Retinal arteriolar narrowing and risk of coronary heart disease in men and women: The Atherosclerosis Risk in Communities Study. Wong TY, Klein R, Sharrett AR, Duncan BB, Couper DJ, Tielsch JM, Klein BEK, Hubbard LD. JAMA 2002;287:1153–1159.

Abstract

Microvascular processes have been hypothesized to play a greater role in the development of coronary heart disease (CHD) in women than in men; however, prospective clinical data are limited. The authors examined the association between retinal arteriolar narrowing, a marker of microvascular damage from hypertension and inflammation, and incident CHD in healthy middle-aged women and men. The Atherosclerosis Risk in Communities Study is an ongoing prospective, population-based cohort study in four US communities initiated in 1987 to 1989. Retinal photographs were taken in 9648 women and men aged 51 to 72 years without CHD at the third examination (1993–1995). To quantify retinal arteriolar narrowing, the photographs were digitized, individual arteriolar and venular diameters were measured, and a summary arteriole-to-venule ratio (AVR) was calculated. During an average 3.5 years of follow-up, 84 women and 187 men experienced incident CHD events. In women, after controlling for mean arterial blood pressure averaged over the previous six years, diabetes, cigarette smoking, plasma lipid levels, and other risk factors, each standard deviation decrease in the AVR was associated with an increased risk of any incident CHD and of acute myocardial infarction. In contrast, AVR was unrelated to any incident CHD in men or to acute myocardial infarction. The authors conclude that retinal arteriolar narrowing is related to risk of CHD in women but not in men, supporting a more prominent microvascular role in the development of CHD in women than in men.—Thomas J. Liesegang