Preventive cardiology
Risk Prediction of Coronary Heart Disease Based on Retinal Vascular Caliber (from the Atherosclerosis Risk In Communities [ARIC] Study)

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Recent studies showed that such retinal vascular signs as quantitative retinal vascular caliber were associated with increased risk of incident coronary heart disease (CHD), but whether these retinal vascular signs add to the prediction of CHD over and above traditional CHD risk factors was not addressed. Whether these signs add to the prediction of CHD over and above the Framingham risk score in people (n = 9,155) without diabetes selected from the ARIC Study was investigated. Incident CHD was ascertained using standardized methods, and retinal vascular caliber and other retinal signs were measured from retinal photographs. After a mean of 8.8 years of follow-up, there were 700 incident CHD events. Women with wider retinal venular caliber (hazard ratio 1.27/1-SD increase, 95% confidence interval 1.08 to 1.50) and narrower retinal arteriolar caliber (hazard ratio 1.31/1-SD decrease, 95% confidence interval 1.10 to 1.56) had a higher risk of incident CHD after adjusting for Framingham risk score variables. Area under the receiver operator characteristic curve increased from 0.695 to 0.706 (1.7% increase) with the addition of retinal vascular caliber to the Framingham risk model. Risk prediction models with and without retinal vascular caliber both fitted the data and were well calibrated for women. In men, retinal vascular caliber was not associated with CHD risk after adjustment. Other retinal vascular signs were not associated with 10-year incident CHD in men or women. In conclusion, although retinal vascular caliber independently predicted CHD risk in women, the incremental predictive ability over that of the Framingham model was modest and unlikely to translate meaningfully into clinical practice.

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Methods

The Atherosclerosis Risk In Communities (ARIC) Study included a cohort of 15,792 women and men selected in 1987 through 1989 as probability samples of 45- to 64-year-old residents of 4 US communities: Forsyth County, North Carolina; Jackson, Mississippi (blacks only); suburbs of Minneapolis, Minnesota; and Washington County, Maryland.3 Detailed protocols and differences between subjects and nonsubjects were described elsewhere.4 The present study was based on the 12,887 subjects (86% of

Results

Table 1 lists baseline characteristics of the study population. Mean follow-up was 8.8 years, 24% were followed up for ≥10 years, and during follow-up, 700 people experienced a CHD event. Three percent of people had retinopathy, 15% had retinal arteriolar focal narrowing, and 14% had arteriovenous nicking.

In the proportional hazards models (Table 2), both arteriolar and venular calibers were associated with incident CHD in women. Decreasing arteriolar and increasing venular calibers were

Discussion

This study showed that smaller retinal arteriolar and larger venular calibers were associated with increased 10-year risk of CHD in women without diabetes after adjusting for the traditional CHD risk factors included in the Framingham equation. No other retinal microvascular sign was related to the 10-year risk of CHD in men or women without diabetes. The increased risk associated with retinal caliber in women corresponded to a small increase in AUC (an increase of 1.7%), which suggested that

Acknowledgments

The authors thank the staff and participants of the ARIC Study for their important contributions.

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  • Cited by (0)

    The ARIC Study is carried out as a collaborative study supported by National Heart, Lung, and Blood Institute contracts N01-HC-55015, N01-HC-55016, N01-HC-55018, N01-HC-55019, N01-HC-55020, N01-HC-55021, and N01-HC-55022.

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