Abstract
Background: Retinal vasculature can reflect microvascular damage from hypertension, and may be a marker of target end-organ damage. We studied the relationship of a range of retinal vascular structural parameters with stroke and its major subtypes. Methods: We conducted a case-control study of acute stroke cases recruited from a tertiary hospital in Singapore. Clinical assessment included neuroimaging and retinal photography, classifying strokes by TOAST criteria. Non-stroke healthy controls selected from the Singapore Epidemiology of Eye Disease program were matched by age, gender and race. Retinal vascular parameters (retinal vascular caliber, tortuosity, fractal dimension and branching angle) were assessed using a semi-automated computer-based program. Logistic regression models were constructed adjusting for age, gender, and race; and additionally for smoking, hypertension, diabetes and hypercholesterolemia status. Results: A total of 563 ischemic stroke cases and 576 controls were included in this analysis. Major subtypes of ischemic strokes included 264 lacunar, 186 large artery and 55 cardioembolic strokes. Narrower arteriolar caliber (multivariable-adjusted odds ratio (OR) per standard deviation (SD) decrease: 2.18; 95%CI: 1.83-2.61), decreased arteriolar fractal dimension (OR per SD decrease: 2.35; 95%CI: 1.95-2.82) and venular fractal dimension (OR per SD decrease: 1.73; 95%CI: 1.48-2.05), and increased arteriolar tortuosity (OR per SD increase: 1.57; 95%CI: 1.25-1.97) and venular tortuosity (OR per SD increase: 1.53; 95%CI: 1.29-1.80) were associated with stroke. Similar associations were found for lacunar, large artery and cardioembolic strokes. Conclusions: Stroke cases were more likely to have altered retinal microvasculature, reflecting microvascular changes that may be independent of hypertension and other traditional risk factors.
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