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Retinal vascular calibre and the risk of coronary heart disease-related death
  1. J J Wang1,
  2. G Liew1,
  3. T Y Wong2,
  4. W Smith3,
  5. R Klein4,
  6. S R Leeder5,
  7. P Mitchell1
  1. 1Centre for Vision Research, Department of Ophthalmology, Westmead Millennium Institute, University of Sydney, Sydney, Australia
  2. 2Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia
  3. 3Centre for Clinical Epidemiology & Biostatistics, University of Newcastle, Newcastle, Australia
  4. 4Department of Ophthalmology & Visual Science, University of Wisconsin-Madison, Madison, Wisconsin, USA
  5. 5Faculty of Medicine, University of Sydney, Sydney, Australia
  1. 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}


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.

  • 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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  • Published Online First 13 July 2006

  • The study is supported by the Australian National Health & Medical Research Council, Canberra Australia (Grant nos 153948, 302068, 974159 and 211069) and US grants to RK and co-workers NIH EY06594 and HL 59259.

    Published Online First Date To Follow

  • Competing interests: None declared.