Abstract
Microalbuminuria is associated with an increased risk of cardiovascular disease (CVD), but not all individuals require treatment. Retinal microvascular abnormalities and microalbuminuria reflect early systemic microvascular changes. We examined the joint effect of retinal abnormalities and microalbuminuria on CVD risk in an Asian cohort. We conducted a prospective, population-based study. Retinal abnormalities were defined as presence of retinopathy and/or retinal venular widening. Microalbuminuria was defined as urinary albumin: creatinine ratio between 30–300 mg/g. Incident CVD was defined as newly diagnosed clinical stroke, acute myocardial infarction or CVD death. Cox regression models were performed to determine the associations between retinal abnormalities and microalbuminuria with risk of CVD, while controlling for established risk factors. 3,496 participants (aged ≥ 40) were free of prevalent CVD. During the follow-up (5.8 years), 126 (3.60%) participants developed CVD. Persons presenting with both retinal abnormalities and microalbuminuria were 6.71 times (95% CI, 2.68, 16.79) as likely to have incident CVD compared with those without either abnormalities. There was a significant interaction effect between retinal abnormalities and microalbuminuria on incident CVD. Assessment of retinal abnormalities in patients with microalbuminuria may provide additional value in identifying persons at risk of developing CVD.
Highlights
Microalbuminuria is an increasing well-recognized indicator of cardiovascular disease (CVD) risk, with many studies consistently demonstrating an association between microalbuminuria and incident CVD1–3
We separately explored the joint effect of presence of clinical retinopathy and microalbuminuria on the risk of CVD events
In this multi-ethnic Asian study, we found that persons with microvascular changes in the eye or in the kidney were at higher risk of CVD than those without these abnormalities
Summary
Microalbuminuria is an increasing well-recognized indicator of cardiovascular disease (CVD) risk, with many studies consistently demonstrating an association between microalbuminuria and incident CVD1–3. Two retinal microvascular abnormalities, retinopathy and retinal venular caliber widening, measured from digital retinal photographs, have been found to be associated with subclinical CVD11–14 and to predict clinical CVD events[10,12,15]. Because both microalbuminuria and retinal microvascular abnormalities are potential microvascular markers of CVD events, it may be possible that a “multiple markers” approach may be useful for risk stratification and identification of patients who are at higher risk of developing CVD. Albuminuria increased the risk of chronic kidney disease as compared with person who has no evidence of microvascular damage[17]
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