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 (42)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in JAMA  Topic Collections  • Ophthalmology  • Ophthalmological Disorders  • Retinal/ Chorioretinal Disorders  • Cardiovascular System  • Congestive Heart Failure/ Cardiomyopathy  • Alert me on articles by topic  Social Bookmarking   What's this?

Tien Y. Wong, MD, PhD; Wayne Rosamond, PhD; Patricia P. Chang, MD, MHS; David J. Couper, PhD; A. Richey Sharrett, MD, DrPH; Larry D. Hubbard, MAT; Aaron R. Folsom, MD; Ronald Klein, MD, MPH

JAMA. 2005;293:63-69.

Context  Congestive heart failure (CHF) affects a substantial proportion of adults including those without preexisting coronary heart disease. The pathogenesis of CHF is uncertain, but microvascular disease has been hypothesized as a possible factor.

Objective  To determine the relationship of retinopathy, a marker of systemic microvascular disease, to risk of CHF.

Design, Setting, and Participants  Population-based, prospective 7-year cohort study in 4 US communities using the Atherosclerosis Risk in Communities Study database. Participants (n = 11 612, aged 49 to 73 years) had retinal photographs taken between 1993 and 1995. The photographs were graded according to a standardized protocol for the presence of retinopathy (eg, microaneurysms, retinal hemorrhages, soft exudates), arteriovenous nicking, focal arteriolar narrowing, and generalized arteriolar narrowing.

Main Outcome Measures  Association between retinopathy and incident CHF, identified from hospitalization and death records.

Results  The 7-year cumulative incidence of CHF was 5.4% (492 events). Participants with retinopathy had a higher incidence of CHF compared with those without retinopathy (15.1% vs 4.8%, P<.001). After controlling for age, sex, race, preexisting coronary heart disease, mean arterial blood pressure, diabetes, glucose level, cholesterol level, smoking, body mass index, and study site, the presence of retinopathy was associated with a 2-fold higher risk of CHF (relative risk, 1.96; 95% confidence interval, 1.51-2.54). Among participants without preexisting coronary heart disease, diabetes, or hypertension, retinopathy was associated with a 3-fold higher risk of CHF (relative risk, 2.98; 95% confidence interval, 1.50-5.92).

Conclusions  Retinopathy is an independent predictor of CHF, even in persons without preexisting coronary heart disease, diabetes, or hypertension. This suggests that microvascular disease may play an important role in the development of heart failure in the general population. Some asymptomatic persons with retinopathy on an ophthalmologic examination may benefit from further assessment of CHF risk.

Author Affiliations: Centre for Eye Research Australia, University of Melbourne, Victoria (Dr Wong); Singapore Eye Research Institute, National University of Singapore (Dr Wong); Department of Epidemiology (Drs Rosamond and Chang), Division of Cardiology (Dr Chang), and Department of Biostatistics (Dr Couper), University of North Carolina, Chapel Hill; Department of Epidemiology, Johns Hopkins University, Baltimore, Md (Dr Sharrett); Department of Ophthalmology, University of Wisconsin, Madison (Mr Hubbard and Dr Klein); and Division of Epidemiology, University of Minnesota, Minneapolis (Dr Folsom).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati     What's this?

RELATED ARTICLE

Retinopathy
Janet M. Torpy, Tiffany J. Glass, and Richard M. Glass
JAMA. 2005;293(1):128.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Vital Exhaustion and Retinal Microvascular Changes in Cardiovascular Disease: Atherosclerosis Risk in Communities Study
Cheung et al.
Psychosom. Med. 2009;71:308-312.
ABSTRACT | FULL TEXT  

Human endothelial function and microvascular ageing
Gates et al.
Exp Physiol 2009;94:311-316.
ABSTRACT | FULL TEXT  

Ocular Associations of Diabetes Other Than Diabetic Retinopathy
Jeganathan et al.
Diabetes Care 2008;31:1905-1912.
FULL TEXT  

Longitudinal Association of Glucose Metabolism With Retinopathy: Results from the Australian Diabetes Obesity and Lifestyle (AusDiab) study
Tapp et al.
Diabetes Care 2008;31:1349-1354.
ABSTRACT | FULL TEXT  

Diabetes, left ventricular systolic dysfunction, and chronic heart failure
MacDonald et al.
Eur Heart J 2008;29:1224-1240.
ABSTRACT | FULL TEXT  

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  

Diabetic Retinopathy and Coronary Artery Disease From the Cardiac Surgeon's Perspective
Ohno et al.
Ann. Thorac. Surg. 2008;85:681-689.
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  

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  

Retinopathy and Survival in a Population without Diabetes: The Beaver Dam Eye Study
Hirai et al.
Am J Epidemiol 2007;166:724-730.
ABSTRACT | FULL TEXT  

Retinopathy in Persons without Diabetes: The Los Angeles Latino Eye Study
Chao et al.
IOVS 2007;48:4019-4025.
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  

Dysglycemia and Heart Failure Hospitalization: What Is the Link?
Petrie and McMurray
Circulation 2007;115:1334-1335.
FULL TEXT  

Diabetic Retinopathy and Diabetic Neuropathy
Bloomgarden
Diabetes Care 2007;30:760-765.
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  

Update in cardiology.
Rapaport
ANN INTERN MED 2006;145:618-625.
FULL TEXT  

Do retinopathy signs in non-diabetic individuals predict the subsequent risk of diabetes?
Wong et al.
Br. J. Ophthalmol. 2006;90:301-303.
ABSTRACT | FULL TEXT  

Impact of Diabetic Retinopathy on Cardiac Outcome After Coronary Artery Bypass Graft Surgery: Prospective Observational Study
Ono et al.
Ann. Thorac. Surg. 2006;81:608-612.
ABSTRACT | FULL TEXT  

Retinal Microvascular Abnormalities and MRI-Defined Subclinical Cerebral Infarction: The Atherosclerosis Risk in Communities Study
Cooper et al.
Stroke 2006;37:82-86.
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  

Retinopathy Linked with New Heart Failure
Journal Watch Cardiology 2005;2005:1-1.
FULL TEXT