This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (105)  • Contact me when this article is cited  Related Content  • Related letter  • Related article  • Similar articles in JAMA  Topic Collections  • Women's Health, Other  • Cardiovascular Disease/ Myocardial Infarction  • Alert me on articles by topic

The Atherosclerosis Risk in Communities Study

Tien Yin Wong, MD, MPH; Ronald Klein, MD, MPH; A. Richey Sharrett, MD, DrPH; Bruce B. Duncan, MD, PhD; David J. Couper, PhD; James M. Tielsch, PhD; Barbara E. K. Klein, MD, MPH; Larry D. Hubbard, MAT

JAMA. 2002;287:1153-1159.

Context  Microvascular processes have been hypothesized to play a greater role in the development of coronary heart disease (CHD) in women than in men; however, prospective clinical data are limited.

Objective  To examine the association between retinal arteriolar narrowing, a marker of microvascular damage from hypertension and inflammation, and incident CHD in healthy middle-aged women and men.

Design, Setting, and Participants  The Atherosclerosis Risk in Communities Study, an ongoing prospective, population-based cohort study in 4 US communities initiated in 1987-1989. Retinal photographs were taken in 9648 women and men aged 51 to 72 years without CHD at the third examination (1993-1995). To quantify retinal arteriolar narrowing, the photographs were digitized, individual arteriolar and venular diameters were measured, and a summary arteriole-to-venule ratio (AVR) was calculated.

Main Outcome Measure  Risk of CHD associated with retinal arteriolar narrowing.

Results  During an average 3.5 years of follow-up, 84 women and 187 men experienced incident CHD events. In women, after controlling for mean arterial blood pressure averaged over the previous 6 years, diabetes, cigarette smoking, plasma lipid levels, and other risk factors, each SD decrease in the AVR was associated with an increased risk of any incident CHD (relative risk [RR], 1.37; 95% confidence interval [CI], 1.08-1.72) and of acute myocardial infarction (RR, 1.50; 95% CI, 1.10-2.04). In contrast, AVR was unrelated to any incident CHD in men (RR, 1.00; 95% CI, 0.84-1.18) or to acute myocardial infarction (RR, 1.08; 95% CI, 0.85-1.38).

Conclusion  Retinal arteriolar narrowing is related to risk of CHD in women but not in men, supporting a more prominent microvascular role in the development of CHD in women than in men. Future work is needed to confirm these findings.

Author Affiliations: Department of Ophthalmology, University of Wisconsin-Madison (Drs Wong, R. Klein, B. Klein, and Mr Hubbard); Department of Ophthalmology, National University of Singapore (Dr Wong); National Heart, Lung, and Blood Institute, Bethesda, Md (Dr Sharrett); Social Medicine Department, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, RS Brazil (Dr Duncan); Department of Biostatistics, University of North Carolina, Chapel Hill (Dr Couper); Department of International Health, Johns Hopkins University, Baltimore, Md (Dr Tielsch).

RELATED LETTER

Retinal Vasculature Findings Do Not Add Information About Cardiovascular Risk—Reply
Tien Yin Wong
Arch Intern Med. 2007;167(11):1210.
EXTRACT | FULL TEXT  

RELATED ARTICLE

March 6, 2002
JAMA. 2002;287(9):1193-1194.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Diabetic retinopathy and risk of heart failure.
Cheung et al.
J Am Coll Cardiol 2008;51:1573-1578.
ABSTRACT | FULL TEXT  

The eye as an indicator of heart failure in diabetic patients.
Ventura and Reddy
J Am Coll Cardiol 2008;51:1579-1580.
FULL TEXT  

Ethnic Variability in Retinal Vessel Caliber: A Potential Source of Measurement Error from Ocular Pigmentation?--The Sydney Childhood Eye Study
Rochtchina et al.
IOVS 2008;49:1362-1366.
ABSTRACT | FULL TEXT  

Low Birthweight Is Associated With Narrower Arterioles in Adults
Liew et al.
Hypertension 2008;51:933-938.
ABSTRACT | FULL TEXT  

Prevalence of Angina in Women Versus Men: A Systematic Review and Meta-Analysis of International Variations Across 31 Countries
Hemingway et al.
Circulation 2008;117:1526-1536.
ABSTRACT | FULL TEXT  

Relation of Retinopathy to Coronary Artery Calcification: The Multi-Ethnic Study of Atherosclerosis
Wong et al.
Am J Epidemiol 2008;167:51-58.
ABSTRACT | FULL TEXT  

Hypertensive Retinopathy: A Window to Vascular Remodeling in Arterial Hypertension
Schmieder
Hypertension 2008;51:43-44.
FULL TEXT  

Relationship Between Retinal Arteriolar Narrowing and Myocardial Perfusion: Multi-Ethnic Study of Atherosclerosis
Wang et al.
Hypertension 2008;51:119-126.
ABSTRACT | FULL TEXT  

Dietary fiber intake and retinal vascular caliber in the Atherosclerosis Risk in Communities Study
Kan et al.
Am. J. Clin. Nutr. 2007;86:1626-1632.
ABSTRACT | FULL TEXT  

Relationship of Retinal Vascular Caliber with Optic Disc Diameter in Children
Cheung et al.
IOVS 2007;48:4945-4948.
ABSTRACT | FULL TEXT  

Impact of Size at Birth on the Microvasculature: The Avon Longitudinal Study of Parents and Children
Tapp et al.
Pediatrics 2007;120:e1225-e1228.
ABSTRACT | FULL TEXT  

Retinal Vascular Changes in Pre-Diabetes and Prehypertension: New findings and their research and clinical implications
Nguyen et al.
Diabetes Care 2007;30:2708-2715.
FULL TEXT  

Aortic Distensibility and Retinal Arteriolar Narrowing: The Multi-Ethnic Study of Atherosclerosis
Cheung et al.
Hypertension 2007;50:617-622.
ABSTRACT | FULL TEXT  

Hypertension in the Young: Preventing the Evolution of Disease Versus Prevention of Clinical Events
Williams
J Am Coll Cardiol 2007;50:840-842.
FULL TEXT  

Retinal vessel diameter and cardiovascular mortality: pooled data analysis from two older populations
Wang et al.
Eur Heart J 2007;28:1984-1992.
ABSTRACT | FULL TEXT  

Retinal Arteriolar Narrowing and Left Ventricular Remodeling: The Multi-Ethnic Study of Atherosclerosis
Cheung et al.
J Am Coll Cardiol 2007;50:48-55.
ABSTRACT | FULL TEXT  

Prognosis of stable angina pectoris: why we need larger population studies with higher endpoint resolution
Timmis et al.
Heart 2007;93:786-791.
ABSTRACT | FULL TEXT  

Diabetic Retinopathy and the Risk of Coronary Heart Disease: The Atherosclerosis Risk in Communities Study
Cheung et al.
Diabetes Care 2007;30:1742-1746.
ABSTRACT | FULL TEXT  

2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC)
Authors/Task Force Members: et al.
Eur Heart J 2007;0:ehm236v1-75.
FULL TEXT  

Retinal Vasculature Findings Do Not Add Information About Cardiovascular Risk--Reply
Wong
Arch Intern Med 2007;167:1210-1210.
FULL TEXT  

Blood Pressure and Retinal Arteriolar Narrowing in Children
Mitchell et al.
Hypertension 2007;49:1156-1162.
ABSTRACT | FULL TEXT  

Retinopathy Predicts Cardiovascular Mortality in Type 2 Diabetic Men and Women
Juutilainen et al.
Diabetes Care 2007;30:292-299.
ABSTRACT | FULL TEXT  

Sex Differences in Endothelial Function Markers Before Conversion to Pre-Diabetes: Does the Clock Start Ticking Earlier Among Women?: The Western New York Study
Donahue et al.
Diabetes Care 2007;30:354-359.
ABSTRACT | FULL TEXT  

Measurement of Retinal Vascular Caliber: Issues and Alternatives to Using the Arteriole to Venule Ratio
Liew et al.
IOVS 2007;48:52-57.
ABSTRACT | FULL TEXT  

Quantitative Retinal Venular Caliber and Risk of Cardiovascular Disease in Older Persons: The Cardiovascular Health Study
Wong et al.
Arch Intern Med 2006;166:2388-2394.
ABSTRACT | FULL TEXT  

Retinal vascular calibre and the risk of coronary heart disease-related death
Wang et al.
Heart 2006;92:1583-1587.
ABSTRACT | FULL TEXT  

Retinal Vascular Caliber, Cardiovascular Risk Factors, and Inflammation: The Multi-Ethnic Study of Atherosclerosis (MESA).
Wong et al.
IOVS 2006;47:2341-2350.
ABSTRACT | FULL TEXT  

Abnormalities of Retinal Microvascular Structure and Risk of Mortality From Ischemic Heart Disease and Stroke
Witt et al.
Hypertension 2006;47:975-981.
ABSTRACT | FULL TEXT  

Genome-Wide Linkage Study of Retinal Vessel Diameters in the Beaver Dam Eye Study
Xing et al.
Hypertension 2006;47:797-802.
ABSTRACT | FULL TEXT  

Insights From the NHLBI-Sponsored Women's Ischemia Syndrome Evaluation (WISE) Study: Part I: Gender Differences in Traditional and Novel Risk Factors, Symptom Evaluation, and Gender-Optimized Diagnostic Strategies
Shaw et al.
J Am Coll Cardiol 2006;47:S4-S20.
ABSTRACT | FULL TEXT  

Some Thoughts on the Vasculopathy of Women With Ischemic Heart Disease
Pepine et al.
J Am Coll Cardiol 2006;47:S30-S35.
ABSTRACT | FULL TEXT  

Are Inflammatory Factors Related to Retinal Vessel Caliber?: The Beaver Dam Eye Study
Klein et al.
Arch Ophthalmol 2006;124:87-94.
ABSTRACT | FULL TEXT  

Retinal vessel diameters and cerebral small vessel disease: the Rotterdam Scan Study
Ikram et al.
Brain 2006;129:182-188.
ABSTRACT | FULL TEXT  

Hypertensive retinopathy revisited: some answers, more questions
Grosso et al.
Br. J. Ophthalmol. 2005;89:1646-1654.
ABSTRACT | FULL TEXT  

Hypertensive retinopathy signs as risk indicators of cardiovascular morbidity and mortality
Wong and McIntosh
Br Med Bull 2005;73-74:57-70.
ABSTRACT | FULL TEXT  

Value of routine funduscopy in patients with hypertension: systematic review
van den Born et al.
BMJ 2005;331:73.
ABSTRACT | FULL TEXT  

Role of Noninvasive Testing in the Clinical Evaluation of Women With Suspected Coronary Artery Disease: Consensus Statement From the Cardiac Imaging Committee, Council on Clinical Cardiology, and the Cardiovascular Imaging and Intervention Committee, Council on Cardiovascular Radiology and Intervention, American Heart Association
Mieres et al.
Circulation 2005;111:682-696.
ABSTRACT | FULL TEXT  

Relationship between the Parameters of Retinal Circulation Measured by Laser Doppler Velocimetry and a Marker of Early Systemic Atherosclerosis
Nagaoka et al.
IOVS 2005;46:720-725.
ABSTRACT | FULL TEXT  

Poor prognosis in proteinuric type 2 diabetic patients with retinopathy: insights from the RENAAL study
Parving et al.
QJM 2005;98:119-126.
ABSTRACT | FULL TEXT  

Retinopathy and Risk of Congestive Heart Failure
Wong et al.
JAMA 2005;293:63-69.
ABSTRACT | FULL TEXT  

Hypertensive Retinopathy
Wong and Mitchell
NEJM 2004;351:2310-2317.
FULL TEXT  

Familial Aggregation of Retinal Vessel Caliber in the Beaver Dam Eye Study
Lee et al.
IOVS 2004;45:3929-3933.
ABSTRACT | FULL TEXT  

Cardiovascular Disease, Mortality, and Retinal Microvascular Characteristics in Type 1 Diabetes: Wisconsin Epidemiologic Study of Diabetic Retinopathy
Klein et al.
Arch Intern Med 2004;164:1917-1924.
ABSTRACT | FULL TEXT  

Are Retinal Arteriolar or Venular Diameters Associated with Markers for Cardiovascular Disorders? The Rotterdam Study
Ikram et al.
IOVS 2004;45:2129-2134.
ABSTRACT | FULL TEXT  

A Prospective Cohort Study of Retinal Arteriolar Narrowing and Mortality
Wong et al.
Am J Epidemiol 2004;159:819-825.
ABSTRACT | FULL TEXT  

Metacarpal Cortical Area and Risk of Coronary Heart Disease: The Framingham Study
Samelson et al.
Am J Epidemiol 2004;159:589-595.
ABSTRACT | FULL TEXT  

Women's Ischemic Syndrome Evaluation: Current Status and Future Research Directions: Report of the National Heart, Lung and Blood Institute Workshop: October 2-4, 2002: Section 5: Gender-Related Risk Factors for Ischemic Heart Disease
Shaw et al.
Circulation 2004;109:e56-58.
FULL TEXT  

Variation associated with measurement of retinal vessel diameters at different points in the pulse cycle
Knudtson et al.
Br. J. Ophthalmol. 2004;88:57-61.
ABSTRACT | FULL TEXT  

Retinal Vascular Changes and 20-Year Incidence of Lower Extremity Amputations in a Cohort With Diabetes
Moss et al.
Arch Intern Med 2003;163:2505-2510.
ABSTRACT | FULL TEXT  

Retinal Vessel Diameters and Their Associations with Age and Blood Pressure
Wong et al.
IOVS 2003;44:4644-4650.
ABSTRACT | FULL TEXT  

Hypertensive Retinal Vessel Wall Signs in a General Older Population: The Blue Mountains Eye Study
Wang et al.
Hypertension 2003;42:534-541.
ABSTRACT | FULL TEXT  

Explaining Gender Differences in Coronary Heart Disease: Hunting for Clues With the Ophthalmoscope
Maguire
Arch Ophthalmol 2003;121:1328-1329.
FULL TEXT  

Retinal Arteriolar Narrowing and Risk of Coronary Heart Disease--Correction
Arch Ophthalmol 2003;121:738-739.
FULL TEXT  

Retinal Arteriolar Narrowing and Risk of Coronary Heart Disease
Bressler
Arch Ophthalmol 2003;121:113-114.
FULL TEXT  

Visual Acuity Impairment and Mortality in US Adults
Lee et al.
Arch Ophthalmol 2002;120:1544-1550.
ABSTRACT | FULL TEXT  

Hypertensive retinopathy and incident coronary heart disease in high risk men
Duncan et al.
Br. J. Ophthalmol. 2002;86:1002-1006.
ABSTRACT | FULL TEXT  

Retinal microvascular abnormalities and blood pressure in older people: the Cardiovascular Health Study
Wong et al.
Br. J. Ophthalmol. 2002;86:1007-1013.
ABSTRACT | FULL TEXT