Cardiovascular Risk Factors for Retinal Vein Occlusion and Arteriolar Emboli: The Atherosclerosis Risk in Communities & Cardiovascular Health studies

Received 2 September 2004; accepted 23 October 2004. published online 11 February 2005.

Objective

To examine the associations of retinal vein occlusion and arteriolar emboli with cardiovascular disease.

Design

Population-based cross-sectional study.

Participants

Pooled from the Atherosclerosis Risk in Communities Study (n = 12 642; mean age, 60 years) and the Cardiovascular Health Study (n = 2824; mean age, 79 years).

Methods

Retinal vein occlusion and arteriolar emboli were identified from a single nonmydriatic retinal photograph using a standardized protocol. Photographs were also graded for arteriovenous nicking and focal arteriolar narrowing. All participants had a comprehensive systemic evaluation, including standardized carotid ultrasonography.

Main Outcome Measures

Retinal vein occlusion and arteriolar emboli.

Results

Prevalences of retinal vein occlusion and arteriolar emboli were 0.3% (n = 39 cases) and 0.2% (n = 34 cases), respectively. After adjusting for age, retinal vein occlusion was associated with hypertension (odds ratio [OR], 2.96; 95% confidence interval [CI], 1.43–6.14), systolic blood pressure (BP) (OR, 4.12; 95% CI, 1.40–12.16; highest quartile vs. lowest), diastolic BP (OR, 2.64; 95% CI, 1.07–6.46; highest quartile vs. lowest), carotid artery plaque (OR, 5.62; 95% CI, 2.60–12.16), body mass index (OR, 3.88; 95% CI, 1.23–12.18; highest quartile vs. lowest), plasma fibrinogen (OR, 3.29; 95% CI, 1.08–10.02; highest quartile vs. lowest), arteriovenous nicking (OR, 4.09; 95% CI, 2.00–8.36), and focal arteriolar narrowing (OR, 5.17; 95% CI, 2.59–10.29). After adjusting for age, retinal arteriolar emboli were associated with hypertension (OR, 3.14; 95% CI, 1.44–6.84), systolic BP (OR, 3.46; 95% CI, 1.13–10.65; highest quartile vs. lowest), prevalent coronary heart disease (OR, 2.33; 95% CI, 1.01–5.42), carotid artery plaque (OR, 4.62; 95% CI, 1.85–11.57), plasma lipoprotein (a) (OR, 3.69; 95% CI, 1.20–11.41; highest quartile vs. lowest), plasma fibrinogen (OR, 3.09; 95% CI, 0.98–9.76; highest quartile vs. lowest), and current cigarette smoking (OR, 3.08; 95% CI, 1.47–6.47). Approximately a quarter of participants with retinal vein occlusion and arteriolar emboli had evidence of carotid artery plaque as defined from ultrasound.

Conclusions

Retinal vein occlusion and retinal arteriolar emboli are associated with carotid artery disease, hypertension, and other cardiovascular risk factors.

1 Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia

2 Singapore Eye Research Institute, National University of Singapore, Singapore

3 Department of Biostatistics, University of Washington, Seattle, Washington

4 Department of Ophthalmology, University of Wisconsin, Madison, Wisconsin

5 Department of Ophthalmology, University of Sydney, Sydney, Australia

6 Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina

7 Departments of Medicine and Epidemiology, University of Washington, Seattle, Washington

8 Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland

Correspondence to Tien Y. Wong, MD, PhD, Centre for Eye Research Australia, University of Melbourne, 32 Gisborne Street, Victoria 3002, Australia

Manuscript no. 2004-73.

The Atherosclerosis Risk in Communities Study was supported by the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland (contract nos.: N01-HC-55015, N01-HC-55016, N01-HC-55018, N01-HC-55019, N01-HC-55020, N01-HC-55021, and N01-HC-55022). The Cardiovascular Health Study was supported by the National Heart, Lung, and Blood Institute, National Institutes of Health (contract nos.: N01-HC-85079–N01-HC-85086, N01-HC-35129, and N01 HC-15103). Additional support came from the National Heart, Lung, and Blood Institute, National Institutes of Health (grant no.: R21-HL077166); Biomedical Research Council of Singapore, Singapore; and Sylvia and Charles Viertel Foundation, Australia (TYW).

PII: S0161-6420(04)01775-0

doi:10.1016/j.ophtha.2004.10.039

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