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Retinal microvascular abnormalities and incident stroke: the Atherosclerosis Risk in Communities Study.

Publication ,  Journal Article
Wong, TY; Klein, R; Couper, DJ; Cooper, LS; Shahar, E; Hubbard, LD; Wofford, MR; Sharrett, AR
Published in: Lancet
October 6, 2001

BACKGROUND: Retinal microvascular abnormalities reflect damage from hypertension and other vascular processes. We examined the relation of such abnormalities to incident stroke. METHODS: A cohort of 10358 men and women (aged 51 to 72 years) living in four US communities underwent retinal photography and standard grading for retinal microvascular abnormalities. The calibres of all retinal arterioles and venules were measured after digital conversion of the photographs, and a summary arteriole-to-venule ratio (AVR) was calculated as an index of arteriolar narrowing (smaller AVR indicates greater narrowing). Cases of incident stroke admitted to hospital were identified and validated by case record reviews. FINDINGS: Over an average of 3.5 years, 110 participants had incident strokes. After adjustment for age, sex, race, 6-year mean arterial blood pressure, diabetes, and other stroke risk factors, most retinal microvascular characteristics were predictive of incident stroke, with adjusted relative risks of 2.58 (1.59-4.20) for any retinopathy, 3.11 (1.71-5.65) for microaneurysms, 3.08 (1.42-6.68) for soft exudates, 2.55 (1.27-5.14) for blot haemorrhages, 2.26 (1.00-5.12) for flame-shaped haemorrhages, and 1.60 (1.03-2.47) for arteriovenous nicking. The relative risk of stroke increased with decreasing AVR (p=0.03). The associations were similar for ischaemic strokes specifically, and for strokes in individuals with hypertension, either with or without diabetes. INTERPRETATION: Retinal microvascular abnormalities are related to incident stroke. The findings support a microvascular role in the pathogenesis of stroke. They suggest that retinal photography may be useful for cerebrovascular-risk stratification in appropriate populations.

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Published In

Lancet

DOI

ISSN

0140-6736

Publication Date

October 6, 2001

Volume

358

Issue

9288

Start / End Page

1134 / 1140

Location

England

Related Subject Headings

  • United States
  • Surveys and Questionnaires
  • Stroke
  • Smoking
  • Risk Factors
  • Retinal Vessels
  • Retinal Diseases
  • Middle Aged
  • Male
  • Incidence
 

Citation

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Wong, T. Y., Klein, R., Couper, D. J., Cooper, L. S., Shahar, E., Hubbard, L. D., … Sharrett, A. R. (2001). Retinal microvascular abnormalities and incident stroke: the Atherosclerosis Risk in Communities Study. Lancet, 358(9288), 1134–1140. https://doi.org/10.1016/S0140-6736(01)06253-5
Wong, T. Y., R. Klein, D. J. Couper, L. S. Cooper, E. Shahar, L. D. Hubbard, M. R. Wofford, and A. R. Sharrett. “Retinal microvascular abnormalities and incident stroke: the Atherosclerosis Risk in Communities Study.Lancet 358, no. 9288 (October 6, 2001): 1134–40. https://doi.org/10.1016/S0140-6736(01)06253-5.
Wong TY, Klein R, Couper DJ, Cooper LS, Shahar E, Hubbard LD, et al. Retinal microvascular abnormalities and incident stroke: the Atherosclerosis Risk in Communities Study. Lancet. 2001 Oct 6;358(9288):1134–40.
Wong, T. Y., et al. “Retinal microvascular abnormalities and incident stroke: the Atherosclerosis Risk in Communities Study.Lancet, vol. 358, no. 9288, Oct. 2001, pp. 1134–40. Pubmed, doi:10.1016/S0140-6736(01)06253-5.
Wong TY, Klein R, Couper DJ, Cooper LS, Shahar E, Hubbard LD, Wofford MR, Sharrett AR. Retinal microvascular abnormalities and incident stroke: the Atherosclerosis Risk in Communities Study. Lancet. 2001 Oct 6;358(9288):1134–1140.
Journal cover image

Published In

Lancet

DOI

ISSN

0140-6736

Publication Date

October 6, 2001

Volume

358

Issue

9288

Start / End Page

1134 / 1140

Location

England

Related Subject Headings

  • United States
  • Surveys and Questionnaires
  • Stroke
  • Smoking
  • Risk Factors
  • Retinal Vessels
  • Retinal Diseases
  • Middle Aged
  • Male
  • Incidence