Abstract
BackgroundThere is evidence to suggest that microvascular disease, particularly diabetic retinopathy, plays a role in the pathogenesis of HF. However, whether changes in retinal vessel calibre predicts HF is unclear. The purpose of this study was to examine the association of retinal microvascular structure with prevalent heart failure (HF).MethodsThe Australian Heart Eye Study (AHES) is a cross-sectional study that surveyed 1680 participants who presented to a tertiary referral hospital for the evaluation of potential coronary artery disease by coronary angiography. Retinal vessel calibre was graded using retinal photography and participants’ self-reported echocardiography-confirmed HF was obtained via an extensive medical questionnaire.ResultsThere were 107 participants (8.1%) with prevalent self-reported HF. Persons with wider retinal arteriolar calibre (comparing highest versus lowest tertile or reference) were more likely to have prevalent HF (OR 3.5; 95% CI, 1.7–7.2) when adjusted for age and sex. After further adjustment for body mass index, hypertension, diabetes, smoking status, triglycerides and estimated glomerular filtration rate, this association remained significant (OR 4.5; 95% CI, 2.0–9.8). After further stratification, this association remained significant among participants with diabetes (OR 10.3; 95% CI, 2.7–39.3) but not in those without diabetes (OR 2.7; 95% CI, 0.9–7.5). The strength of this association was not dependent on the length of history of diabetes, or retinopathy status. There was no significant association between retinal venular calibre and prevalence of HF.ConclusionsWider retinal arteriolar diameter was significantly and independently associated with prevalent HF in participants of a cross-sectional study. This association was significant stronger among participants with diabetes compared to without diabetes. No association was found between retinal venule calibre with prevalent HF.
Highlights
Chronic heart failure (HF) is one of the major causes of mortality and morbidity in the Western world, occurring in more than 5 million individuals and responsible for more than 1 million hospital studies.[1]
Persons with wider retinal arteriolar calibre were more likely to have prevalent HF when adjusted for age and sex
After further adjustment for body mass index, hypertension, diabetes, smoking status, triglycerides and estimated glomerular filtration rate, this association remained significant
Summary
Chronic heart failure (HF) is one of the major causes of mortality and morbidity in the Western world, occurring in more than 5 million individuals and responsible for more than 1 million hospital studies.[1]. The Atherosclerosis Risk In Communities (ARIC) study demonstrated an independent association between retinopathy and congestive HF,[7] even after exclusion of patients with CAD, diabetes or hypertension. This association remained significant at the 9-year follow-up, and after further adjustment for known cardiovascular risk factors, glycemic control, carotid atherosclerosis and serum markers of endothelial function.[8] While retinal arteriolar dilation has been shown to predict incident retinopathy in diabetic individuals, there is limited evidence investigating the relationship between changes to the retinal vessel calibre and HF. There is evidence to suggest that microvascular disease, diabetic retinopathy, plays a role in the pathogenesis of HF. The purpose of this study was to examine the association of retinal microvascular structure with prevalent heart failure (HF)
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