Heart 95:391-394 doi:10.1136/hrt.2008.146670
  • Original article
  • Epidemiology

Retinopathy predicts coronary heart disease mortality

  1. G Liew1,
  2. T Y Wong2,3,
  3. P Mitchell1,
  4. N Cheung2,
  5. J J Wang1,2
  1. 1
    Centre for Vision Research, Department of Ophthalmology and Westmead Millennium Institute, University of Sydney, Sydney, NSW, Australia
  2. 2
    Centre for Eye Research Australia, University of Melbourne, Victoria, Australia
  3. 3
    Department of Ophthalmology, National University of Singapore, Singapore
  1. Dr J J Wang, Centre for Vision Research, Department of Ophthalmology, University of Sydney, Westmead Hospital, Hawkesbury Rd, Westmead, NSW Australia 2145; jiejin_wang{at}
  • Accepted 3 June 2008
  • Published Online First 12 August 2008


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 a risk of CHD-related mortality in people with and without diabetes.

Methods: In an Australian population-based cohort of people with (n = 199) and without (n = 2768) diabetes (Blue Mountains Eye Study, total n = 2967), the presence and severity of retinopathy was assessed 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-year by an amount (0.005) equivalent to the presence of diabetes itself (12-year CHD mortality rate per person-year of 0.010 in people with neither diabetes nor retinopathy, 0.015 in those with diabetes alone, 0.016 in those with retinopathy alone). After adjusting for cardiovascular risk factors, retinopathy remained an independent predictor of CHD death both in people with diabetes (hazard ratio (HR) = 2.21, 95% CI 1.20 to 4.05) and in those without diabetes (HR = 1.33, 95% CI 1.02 to 1.83). Moderate retinopathy was associated with adjusted HR = 6.68 (95% CI 2.24 to 20.0) in people with diabetes and adjusted HR = 2.29 (95% CI 1.10 to 4.76) in people without diabetes.

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


  • Funding: The study was supported by the Australian National Health and Medical Research Council, Canberra, Australia (grant nos153948, 302068, 974159, 211069).

  • Competing interests: None.

  • Ethics approval: Approved by the Western Sydney Area Health Service Human Research Ethics Committee.

  • All authors have contributed in part or in total to the study conception, collection of data, analysis, interpretation, drafting and revision of the manuscript. All authors have seen and agree to the contents of the manuscript. GL guarantees the integrity of the data.

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