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American Journal of Epidemiology Advance Access originally published online on November 1, 2009
American Journal of Epidemiology 2009 170(11):1323-1332; doi:10.1093/aje/kwp306
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American Journal of Epidemiology © The Author 2009. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

Prediction of Incident Stroke Events Based on Retinal Vessel Caliber: A Systematic Review and Individual-Participant Meta-Analysis

Kevin McGeechan, Gerald Liew, Petra Macaskill, Les Irwig, Ronald Klein, Barbara E. K. Klein, Jie Jin Wang, Paul Mitchell, Johannes R. Vingerling, Paulus T. V. M. de Jong, Jacqueline C. M. Witteman, Monique M. B. Breteler, Jonathan Shaw, Paul Zimmet and Tien Y. Wong*

* Correspondence to Dr. Tien Y. Wong, Singapore Eye Research Institute, National University of Singapore, 11 Third Hospital Avenue, Singapore 168751, Singapore (e-mail: ophwty{at}nus.edu.sg).

Received for publication May 27, 2009. Accepted for publication August 27, 2009.

The caliber of the retinal vessels has been shown to be associated with stroke events. However, the consistency and magnitude of association, and the changes in predicted risk independent of traditional risk factors, are unclear. To determine the association between retinal vessel caliber and the risk of stroke events, the investigators combined individual data from 20,798 people, who were free of stroke at baseline, in 6 cohort studies identified from a search of the Medline (National Library of Medicine, Bethesda, Maryland) and EMBASE (Elsevier B.V., Amsterdam, the Netherlands) databases. During follow-up of 5–12 years, 945 (4.5%) incident stroke events were recorded. Wider retinal venular caliber predicted stroke (pooled hazard ratio = 1.15, 95% confidence interval: 1.05, 1.25 per 20-µm increase in caliber), but the caliber of retinal arterioles was not associated with stroke (pooled hazard ratio = 1.00, 95% confidence interval: 0.92, 1.08). There was weak evidence of heterogeneity in the hazard ratio for retinal venular caliber, which may be attributable to differences in follow-up strategies across studies. Inclusion of retinal venular caliber in prediction models containing traditional stroke risk factors reassigned 10.1% of people at intermediate risk into different, mostly lower, risk categories.

cohort studies; meta-analysis; retinal vessels; risk; stroke

Abbreviations: ARIC, Atherosclerosis Risk in Communities; AusDiab, Australian Diabetes, Obesity and Lifestyle; BDES, Beaver Dam Eye Study; BMES, Blue Mountains Eye Study


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