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A new vascular biomarker for atherosclerotic cardiovascular disease event (ASVE) risk prediction

By Henner Hanssen - EBTR Section



Retinal vessel imaging is an inexpensive, reproducible and non-invasive diagnostic tool for the assessment of cardiovascular risk. Retinal vessel diameters are part of the cerebrovascular bed and have been described as a window to the heart. Narrower central retinal arteriolar (CRAE) and venular (CRVE) diameter equivalents have been shown to be associated with an increased risk of hypertension1, obesity2, stroke3 and a higher cardiovascular mortality and morbidity4, 5. Whether retinal vessels are associated with long-term cardiovascular outcome and whether they offer added value for predicting cardiovascular disease (CVD) events remained to be elucidated.

A new vascular biomarker for atherosclerotic cardiovascular disease event (ASVE) risk prediction

In the ongoing, prospective Atherosclerosis Risk in Communities (ARIC) cohort study, 10470 individuals without a history of cardiovascular events underwent retinal vessel imaging in 1993-95 with regular follow-ups until the 2011-2013 period6. During a mean follow-up of 16 years, 4736 ischemic strokes, heart failure events or deaths occurred. Narrower retinal arterioles (CRAE) and wider venules (CRVE) were independently associated with a higher long-term risk of death and stroke in both sexes and incident coronary heart disease in women. It is argued that microvascular dysfunction is a stronger contributor to myocardial ischemia in women. Retinal vessel diameters reclassified 21% of low-risk women as intermediate risk for CVD events, which would otherwise not have been recognised using current practice guidelines. This data outperforms the added value of most other macrovascular biomarkers that have a reclassification rate of about 10-15%. It remains to be determined whether adding retinal vessel imaging to CV risk stratification may reduce long-term morbidity and mortality in low-to-intermediate risk individuals. The presented data, however, seems a strong advocate for more frequent use of retinal vessel imaging in CV risk stratification and clinical practice.


Note: The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology


Henner Hannsen commented on this article:

Retinal Vessel Calibers in Predicting Long-Term Cardiovascular Outcomes: The Atherosclerosis Risk in Communities Study
Seidelmann et al.

Circulation 2016 ; 134 ; 1328-1338

additional references:

1. Ikram MK, Witteman JC, Vingerling JR, Breteler MM, Hofman A and de Jong PT. Retinal vessel diameters and risk of hypertension: the Rotterdam Study. Hypertension. 2006;47:189-94.
2. Boillot A, Zoungas S, Mitchell P, Klein R, Klein B, Ikram MK, Klaver C, Wang JJ, Gopinath B, Tai ES, Neubauer AS, Hercberg S, Brazionis L, Saw SM, Wong TY, Czernichow S and Group M-ES. Obesity and the microvasculature: a systematic review and meta-analysis. PloS one. 2013;8:e52708.
3. Ikram MK, de Jong FJ, Bos MJ, Vingerling JR, Hofman A, Koudstaal PJ, de Jong PT and Breteler MM. Retinal vessel diameters and risk of stroke: the Rotterdam Study. Neurology. 2006;66:1339-43.
4. Wong TY, Klein R, Sharrett AR, Duncan BB, Couper DJ, Tielsch JM, Klein BE and Hubbard LD. Retinal arteriolar narrowing and risk of coronary heart disease in men and women. The Atherosclerosis Risk in Communities Study. JAMA : the journal of the American Medical Association. 2002;287:1153-9.
5. Wang JJ, Liew G, Klein R, Rochtchina E, Knudtson MD, Klein BE, Wong TY, Burlutsky G and Mitchell P. Retinal vessel diameter and cardiovascular mortality: pooled data analysis from two older populations. European heart journal. 2007;28:1984-92.
6. Seidelmann SB, Claggett B, Bravo PE, Gupta A, Farhad H, Klein BE, Klein R, Di Carli M and Solomon SD. Retinal Vessel Calibers in Predicting Long-Term Cardiovascular Outcomes: The Atherosclerosis Risk in Communities Study. Circulation. 2016;134:1328-1338.