American Journal of Epidemiology Advance Access published online on September 24, 2007
American Journal of Epidemiology, doi:10.1093/aje/kwm256
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Original Contribution |
Relation of Retinopathy to Coronary Artery Calcification
The Multi-Ethnic Study of Atherosclerosis
1 Centre for Eye Research Australia, Department of Ophthalmology, School of Medicine, University of Melbourne, Australia
2 Singapore Eye Research Institute, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
3 Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, WI
4 Department of Medicine, School of Medicine, University of California, San Diego, San Diego, CA
5 Division of Epidemiology and Clinical Research, National Eye Institute, Bethesda, MD
6 Division of Radiological Sciences, School of Medicine, Wake Forest University, Winston-Salem, NC
7 Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
Correspondence to Dr. Tien Yin Wong, Centre for Eye Research Australia, University of Melbourne, 32 Gisborne Street, Victoria 3002, Australia (e-mail: twong{at}unimelb.edu.au).
Received for publication March 26, 2007. Accepted for publication August 13, 2007.
Microvascular disease, reflected by retinal vascular changes, has been shown to predict clinical coronary heart disease. Whether retinal vascular changes are associated with subclinical coronary artery disease is unclear and was examined in this study. The authors conducted a multiethnic, population-based study of 6,147 persons aged 45–84 years, sampled from six US communities in 2002–2004, who were free of clinical cardiovascular disease. Coronary artery calcification (CAC), a noninvasive measure of subclinical coronary artery disease, was assessed by cardiac computed tomography scanning and categorized into three groups of increasing severity: none (average CAC score = 0), mild (1–100), and moderate-to-severe (>100). Retinopathy signs and retinal vascular caliber were graded from retinal photographs following standardized protocols. After adjustment for age, gender, race/ethnicity, blood pressure, diabetes, lipid profile, smoking, and other risk factors, retinopathy was associated with having a moderate-to-severe CAC score (odds ratio = 1.43, 95% confidence interval: 1.18, 1.75). This association remained significant in both men and women and in persons with and without diabetes or hypertension. Variations in retinal vascular caliber were not significantly associated with CAC score. This study shows that retinopathy signs are independently associated with CAC, supporting the concept that common pathophysiologic processes may underlie both micro- and macrovascular disease.
arterioles; atherosclerosis; cardiovascular diseases; coronary disease; diabetic retinopathy; microcirculation; retinal vessels; venules
Abbreviations: CAC, coronary artery calcification; CI, confidence interval; MESA, Multi-Ethnic Study of Atherosclerosis; OR, odds ratio
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