Retinal Vessel Calibers in Predicting Long-Term Cardiovascular Outcomes: The Atherosclerosis Risk in Communities Study.
Retinal Vessel Calibers in Predicting Long-Term Cardiovascular Outcomes: The Atherosclerosis Risk in Communities Study.
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DOI：
10.1161/circulationaha.116.023425
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发表时间：
2016-11-01
期刊：
影响因子：
37.8
通讯作者：
Solomon SD
中科院分区：
文献类型：
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作者：
Seidelmann SB;Claggett B;Bravo PE;Gupta A;Farhad H;Klein BE;Klein R;Di Carli M;Solomon SD
狭窄的视网膜小动脉和较宽的视网膜小静脉与不良的心血管结局相关。我们研究了视网膜血管口径是否与长期随访的心血管结局相关，并在2013年美国心脏病学院/美国心脏协会合并队列方程（PCE）预测动脉粥样硬化性心血管疾病事件（ASCVE）方面提供了增量价值。在社区动脉粥样硬化风险（ARIC）研究中，10，470名既往无ASCVE或心力衰竭（HF）的男性和女性在第3次访视（1993-1995）时接受了视网膜摄影。在平均16年的随访中，有1779例CHD事件，548例缺血性卒中，1395例HF事件和2793例死亡。视网膜小静脉较宽和视网膜小动脉较窄的患者所有结局的发生率较高。视网膜小静脉较宽的受试者[风险比（HR）1.13（95%置信区间：1.08-1.18），HR 1.18（1.07-1.31）和人力资源1.10（1.00-1.20）/标准差（SD）增加]和视网膜小动脉变窄[HR 1.06在校正PCE风险评分变量后，HR 1.14（1.03-1.26）和HR 1.13（1.03-1.24）/SD降低]在两种性别中具有较高的死亡和卒中风险，在女性中具有较高的CHD事件风险，但在男性中没有（相互作用p=0.02）。调整收缩压后，视网膜血管口径与HF之间的相关性不显著。在PCE预测的10年ASCVE风险<5%的女性中（总风险为3.9%），最西小动脉四分位数的女性10年事件发生率为5.6%，而最宽四分位数的女性为2.8%（5.0% vs. 3.4%，较宽与较窄的小静脉）。视网膜血管口径将21%的低风险女性（占所有女性的11%）重新分类为中度风险（>5%）。较窄的视网膜小动脉和较宽的视网膜小静脉会给男性和女性带来死亡和缺血性中风以及CHD的长期风险。这些措施作为一种廉价的，可重复的生物标志物，增加了低风险女性ASCVE风险预测的当前实践指南的增量价值。
Narrower retinal arterioles and wider retinal venules have been associated with negative cardiovascular outcomes. We investigated whether retinal vessel calibers are associated with cardiovascular outcomes in long-term follow-up and provide incremental value over the 2013 American College of Cardiology/American Heart Association pooled cohort equations (PCE) in predicting Atherosclerotic Cardiovascular Disease Events (ASCVE). 10,470 men and women without prior ASCVE or heart failure (HF) in the Atherosclerosis Risk in Communities (ARIC) study underwent retinal photography at visit 3 (1993–1995). During a mean follow up of 16 years, there were 1779 incident CHD events, 548 ischemic strokes, 1395 HF events and 2793 deaths. Rates of all outcomes were higher in those with wider retinal venules and narrower retinal arterioles. Subjects with wider retinal venules [hazard ratio (HR) 1.13 (95% CI: 1.08–1.18), HR 1.18 (1.07–1.31) and HR 1.10 (1.00–1.20) per standard deviation (SD) increase] and narrower retinal arterioles [HR 1.06 (1.01–1.11), HR 1.14 (1.03–1.26) and HR 1.13 (1.03–1.24) per SD decrease] had a higher risk of death and stroke in both sexes as well as incident CHD in women but not men (interaction p=0.02) after adjustment for the PCE risk-score variables. The association between retinal vessel caliber and HF was non-significant after adjustment for systolic blood pressure. Among women with PCE-predicted 10-year ASCVE risk <5% (overall risk 3.9%), women in the narrowest arteriolar quartile had a 10-year event-rate of 5.6% compared to 2.8% for the widest quartile (5.0% vs. 3.4% for wider vs. narrower venules). Retinal vessel caliber reclassified 21% of low-risk women (11% of all women) as intermediate-risk (>5%). Narrower retinal arterioles and wider retinal venules conferred long-term risk of mortality and ischemic stroke in both genders and CHD in women. These measures serve as an inexpensive, reproducible biomarker that added incremental value to current practice guidelines in ASCVE risk prediction in low-risk women.