Elsevier

Ophthalmology

Volume 112, Issue 4, April 2005, Pages 540-547
Ophthalmology

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

https://doi.org/10.1016/j.ophtha.2004.10.039Get rights and content

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.

Section snippets

Study Population

The study population was derived by pooling 2 large population-based cardiovascular studies, the Atherosclerosis Risk in Communities (ARIC) Study and the Cardiovascular Health Study (CHS). The study population and methods of these 2 studies26, 27, 28 and a previous analysis pooling the 2 populations have been described in detail elsewhere.29

In brief, the ARIC Study included 15 792 men and women 45 to 64 years of age at recruitment in 1987 to 1989.26 Population samples were selected from 4

Results

Table 1 shows the characteristics of the participants for the combined population and for the individual studies. The mean age of the study participants was 63 years (standard deviation, 9). Less than half were men (43.7%), and about a quarter (21.4%) were black.

There were 39 cases of retinal vein occlusions, of which 33 were branch vein occlusions, and 34 cases of retinal arteriolar emboli. Of the 39 cases of retinal vein occlusions, 16 were considered definite; of the 34 cases of emboli, 18

Discussion

The ARIC Study and the CHS provided an opportunity to examine the relationship of retinal vein occlusion and arteriolar emboli with cardiovascular disease and several cardiovascular risk factors in a community-based sample of middle-aged and elderly people. We found various associations with retinal vein occlusion and retinal arteriolar emboli. After adjusting for age, both retinal vein occlusion and retinal arteriolar emboli were associated with hypertension, higher systolic BP, carotid artery

Acknowledgement

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

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    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).

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