Retinopathy and risk of congestive heart failure

Abstract

Congestive heart failure (CHF) affects a substantial proportion of adults including those without preexisting coronary heart disease. The pathogenesis of CHF is uncertain, but microvascular disease has been hypothesized as a possible factor. The objective of this study was to determine the relationship between retinopathy, a marker of systemic microvascular disease, and the risk of CHF. This study was part of the population-based, prospective seven-year cohort study in four US communities (Atherosclerosis Risk in Communities Study). Participants (n = 11,612, aged 49 to 73 years) had retinal photographs taken between 1993 and 1995. The photographs were graded according to a standardized protocol for the presence of retinopathy (for example, microaneurysms, retinal hemorrhages, soft exudates), arteriovenous nicking, focal arteriolar narrowing, and generalized arteriolar narrowing. The main outcome measure was the association between retinopathy and incident CHF, identified from hospitalization and death records. The authors found a seven-year cumulative incidence of CHF of 5.4% (492 events). Participants with retinopathy had a higher incidence of CHF compared with those without retinopathy (15.1% vs 4.8%, P < .001). After controlling for age, gender, race, preexisting coronary heart disease, mean arterial blood pressure, diabetes, glucose level, cholesterol level, smoking, body mass index, and study site, the presence of retinopathy was associated with a two-fold higher risk of CHF (relative risk, 1.96; 95% confidence interval, 1.51–2.54). Among participants without preexisting coronary heart disease, diabetes, or hypertension, retinopathy was associated with a three-fold higher risk of CHF (relative risk, 2.98; 95% confidence interval, 1.50–5.92). The authors conclude that retinopathy is an independent predictor of CHF, even in persons without preexisting coronary heart disease, diabetes, or hypertension. This suggests that microvascular disease may play an important role in the development of heart failure in the general population. Some asymptomatic persons with retinopathy on an ophthalmologic examination may benefit from further assessment of CHF risk.—Valérie Biousse