHD mortality associated with retinopathy in persons without diabetes was equivalent to the presence of diabetes itself.