Abstract 11652: Sex-Specific Association of Retinal Microvascular Signs With Atrial Fibrillation: The Multi-Ethnic Study of Atherosclerosis

Abstract

Background: Atrial fibrillation (AF) affects men more frequently than women in elderly individuals. Several risk factors have been identified; however the relationship of microvascular characteristics with AF is unclear. Assessment of the relationship of retinal microvascular signs with AF in men and women may provide insights into such a relationship. Methods: We prospectively examined the sex-specific association of retinal microvascular signs with incident AF events in 2,394 men and 2,618 women ages 47-86 years, who were free of prior AF, underwent fundus photography at the second exam (2002-2004) of the Multi-Ethnic Study of Atherosclerosis (MESA), and were followed through 2012. Retinal microvascular signs evaluated include retinal vascular caliber measurements from computer software (defined as the central retinal arteriolar equivalents (CRAE) and venular equivalents (CRVE)), and presence of retinopathy signs. AF events were identified using hospital discharge records, Medicare claims data, and electrocardiographic findings at visit. Results: Over an 8.8-year average follow-up period, 255 and 202 AF events were identified in men and women respectively. In Cox regression analyses, we adjusted for age, race, body mass index, smoking status, diabetes status, systolic blood pressure, lipid profile, HbA1c, C-reactive protein, anti-hypertensive therapy, lipid-lowering therapy, cardiovascular disease, and heart failure. In men, wider CRVE (wider venular diameter) was associated with lower risk of incident AF (hazard ratio [HR] and 95% confidence interval per 10-μm increase in CRVE: 0.92 [0.86-0.99]), whereas in women, wider CRVE was associated with higher risk of incident AF (HR: 1.09 [1.01-1.18], p-value for interaction of sex = 0.0023). There were no associations of CRAE or of any retinopathy with AF in men or women. Conclusions: We found associations of narrower retinal venular diameters in men and wider retinal venular diameters in women at baseline with the incidence of AF but with no evidence of relationships of retinal arteriolar diameters or the presence of any retinopathy at baseline to the incidence of AF in either men or women. The reasons for the interaction are not understood and its clinical relevance remains to be determined.