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American Journal of Epidemiology Advance Access originally published online on October 13, 2006
American Journal of Epidemiology 2007 165(1):78-84; doi:10.1093/aje/kwj350
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American Journal of Epidemiology Copyright © 2006 by the Johns Hopkins Bloomberg School of Public Health All rights reserved; printed in U.S.A.

ORIGINAL CONTRIBUTIONS

Associations between Findings on Cranial Magnetic Resonance Imaging and Retinal Photography in the Elderly

The Cardiovascular Health Study

WT Longstreth, Jr.1, Emily K. Marino Larsen2, Ronald Klein3, Tien Yin Wong4,5, A. Richey Sharrett6, David Lefkowitz7 and Teri A. Manolio8

1 Departments of Neurology and Epidemiology, University of Washington, Seattle, WA
2 Department of Biostatistics, University of Washington, Seattle, WA
3 Department of Ophthalmology, University of Wisconsin, Madison, WI
4 Centre for Eye Research Australia, University of Melbourne, East Melbourne, Victoria, Australia
5 Singapore Eye Research Institute, National University of Singapore, Republic of Singapore
6 Department of Epidemiology, Johns Hopkins University, Baltimore, MD
7 Department of Neurology, Wake Forest University, Winston-Salem, NC
8 Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, Bethesda, MD

Correspondence to Dr. W. T. Longstreth, Jr., Department of Neurology, Box 359775, Harborview Medical Center, 325 Ninth Avenue, Seattle, WA 98104-2420 (e-mail: wl{at}u.washington.edu).

Associations between findings on cranial magnetic resonance imaging (MRI) and retinal photographs have been described mostly in middle-aged people. In the Cardiovascular Health Study, 1,717 elderly participants underwent MRI and retinal photography between 1991 and 1999. Associations were sought between MRI findings and four findings of retinal microvascular disease: retinopathy, focal arteriolar narrowing, arteriovenous nicking, and the arteriovenous ratio—the last based upon semiautomated measurements of arterioles and venules. After controlling for age and gender, the authors found associations between MRI findings and the smaller arteriovenous ratio (per standard deviation decrease): prevalent infarcts (odds ratio = 1.18, 95% confidence interval: 1.05, 1.34; p = 0.007), white matter grade (regression coefficient, 0.093; p = 0.011), incident infarct (odds ratio = 1.26, 95% confidence interval: 1.09, 1.46; p = 0.002), and worsening white matter grade (odds ratio = 1.12, 95% confidence interval: 0.98, 1.29; p = 0.09). Arteriovenous nicking was also associated with prevalent (odds ratio = 1.84, 95% confidence interval: 1.23, 2.76; p = 0.003) and incident (odds ratio = 1.84, 95% confidence interval: 1.15, 2.94; p = 0.011) infarcts. Adjustment for hypertension and diabetes had minimal effect. Evidence of small vessel disease in the retina increases the likelihood of finding it in the brain. Associations were less prominent in this elderly population than have been described in middle-aged people.

arteriosclerosis; brain infarction; leukoaraiosis; magnetic resonance imaging; microcirculation; retinal artery; retinal vein

Abbreviations: ARIC, Atherosclerosis Risk in Communities; MRI, magnetic resonance imaging


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